Integrated rehab improves referrals and cost savings
Health plans also like the change
Affinity Health System of Appleton, WI, had all rehab units integrate their documentation and operations to improve cost efficiency, quality of care, and staff time efficiency.
Now, more than five years after the health system started the process, the rehab departments are finding that it indeed provided all of those benefits. Plus, physicians and health plans express more confidence since the changes that their patients will be handled consistently across the health system.
Rehab staff now can fill in for colleagues at various clinics across the health system, particularly when one site is busier than others or when therapists are on maternity leave, says Maija West, OTR, MPA, manager of rehab services for St. Elizabeth Hospital, a member of the Affinity system.
"Having documentation standardization makes it much easier for staff to walk in and out of different clinics," West says.
Managers of the various rehab units work together, meet monthly, and constantly compare processes, looking for ways to standardize systems, she adds.
Before the rehab departments integrated their processes, the rehab managers already were a cohesive group that shared ideas, West explains. "So we thought that we could use each other for our expertise and make our work more efficient if we share workloads and standardize the process."
Here are the steps the rehab managers took:
1. Standardize policies, procedures, and job descriptions.
Rehab managers asked the staff for their input, West says. "The staff gave us the blessing for the management team to go ahead with the changes."
Managers brought all of their site-specific policy manuals to a meeting. Then they reviewed all standards by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, and by CARF The Rehabilitation Accreditation Commission in Tucson, AZ. They rewrote policies to form one standard manual for all sites.
Rewriting policies takes time
"It took time, over a year of writing and rewriting them," West recalls. "We started with the core policies and worked through those until we got down to the details."
Managers also acknowledged that occasionally there would be functions that needed to remain different for a particular site. "We have individualization in programs where it’s appropriate, but we’re always looking for ways to standardize," West says.
Next, they worked on job descriptions. The managers received a directive from the health system’s human resources department that all job descriptions had to be rewritten, so it was a convenient time to standardize the new job descriptions. "This was handled pretty quickly," West says.
2. Revise documentation forms.
Since documentation is an enormous task, the group handled most of the changes by standardizing a form each time a documentation tool needed to be revised.
"We started with what the health information system required in forms and created a format or template of what rehab documentation would look like," West explains. "And anytime it was revised with notes, forms, clinical pathways, they all follow that format and have it done the same way across the system."
Although this started as a management initiative, staff soon formed a committee to assist with the project. The hands-on working committee, consisting of representatives from each site, is dedicated to making documentation changes.
The committee’s first task was to create outpatient rehab pathways because that was something physicians and health plans often requested. They wanted to know why rehab services costs varied between sites, West says.
"We wrote those pathways and when we finished them we started to make the evaluation forms match the pathways," she adds.
Then the committee worked on inpatient forms and brought in a physical therapist and occupational therapist to assist them in drafting new forms.
3. Assess quality assurance.
Rehab managers formed a quality assurance committee that began with identifying who the customers are and what sort of feedback is needed from those customers. "We designed a method for reporting quality information from each site and putting it into a quarterly report," West says. "All of our reports are on the same e-mail system, and we have rehab resources in our library."
The quality assurance committee looked at patient satisfaction surveys and standardized those for both inpatient and outpatient. They made recommendations for how to report information from a rehab site’s quality team. Each quarter the rehab site uses the quarterly reporting mechanism the team created.
The committee didn’t require rehab sites to follow a cookie-cutter approach, but there are standardized outcomes reporting tools for outpatient, inpatient, and nursing staff. Each site selects its own quality improvement projects. A rehab quality manager can share the project with managers from other rehab sites, so that if one site has a solution; that improvement can be shared by all involved.
"They’re using each other’s knowledge and working on things to save from repeating," West says. "For example, if someone is working on improving a process or productivity you can look at what they’re doing and how it worked and maybe revise your own processes."
4. Form orientation and competency team.
The managers formed a team to handle standardizing the orientation and competency processes. The team created a standardized format that each site could customize to meet particular orientation needs. "We came up with the definition of what a mentor would be and what were the orientee’s rights and responsibilities," West says.
Years earlier, managers had organized staff to assist in writing competencies, and these were turned over to the team to assess and make available for all to use. For instance, one site might have a competency for iontophoresis, a modality for pain relief, that none of the other sites has used. Now all sites can pull up that competency if there is a need for that service.
The team lets sites know which competencies will be needed for the next year for various staff. "We keep a monthly calendar for all sites’ inservices so the staff can go to any of these," West says. This way, an employee who needs a particular competency but cannot attend the inservice that’s held at his or her site can go to the inservice held at a different site on the same topic.
Since the sites can pool staff to attend the inservices, this has made the process more efficient. Sites can hold fewer inservices, but make them available to more staff at one time.
5. Focus on marketing and continuing education.
Rehab managers have formed a new team to handle marketing issues for all of the rehab sites. The team includes a marketing representative from the health system. "They’ll look at what we’ll do when new physicians move into the area," West says. "Also, they’ll address what we will do for community service, such as health fairs and job fairs."
The marketing team also will come up with ideas for getting publicity for the rehab facilities and ways to promote rehab services.
The continuing education team identifies educational needs within the health system and makes recommendations for courses that the system might sponsor. For example, if a physical therapist attends a conference and learns about a new technique, the team might decide to hold a course on that so all therapists may learn the technique.
"The education team looks at the budgeted dollars we have and polls the staff on what their priorities are," West explains. "Then they determine what courses we’ll sponsor and assist with coordinating that sponsorship."
Each site still has its own continuing education budget to pay for off-site education for staff. The education team’s budget comes from one line item that is intended for sponsoring courses, West adds.
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