Behind the Scenes: Quality Management

For the final installment of the series, we sat down with some of the Quality team to learn about what they do. Unlike other ‘Behind-the-Scenes’ interviews, this one had only one guiding question: “How does your work support the mission of KVH to provide quality patient care?”

It seems like you don’t have any redundancies in your staffing, right? Everybody has a different role.

Mandee: Carissa and Kimber are both process improvement facilitators. That is one thing that is very similar for all of us – we all facilitate improvement, whether it’s a surgical site infection, or a needle stick, or sepsis care – figuring out what’s going on with the process and how we could improve it.

How does the work that you do impact patient care?

Julie: One example is the lack of surgical site infections. We work hard to maintain a standard, so that there’s less of a chance for surgical site infections.

How does that happen?

M: Julie doesn’t directly go and clean all the rooms and check all the labs. But what she’s doing every day is looking at our stats, our data, and seeing how we’re doing and where we need to improve, working with departments like housekeeping, sterile processing, surgery, med/surg, all the different areas. She talks with Home Health, too, helping them understand best practices for protecting the environment, keeping it clean, and also for patients, and for protecting themselves. We support the rest of the organization, helping address any barriers to providing reliable care or processes, even in billing, removing those barriers and identifying ways to make the work more effective.

The most basic example would be employee flu shots, right? So, yes, it’s caring for the staff, but it’s also helping ensure that when the patient and the community come into the facilities –

J: It’s mostly caring for the patients.

That may be something people don’t realize, that KVH staff are vaccinated against the flu primarily for the patients’ protection. They don’t necessarily know all the work that’s going on to make it happen, but that kind of thing has a direct impact.

M: It’s when things haven’t gone well that it gets to Brandee and Linda, when we’re seeing incidents in the incident reporting system. It’s looking at that and saying, “Is this a one-off, or is this something bigger that we need to do improvement with teams and help them make sure this doesn’t happen again?”

Brandee works on the falls team, too. They do root cause analysis on every fall and say, “What could we do differently?” So the parking lot repairs are the work of the falls team saying, “These curbs, this isn’t working. We’ve had this many falls. The pothole in the middle there, that’s a problem, we need to address it.”

And in some sense you are getting, even if it’s in writing, direct communication from patients and the community, as well.

Brandee: Another piece of that is the service recovery program. I tell staff “It’s a way that you can make it right, right now.” It’s an opportunity to show a patient that you care, that you’re not just going to blow it off to somebody else, that you’re trying to do the best you can to make it right for them.

Because quality patient care is mostly about the actual physical care, but it also involves satisfaction, and feeling that you’ve been heard, and that kind of thing.

M: A huge part of what we do is empower employees to speak up, try and make it right. Incident reporting is a huge part of it, as are SAFE boards, or Linda as a compliance officer hearing concerns.

I was just looking at some of Amy’s work. We do measure a ton of things in here, but we even measure what we measure. Amy had 99 different report requests this year that she’s worked on and that has helped staff from, for example, the clinics, with a list of their patients who were recently in the emergency department, so they can follow up with those patients and make sure they’re getting appropriate care. That’s made a huge difference for them because they didn’t have a system to notify them. A lot of what Amy does is build reports for people that make their job easier every day.

You can boil a year’s worth of data down into a report that you can wrap your brain around. It makes a difference.

M: We report a lot of data externally because it’s either the law or we won’t get paid if we don’t do it – things like surgical site infections, sepsis and stroke data. We don’t get our stroke designation if we don’t have data reported to Get with the Guidelines. We do this so that our staff can take care of patients. I don’t want the ER nurse having to worry about abstracting charts and putting that into Get with the Guidelines so that we can have that stroke designation or get paid from CMS.

Linda: Part of the process with patients, when it actually becomes a grievance and they’re voicing what it felt like to them, their perception of that care experience – that information gets shared with the department leaders and then with staff, who are not always aware until that patient voice speaks up that the patient doesn’t know you’re doing all these other things in the background supporting their care at the time. You know, at the time they can only see what’s within their own vision.

