Continuous Improvement - A Never Ending Cycle

The following article is written by Louise Werder-Bridgeman, Quality Coordinator responsible for submitting data for 5 facilities, all part of the Presbyterian Support Central group in New Zealand. Read on to learn how Louise developed a system which allows her to analyse in detail, each KPI at the time of data entry and as a result, improves resident care.

Commit. All the data is entered and analysis completed. Scorecards loaded and ready to go. Hit the button and the job is complete. Time to relax and take a breath? Not likely.

As Quality Coordinators we are always striving to find ways to improve the service to our clients, auditing, planning, implementing changes and evaluating improvements. When it comes to QPS Benchmarking the theory is the same. To get the most out of benchmarking we need to put the most in. Once I have pushed the Commit button I begin the planning for the next data entry.

First I print off the summary sheet after I commit the benchmarking data and then the Data Entry sheets for all my next three months of information. I file these together and they become my benchmarking working documents for the next three months.

On the data sheet I enter all the stats from this quarter so I have the information ready to compare with the upcoming quarter. All the falls, skin tears, infections, care hours and absenteeism are entered. I do not need to remember the analysis of these as I have the summary from the last quarter attached.

I then look at the QPS audits that are due for the coming quarter and retrieve the previous results, entering them into the Office Use Only section of the Data Entry form. I usually add notes regarding the results so that I have the information ready for when I enter the data on-line. By doing this I do not have to go back to the audits again.

Over the next three months I add further data such as falls, infections etc information and audit results as I complete them. By the time I come to enter the data the pages are pretty messy. I use pencil rather than pen as it is easier to erase and make adjustments as I continue.

Let's take an example of how I set about it and how we are using the benchmarking to make improvements to our service. As I enter the falls data onto the Data Entry Sheet I make notes regarding how many were non injury, fractures, possible concurrent infections and any information that may help when I am doing the analysis. I also collect data regarding any interventions used to prevent either falls or if unable to prevent the falls to minimise injury. Anything that may help me to analyse the falls and enable me to compare with the previous quarter(s).

When it comes time to enter the benchmarking data for the next quarter I have most of the information I need to enter the data on line. I find that being able to do the analysis at the same time as entering the data is a time saver. Analysing the data at the point of entry means I don't need to back track. Once the data cleansing has been completed and the reports are produced, each KPI has already been analysed for its results and captured on the report.

My analysis is very detailed and I also review and make comment on my Peer Group and Quartile Rankings.

I have to be very methodical about the way I enter the data, completing one section at a time. I tried entering all the data then going back and writing up the analysis but I found this cumbersome and not a logical way to complete the entries. Once I have entered the data I compare the results with the previous quarter, and information gathered during the quarter and depending on the outcome I am already halfway to completing my analysis.

I look at what has been happening in the facility, the client mix, staffing, changes implemented, anything that I feel may have a bearing on the outcome. I compare this information with the last quarter and come up with a detailed analysis of the results.

In some areas I find that I may not only compare with the last quarter but also with the same period last year. This is often helpful when comparing things such as staff absenteeism and indicators with seasonal trends such as respiratory Infections.

The Benefits

Using the falls data as an illustration

The falls data collection/analysis has lead to a new project to improve our fall incidents.

With advice from our QPS principal consultant and data cleanser, I read "The Guidebook for Preventing Falls and Harm from Falls in Older People: Australian Residential Aged Care Facilities" published by the Australian Commission on Safety and Quality in Healthcare Best Practice guidelines.

From this we have developed a project to educate staff on how to investigate falls, what to look for and how to manage frequent fallers. This will help us to identify and document the risk management approach to managing falls.

This project is wide reaching, looking for the reasons for falls, ways to prevent falls or injuries from falls, education of staff, developing new ways of investigating with an emphasis on contributing factors and where possible removing any causative factors to prevent or minimize further falls.

One exercise that had interesting outcomes was to sit at the dining room door with a resident list and check all footwear for appropriateness. This was a very effective way to review a large number of residents on a single day. Once the review was completed we prioritized the degree of risk and completed individual checks for these residents. Families were very receptive to what we were trying to achieve and replaced footwear as required. This lead to the development of an audit tool that checks we have covered all the bases in preventing/minimizing falls including looking at footwear, spectacles, care plans medical history and other areas.

The development of online reporting for QPS and being able to analyse as you input data has enabled us to obtain far more relevant outcomes and action plans to improve our service. The information is evaluated earlier and we are able to implement any improvements without delay.

While benchmarking shows us where we sit in the market place it is also an excellent tool to prove our services are optimal. I believe that it is the analysis of our own data that gives us the information to improve that service even further by understanding why we are achieving the results we are, be they great or not.

Christian Friedrich Hebbel (1813 - 1863) German Poet & Dramatist said

"Nothing great in the world has ever been accomplished without passion."

I am passionate about using information to paint a picture of where we have come from, where we are now and what path we might take to get us to where we want to be. And then to see if it took us as far as we can go, or that maybe it is just a step on our journey.

Louise Werder-Bridgeman
Quality Coordinator
PSC Manawatu
New Zealand