In the first two installments of this four-part series on QI, PI, QA – Making Sense of Alphabet Soup, we discussed the basics of QI and how to create a Quality Study. This blog takes you to the next step in the process: now that you have some data, what do you do with it?
If you recall, our audit on supervisory visits yielded some interesting results. We audited three charts and the scores were 100%, 33% and 50%. If the goal – as imposed by CMS – is 100% compliance, this agency obviously has a problem performing supervisory visits on time. One hundred percent compliance means that CMS expects that supervisory visits will occur as mandated every single time for every single patient. They don’t allow any flexibility on that guideline; that’s why our target is 100%. For patient satisfaction, your ideal goal might be 100%, meaning you want every single patient to be thrilled with your agency’s service, but how realistic is that? Aren’t there always patients who aren’t satisfied no matter what you do? If there is no external requirement for 100% compliance, give yourself some leeway and start with a lower number, say, 85%. You can raise the bar every year so you and your staff can meet the challenge.
Ok, so now that we have audit results, the next step is to ‘drill down’ to find the root cause. It’s important to resist generating solutions ‘on the fly.’ Sometimes what we believe is the problem isn’t really the problem. Assemble your QI committee (which should represent your major service lines) and discuss the results of your audit. Here are some questions your team might consider:
- Was all the filing current when the audit was performed? (If not, that brings up a different issue, especially if the supervisory visits were done, but the notes were not filed.)
- What does your agency policy state?
- Who are your supervisory staff members? Have they been trained on the requirement of supervisory visits?
- How are the visits tracked by the agency? Is there a mechanism to prompt a reminder so the clinical professional can be reminded?
Obviously these are just a few questions, and your team is bound to consider many other aspects. The result of this exercise will lead you closer to generating alternative solutions. If the supervisory visit policy isn’t understood by the staff, additional training may be required. If your agency doesn’t have a good system for tracking when visits are due, you will need to establish a process. There is no one-size-fits-all solution to this problem, as its source will vary with each agency. The important thing is to spot the issue, discuss it with other knowledgeable professionals, dig into the possible causes, generate solutions, educate staff, and then monitor.
Once you’ve generated some solutions, select the ones to implement and create a Corrective Action Plan. In a nutshell, write down what was discussed (bullet points are fine), the different alternatives, what you selected and why, and how you will implement the solution(s). Also, state when you will check again to make sure the solutions fixed the problem. With something as critical as supervisory visits, you might consider checking them on a weekly basis so that you can catch issues early. Once you have observed (this means measured) compliance for a prolonged period of time, say one quarter of weekly reviews, you can scale back your audit schedule to monthly. The idea is to make sure your solutions have truly fixed the problem before you relax your vigilance. If you find that the problem persists, re-do the exercise of investigation/solutions/monitoring.
Next time, we will wrap up our four-part series on Quality Improvement by discussing documentation and how to file your QI materials for easy retrieval.