Michigan Community Dental Clinics Quality Improvement with a Patient Centered Perspective

August 5, 2014

Discussion Questions What, if any, barriers does MCDC face when instituting quality

improvement in its dental clinics?

How is baseline quality data obtained?

How is clinical quality measured?

How is administrative quality measured?

How does peer review have a place in clinical quality improvement?

How is clinical quality improvement performed without animosity among clinical staff?

How is quality improvement information shared with staff?

 

Discussion Questions con’t

How does MCDC include productivity as a part of quality improvement?

Does MCDC use quality improvement processes such as Six Sigma or LEAN? If so, how are staff trained?

How often are formal quality improvement reviews performed?

Does MCDC partner with universities or other community partners to expand its quality improvement capacity and expertise?

Could MCDC share any patient satisfaction surveys that have been used in its quality improvement process?

Could MCDC share any staff satisfaction surveys that have been used in its quality improvement process?

Quality Improvement

Presented by:Nicole Murray RN BSN

Our Mission: ◦ to create and expand access to ever improving

quality dental care for Medicaid recipients and low income, uninsured individuals.

Our Vision: ◦ to have a healthy Michigan population who

assume responsibility for their own wellness, with our staff’s guidance and proper intervention.

Changing Lives One Smile at a Time

Oral Healthcare Network

A Strong Infrastructure- to support our Clinic System

2013

◦ 179,068 Total Office Visits

◦ 65,269 Patients received care in our clinics 51% Adults 21-60 40% Children 1-20 9% Senior Adults over 60

Having an Impact

Relentless Pursuit of Excellence

In an effort of transparency, the primary objective of the QI Department is to assess, develop, and implement MCDC community standards.

These efforts support our organization’s quest to provide oral health care services with a patient centered perspective.

 

Quality Improvement Initiatives

Director(s) of Quality Improvement & Patient Safety◦ Amanda Desjardins DDS◦ Rebekah Sheppard DDS

Quality Improvement Coordinator◦ Nicole Murray RN BSN

QI Team Members

Assess

Develop

Implement

Continuous Improvement

MCDC entered into a partnership with Press Ganey in 2012.

This collaborative relationship has ultimately improved the MCDC patient experience by creating continuous, sustainable improvement.

Quality Initiatives

A Patient’s Voice Patients are selected through a randomized process.

PG operators contact our patients by phone to complete survey.

Survey Questions have been modified for our organization and unique patient population.

In 2014: 5 surveys completed per clinic each month

Their sophisticated analytics help MCDC discover and prioritize key performance improvement efforts with real time Survey data.

Each Quarter in 2014: ◦ new priority indexes will be calculated – providing

each clinic their best opportunities for improvement

Top 3 OFI – Action Plans◦ Clinic receives each quarter via email ◦ Action plans developed at the clinic level

Opportunities for Improvement

Press Ganey Action Plans

NEW

NEW

NEW

Add Clinic Specific InfoREVISED

2014 Press Ganey Score Board – Team Approach Goals and achievements are reviewed at daily huddles and

staff meetings

Press Ganey Tools

Quality Assurance begins with a set of standards and accountability to one another.

Clinical and Administrative Policies & Procedures for the Dental Office were written in an effort to establish the MCDC community standard of oral health care delivery for our providers.

A Provider Evaluation (OPPE) will be conducted on each provider annually. The QI Department will be responsible for completing and communicating findings with providers, administration, and board of directors.

Quality Assurance

Provider Evaluation process begins in June.

Approximately 6-10 charts will be randomly selected for review within 30 days of provider’s scheduled evaluation.

QI department is responsible for reviewing charts and completing assessments together

Annual OPPE Evaluations

Ongoing Professional Practice Evaluation (OPPE)

Was a Dental Diagnosis documented or completed prior to rendering treatment?

Was the treatment reviewed with the patient prior to initiating and was an appropriate consent obtained?

Were radiographs taken per MCDC guidelines?

Was the procedure properly documented in the patient’s clinical note?

Was the next appointment needs documented and scheduled with the patient?

Documentation Section

Is the treatment plan consistent with the patient’s desire, in relation to their exam, diagnosis, and prognosis?

If anesthetic was required, was the type and dosage used appropriate?

Did the radiograph’s quality meet the MCDC community standard of care?

Clinical Quality Section

Restorative

Endodontic

Oral Surgery

Prosthodontics

Clinical Elements

Attendance at Spring Doctor Meeting

Does provider actively participate with Doctor’s Corner?

Does Provider engage with MCDC administration via email communications?

Does Provider participate in any MCDC adjunct committees?

Engagement Section

If a specific concern is identified, a focused evaluation may be warranted.

A new hire will be clinically evaluated within 90 days of their employment.

An FPPE may also be completed on a case by case basis and initiated by the DQIPS.

Focused Professional Practice Evaluation

(FPPE)

Focused Professional Practice Evaluation (FPPE)

An interactive resource to share information with other providers

Cases are posted for DDS review & comment

Doctor’s Corner

Example - Case Study

Example - Question

Quality Concerns – Case Submission◦ MCDC staff members are required to alert the DQIPS or

QI department of any quality or patient safety concerns. Email Phone call

◦ Patient Safety Hotline – (January 2014) Accessible from IES Exchange Anonymous All staff have access

◦ Concerns will be reviewed by the QI Department. If appropriate, the concern may be forwarded on to the committee for review.

Quality Improvement & Patient Safety Committee

Access from IES Exchange

Hotline View

Committee Duties◦ Care rendered by provider will be reviewed by the committee upon the

request of the DQIPS.

◦ The members are tasked with validating the issue of quality and safety in question and presenting a recommendation to the Chief Dental Officer.

Key Points◦ The anonymity of the provider, patient, & clinic will be maintained

throughout the entire review process.

◦ All pertinent information will be presented to members in a confidential format in order to preserve objectivity.

◦ The preferred venue for improvements is the MCDC Performance Improvement Program.

Quality Improvement & Patient Safety Committee

Performance Improvement Program◦ Designed to provide assistance for providers who may have

challenges practicing within the MCDC Community standard of practice.

◦ Upon recommendation, active participation is presumed.

Program Initiation◦ Self-Reporting by the dentist to senior management team.◦ A recommendation from the Quality Improvement & Patient

Safety Committee following a review of provider’s delivery of care.

Quality Improvement Initiative

Option 1- Internal Mentorship◦ Consists of an employed dentist that has been identified as one

who has demonstrated competency in the specified area of concern needing improvement by participating dentist.

◦ The specific improvement opportunities will be discussed with the mentoring dentist and participating dentist. A clinical competency checklist will be created specifically for those needs that have been identified.

Performance Improvement Program

Option II – External Membership◦ The selection of the external mentor will be a collaborative

effort between the DQIPS and participating dentist.

◦ The specific improvement opportunities will be discussed with the external mentoring dentist and participating dentist.

◦ A clinical Competency checklist will be created specifically for needs identified.

◦ Formal written feedback will be provided to DQIPS regarding final impression and any improvement identified for the participating dentist.

Performance Improvement Program

Option III – CE Instructional Program◦ Upon recommendation of committee, the dentist may be

directed to participate in a CE Instructional Program with specific course content to facilitate improvement for an area of identified concern.

◦ The selection of the CE Course will be a collaborative effort between the DQIPS and participating dentist.

◦ The costs associate with the selected CE Program will be the responsibility of the participating dentist.

Performance Improvement Program

Questions?

In Summary