Agenda

1. Assisted Living Enforcement Process Improvement ProjectLeading Age Assisted Living Enforcement Training October 18, 2013Oklahoma State Department of HealthandOklahoma University Center for Public Management

2. Agenda • Introduction, meeting process, ground rules • Ginger Thompson, OUCPM and Performance Solutions • Quality Improvement Project Overview – How we got here • Henry F. Hartsell Jr., Protective Health Services • Swim Lane Steps – Understanding complexity & consequences • Mike Cook, Long Term Care Service • Plan of Correction Tool -- Reduce or eliminate fines & waste • Patty Scott, Long Term Care Service • Informal Dispute Process – New law November 1, 2013 • Sue Davis, Patty Scott, Long Term Care Service

3. Ground Rules! Know the agenda One person talk at a time Listen Don’t talk over someone Respect Be on time, return from breaks timely Provide session summaries Turn electronics off or vibrate Knock-Knock rule

4. Objectives • Gain familiarity with: • Quality improvement project • Swim Lane process map • Optional plan of correction template • How to participate in pilot • Informal dispute resolution

5. Project Overview: How we got here(and where we are going) • Henry F. Hartsell Jr., Ph.D. • Deputy Commissioner for Protective Health Services

6. Quality Improvement in Public Health • Deliberate improvement process - PDCA • Plan • Do • Check • Act

7. Quality Improvement in Public Health • Achieve measureable improvements • Efficiency • Effectiveness • Performance • Accountability • Outcomes

8. Plan: Identify Opportunities • Opportunity exists to ensure OSDH implements clear & reasonable enforcement process for assisted living centers to: • Positively impact residents • Reduce need for penalties • Reduce waste for all involved

9. Plan:Participants • OSDH staff members • Assisted living providers • University of Oklahoma Center for Public Management

10. PDCA Plan Phase:Describe Current Process • Swim Lane map shows: • Steps • Responsibilities • Where delays, mistakes, inefficiency are most likely • See the waste

11. Swim Lane Process Map • Lanes (responsibilities) are horizontal • Steps are vertical • Time moves left to right • Boxes are steps or tasks • Diamonds are decision points • Lines & arrows are connections • Ovals are start and end points

12. Swim Lane Lanes • Surveyors • Enforcement staff • OSDH Long Term Care Leadership • General Counsel • Assisted Living Centers • Administrative Law Judge • Informal Dispute Resolution Panel

13. Building the Swim Lane

15. Swim Lane Analysis:Find Causes of Waste • Plan of correction incomplete • By first revisit, problems not: • Corrected • Monitored • Documented • Rework, delays, penalties • 40 centers had 2nd revisits in 2012!

16. PLAN: Root Cause Analysis Issue Issue Issue Issue Idea Issue Issue Idea Issue Idea Issue Issue Issue Issue Issue Idea Issue Issue

17. Plan Phase: Identify Improvements • Ensure a complete & acceptable plan of correction 1st time • Optional POC template walks assisted living centers through all required elements • Improvement Theory: • Increase proportion of POCs accepted 1st time • Reduce proportion of 2nd revisits by 15% in three months

18. Knowledge Test

19. PDCA: Where we are going • Plan: • Reduce POC rejections • Reduce 2nd revisits • Use Optional Plan of Correction Template • Do: • Test Optional POC Template in Nov - Jan • Check: • Adopt, adapt, abandon • Act: • SOPs, train, track, solve problems, feedback

20. Next Up: Mike Cook and the Swim Lane Process Map