Staff are the ones who can really look at their processes to care for a patient and if there’s anything that they could do differently that would better have met the needs of that patient at that time. And maybe everything was done, and met the standard of care. But maybe it was just more communication that needed to occur to help the patient be aware, “This is why we’re doing this. This is why we may be waiting for a while.”

M: We try to bring that patient perspective back to staff. For KVH employees, it’s our job, every day, and we get very used to it. It’s very routine to us. But for a patient it could be the worst day of their life. And so it’s bringing that perspective back to folks that they may have lost touch with.

B: Another thing Linda does is family meetings. In certain cases, grievances that we get, we actually will bring the patient and their family in and we’ll do timelines and everything, and they have the opportunity to just really see how everything was over the period of time during their stay. And then they can really have a good conversation about why decisions were made, and it’s just a different perspective.

L: Some of the patients actually participate in process improvements, like updating educational materials or evaluating processes and things like that.

M: We, especially Linda, also help support our staff and the organization when someone is behaving inappropriately by being abusive, seeking help to stop that, legally if we have to. We also have resources to help with lawsuits, even the ones that aren’t against KVH, such as when emergency and surgical staff are subpoenaed to testify in cases, which can be scary.

We help support strategic initiatives too, like the work we’re doing with chronic care management in the clinics. If we just ask staff to pile on this work, and figure out how to navigate all these requirements and milestones that these new programs are asking us to do, I think that would be overwhelming. I don’t think we’d be able to do it. But process improvement helps break the whole thing down, makes the work manageable, and ensures the right people are involved.

That’s a huge part of what Carissa and Kimber do. It means we’ve been able to implement chronic care management for our patients. That’s a real thing that’s happening with patients in the clinics. They’re improving upon the piece of behavioral health that we have up in Cle Elum, expanding that program, seeing where we could take it further, getting patients in for annual wellness visits, asking how can we make sure we’re good at doing more of that preventative work.

I’m excited about a lot of the work we’ve been able to achieve. We’re not the ones providing care, but we’re helping so those who are can get that work done.

What ways do you celebrate your hard work and help each other out when things are tough? Why do you keep coming back to work every day, besides the paycheck?

Anna: Because we like each other. We’re a close knit group, like a family.

B: I’ve worked in a lot of different departments. This one is unique in the relationships we have with each other and the way we work.

M: One of the ways we recognize each other is in our daily huddle meetings. I also meet one-on-one with each of them every week. Part of that is to acknowledge the good work they’re doing. Everyone functions pretty independently. They really are the experts. Recognizing that every week, and having the autonomy to be the expert in your area, helps us feel like it’s not drudgery.

L: And sometimes we’re just pulling everyone who has available time to shift to supporting whatever things are going on.

A: Everybody just jumps in and helps.

B: I know if I am swamped with care and service, I have people that can help me with that.

To me that’s a sign of a healthy department. I know sometimes I’ll be too proud, “I’ll get all this done if it kills me,” and then it’s not done well.

M: Well, that’s taken work. We have given each other crap repeatedly about asking for help.

It seems like you guys are getting there. That’s great.

B: We’re holding each other accountable, too.

M: You were asking about how we celebrate the work. The SAFE Catch awards is my favorite part of my job. Brandee has a big part in organizing that, and everybody’s nominated somebody at some point. Just sharing those stories is really inspiring to me.

Those people are part of your team that you’re celebrating. They had that ‘Quality’ mindset and did something that you’re now publicly recognizing.

M: Brandee went to Materials Management yesterday to talk to them about their award and they invited her to their holiday gathering. We have a great team here, but the relationships we have with people outside of our department are really rewarding, too. The really smart, funny, caring people that we get to interact with every day.

It’s a great place to work in general.

B: And I think to like people are more and more comfortable coming to us with questions, even if it’s just for our 2 cents, like it’s not even our monkeys, but they’re saying, “Okay, I’ve got this thing. I’m not really sure how to deal with it.” They know we may have some good advice. People know we’re a resource for them.