Implementing Policy In the Health Care Delivery SystemIn this episode, you are the Director of Quality Improvement for a Health Care System. Your team is in the process of establishing policies and pr

Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 1 Implementing Policy in the Health Care Delivery System Introduction: You are the Director of Quality Improvement for Bright Road Health Care System. Your team i s in the process of establishing policies and procedures to ensure health law compliance. You must work with team members to create policies and procedures that address the requirements, determine who the changes impact the most, and work with those people to develop a comprehensive communication strategy. Characters: 1. Student 2. Tiffany Halpert (Chief of Medical Staff) 3. Ken Bloom (Chief Nursing Officer) 4. Ronald Baxter (Chief Administrative Officer ) Locations: 1. Director of Quality Improvement Office (Student’s o ffice) 2. Hospital conference room 3. Chairman of the Health Care Board’s Office 4. Coffee Shop Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 2 Scene 1: Meeting with Team In this scene , the student meets with the entire team to discuss how to best establish policies and procedures to ensure health law compliance. The team will walk through the new requirements and briefly discuss their impact. The meeting will adjourn with the student setting a meeting to discuss each requirement with a team member in more detail. Location Conference Room Scene setup The team is seated around the table On -screen characters Tiffany Halpert, Ken Bloom, Ronald Baxter Off -screen characters N/A On screen text: There's lot of work to do today! Hopefully the team is ready. TIFFANY There you are! I mean, good morning! STUDENT Good morning, everyone. Ready to get to work? RONALD I think we are. So, what do you need from us? TIFFANY As you all know, there are some new policies regarding compliance with Medicare regulations that affect whether or not Bright Road ca n collect federal funding. We' ve always done our best to stay in compliance anyway, but the new policy is going to mean we have to be even more focused on making sure that we don’t accidentally violate the policy. KEN I don’t understand . W e already have pol icies here that require us to abide by the Medicare regulations. Why do we need to change when things are already working? STUDENT It comes down to proving to DHHS that we are in compliance. I know everyone here already works hard to follow the rules, but we just have to do it a little more formally now. RON ALD Exactly. DHHS has some pretty specific requirements based on the new policy that we need to live up to. TIFFANY Let’s walk through the new requirements. Is everyone familiar with them before we st art? Student must click all three to continue . STUDENT CHOICE 1 Tiffany, I would like your take on this. Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 3 STUDENT CHOICE 2 Ken, which of the requirements affects you the most? STUDENT CHOICE 3 Ronald, what do you think? TIFFANY RESPONSE 1 Well, a lot of the requirements are related to monitoring and reporting. In particular , DHHS is concerned about medical errors going unreported. I think we can all agree this is a potentially big problem. Also, as errors are uncovered, we need to perform root -cause an alysis to figure out WHY they are occurring, so that we can fix them and prevent them in the future. KEN RESPONSE 2 On the nursing side, I find it important that we are going to be required to track and report patient outcomes focused on problems listed in the National Health Care Quality Report. I can see the benefit there. Also, we have to integrate the five health care profession core competen cies into our staff education, and track our progress. RONALD RESPONSE 3 Well, these requirements are mostly a bout monitoring. And that can make people pretty nervous, and more prone to cover up mistakes. So I think t he requirement to establish a no -blame culture is most critical in making this policy a success. Continue after everyone has spoken. STUDENT You al l make great points. I know everyone is busy, but it might be best if I meet with each of you later to talk about your particular areas of concern. TIFFANY I'm swamped until later this afternoon, but I’d be happy to meet then. RONALD I can meet whenever you need. Plus, I’d like to talk a few things over with you before we get too far into this. KEN I have another meeting right after this . B ut other than that, I’m free . STUDENT OK, then. Ronald, let’s head back to my office. Everyone else, we will talk soon. TIFFANY Sounds good. See you later. KEN Bye everyone. Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 4 Scene 2: Meeting with CAO In this scene, the student meets Ronald Baxter, Chief Administrator, to discuss how to implement the new policies. Location Director of Quality Improvement’s Office Scene setup Ronald is seated across the desk On -screen characters Ronald Off -screen characters N/A On screen text: Hopefully Ronald can help you out with this project… RONALD Hi there. Are you ready to work on this? STUDENT I am. Ronald, you said your biggest concern was the no -blame culture. Why is that? RONALD I wanted to talk to you first for a reason. Do you know what a “no -blame culture” is? Student must click correct option to continue . STUDENT CHOICE 1 (INCORRECT) When things go wrong, you focus on solutions, not finger -pointing. STUDENT CHOICE 2 (CORRECT) You recognize that errors will occur but make planned efforts to prevent as many as possible and the focus is more on awareness of system causes rather than blaming and punishing indi vidual staff. STUDENT CHOICE 3 (INCORRECT) You accept that mistakes happen and don’t worry about holding people accountable. RESPONSE 1 Well, t here’s some truth there, but it’s more than that. Response 1 kicks student back to options. RESPONSE 2 Exactly! The idea is that people will LEARN from mistakes if you give them the opportunity to do so and since most errors are system s errors we can learn more about improving our system . A hospital is a very high -stress environment and unfortunately, mista kes do happen . We don’t want people to be so afraid of being punished that they aren’t willing to think for themselves. Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 5 Response 2 moves student to next statement from Ronald . RESPONSE 3 No, no . Th at’s not it at all. People need to be accountable, but t hat’s not the same as placing blame. Response 3 kicks student back to options. STUDENT But we need policy and protocol to help keep people doing the right thing, right? RONALD Of course. This isn’t just about letting everyone do whatever they want. It’s about encouraging them to think about their actions and to DO THE RIGHT THING. STUDENT How does blame fit into that? RONALD We are in health care. Every patient that comes in the door has a different situatio n. You can’t write a manual that would tell a nurse what to do for every specific scenario . We need people who can think on their feet and adapt to the circumstances. If you take that environment and make peopl e think they will be punished if they think ou tside the box, well, you have a big problem. STUDENT OK, that makes sense. But we already encourage people to think on their feet.

How does this requirement apply? RONALD The requirements we' re talking about here mostly relate to monitoring and tracking. If we suddenly institute a policy that says we will start keeping metrics and trac king performance for staff, it's going to scare people. They' ll worry that if they make the wrong decision, it could mean their job. STUDENT I see. RONALD Well, w e can’t have a great staff if they are always worried about the consequences if they make a mistake , particularly here, where a mistake can literally be a matter of life and death. Student can click any one of the three to continue. STUDENT CHOICE 1 (INCORRECT) I’m not comfortable with our staff not being accountable for their actions. STUDENT CHOICE 2 So we need to find a balance between this freedom and also responsibility to do the right thing. Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 6 (CORRECT) STUDENT CHOICE 3 (INCORRECT) Are you saying we don’t hold the staff to ANY standards? RONALD RESPONSE 1 No. That’s not it. That' s why I wanted to talk with you in the first place . RONALD RESPONSE 2 PRECISELY. RONALD R ESPONSE 3 No, of course not. We still need to evaluate performance. RONALD Whatever policies , monitoring , or tracking we implement for compliance must not threaten our staff’s willingness to think for themselves or their freedom to make a mistake. And to learn from it. STUDENT You just made my job a lot more difficult than coming up with some simple metrics. RONALD Yeah, probably. I’ve taken enough of your time . Why don’t you meet with the others and then we can touch base a little later? STUDENT Sounds good. Thanks for your time, Ronald. RONALD My pleasure. Bye. Scene 3: Meeting with CNO In this scene, the student meets Ken, Chief Nursing Officer, to discuss additional requirements. Location Director of Quality Improvement’s Office Scene setup Ken is seated across the desk. On -screen characters Ken Bloom Off -screen characters N/A On screen text: Ken’s turn . Time to find out how this will affect nursing … KEN Hi, good to see you again. STUDENT Hello, Ken. I am curious to hear your input on these new requirements. KEN I’ve been thinking about this a lot, and I’d like to start with how to track and Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 7 report patient outcomes , particularly in regard to the five health care core competencies. STUDENT Refresh my memory on what the competencies are. KEN Sure. T hey are: • Provid e patient -centered care • Work in interprofessional teams • Employ evidence -based practice • Apply quality improvement • Utilize informatics Student can click any one of the three to continue. STUDENT BRANCH 1 Let’s talk about patient -centered care. STUDENT BRANCH 2 Let’s talk about working in Interprofessional teams. STUDENT BRANCH 3 How do you employ evidence -based practice? BRANCH 1 KEN Sure. Providing patient -centered care means that we treat each patient on a case -by -case basis. You know as well as I that no two patients are exactly alike, even if they suffer from the same condition. A disease can affect people in different ways, and we want to take each patient’s needs into consideration whe n providing treatment s. This gives each patient the opportunity to make final decisions about his or her care . STUDENT That makes sense. KEN There are risks because when things are busy , and they ARE usually busy , it’s easy to fall into the trap of treat ing the disease instead of treating the patient. This can lead to problems if we overlook patient details , like an allergy the patient might have or not listening to what the patient wants . STUDENT How do we go about tracking how well we perform in terms of patient - Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 8 cent ered care? KEN Well, that’s a tough one to put on a chart, since the whole concept is that each patient is different. S o you don’t necessarily have a lot of common data. But one idea is to look at places where mistakes happen. If it’s an avoidable mistake, where did things go wrong? Did we provide the nurse or doctor enough information to treat that patient as an individual? Or was some detail overlooked? We also collect data on patient satisfaction . Maybe we could review our questions so that we could get more data that relates to this competency. STUDENT I think I understand. KEN We can then pool that data and look at where mistakes are happening in a general sense. That way we can determine if the cause is our lack of focus on the indi vidual patient . Student continues at next branch response that was not selected previously, or continues . BRANCH 2 KEN Interprofessional teams are groups of health care providers from different backgrounds who work together, each of them bringing their unique expertise to the group. Nobody can be an expert in everything, but if you gather several specialists into one team, you end up with something that is much greater than the individual parts. STUDENT Can you give me an example? KEN Well, let’s say we have an elderly patient with lung cancer. Rather than have one physician handling everything about that patient’s care, we use a team. The nature of the team could vary depending on the patient’s needs, but might include an oncologist, radiologist, diet ician, and so on. By combining skills of these individuals, the patient receives much better and more personalized care than is possible with just one doctor. STUDENT That makes sense, but how is it trackable? KEN Well, that’s your job to figure out! But one idea would be to document how teams are formed , using peer review within the teams to evaluate what works and what doesn’t. Then, of course, we take that infor mation and improve our process for the future. Stud ent continues at next branch response that was not selected previously, or continues . Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 9 BRANCH 3 KEN Evidence based practice means that we are using practices and procedures that we KNOW work ; based on evidence . We don’t engage in risky experimental practices . O nly those that have been documented in peer -reviewed journals and are known to work. This is really a foundational aspect of nursing. STUDENT Makes sense . It would be potentially dangerous any other way. KEN It also helps identify problems because if something goes wrong, we can see if someone broke procedure. There are certainly some unavoidable mistakes, but if we don’t use evidence -based practice, then we are making a very avoidable one. This should provide a fairly clear metric for you. Student can click either of these to continue. STUDENT BRANCH 4 I’m always interested in quality improvement. STUDENT BRANCH 5 Tell me about using informatics. BRANCH 4 KEN I’m sure you are . That’s kind of what we have you here for. I don’t need to tell you about all the way s we can track quality trends in care, success rates, and so on. We already use a lot of fairly automated systems to help track this. By analyzing trends over time, you can see if things are going well or not. If they aren’t, you can then drill down into the problem areas to figure out where things are breaking down. Student continues at next branch response that was not selected previously, or continues . BRANCH 5 KEN In nursing, informatics takes patient care to an entirely new level. Rather than just treat ing the patient and mov ing to the next, informatics combines nursing, computer technology, and information science to improve care. It increases communication, documentation, and efficiency. END BRANCH ES STUDENT That’s a big help. I think I have enough information for now. KEN OK, great. Let me know if you need any more help. Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 10 Scene 4: Meeting with Chief of Medical Staff In this scene, the student meets with the Chief of Medical Staff to discuss how to set up policies dealing with some of the requirements. Location Chief of Health Care’s Office Scene setup Tiffany is seated across the desk. On -screen characters Tiffany Halpert Off -screen characters N/A On screen text: Let’s see what Tiffany has to say. TIFFANY Hi. I don’t really have a lot of time today, so do you mind if we get started? STUDENT Of course, let’s go. I want to talk to you about how we should monitor and report errors to DHHS. TIFFANY Sure. What do you want to talk about? Student can click either of these to continue. STUDENT CHOICE 1 What areas do you think we should track? STUDENT CHOICE 2 How should we set up metrics? BRANCH 1 TIFFANY Well, on a broad level, let’s focus on the specific requirements in this provision. Medical errors, patient outcomes, adherence to the five core competencies, and so on. STUDENT We already track a lot of these. TIFFANY Right, but as you are putting together your plan, think about how we can get this information to DHHS. Are there ways to automate our t racking and generate reports that can clearly show where we are doing well and where we need