NHPCO rolls out its national quality initiative in September
Hospices will work together for performance improvement
Hospice organizations and professionals pride themselves on their attention to quality care. But the federal government's new focus on performance improvement and quality programs will mean that quality efforts will need to be documented, measured, and compared.
The Centers of Medicare and Medicaid Services (CMS) will require hospices to implement quality improvement programs after the final rule for the Conditions of Participation is published in 2008. But hospice directors will not have to face this deadline alone.
The National Hospice and Palliative Care Organization (NHPCO) of Alexandria, VA, is launching its own Quality Partners initiative at the 21st Management and Leadership Conference, held Sept. 11-13, 2006, in New York, NY. The initiative will assist hospice professionals with creating and starting their own performance improvement projects and programs.
"We are designing some projects and a framework for hospices to use to improve their quality, to do some assessment of their operations, and to also get them ready for the new quality assessment performance improvement (QA/PI) project," says Judi Lund Person, MPH, vice president of quality and access at NHPCO.
Quality Partners will focus on 10 areas for quality and performance improvement. They are as follows:
- Patient and family-centered care;
- Ethical behavior and consumer rights;
- Clinical excellence and safety;
- Inclusion and access;
- Organizational excellence and accountability;
- Workforce excellence;
- Standards;
- Compliance with laws and regulations;
- Stewardship and accountability;
- Performance measurement.
"Medicare has always asked for quality measures in hospice, but this time there is a much stronger focus on making it transparent how the quality is being achieved in hospice care," says Lin Noyes Simon, PhD, RN, CHPN, quality and research specialist with NHPCO.
"They're asking hospices to do a 360 degree evaluation of themselves and see where their strengths and weaknesses are," Simon says. "And if they do find weaknesses, they have to show what they will do to try to improve those areas."
NHPCO's quality program operates under the premise that hospices will be able to meet this challenge better prepared if NHPCO and hospices work together, Simon notes.
"In my past, I've worked on collaboratives with other areas of the health care field and sometimes with hospices, and I've found it to be a very useful way for groups of people to learn how to make changes that improve their organizations," Simon says.
The goal is to apply the scientific process to a quality improvement plan and to use the PDSA process of Plan-Do-Study-Act, she adds.
Under the PDSA model, hospices will decide on a process to improve, make changes in hopes of improving the process, study the results to see if the changes made the desired improvement, and act according to what evidence suggests, either adopting the change or adjusting if the outcomes suggest it was not successful.
"The big part of this is to find out what changes we can make that will result in improvement," Simon says.
Many hospices have quality improvement programs and have studied their outcomes, but to other organizations, this will be an entirely new venture, and it's through collaboration that hospices might learn from one another about better processes, best practices, and tools that will assist them with meeting their goals, Simon says.
For example, one organization that has already achieved positive outcomes from a year-long quality improvement project is the Center for Hospice and Palliative Care in Cheektowaga, NY.
The hospice has successfully piloted a project in which a long-term facility collaborates with the hospice in identifying patients who qualify for end-of-life care, says Kathy Chowaniec, RN, hospice/nursing home/professional relations liaison.
"We're trying to take hospice to where the people are," Chowaniec says.
Previously, the hospice had passive business relationships with long-term facilities, but there was no structured, formalized process for introducing hospice care to their patients, she says.
So about a year ago, the hospice approached an area senior care center to discuss forming a more active collaboration in one of the center's long-term care facility buildings on a pilot study basis, Chowaniec says.
The result has been a 25 percent increase in the length of stay (LOS) among patients in that building, Chowaniec says.
Achieving buy-in from staff at both the long-term facility and the hospice was not easy, and the changes were tweaked over time, but the effort was successful, Chowaniec says.
Hospices who are undergoing a performance improvement initiative for the first time should keep in mind that it's challenging to incorporate changes in the daily routine, but it ultimately will result in a greater focus on quality care, Chowaniec says.
"If hospices can support each other through that, and if those with quality improvement structures in place could support the organizations that don't have them in place thus far, then everyone will come out where they need to be in a few years (when the Medicare changes go into effect)," Chowaniec says.
"If we try to go at it alone, there may be more difficulty in obtaining buy-in," she adds.
