The purpose of this Section is to provide information about
administrative systems and processes related to the long-term care continuum.
"Contents" lists topics covered in this Section. This is followed by a list of
major questions that will be addressed by the topics in this Section.
The content of this Section will be expanded gradually over time. Highlighted
items are most likely to be linked to more detailed content. Refer back periodically for
issues of interest. The monthly "Tips and Information" columns will address
various items prior to being transferred into this Reference Manual.
2. Participants in care delivery and their oversight and management
a. Essential leadership and management
principles relevant to providing long-term care
b. The role of policies and procedures in
supporting and improving care
c. The participants in care, and their
relationships
d. Optimizing the performance of care
participants
3. Physicians and their oversight and management
a. Optimizing physician
performance
b. The medical director's leadership and
management role
c. Organizing physician services
4. Quality improvement concepts and programs
a. Defining quality care
b. Challenges in providing quality care
c. Factors influencing patient outcomes
d. Factors influencing care outcomes
e. The relationship between care and patient
outcomes
f. Measuring quality
g. Defining and using quality indicators
h. Relating process to care quality
i. Improving care quality through process
improvement
j. Improving care and support processes
k. Establishing a successful quality
improvement program
l. Medical quality improvement programs
m. An effective risk management program
CARE DELIVERY AND MANAGEMENT SYSTEMS
THE CONCEPT OF A CARE DELIVERY SYSTEM
COORDINATING AND INTEGRATING CARE WITHIN A FACILITY AND ACROSS SITES
THE CONCEPT OF A CARE MANAGEMENT SYSTEM
SYSTEMS NEEDED TO SUPPORT THE PROVISION OF CARE
PARTICIPANTS IN CARE DELIVERY AND THEIR OVERSIGHT AND MANAGEMENT
ESSENTIAL LEADERSHIP AND MANAGEMENT PRINCIPLES RELEVANT TO PROVIDING LONG-TERM CARE
THE ROLE OF POLICIES AND PROCEDURES IN SUPPORTING AND IMPROVING CARE
THE PARTICIPANTS IN CARE, AND THEIR RELATIONSHIPS
OPTIMIZING THE PERFORMANCE OF CARE PARTICIPANTS
Rationalization and justification
Vigorously resist the temptation to use or allow others to use
problems and obstacles as reasons not to address problems or improve systems. They are
obstacles to be overcome, not excuses to prevent acting.
- Any NF in the U.S. should
be able to give basic decent care (i.e., meets the criteria of timeliness,
effectiveness, etc.) and still make money.
- Rationalization: the attempt to defend the indefensible by
making it sound plausible; justification: a plausible explanation or reason
supported by evidence or accepted theory
- Rationalization ("not enough money," "not
enough time," "too many regulations," "can’t find good
people," etc.) is frequently disguised as justification, which obstructs
essential change. We must undercut the excuses that obstruct systems improvement.
- Many reasons offered for inadequate, inefficient NF performance,
but efficient, effective care is always possible
- Most important decisions affecting care quality cost very
little money because they relate to attitudes, systems, and processes
Identify and enhance the knowledge and skills at all levels
- LTC is now a complex mix of business, personal care, and
health care
- Previously, it was possible to get by and to make a lot of money
without necessarily having or using appropriately skilled individuals
- There are many challenges requiring a high level of skills,
problem-solving abilities, communications, and professionalism (for example, the
substantial knowledge and skill base of a nurse's aide)
- Skilled practitioners and staff must be identified and used
effectively; individuals with limited abilities must be identified. Either improve their
skills, compensate for their weaknesses, or remove them from the system before they do
damage.
PHYSICIANS AND THEIR OVERSIGHT AND MANAGEMENT
OPTIMIZING PHYSICIAN PERFORMANCE
The foundation for physician performance is to clearly
identify performance expectations. A practice agreement (often called
"rules and regulations") is a good tool for doing so.
Click
here to see what should be included in a practice agreement / rules and
regulations.
THE MEDICAL DIRECTOR'S LEADERSHIP AND MANAGEMENT ROLE
ORGANIZING PHYSICIAN SERVICES
QUALITY IMPROVEMENT CONCEPTS AND PROGRAMS
DEFINING QUALITY CARE
CHALLENGES IN PROVIDING QUALITY CARE
FACTORS INFLUENCING OUTCOMES
Idea of shared responsibility
- Everyone — including owners, managers, physicians, and staff — has
an important role in providing quality care.
- The rules apply to everyone; otherwise, there cannot be an orderly game
- Focus on the customer: retain existing ones; win new ones, improve
satisfaction
All individuals as customers: What do you need from me? What are you
getting from me? What are the gaps? What do we need to close the gaps? What are you
getting from me that you don't need?
All practitioners and staff are customers of the facility
ownership and management, and vice versa
Satisfy customers by continuously improving systems and
processes (organizational, process, and personal quality)
"If you want great customer service you must have magnificent employee
relations" — Walt Disney
THE RELATIONSHIP BETWEEN CARE AND PATIENT OUTCOMES
MEASURING QUALITY
DEFINING AND USING QUALITY INDICATORS
RELATING PROCESS TO CARE QUALITY
IMPROVING CARE QUALITY THROUGH PROCESS IMPROVEMENT
IMPROVING CARE AND SUPPORT PROCESSES
ESTABLISHING A SUCCESSFUL QUALITY IMPROVEMENT PROGRAM
MEDICAL QUALITY IMPROVEMENT PROGRAMS
RISK MANAGEMENT
For More Information Contact:
Long-Term Care Information
7801 Ruxwood Road
Baltimore, MD 21204-3540
Tel: 410-825-4728
FAX: 410-825-4728
Internet:
information@ltcinfo.net
