QAIT

Quality Assessor Education and

Strategic Continuous Improvement

The Aged Care Standards and Accreditation Agency Ltd

Seminar objectives
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

The seminar aims to: Reiterate the information provided in the continuous improvement seminar series Review the importance of continuous improvement in the assessment of homes

Participant outcomes
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

On completion of this seminar, participants should be able to: Understand the relationship between continuous improvement and strategic planning Identify the elements of an effective continuous improvement program that provides measurable benefit for residents

The Aged Care Standards and Accreditation Agency Ltd

Where does Accreditation fit?

QAIT
Quality Assessor Education and

The Accreditation Standards provide a template for a well functioning aged care home the what These standards provide a solid foundation for homes continuous improvement program an external review of the organisation The continuous improvement program determines the level of care and services the organisation strives to provide the how and how well
4

The Aged Care Standards and Accreditation Agency Ltd

What constitutes high quality aged care?

QAIT
Quality Assessor Education and

A number of areas of care must be addressed to be comprehensive: Health care physical and psychological health and care Personal issues belonging, wellbeing, autonomy, dignity and respect Interactions inside and outside the organisation family role, staff and social communication Services meals, recreational activities Environment safe, homelike, personal space

The Aged Care Standards and Accreditation Agency Ltd

Why have a continuous improvement program?

QAIT
Quality Assessor Education and

A strategic continuous improvement program is the way in which these quality of care and quality of life issues are addressed: By setting clear goals and priorities for these areas that need to be monitored and improved areas of importance to residents, carers and staff across the domains of quality By systematically planning and implementing how monitoring and improvement will occur through relevant and effective improvement activities By measuring progress towards achieving the goals, and being able to demonstrate exactly what level of care is being provided
6

The Aged Care Standards and Accreditation Agency Ltd

What can a continuous improvement program achieve - overview

How it is done

QAIT
Quality Assessor Education and

What it does
Define the level of quality Establish the people and processes required to achieve it Implement the processes Monitor the processes Manage and respond to risks Evaluate effectiveness

Organisational vision and goals Governance, planning, standards, priorities Staff involvement and the right tools Monitoring and evaluation Risk management Goals versus outcomes

The Aged Care Standards and Accreditation Agency Ltd

A planned approach to a successful continuous improvement program

QAIT
Quality Assessor Education and

The continuous improvement program plan will demonstrate input from all levels of the organisation and should include both what will be done to improve care and services, and how that will happen, including: 1. 2. 3. Goals and priorities for providing a high quality of life and care prioritised and linked to the strategic goals A governance structure that supports the achievement of the goals A description of how the continuous improvement program works how improvement activities are generated, implemented and assessed Sound data collection, analysis and reporting - to support improvement and achievement of the goals A system to evaluate the overall continuous improvement program
8

4. 5.

The Aged Care Standards and Accreditation Agency Ltd

Goals and priorities are clearly defined

QAIT
Quality Assessor Education and

Sources of information to help organisations to identify goals and priorities for improvement include: The organisations strategic goals Information about things that impact on quality of care and quality of life of residents, and appropriate levels of care (from the Accreditation Standards, the aged care literature, other organisations and internal discussions) Areas in which routine data collections identify that things could be better Issues of importance to residents and staff planned, and as issues occur, across the domains of quality
9

Defining goals and priorities

The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Priority improvement activities will include those that contribute to achieving the strategic goals and good governance of the organisation Governing bodies have the same governance responsibility for the quality of care and services provided in their home as they do for the homes business performance Data needs to continue to be collected as part of the continuous improvement program to support the governing bodys accountabilities
10

Defining goals and priorities

Defining health care risks in aged care
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Another way of identifying priorities is to look at areas of risk to residents and staff. Key issues to be monitored in the health of aged care residents include: medications falls infections pressure ulcers depression nutrition and hydration pain
11

Defining goals and priorities

Quality of life issues
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Key issues of importance to be monitored in the quality of life of aged care residents: Health care physical and psychological health and care Personal issues choice, belonging, wellbeing, autonomy, dignity and respect Interactions inside and outside the organisation family role, staff interactions and social communication Services meals, recreational activities Environment safe, homelike, personal space
12

