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Thanks for joining our 2017 Grievance Quality Improvement Activity ACT 2 RESOLVE Intervention Kickoff

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Grievance Quality Improvement Activity 2017 Intervention Kickoff Webinar

May 11, 2017

Welcome/ Opening Remarks Erin Baumann, Patient Services Director, NW2

Erin Baumann, Patient Services Director, NW2

Housekeeping Reminders

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• Be mindful of muting your phone when not speaking
• Please don’t place the call on hold, instead disconnect

your line and rejoin the call when able

• We’ll also be monitoring our WebEx chat board

throughout the webinar for questions or comments

Housekeeping Reminders

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• Be present and engaged in our topic presentations
• Please be prepared for sharing and actively participating

in the open discussion

• Speak up on the line, send in questions/comments in

the chat

• Remain open-minded and respectful in hearing other’s
• pinions

Meeting Facilitators / Hosts

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Erin Baumann

Patient Services Director ESRD Network of New York ebaumann@nw2.esrd.net 516-209-5348

Melissa Arrington

Patient Services Director ESRD Network of the South Atlantic marrington@nw6.esrd.net 919-463-4515

Agenda

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• Overview of Grievance QIA Interventions
• ACT2RESOLVE Intervention
• ACT NOW Team Roles and Responsibilities
• Overview of Educational Materials
• Review of materials needed each month
• Project Timeline
• Open Forum Q&A
• Closing Remarks/Next Steps

Learning Objectives

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• Discuss the ACT2RESOLVE Intervention
• Understand new approaches and develop best practices
• Understand Project Interventions and accompanying

materials

• Understand reporting requirements and deadline dates

2017 Grievance QIA & Interventions Overview

Melissa Arrington, Patient Services Director NW6

What is a Grievance?

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A grievance is an escalated process that is necessary when a complaint is unresolved/unanswered to resolve and address the patient, acknowledge their experience and resolve any issues involved. Example: A patient complains that their dialysis chair is not ready upon their arrival and had to wait to start treatment each day and no one responds after a week. CMS defines a grievance as:

• A written, verbal, or electronic request for assistance
• Initiated by or on behalf of an ESRD patient(s)
• ESRD issues including, but not limited to care, treatment, or providers

ESRD Network Authority and Role in Grievances

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• The authority establishing the scope of responsibility for the ESRD Networks is provided in

Section 1881 of the Social Security Act and the Omnibus Budget Reconciliation Act of 1986. Section 1881(c)(2)(D) of the Social Security Act requires the Network to:

–Implement “a procedure for evaluating and resolving patient grievances.” –Utilizing standards of care established by the Network to assure proper medical care.” –Responsible for identifying ESRD providers that are “not cooperating toward meeting Network goals and assisting [them] in developing appropriate plans for correction....”

• Network Roles

–Facilitator –Expert Investigator –Educator –Quality Improvement Specialist –Advocate –Referral Source

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Analysis Outcome

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The following categories were identified as problem areas that affect the ability of facilities to handle grievances: – Patient-Provider Relationships – Communication – Operational Culture – Grievance Process

Grievance Project Outcome Objectives

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• Major Quality of Care (QoC) or Access to Care (e.g., major bleeds, wrong dialyzer,

prescription changes w/o physician order, IVDs either at risk or actual)

• Minor QoC issues (e.g., simple bleeding after dialysis, minor infection control issues)
• Operational Issues (e.g., inadequate staffing, other issues related to the operation of the

facility).

• Interpersonal Issues (e.g., conflicts between patients, conflicts between staff and patients)
• Environmental issues (e.g., facility too cold, basic maintenance issues such as chair, lobby)

Project Intervention Outcome Objectives

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• Improve communication process when addressing a patient concern or issue

preventing escalation

• Strengthening patient and provider relationships
• Empowering patients to take a more active role in their care
• Expanding the focus beyond the patient’s physical needs to a holistic patient

centered approach

• Assisting the facility in establishing and maintain an effective and efficient

grievance process.

