To accomplish the mission the team will need a plan. FHCA’s Quality Cabinet (Cabinet) mission statement is: To emphasize and support quality throughout the senior care continuum through training and education; identifying resources; identifying and tracking trends that promote or hinder quality; and supporting national quality initiatives.
Last month, the Quality Cabinet and its Councils met over two days in Tallahassee to develop their two-year quality strategic plan. To begin, Cabinet Chair Scott Allen gave an overview of the Cabinet’s history. The Quality Cabinet has evolved from its beginning in 1999 when the FHCA Board of Directors created a Quality Initiative Workgroup and that Workgroup recommended the establishment of the Quality Credentialing Foundation. The Quality Credentialing Foundation was created in 2011 to recognize and set standards for quality care.
In 2011, the focus on “credentialing” was dropped and the purpose of the Quality Foundation was refined to emphasize and support quality throughout the senior care continuum through training and education; identifying resources; identifying and tracking trends that promote or hinder quality; and supporting national quality initiatives. In 2016, the Quality Foundation met for a strategic planning session and as a result of that session, reaffirmed the purpose, but changed the organizational structure to function directly under the FHCA Board of Directors as the Quality Cabinet. The Cabinet will vote on Councils that are needed to complete the approved initiatives.
After a history lesson from the Cabinet Chair, members of the Cabinet and Council Chairs and Vice Chairs discussed the 2016 strategic planning session areas of misalignment and the recommendations to determine if those recommendations were met or still needed to continue. The first recommendation was quality integration into all areas, such as legislative, reimbursement and operations. Members acknowledged that integration has improved but would still like the integration of quality measures and quality dynamics in improving patient outcomes and operational success to continue being a focus of the Quality Cabinet.
The second recommendation was the connection between quality and reimbursement, and the Cabinet agreed this should continue to be a focus area. The third recommendation was the inclusion of long term care quality leaders at top levels. This was improved by the appointment of CEO to the Cabinet, therefore bringing the C-suite perspective. There is improvement, but the consensus was to continue this focus.
The fourth recommendation was the response to changing opportunities to lead. FHCA is invited to participate in statewide, regional and national cross-disciplinary initiatives, such as reducing rehospitalizations and the opioid crisis. The Cabinet determined that FHCA has exhibited tremendous leadership and that we are seen nationally as the leader in long term care quality. The consensus is that the Quality Cabinet should continue to focus and look for ways to respond to emerging and compelling opportunities to lead. The fifth recommendation discussed was the communication of the Quality Cabinet’s commitment to quality. Cabinet members voiced there are improvements happening, such as the updating of the website, but this still needs to continue to be a focus. The last recommendation discussed was the Quality Cabinet structure. It was agreed that the new structure under the Board of Directors has had positive impacts and should continue.
Cabinet stakeholders gave presentations on their initiatives. The Health Services Advisory Group presented on 11th Scope of Work, plans for the 12th Scope of Work and a status of the antipsychotic drug use. The Florida Society for Post-Acute and Long Term Care Medicine (also known as FMDA) presented on POLST, readmissions work, the emerging trend of hospitalist shifting to long term care settings and training needs. An Institutional Pharmacist Consultant presented on pharmacy issues that could affect quality in the skilled nursing centers, and the Florida Center for Nursing presented on the nurse labor statistics. FHCA staff presented on the state of affairs for skilled nursing centers, including a legislative outlook, reimbursement changes, survey data and a quality snapshot. Each Council gave reports on their mission and projects.
The Cabinet looked at the American Health Care Quality Initiatives which are to safely reduce long-stay and short-stay hospitalizations by improving 10% or maintaining a rate of 10% by March 2021; improving long-stay and short-stay satisfaction by 10% or achieve a rate of less than 90% by March 2021; improving functional outcomes by 15% by March 2021; and to safely reduce the off-label use of antipsychotics by 10% or maintain a rate of 8% or less in long-stay residents and maintain a rate of 1% or less in short-stay residents by March 2021. The Quality Cabinet voted to adapt these initiatives as part of the strategic plan.
The Quality Cabinet assigns Councils as needed to accomplish its mission and deliver on the initiatives and then affirms that the Council will need to continue. The Quality Improvement and Culture Change Council gave a recommendation to rename the Council to the Performance Excellence (PE) Council which will reflect a broader goal and align with the National Quality Awards and Baldridge Award criteria. The PE Council’s goals will focus on promoting the Baldridge criteria; strengthening long term care leadership; helping members know about and use strategic planning tools; and focusing on specific quality measures aligned with national goals. The Cabinet approved the Performance Excellence Council name change and affirmed that the Workforce Council, Senior Clinicians Council and Risk/Compliance Council would also continue.
The length of appointments to serve on the Quality Cabinet and Councils was also discussed. The appointment process that applies to all committees, which is currently a one-year term beginning after FHCA’s Board of Directors is annually elected at Annual Conference followed by the committee sign up/appointment process (6-8 weeks) reduces the time the Cabinet and Councils can continue to function. The quality initiatives that are approved by the Cabinet are two-year goals. It was recommended and approved that the Cabinet and Council appointments be two-year terms. The Council appointments will begin immediately, but the Cabinet appointments will require a change to the FHCA Bylaws. This recommendation will be presented to the Bylaws Committee for review.
After the quality initiatives were approved, the Councils were dismissed to meet individually and establish measurable goals that work toward meeting the Quality Cabinet-approved initiatives. Each Council had discussion on how their plans and projects related to meeting the approved initiatives. After each Council meeting, the Cabinet and Councils reconvened to give reports on their plan.
The Workforce Council established a measurable goal of improving retention; the current national average rate in l0ng term care is 51%. The Council plans to measure and track retention based on the percentage of direct care employees who stay employed at least six months. The Performance Excellence Council will focus on safely reducing the use of off-label antipsychotics and improving long-stay and short-stay customer satisfaction. The Risk/Compliance Council will work on projects that will help in reaching the hospitalization and customer satisfaction goals. The Senior Clinicians Council set goals that will assist with reducing hospitalizations and reducing the functional outcome decline.
Each Council will continue to track their work, measure the outcomes and report to the Quality Cabinet the status of the strategic work plan. Together, the Quality Cabinet and Councils are improving quality with focused goals and measured outcomes.