Defining goals and priorities

Building in one-off activities
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

As well as planned continuous improvement activities, the continuous improvement plan should make provision for one-off improvement activities to address issues as they arise you cant plan for everything The continuous improvement plan should describe the process for managers and staff to respond to unexpected problems that arise how to link them to the continuous improvement goals, how to plan and report on them The continuous improvement program will include planned (proactive), one-off (responsive) and monitoring (high risk and quality assurance) activities to achieve the goals
13

Governance
Defining staff responsibilities
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Allocating clear continuous improvement responsibilities to staff promotes a strategic and accountability based approach to organisational continuous improvement To build a culture of improvement that achieves the improvement goals, staff responsibilities for resident quality of care and quality of life need to be clear and supported through line management

14

The Aged Care Standards and Accreditation Agency Ltd

Examples of organisational improvement roles

Leadership in safety and quality: local and organisational

QAIT
Quality Assessor Education and

Innovation: doing different things for improved outcomes

Improving quality of care and quality of life

Improvement basics: spotting, reporting, suggesting, discussing, data collection

Continuous improvement: doing things better for improved outcomes

Ensuring safety: proactive monitoring, minimising and managing risk

15

Governance
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

A continuous improvement culture

Good governance should also help build a culture of improvement, that includes: a just culture a culture where unsafe situations for residents and staff are not tolerated and action is taken a culture that focuses on improving systems to prevent problems and promote good practice, rather than relying on people to be perfect all the time a culture of seeking customer feedback a culture wherein improvement is seen as something important to be involved in every day as it makes a real difference to the organisation
16

The Aged Care Standards and Accreditation Agency Ltd

How the continuous improvement process works

QAIT
Quality Assessor Education and

The improvement plan will include information to enable staff to easily participate: Where to get assistance in the organisation Individual roles and responsibilities for improvement The continuous improvement cycle, including: How to decide what improvement issue to tackle Who to involve in an improvement activity How to choose the appropriate method/tools How to report and evaluate the results.
17

The Aged Care Standards and Accreditation Agency Ltd

How the continuous improvement process works

QAIT
Quality Assessor Education and

This information should guide staff in developing effective improvement activities that contribute to achievement of the improvement goals, and include: A clear aim that is understood by all those involved and contributes to care and service improvement A good reason for doing it clearly communicated A clear plan and process for achieving it that all interested stakeholders have worked on Those involved are enabled to participate through support and skills And senior level support for all these things.
18

The Aged Care Standards and Accreditation Agency Ltd

How the continuous improvement process works

The improvement cycle
1. An area for improvement is identified from routine data collection, a problem, anecdotal reporting or a desire to improve something. 2. Analyse the problem/issue. 3. Develop ideas for solving the problem/improving the area. 4. Put ideas into action and evaluate them using the quality cycle
Do Plan Study Act

QAIT
Quality Assessor Education and

19

The Aged Care Standards and Accreditation Agency Ltd

The continuous improvement process

QAIT
Quality Assessor Education and

Each improvement activity should be planned to ensure long term change and sustainability: All improvement requires change but not all change is an improvement. To sustain and embed change, homes should: capture both hearts and minds of staff show clear benefits of the change change the system to embed the change work out long term monitoring keep an eye on how the change is going Without sustainability, an improvement is just a project, not a solution.
20

The Aged Care Standards and Accreditation Agency Ltd

Data analysis and reporting

QAIT
Quality Assessor Education and

Key to effective continuous improvement is the appropriate use of data: Some data will relate to continuous monitoring of risks Some will be generated by improvement activities Data on individual activities needs to be presented and reported in such a way that it prompts action this should be part of the planning phase of any continuous improvement activity Staff responsible for data analysis and reporting should receive relevant skills development in improvement tools including data collection, analysis and presentation