improvement? Student continues at next branch response that was not selected previously, or continues . Branch 2 TIFFANY Good question. First, I would recommend we establish a baseline for performance . T his can probably be based directly on the DHHS requirements. That’s not to say we should shoot low, but we need to clearly mark the point Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 11 where we would not be in compliance. Student continues at next branch respo nse that was not selected previously, or continues . STUDENT OK, this sounds easy enough. TIFFANY Hold on, that’s only part of it. What are you going to do when things go wrong? Student must click the correct option to continue. STUDENT CHOICE 1 (INCORRECT) Look at our metrics, determine where we have a problem, and then fix it. STUDENT CHOICE 2 (CORRECT) I suppose the first step is to figure out what went wrong. STUDENT CHOICE 3 (INCORRECT) Make sure everyone knows what happened, and not do it again. RESPONSE 1 It’s not that easy. Metrics show you trends over time, and you can identify weak areas with that information . Bu t they won’t give you a solution. Response 1 kicks student back to options. RESPONSE 2 Right! This is called root cause ana lysis, and it’s a critical step in improving a process. Response 2 moves student to next statement from Tiffany . RESPONSE 3 What if the problem isn’t just human error, though? A lot of problems arise from more systematic issues, and no one person can solve them without changing the system in place. Response 3 kicks student back to options. STUDENT Tell me about root -cause analysis. TIFFANY Sure. There are three main things to think about. Identifying a problem, finding out what caused it, and implementing systems to avoid it in the future. What do you want to talk about? Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 12 STUDENT How do we identify a problem? TIFFANY Well, some problems are easy to spot. If a nurse makes a n obvious mistake , we can see it right away and address the issue with training or find some other solution. But what if we notice a trend of patients being misdiagnosed? What would we do about that? Student must click correct option to continue. STUDENT CHOICE 1 (Correct) Try to figure out why the misdiagnoses are occurri ng. STUDENT CHOICE 2 (Incorrect) Tell everyone to double -check their diagnosis. TIFFANY RESPONSE 1 Right! Specific incidents can be handled directly, but when we see a trend, we have to drill down and look at what is REALLY causing it. Not just the specific trigger, but also the underlying process. In this example, we might find that patient information wasn’t being properly shared between departments. Once we determine that, we can step in and actually change the system itself so that the trend stop s. Response 2 moves student to next statement from Tiffany. TIFFANY RESPONSE 2 Good thought, but that isn't really IDENTIFYING the problem. That's more of a solution. Response 2 kicks student back to options. Student can click either branching option . STUDENT CHOICE 1 How do we tell what caused a problem? STUDENT CHOICE 2 How can we avoid problems? Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 13 BRANCH 2 TIFFANY Once we identify a trend, there could be a lot of reasons that cause it. Miscommunication is a common one. Maybe it's a lack of training for the staff to make sure everyone is following the correct procedures. Maybe we determine that errors are occurring because our staff is too overworked and not getting enough rest. In that case, we might change schedules and shifts.

There are s o many possible causes of negative trends. We need to deal with them on a case -by -case basis. The important thing is to drill down to the core issue. We want to treat the disease, not the symptom. Student continues at next branch response that was not selected previously, or continues . BRANCH 3 TIFFANY Avoiding a problem can mean a few things. First, we can change processes enough that the problem isn't an issue at all. Streamlining our workflow in this way is the best solution. But, things aren't alway s that simple. Some problems just WILL happen from time to time. But if we know to expect it, we can implement a new procedure that will help staff to deal with it. This all comes down to risk management. Evaluate the possibility, severity, and likelihood of a risk, and determine in advance how to avoid or address it. Student continues at next branch response that was not selected previously, or continues . END BRANCH STUDENT You have given me a lot to think about, Tiffany. TIFFANY It’s a very complex subject! Fortunately, we aren’t exactly starting from scratch. For your plan, you should pick maybe three points that you want to use as examples. Consider how you would evaluate them, how you would identify problem areas, and a possible solution for each. STUDENT That sounds like a good idea. Thanks for your time, Tiffany. TIFFANY Glad I could help. Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 14 Scene 5: Touching Base with CAO In this scene, the student meets Ronald to go over what he has learned from his interviews with the team. Location Coffee Shop Scene setup Ronald is seated across the table . On -screen characters Ronald Baxter Off -screen characters N/A On screen text: Back in your office, you receive an email... Email indicator flashes on computer screen. Student clicks to open email. Email From: Ronald Baxter Subject: Coffee? Hey, I know you are busy, but take a quick break and join me for a cup of coffee! I want to see how you are doing on this project. A couple things I want to talk about: • Metrics and reporting • Core competencies • Implementing change in a no -blame culture See you soon! Ronald On screen text: Ahhh, time for a cup of coffee... RONALD Hi there, thanks for meeting me . How’s your research going? STUDENT I’m about done, I think. I’ll write up my plan after leaving here. RONALD Oh, that’s great to hear. Do you mind if I ask you a few questions first? STUDENT Not at all, what’s on your mind? Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 15 Student can click any one of the three to continue. RONALD QUESTION 1 We already gather a lot of data internally. How would you propose we get this into a report for DHHS? Student must click correct option to continue. STUDENT CHOICE 1 (CORRECT) We build a report that shows baseline metrics of performance from DHHS, and how well we are doing in comparison. STUDENT CHOICE 2 (IN CORRECT) It would be easiest to just send them raw data and let them sort through it. STUDENT CHOICE 3 (INCORRECT) They will probably tell us how to report our data. RESPONSE 1 That’s a good idea. We can probably modify our existing reports fairly easily, and integrate their standards to show how we 're doing. Response 1 moves student to next statement from Ronald. RESPONSE 2 No, that won’t work. They don’t have the resource s to do all of th at work for us. Also, it wouldn’t seem very cooperative on our part. Response 2 kicks student back to options. RESPONSE 3 No, I don’t think you’re right. They are going to want us to actively show that we are attempting to stay in compliance, and that means we are going to have to report on ourselves. Response 3 kicks student back to options. RONALD OK, another issue you will need to focus on is the five core competencies. Can you list them for me? Note : Student is given three options, each with a different set of core competencies . If student selects wrong option, display "Incorrect" and disable that option for the next attempt. On screen text : Select the option that has all five core competencies . Opti on 1 (incorrect): Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 16 1 - Provide patient -oriented care 2 - Provide training 3 - Employ supportive hospital staff 4 - Use of quick, effective, and accurate documentation 5 - Apply quality improvement Option 2 (incorrect): 1 - Work in i nterprofessional teams 2 - Demonstrate effective bedside manner 3 - Provide outstanding service 4 - Employ evidence -based practice 5 - Provide training Option 3 (correct): 1 - Provide patient -oriented care 2 - Work in interprofessional teams 3 - Employ evidence -based practice 4 - Apply quality improvement 5 - Utilize informatics RONALD Great. Now, the last thing I want to talk about isn’t a question so much as how I want you to frame your plan. STUDENT What do you mean? RONALD We talked before about creating a no -blame culture. As you have done your research, you learned a lot about metrics, reporting, tracking, and ways for us to improve. However, like I said before, it 's really important that your plan implements these changes in a way that will not make people think they are going to get in trouble. The bottom lin e is we want staff members who can Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 17 consider factors and make sound decisions. STUDENT I understand. RONALD Great. I’ll let you go. Scene 6: Assessment If all previous scenes have been completed, a 10 -question assessment is presented to the student. It's time to check your knowledge. Answer the following 10 questions to show what you know about hea lth care policy. Good luck! The student answers the questions and then sees the assessment results. Assessment Results Here are your results. Click Save Results if you are satisfied with the outcome. Or you can click Try Again if you want to try and improv e your score. NOTE: The student can retry the assessment by clicking the Try Again button, or can continue to final scene by clicking the Continue button. Scene 7 : Submitting Policy In this scene, the student will sit down in the office to write up policy points for the team to review. Location Director of Quality’s Office Scene setup Student is seated at desk, working on computer – show the screen large. On -screen characters N/A Off -screen characters N/A On screen text: OK, you should know everythin g you need to. Time to get started! [This is a short essay assessment where the student will choose three areas of health care and talk about ways to track improvements. ] On screen text: Pick three areas of health care (nursing care in a medical unit , ER wait times, surgery, etc.) for which you could monitor and track for potential problem areas. Write a brief summary of how you would monitor that area, potential areas of weakness that you see, and a potential solution. Health Care Policy Navigate 2 Scenario : Implementing Policy in the Health Care Delivery System March 6, 2018 18 Topic 1: ________________ Enter y our description. Topic 2: ________________ Enter your description. Topic 3: ________________ Enter your description. NOTE: Student clicks Save button to save their responses. Form closes on click of Continue button. On -screen text: Congratulations! You have successfully documented your plan . THE END