ACT NOW Project Intervention

Melissa Arrington, Patient Services Director, NW6

ACT 2 RESOLVE NOW

• Partnered Team Approach

– Identification of 2 different staff disciplines as project leads (i.e. Nurse, Social Worker) – Identification of at least 2 Patient Advisory Committee (PAC) Representatives

• Facility staff members and patient representatives will work together to

promote:

– Promote patient empowerment and patient involvement on health care team – Provide patient perspective and feedback on effectiveness of patient related initiates – Utilization and implementation of educational materials at facility

• Role of the Network

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ACT 2 RESOLVE TEAM Patient Toolkit

ACT 2 RESOLVE TEAM Objectives

• Changing the thinking behind communication to improve upon interpersonal

issues and encouraging proactive approaches instead of reactiveness

• Establishing and understanding opportunities in partnership
• Reframing current interactions between staff and patients
• Creating avenues and procedures that address the real issues

– Analyzing your grievances

• Patient Perspective

– Impact on effectiveness of initiatives – Policy implementation – Resolution of grievances and issues

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ACT 2 RESOLVE TEAM Responsibilities

Facility

• Analyze reported Grievances (talk about types)
• Promoting educational tools and resources with staff and patients
• Implementing the “What Matters” concept
• Analyzing all communications with patients
• Acknowledging that goals and perspective gets lost in clinical care
• Implementing shared decision making
• Patient Participation

– Activation – Perspective on initiatives, changes and resolution of issues – Opportunities for interested patients at the facility and/or with the Network

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ACT 2 RESOLVE TEAM Responsibilities

Patient

• Grievance Resolution discussions
• Promoting educational tools and resources with staff and patients
• Advocate
• Active Participation

– Activation – Perspective on initiatives, changes and resolution of issues – Opportunities for interested patients at the facility and/or with the Network

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ACT 2 RESOLVE TEAM Responsibilities

Network

• Facilitator
• One on One Coaching
• Support and Guidance
• Advocate
• Providing educational materials and resources

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Let’s Practice Partnering!

Susan is a patient partner in her facility. She and other patients have been discussing their concerns about receiving no response from management regarding complaints about the dialysis chairs at the facility being old and broken.

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• Susan is asked to chime in on the

conversation and share on the subject.

What happens next?

Communication Scenario

Susan approaches Joanne, who is a nurse and apart of the ACT NOW

• team. Susan expresses the concerns that she and other patients have
• discussed. Joanne talks over Susan and then stops to answer her
• cellphone. She takes a call from her sister and they make plans to meet
• later. Joanne then begins to speak to Susan again.

When Susan says that she and other patients feel frustrated with all of the issues gone unnoticed:

–Joanne interrupts Susan before she finishes speaking then tells her she knows about the concerns, and begins to tell Susan about her own frustration about patients constantly complaining about everything.

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What do you think about Joanne’s approach to Susan?

• What tips did Joanne follow or not follow?
• Did she use active listening techniques and promote a

environment of trust? Remember, we must be mindful of ourselves and be respectful towards each other in order to focus on finding a resolution together.

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Let’s Practice Some More!

John is a patient and wanted to speak with Mike the Administrator at the facility about an issue he is having with other staff members. John is upset that staff members constantly have comments about his being late to treatment. John is a father and has to take his daughter to school everyday and that he has informed staff about his obligations. John tells Mike that he is doing the best he can to get to treatment on time, but finds it difficult. John suggests to Mike that he would like to be able to discuss other options to help his situation and how he and other patients can be educated on them.

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• John approaches Mike, and asks if it is a good time for them to
• talk. John tells Mike he would like to talk about his issue and

how resolving it can possibly help other patients. Mike invites John to sit down with John and listens to his concerns without

• interrupting. Mike asks John questions about his schedule and

the responsibilities he has outside of treatment. Mike suggests that they create goals together and continue to assess them going forward.

