Organizational Culture

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Organizational Culture ACH Rates

• Presented by Susan Tucker
• VP for Performance Improvement
• VNA of Hudson Valley

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Background

• CHHA with an active census of approximately
  650-700 patients
• Serves approximately 5000 patients/year
• 92 of referrals come from inpatient
  facilities(25 rehab facilities)
• Assumed caseload for a CHHA that had surrendered
  their CON in 2001 primarily a Fee-For-Service
  model. All staff was hired.
• 2 sites until 5/06 ( approx 30 /70 split)
• Organization moved 5/06 All services in one
  location
• Have been collecting Outcomes data since 90s
• OCS developed outcomes measurement systems at VNA
  
• 
  
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Organization Commitments

• Case Management Model
• Providing coordinated care while incorporating a
  substantial number of Fee for Service RNs
• Quality Improvement
• Change from negative focus
• Staff buy in
• Technology laptop and telehealth
• Education
• Get consistent message and information to staff
• 
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Case Management

• Case Management
• Patient has identified contact person for status
  changes or questions
• Visits scheduled and communicated with patient
  more effectively
• Improved continuity of care
• Coordination of Services
• Improved management of medical issues
• RN satisfaction improved with consistent caseload
  and familiarity with patients
• 20 Full Time Case Managers, 1 Part Time Case
  Manager, MHN Director with Fee for Service Case
  Managers, MCH program manager
• 
  
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In House Case Managers

• 2 In-house Case Manager Positions
• One Manages Therapy only cases
• Allows therapist to have more timely contact with
  RN to identify further needed interventions.
• With 25 of referrals coming from Rehab
  facilities we have a very high utilization of
  therapy services
• Therapy entry into case from SOC if on referral
• Low falls rate

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Case Management (cont)

• In House Case Manager for SN cases seen by Fee
  for Service RNs
• Many Fee for service RNs( many have no desire to
  case manage)
• One team relies heavily on Fee For Service RNs
• Utilized for daily patients in rare situations
• 3 Full Time LPNs mix with Fee For Service RNs
• Benefits
• Coordinates care and continuity issues, more
  timely follow-up of clinical issues
• Fee for Service RN report increased satisfaction
  with dealing with one person for several cases
  reporting process simplified and more concise
• 
  
• 
  
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Quality Improvement

• Change staff perception of QI
• Goals
• QI viewed as a resource
• Staff participation in performance improvement
  activities
• a) Small inservice/meeting sessions given by QI
  scheduled on a regular basis
• b) Outcomes data shared feedback on priority
  areas sought from clinicians
• c) Staff chooses which session to attend, session
  offered 5 or 6 times
• d) Joint home visits
• e) Staff encouraged to call QI with clinical,
  coding or OASIS issues
• f) Staff selects which PI team they will work on
• g) Teams are not only SN (PT,OT,MSW,SLP)
• 
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Education

• Clinical Educator Full/Time
• Assure uniform orientation of clinical field
  staff
• Case management orientation a large focus
• Skills competencies at hire and annually
• Consistent message
• Joint visits
• Ongoing follow- up for 6 months
• Review of cases opened paperwork Care Plan
  issues
• 
  
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Education (cont)

• QI inservice sessions
• Regular basis
• Same topic offered at multiple times (AM,PM,
  week-end)
• Present Outcomes data highlighting our strengths
• Regulatory issues
• Best Practice guidelines
• Staff summary on process of care investigations
• Present Plans for Improvement and Updates
• Nurse or therapist will have individual
  one-on-one sessions, as needed
• 
  
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Technology

• Telehealth Vital Signs, weight, pulse oximetry
  and visual inspection. All video units.
• Hi risk for hospitalization given priority
• Laptops
• Data available daily
• Most Case managers come to office 1-2xwk
• Currently Per Diem RNs and contract therapists
  are being trained
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Summary

• Why is our rate low?
• Coordinated Care and follow-up case managers,
  clinical managers
• Early PT entry into case low falls rate
• Consistent message re best practices and
  reinforcement of those practices
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(cont)

• Works for Our Population and our staff mix
• Clinical education and orientation need to give
  consistent message
• Thank you!
• Questions?