Assisted Living Enforcement

Process Improvement

Project

Leading Age Assisted Living Enforcement Training

October 18, 2013

Oklahoma State Department of Healthand

Oklahoma University Center for Public Management

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AgendaIntroduction, meeting process, ground rules• Ginger Thompson, OUCPM and Performance Solutions  Quality Improvement Project Overview – How we got here• Henry F. Hartsell Jr., Protective Health Services Swim Lane Steps – Understanding complexity & consequences•  Mike Cook, Long Term Care Service

Plan of Correction Tool -- Reduce or eliminate fines & waste• Patty Scott, Long Term Care Service Informal Dispute Process – New law November 1, 2013 • Sue Davis, Patty Scott, Long Term Care Service

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Ground Rules!• Know the agenda • One person talk at a time • Listen • Don’t talk over someone • Respect • Be on time, return from breaks timely • Provide session summaries • Turn electronics off or vibrate • Knock-Knock rule

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• Gain familiarity with:• Quality improvement project• Swim Lane process map• Optional plan of correction

template• How to participate in pilot• Informal dispute resolution

Objectives

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Project Overview:

How we got here

(and where we are going)

Henry F. Hartsell Jr., Ph.D.Deputy Commissioner for Protective Health

Services 

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Quality Improvement in Public Health

• Deliberate improvement process - PDCA• Plan• Do• Check• Act

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• Achieve measureable improvements• Efficiency• Effectiveness• Performance• Accountability• Outcomes

Quality Improvement in Public Health

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Opportunity exists to ensure OSDH implements clear & reasonable enforcement process for assisted living centers to:

Positively impact residentsReduce need for penaltiesReduce waste for all involved

Plan: Identify

Opportunities

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OSDH staff membersAssisted living providersUniversity of Oklahoma Center

for Public Management

Plan:Participants

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Swim Lane map shows:StepsResponsibilitiesWhere delays, mistakes, inefficiency are most likely

See the waste

PDCA Plan Phase:Describe Current

Process

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Lanes (responsibilities) are horizontalSteps are verticalTime moves left to rightBoxes are steps or tasksDiamonds are decision pointsLines & arrows are connectionsOvals are start and end points

Swim Lane Process Map

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SurveyorsEnforcement staffOSDH Long Term Care LeadershipGeneral CounselAssisted Living CentersAdministrative Law JudgeInformal Dispute Resolution Panel

Swim Lane Lanes

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Building the Swim Lane

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Swim Lane Analysis:Find Causes of

Waste• Plan of correction incomplete• By first revisit, problems not:

• Corrected• Monitored• Documented

• Rework, delays, penalties• 40 centers had 2nd revisits in 2012!

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Team:

IMPROVEMENTS IN PROGRESS:What Who By When

IMPLEMENTED IDEAS

TEAM MEMBERS:

TEAM MEASURES:

---

Process Step 1

Process Step 2

Other Types of Waste

Open Issues for Supr

Process Step 3

PLAN: Root Cause Analysis

Issue

Issue

Issue

Idea

Idea

Issue

Issue

Issue

Issue

Issue

Issue

Issue

Issue

Issue Issue

Issue

Idea

Idea

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• Ensure a complete & acceptable plan of correction 1st time

• Optional POC template walks assisted living centers through all required elements

• Improvement Theory:

• Increase proportion of POCs accepted 1st time

• Reduce proportion of 2nd revisits by 15% in three months

Plan Phase: Identify Improvements

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Knowledge Test

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PDCA: Where we are going

• Plan:

• Reduce POC rejections

• Reduce 2nd revisits

• Use Optional Plan of Correction Template

• Do:

• Test Optional POC Template in Nov - Jan

• Check:

• Adopt, adapt, abandon

• Act:

• SOPs, train, track, solve problems, feedback

•

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Next Up: Mike Cook and

the Swim Lane Process Map