NHPCO will assist hospices develop formal collaborations with other hospices, including up to 20 groups of hospices that will meet for the first time at the New York City conference. The cost is $4,000 per team, and it includes attendance at four learning sessions; participation in monthly coaching calls; faculty review of reports and guidance; a trained improvement advisor as guide; staff-coach support for reports, graphs, and data collection; 30 hours of continuing education credit, and recognition on the Quality Partners Web page.
"We've limited it to 20 groups, but will probably have 10 groups of three to six people from each hospice," Simon says.
From 30 to 60 hospice professionals will meet, first in September, followed by a December meeting in Alexandria, VA, and then at a third meeting in Washington, DC at NHPCO's 22nd Management and Leadership Conference, held April 19-21, 2007.
Eventually, all hospices will have the opportunity to form collaborations, Person and Simon say.
"We want to help as many people as we can," Simon says. "We recognize that the collaborative method is one way to improve quality as a business strategy."
The Institute for Healthcare Improvement (IHI) of Cambridge, MA, offers a model of collaboration that has been a resource for NHPCO's collaborative initiative, Simon says.
The IHI model calls for teams of four to six people, but no less than three, to work together on performance improvement. They will be trained at the NHPCO meetings, and they will complete these additional tasks:
- participate in monthly phone calls for nine months;
- write and send in monthly reports;
- test small scale changes;
- collect data each week;
- attend change team meetings to plan and analyze data;
- inform senior leaders and staff about changes.
"I think this IHI model for improvements offers people a tool they can keep in their toolkit and routinely build into their business strategy," Simon says.
"Through the first wave of collaborations, we'll follow the IHI model, and after that we'll see what makes sense," Simon says. "It may be we have to move to original collaborations so hospice staff won't have to travel so far."
Also, NHPCO officials are checking out the possibility of telephone or Web-based collaborations for small and rural hospices that could not afford to send three employees to a collaborative meeting, Simon adds.
NHPCO already has a hospice email list service that can provide new information and ideas about performance improvement, Simon says.
"So we're looking into alternatives, and we're open to suggestions about how to make this as useful as it could be to hospice providers," Simon says.
NHPCO officials have studied the quality requirements CMS made of other health care organizations, and they've based the 10 quality commitments on these, Person says.
"What CMS continues to talk about is a 360 degree surveillance of an entire hospice organization," Person says. "It's a clinical and administrative surveillance, looking at best practices and performance improvement practices from the boardroom to the bedside."
So far, 25 states have agreed to work with NHPCO on the quality initiative.
"We expect to see a lot of networks forming to improve quality, both at the state level and among folks using the same information technology software," Person says. "What we're trying to do is put out a framework, letting people know this is the framework that will meet the 360-degree requirement."
NHPCO also will assist hospices in their QI/PI projects through promulgating tools they can use as part of QI projects, Person says.
These tools will include self-assessment tools and others that have been used successfully by hospices or are recommended by certification boards and other organizations, Person adds.
NHPCO's other quality projects will continue to provide resources and information for hospices, including the on-line family satisfaction product, end-result outcomes measures, the national data set, etc., Person notes.
Hospice directors and boards interested in participating with NHPCO can sign an organizational commitment to quality pledge, which makes them a quality partner, Person says.
"Then they can go to our Web site and look at self assessment tools, which will help them move forward, as well as look at case studies from other programs," Person explains. "They will see how these match with NHPCO's standards for a hospice program of care."
Need More Information?
- Kathy Chowaniec, RN, Hospice/Nursing Home/Professional Relations Liaison, Center for Hospice and Palliative Care, 225 Como Park Blvd., Cheektowaga, NY 14227. Telephone: (716) 686-8247.
- Judi Lund Person, MPH, Vice President of Quality and Access, National Hospice & Palliative Care Organization, 1700 Diagonal Road, Suite 625, Alexandria, VA 22314. Telephone: (703) 837-1500; Fax: 703/837-1233; Web site: www.nhpco.org.
- Lin Noyes Simon, PhD, RN, CHPN, Quality and Research Specialist, National Hospice & Palliative Care Organization, 1700 Diagonal Road, Suite 625, Alexandria, VA 22314. Telephone: (703) 837-1500; Fax: (703) 837-1233; Email: [email protected]; Web site: www.nhpco.org.
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