Welcome to Module 5, Session 2 of the Cardiovascular Program Coordinator course. This module is Performance and Quality Improvement with content provided by Susan Rogers and Michelle Wood. While this is Session 2 of this series, the overall objectives for Module 5 are to formulate a performance improvement plan for the ACC accreditation process, select proper tools for completing a performance improvement project, and analyze available resources to isolate which performance to improve. We will pick up with Part 3 of the agenda. In this session, the learner should be able to design a performance improvement plan. Let's begin with the case study on Mary again. While Mary is reviewing available resources to determine which process to focus on, she will consider processes that affect patient outcomes, cost, and can be related to the hospital's strategic goals. Mary will need to be resourceful to connect all the appropriate dots and gain a clear understanding of her processes. After data is reviewed, including drilling down into each metric, the next step is to identify areas for improvement. Prioritize the areas for improvement. It is vital to align process improvement activities with your hospital's strategic plan, your service line goals, and any external drivers or reimbursement opportunities. Here are a few examples. Cardiac rehab using the Chest Pain MI Registry, acute kidney injury using the Cath PCI Registry, low-risk chest pain patient turnaround time from Accreditation Conformance Database, ACD, or within the Chest Pain MI Registry, or patients discharged with appropriate discharge medication using the EP Device Implant Registry. The goal here is to choose measures that are impacting patient outcomes, causing delays in care, and those that impact reimbursement. Start the performance improvement plan with three fundamental questions that lead to success. One, what are we trying to accomplish? Two, how will we know that a change is an improvement? Three, what change can we make that will result in the improvement? Reach out to the quality department at your hospital to understand the PI methodology agreed upon at your facility. The cornerstone of any project starts with the development as a team. We'll spend some time discussing the building of this team. So how do you form an effective quality improvement team? You have reviewed your data and identified your project. Now make sure your team includes members familiar with all the different parts of the process, including your executive sponsor. This person is critical to the success of a project. The executive sponsor should have the authority to be an effective liaison with other applicable departments and assist with accountability of all team members. The project leader. This should be yourself or another person, but they must have the ability to take responsibility for the project and help escalate any barriers. It is critical that this person have good communication skills and a clear understanding of all components of the process. A physician sponsor. This is critical to any project that directly involves physicians or provider processes. Clinical leaders and representation from appropriate departments to test and implement changes and then provide feedback on the barriers. A clinical leader will understand implications of the proposed change and identify potential consequences that just change may trigger. Quality department representatives. They will help you apply effective measurement tools, provide insight into the interpretation of the data and apply an appropriate PI methodology. It is important to be aware of potential challenges in rolling out any performance improvement project. Challenges may come from many different factors such as those listed here. Try to be proactive in removing those barriers prior to starting. Most challenges arise from the lack of senior leadership support. Not aligning the project objectives with the organizational strategic initiatives or not having process owner participation or having sufficient resources. These are fundamental challenges. Those barriers can fit into one of these buckets. Defining the goal is a critical step when starting a process improvement initiative. SMART is an acronym that makes it easy. S is for specific. Your goal needs to be specific. What are you trying to accomplish? M is for measurable. Understand where the process is now and where it should be. A is for attainable. Make sure the goal is attainable. Don't set your team up for failure with these lofty goals. R is for relevant. Ensure the goal is relevant to improving patient care, decreasing the cost of care, increasing efficiencies, etc. T is for time-based. Set time parameters of when the goal should be achieved. Now let's apply an example for SMART goals. We'll use the example of decreased heart failure, 30-day readmissions by 50% within one year. So we want to be specific. What is it that we're trying to do? Decrease heart failure readmissions. We want it to be measurable. Decrease by 50%. Attainable. Monitor monthly to adjust the processes as needed. Relevant. This will improve patient care and outcomes. And time-based. We aim to achieve this goal within one year. To better understand your current process and identify stakeholders, review the current protocol or policy versus what is being practiced and where is it happening. Are the standard order sets available and are they being used? How are eligible patients identified? What systems exist to catch any oversights? We will go into further detail on some tools available to assist with the understanding of process in the next session. The next step is designing and implementing your plan. Select the change you want to make after you've reviewed the data and identified the goal. Begin the process of developing potential solutions. Frontline staff are excellent resources for brainstorming solutions. Start with asking what change can we make that will result in improvement to our goal? Change can take many forms. Here are a few examples. Work environment revisions, workflow improvements, enhanced time management, decreasing variation or even minimizing errors. In looking at this example presented, increased rate of ACE, ARB and beta blockers at discharge for eligible ICD patients to 95% by the end of quarter four 2020. Here they are using the EP device implant registry as the source of metrics and they can see how other hospitals are performing. Be sure to use reliable data when setting goals. Also notice this is a quantitative measure and goal. Quantitative measures provide an objective result where qualitative measures are more descriptive and not always the best option. Now consider what steps could they take to accomplish this goal? Perhaps it would be an upgrade to the EHR or discharge order set that would assist them. Also identify barriers that may be contributing to the problem. In this particular example, are all aware of the problem and is it being reported to the appropriate stakeholders? How many disciplines are involved in this process? Are contraindications to the medication being documented? Is there a need for physician education on evidence-based practice? Then once these questions are answered, the team identifies possible solutions. They implement them and evaluate the performance. It may take multiple attempts for a permanent solution as discovered and implemented. Don't be discouraged. This process improvement cycle is a continuous method of trying different solutions and evaluating outcomes until your goal is reached. This is where having a diverse team and frontline engagement will be very advantageous. Evaluate your performance. Did you make progress towards your goal? What were the challenges and lessons learned? Utilize these points for ongoing monitoring or next steps. Once your goal is reached, celebrate your success with all the team members. Now we will follow up with Mary's case study. So the team at Mary's Hospital has chosen to work on the length of stay on the observation unit's low-risk chest pain patient population. The team has determined that the hospital's length of stay is consistently greater than recommended. Again, the next steps would be for the team to review the data, identify improvement areas, set some goals, understand their current process, design and implement a plan, and finally evaluate the performance. It is important the steps are followed in this order for successful process improvement. We will review specific tools in the next session. This concludes Module 5, Session 2 of the Cardiovascular Program Coordinator course.

Cardiovascular Program Coordinator

Performance and Quality Improvement

ACC accreditation

Performance Improvement Plan

SMART approach