Process Improvement in Post-Acute HealthcareA Proactive Approach

12/5/2024 - By Jennifer Ziolkowski, MBA, CLSSYB & Kelly Smith, PhD, CPHQ, CLSSBB

Post-acute healthcare organizations today grapple with a variety of complex challenges, including rising operational costs, increased regulatory scrutiny, and the pressing need to enhance resident care amidst staffing shortages. These issues can lead to inefficiencies, errors, and diminished resident satisfaction if not addressed proactively.

Process improvement can help providers streamline operations and ensure high-quality care. By adopting a proactive approach, organizations can identify potential issues before they escalate, leading to better outcomes for residents and staff alike.

Understanding Process Improvement in Post-Acute Healthcare

Given the unique nature of post-acute care (e.g., individuals served, care setting, goals), process improvement requires a broad and comprehensive approach which may require improvement in one of many critical areas:

Admission and discharge planning
Clinical care and treatment
Therapy and rehabilitation
Chronic disease and comorbidity management
Patient and family education
Quality and safety monitoring
Care coordination and case management
Documentation and compliance
Patient satisfaction and experience
Staff training and development

These practices provide the foundation for care delivery in post-acute care; however, implementing improvements effectively and sustainably often proves challenging for many providers.

Why Embrace Proactive Process Improvement in Post-Acute Healthcare?

Proactive process improvement allows post-acute provider organizations to identify and address potential problems before they arise. This strategy involves regular assessments of policies, procedures, and financial performance, systematic evaluations of patient care processes, and mock surveys to prepare for accreditation.

By implementing these proactive measures, providers can:

Prevent adverse events
Reduce hospital re-admissions
Reduce staff burnout
Optimize resource utilization
Align with value-based care models
Enhance resident and family experience
Strengthen provider reputation

By contrast, reactive process improvement can lead to rushed, ineffective solutions, increased stress on staff, higher costs due to crisis management, and potential negative impacts on resident care.

Overall, proactive process improvement allows organizations to stay ahead of challenges, creating a more stable and efficient healthcare environment. It empowers staff to address issues systematically rather than constantly fighting fires, leading to better morale and more sustainable improvements over time.

Tools & Methodologies for Healthcare Process Improvement

Several proven methodologies can be applied to process improvement in the post-acute care setting:

PDSA (Plan, Do, Study, Act) Cycle: This iterative approach is particularly effective for small-scale improvements and rapid testing of changes in healthcare settings. For example, a skilled nursing facility might use PDSA to implement an initiative to improve tray delivery time in the dining room.
DMAIC (Define, Measure, Analyze, Improve, Control): This data-driven quality strategy is effective for more complex, structured improvement initiatives. A healthcare organization might use DMAIC to reduce healthcare-associated infections by systematically analyzing current practices and implementing targeted interventions.
Lean Methodology: Focusing on eliminating waste and improving efficiency, Lean principles can significantly streamline healthcare operations. For instance, a skilled nursing facility might use Lean to reduce response times to resident call lights by adjusting staff coverage based on resident acuity.
Six Sigma: This set of techniques aims to reduce variability and defects in healthcare processes. It's particularly useful in standardizing clinical procedures across multiple facilities, such as ensuring consistent medication administration practices.

The choice of methodology depends on the specific needs and goals of the healthcare organization in question. Often, a combination of these approaches can yield the best results.

Using Benchmarking to Assess & Improve Processes

Benchmarking is the process of measuring performance and comparing the results to an industry standard. In process improvement, this practice allows you to measure your processes objectively and identify the best candidates for improvement.

You can find benchmarking data in a variety of sources, including:

CMS provider reports
American Health Care Association Long Term Care Trend Tracker® tool
Care Compare

To achieve the best results, make sure you’re always benchmarking against valid and reliable comparative data. For example, a skilled nursing facility might use the American Healthcare Association's LTC Trend Tracker to compare its quality measures against state and national averages, identifying areas where they excel and where improvement is needed.

You should also consider both internal comparisons (across departments or facilities within your organization) and external comparisons (with similar organizations). This comprehensive approach provides a complete picture of your performance and opportunities for improvement.

How to Implement Process Improvement Projects

When implementing process improvement projects in post-acute settings, organizations should follow these key steps:

Prioritize improvement areas: Focus on both "low-hanging fruit" that result in quick wins and high-impact outcomes. Use tools like a Failure Modes Effect Analysis to quantify risks and prioritize efforts objectively.
Form interdisciplinary teams: Assemble teams that represent various departments and roles within your organization. For instance, a project to reduce falls may might include nursing staff, certified nursing assistants, physical therapists, housekeeping, and activities staff.
Set SMART goals: Establish Specific, Measurable, Achievable, Realistic, and Timely objectives for each improvement project. For example:

Specific: Reduce response time to resident call lights by 5 minutes.
Measurable: Track average response time in minutes.
Achievable: Ensure the goal is attainable within current resources and constraints.
Realistic: Consider staff capabilities and potential barriers.
Timely: Set a deadline, such as achieving the reduction within 6 months.

Develop and implement an action plan: Create a detailed plan outlining specific steps, responsibilities, and timelines. Consider using project management tools like Gantt charts to visualize the project timeline.
Provide necessary training and resources: Ensure all staff involved in the new process are adequately trained and have the tools they need to succeed.
Monitor progress and adjust: Regularly collect data and feedback to assess the effectiveness of the new process. Be prepared to modify the approach based on real-world results.

Using a process improvement template like this one ensures that your efforts are both consistent and comprehensive so that you don’t miss any details or cause unnecessary disruption for your team.

Continuous Monitoring & Adjustment

Process improvement is an ongoing journey that requires consistent attention and flexibility. Here's how to ensure your improvements stick and continue to evolve:

Establish a regular review schedule: Set up monthly or quarterly meetings to assess the progress of your improvement initiatives. This helps maintain focus and allows for timely adjustments.
Make decisions backed by data: Continuously collect and analyze relevant data to inform your improvement efforts. For example, you might refer to patient satisfaction surveys, throughput times, error rates, or financial performance metrics.
Implement a feedback loop: Create channels for staff and residents to provide ongoing feedback about the improved processes. This could include suggestion boxes, regular surveys, or team huddles.
Celebrate successes and learn from setbacks: Acknowledge when goals are met or exceeded and use setbacks as learning opportunities to refine your approach.
Stay informed about industry trends: Regularly review benchmarking data and stay up-to-date with best practices in post-acute process improvement. This ensures your organization remains competitive and continues to provide high-quality care.
Be prepared to pivot: As healthcare regulations, technologies, and patient needs evolve, be ready to adapt your processes accordingly. Flexibility is key to long-term success in process improvement.
Foster a culture of continuous improvement: Encourage all staff members to identify potential areas for improvement and contribute ideas. This creates a sense of ownership and helps sustain the momentum of your process improvement initiatives.

By following these steps and maintaining a commitment to ongoing monitoring and adjustment, healthcare organizations can create a robust, adaptive approach to process improvement that leads to better patient outcomes, increased operational efficiency, and long-term financial stability.

Foster a Culture of Continuous Healthcare Improvement

Process improvement in healthcare is not a one-time event but an ongoing journey. By adopting a proactive approach, you can create a culture of continuous improvement that leads to better patient outcomes, increased operational efficiency, and long-term financial stability.

Ready to Take Your Healthcare Organization to the Next Level?

Partner with Saltmarsh for expert guidance in process improvement in your healthcare organization. Saltmarsh can help you assess your current processes, implement improvements and support ongoing evaluation. Don't let inefficiencies hold you back—contact Saltmarsh today.