Start spring cleaning with mini QI projects
QI process reduces staff sick days by 50%
It’s almost spring-cleaning time. There is no time like the present to clean up and clear out all those annoying little problems that nag just about every home care agency. Are you interested in two QI tips that work, and that you can read about in less than 20 minutes?
Maybe your agency has chronic troubles with staff calling in sick, or aides’ reports not matching nursing care plans. Even if your problems don’t warrant a full-blown quality improvement project, the QI process will help nonetheless, as a New Jersey agency has discovered.
Metro Healthcare Services Inc. of Edison, NJ, hired a consultant and then revamped its quality improvement program to clear up several messy details as it prepared for a survey by the Joint Commission on Accreditation of Healthcare Organizations of Oakbrook Terrace, IL.
"We changed everything you could think of everything from employee aspects to client satisfaction," says Denise Connors, RN, vice president of nursing for Metro Healthcare Services. Metro is a full-service agency that covers most of the state of New Jersey through three offices.
The agency focused on the common problems that sometimes are overlooked when an agency emphasizes quality improvement. "I think it’s important that you do QI on a lot of day-to-day things," Connors says.
Through one of these mini QI projects, the agency reduced the number of times aides called in sick by 50%. Another project resulted in an improvement in the aides’ work notes, and yet another made sure there was timely compliance with each employee’s licensing requirements. These small projects helped contribute to the agency’s performance on its Joint Commission survey, which resulted in accreditation with commendation, Connors states. (See story on improving aides’ documentation, p. 29.)
Here’s a look at some common problems, and how Metro Healthcare cleaned them up through QI:
• Work no-shows.
Home care aides sometimes have high rates of calling in sick, and Metro’s aides were no exception. Connors decided to tackle this problem with the QI process.
First she looked at the agency’s records of employees calling in sick. She analyzed which days appeared most often, using a QI study/ monthly tracking tool filled out by the staffing coordinator.
The tool has a column for each month of the year in which the coordinator may write how many people did not show up for work.
In the far left column, under the heading STUDY: Staff Reliability, are the criteria, as follows:
Days of week (each day has separate line)
RN Canceled
RN Late
LPN Canceled
LPN Late
CHHA Canceled
CHHA Late
% Canceled/Replaced (#Replaced/ Canceled)
% Canceled by Employee (#Employee/ Total)
% Canceled by Metro (#Metro/Total)
% Canceled by Client (#Client/Total)
REASONS:
Sick
Babysitting
Car/Transportation Traffic
Family Sick
Family Emergency
Directions Error
Scheduling Error
Miscommunication
Weather
Other:
% Employee Counseled
# Counseled/Total Employee Calls
The tool provided reasons for employees’ absenteeism, so Connors analyzed these to see which reasons appeared most frequently.
"Most of the time when someone calls out sick they are responsible for giving a reason," she explains.
If a pattern emerged for any particular person, then Connors would call that employee to her office or speak with the employee on the telephone to discuss the employee’s attendance problem. "I’d say, You have not been reliable, can I help you?’"
Two reasons appeared quite often: lack of dependable and affordable day care, and lack of dependable transportation.
As the next step of the QI process, Connors began to work on these two problems.
"I called around and found subsidized day care programs that would help low-income families, and that helped a lot," Connors says. Some of the aides took advantage of the subsidized day care.
Also when employees called up to say they could not get a ride to work or that their cars broke down, Connors would get on the phone and offer to pay for a taxi or to call an automobile club to rescue them.
"I would get into my car and pick them up if they were stranded because their car broke down," she adds.
Solutions usually can be found for most of these staff reliability problems, Connors says.
If, for instance, a pattern had emerged that employees often were calling in sick during the flu season, then she would have initiated a company flu vaccination program.
Incentive program boosts attendance
Staff reliability improved, but more needed to be done.
Because motivation also plays an important role in employees’ attendance, Connors also instituted an incentive program for good attendance.
For instance, any employees who did not call in sick during a particular month could put names in a drawing for a prize. The agency gave away turkeys, as well as sweatshirts with the Metro Healthcare logo.
Also, Connors started a "Take the Challenge" program, in which employees were eligible for a bonus if they worked a certain number of hours during a specified time frame.
"So if you had someone working 20 hours normally, then they would be eligible for a bonus if they went up to 25 or 30 hours," Connors explains.
One campaign started before Thanksgiving and resulted in employees receiving bonus checks in time for holiday shopping, she notes. "This was really good for employee morale."
The agency also brought some home health aides to the state of New Jersey’s home health assembly recognition luncheon for home health aide of the year. Agencies across the state attend the luncheon. Every office has a home health aide of the year, and that person attends the luncheon.
"Another thing we do on a monthly basis is we have a Home Health Aide of the Month in every office," Connors says. The names of these aides are posted at the office entrance.
In addition, the agency posts each month a list of employees who have been reliable and have had perfect attendance. These employees’ names also are listed in a regular Metro Healthcare newsletter.
These types of incentives can go a long way toward building employee loyalty, even in the typically low-paying home health aide field, Connors says.
The outcome has been that the number of no-show employees has decreased by 50%, Connors adds.
• Checking license status.
Employees must satisfy certain regulatory and health requirements each year, but sometimes these details are forgotten. How many times have agencies let things slip through the cracks during the daily grind?
Metro Healthcare used the QI process to make sure no employee forgets or is late in fulfilling one of these requirements. The agency developed a personnel tool for each discipline. The tool for certified home health aides, for example, contains the following checklist:
1. Health record contains: Phy last year/current
2. Health record contains: PPD 2stp. unless positive
3. Health record contains: Rubella
4. Health record contains: Rubella p667
5. Passing score on CHHA exam
6. CPR Certification on file/up to date w/in 90 days
7. Evaluation of skills by Supervisor in file on-hire
8. Interview in file
9. Two references on file
10. Supervisor completed an evaluation of performance and competency of 60 days
11. Formal evaluation of performance of year for the past two years
12. Completed a minimum of 14 hours
13. Attended re-orientation since [date]
14. Orientation acknowledgment since [date]
15. Probationary evaluation completed six months after hire
16. Criminal background on file (hired since [date])
17. CHHA Certificate
18. W-4
19. I-9
20. Hepatitis
21. Driver’s License
22. PPD Annual Dr. CSR if positive
23. Social Security #
The agency regularly checks this tool for each employee to make sure every requirement is up-to-date.
"We’ve always checked these things, but we found a more organized system. That’s really what the QI process is," Connors says.
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