21

The Aged Care Standards and Accreditation Agency Ltd

Data analysis and reporting

QAIT
Quality Assessor Education and

Continuous improvement is not research Cant measure everything - depends on the purpose of the activity Need just enough data to see a trend and tell a story about the effect of the changes Needs to be accurate to carry any weight or to make a case for change Both quantitative and qualitative data are useful Routine and one-off data needs to be reported to staff involved, and to a relevant committee and senior managers to ensure action can be initiated, and that an overview of care and services is maintained
22

The Aged Care Standards and Accreditation Agency Ltd

Data analysis and reporting

QAIT
Quality Assessor Education and

To be confidently acted on, data should be: Valid Validity means that the data are measuring what they are designed to measure Reliable Reliability means that the way in which the data are collected will give you the same result, no matter who collects the data Sufficient Consider if you have enough or adequate data to support your finding
23

Evaluation
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Closing the loop

Evaluation should be built into the overall continuous improvement plan as well as into individual improvement activities. What is evaluation?

Where did we start?

Where are we now?

Where do we want to be?

24

Evaluation
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

There will be two types of evaluation in a continuous improvement program: Evaluation should be built into each continuous improvement activity. Did the activity achieve the improvement outcomes/objectives that were planned? Evaluation of the overall improvement program. Is it achieving the planned goals for the residents, staff and organisation?

25

Evaluation
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

When reviewing the outcome of an individual improvement activity, organisations should be able to demonstrate four steps: 1. Restate the aim - what were they trying to achieve? 2. To what extent did they achieve the goal? How far did they get in the time period and how do they know What does the data say?

26

Evaluation
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

3.

Has the change/action improved the standard of care or situation or fixed the problem that is has the aim been achieved? If the home piloted the solution in one part of the organisation, are they ready now to spread and embed the change across the rest of the organisation (if necessary)?

4.

27

Evaluation
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Evaluation of the overall continuous improvement program Periodically, at least annually, the overall continuous improvement program should be evaluated. This should constitute a mix of process and outcome questions: Is the home doing the right things? Is the home getting the results wanted?

28

Evaluation
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Examples of questions that can be asked to ascertain progress with processes: Does the home use the correct and evidence based standards for resident care and services, staff safety and equipment, and are they meeting state and national requirements in these areas? What are the homes key sources of information to help them monitor and improve? Where has the home reviewed and re-designed its systems to embed improved practice? Is the home including consumers constructively in its improvement efforts? What has the home learned through benchmarking with other organisations?
29

Evaluation
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Examples of questions that can be asked to ascertain progress with outcomes include: To what extent has the home achieved its continuous improvement goals? Is the home delivering the planned levels of care and service in its priority areas across the domains of quality in aged care? What are the homes high risk, high volume, high cost, high problem, high complaint areas? How is the home addressing them? Does the organisation exhibit a culture of continuous improvement? Are the homes staff competent and credentialed to do what they do to promote a high standard of care and service? Are staff effectively participating in the program through the support and skills being offered to them?

30

Evaluation
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

And four questions that should be asked quarterly to ensure things are on track, by individual departments and by senior management: How safe are the people in the homes care? How is the residents quality of life? How are the residents and staff better off because of the homes continuous improvement program? Is the continuous improvement program supporting the organisation to be the type of home the home wants it to be?
31

Seminar review
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

Summary of the critical elements of a continuous improvement program: The what: A planned approach with high level support Clear goals the why do it? factor A few key priorities at a time, over time, across the domains of quality Evidence of achievement or not

32

Seminar review
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

The how: Staff buy-in via clear goals and roles, training and support Consumer input Clear processes for achieving the goals action steps, improvement tools, data, learning from others Regular review to ensure that both individual activities, and the overall continuous improvement program, is working towards the goals

33

Seminar review
The Aged Care Standards and Accreditation Agency Ltd

QAIT
Quality Assessor Education and

The continuous improvement program doesnt have to be large and complicated, but to be useful, it does have to be: relevant to the key areas of care provided and residents experience planned, focused and systematic evaluated for its effectiveness in improving the health and quality of life of residents
34

QAIT
Quality Assessor Education and
The Aged Care Standards and Accreditation Agency Ltd

Thank you

35