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Chapter 2

Mary Maven Chapter 2

We Can Do This!

End-of-Chapter Questions  


1. After performing a 360 degree review, which areas for improvement in your organization rank as priorities for improvement? That is, which ones are high-risk, high-volume or problem prone areas? How do these priority areas for improvement relate to better outcomes for patients, families or staff in your organization?

Answer: Question 1

  1. Perform a comprehensive, full circle review of your organization including business operations and practices as well as clinical practices and outcomes. (You may choose to use the web-based Self-Assessment System available to all NHPCO members as a web based technology - www.nhpco.org/quality.
  2. Identify areas that need to be improved, giving priority to improvement needs that have risk associated with them, affect many patients, families or staff and those areas that may have several incidences associated with them because the process is weak.
  3. Select the area(s) that are most in need of improvement and ensure that this area is also considered a priority area for the organization. For example, you may determine that improving the referral to admissions ratio is really important.However, one of this year’s annual goals for the organization is to ensure patients are at their desired comfort level within 24 hours of symptom onset, therefore comfort may be a priority improvement project because it is in keeping with the Board’s goals and also is likely to improve a palliative outcome for patients.

2.  Where is the data in your organization? How can you use data to show improvement for a patient and also show improvement across the organization?

Answer: Question 2

Data is simply information: facts, figures, numbers, records that you probably already have. Your patient records are filled with data as are your organizational and employee records. For many people, the problem is not having data but not being able to retrieve data for useful analysis.

For example, if your PIP is to attain patient’s comfort level within 24 hours of onset of symptoms, the patient record shows time of report/onset of symptom, assessment, intervention and patient’s level of comfort 24 hours after the onset, if this data is recorded for each patient. These pieces of information become data when you look to see whether the desired comfort level was attained within 24hrs for a particular patient and then for all your patients.

The issue will be how do you retrieve this data over all your patients easily and efficiently to see how you are doing in reaching your 24 hour comfort goal. If you use electronic charts, ask the vendors for help. For both paper and EMR, charting will have to be done in such a way that data can be easily retrieved for collection and analysis. Keep in mind the less time you spend collecting data, the more time you can spend on improving performance. Tools available to NHPCO members such as the Family Evaluation of Hospice Care, Family Evaluation of Bereavement Care, National Data Set also provide outcome data. See www.nhpco.org/research for more information on these valuable tools.

3. How does your data compare with other hospice and palliative care providers across your state? Across the nation?

Answer: Question 3

Using the Self Assessment System (available at no charge to all NHPCO members) enables you to compare your performance with others in your state and in the nation who have also used this tool. This information is also available for the tools cited in question # 2.  Having “benchmark” data may point out areas where your hospice is excelling or needs improvement. Keep in mind that “benchmark” only means you are performing as well as everybody else. It does not mean that you are providing quality outcomes for your patients and families.