Communication Scenario

When John says that he is upset at the comments by my staff to him when he is late to treatment:

–John approaches Mike, and asks if it is a good time for them to talk. John tells Mike he would like to talk about his issue and how resolving it can possibly help other patients. Mike invites John to sit down with John and listens to his concerns without interrupting. Mike asks John questions about his schedule and the responsibilities he has outside of

• treatment. Mike suggests that they create goals together and continue to assess them

going forward.

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What do you think about Mike’s approach to John?

• What tips did Mike follow or not follow?
• Did he use active listening techniques and promote a

environment of trust? Remember, we must be mindful of ourselves and be respectful towards each other in order to focus on finding a resolution together.

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ACT NOW Team Opportunity

Patient Centered Focus

• Identifying areas of improvement regarding concerns as reported by patients

as grievances

• Providing guidance and support to patients
• Opportunities to engage and create shared decision resolutions
• Evaluating the patient experience, encouraging patients to become active

participants in their own care and receive services designed to focus on their individual needs and preferences.

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ACT 2 RESOLVE TEAM - Patient Steps to Successful Communication

• Keep Focused
• Aim for Compromise
• Listen Carefully
• Consider All Viewpoints
• Stay Calm

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ACT 2 RESOLVE TEAM - Professional Steps to Successful Communication

• Respect the Patient’s Interest
• Empathize with the Patient
• Speak Professionally
• Open the Lines of Communication
• Listen Carefully
• Value the Patient Perspective
• Empower the Patient

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ACT 2 RESOLVE TEAM – Interactive Patient Poster - We want to know!

• Hang the Patient Poster in a prominent location

in the facility

• Attach a Pen to the poster for patients to write
• n the poster
• When a poster is full, replace it with a new

poster – you will be provided two posters

• Encourage patients to express themselves
• Discuss the information shared with members of

your ACT2RESOLVE team

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ACT 2 RESOLVE TEAM – Interactive Staff Poster - What would you say?

• Hang the Staff Poster in a prominent location for

staff

• Attach the Post it Pad and Pen to the poster for

staff to write on stick to the poster

• When a poster is full, remove the post its to make

additional room, keep them to submit

• Encourage staff to participate
• Discuss the information shared with members of

your ACT2RESOLVE team

Upcoming Opportunities

• Based on Feedback and grievances reported Report
• Discussions about outcomes
• Opportunities to share

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ACT 2 RESOLVE TEAM – Interactive Poster Session Next Steps

• Posters will be received at the Facility by 5/22
• Collect comments on the posters through Facility
• Take Pictures of the completed Interactive Posters
• Complete the feedback survey on the outcome of your ACT2RESOLVE

reflection on the patient and staff comments received from both posters

• Send completed Patient Poster and Facility Post It comments to the ESRD

Network in the pre-paid FedEx Envelope by 6/19.

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Chat Check-In – Questions/Comments?

Closing Remarks/Next Steps

Melissa Arrington, Patient Services Director NW6

Future Meetings

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• June- Dialysis Patient Grievance Toolkit
• July- ACT 2 RESOLVE Session #2
• August-ACT 2 RESOLVE Session #3
• September- Project Summarization

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Grievance Template Review

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Accurate Reporting of Grievances

• Please continue to fill out the Grievance

Log provided completely and attach any additional documentation (ex: progress notes, patient initiated grievance request)

• Grievance Logs and Worksheet due 1st of

the Month

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We need your feedback and suggestions! Please complete our Webinar Evaluation to share your thoughts. We welcome and value your input!

Thank You for Attending our ACT2RESOLVE Intervention Launch

Melissa Arrington, Patient Services Director NW6

Presentation Template Draft for Review

April 6, 2017

• p. 1

Corporate Headquarters 1979 Marcus Avenue Lake Success, NY 11042-1002 www.ipro.org

Network 2 (NY) Erin Baumann, LMSW Patient Services Director Phone: 516-209-5578 Fax: 516-326-8929 Network 6 (GA, NC, SC) Melissa Arrington, MSW Patient Services Director Phone: 919-463-4500 Fax: 919-388-9637