OCTH 533

Professional Development –Leadership

in Occupational Therapy

Risk Management, Quality

Improvement and How Data Informs
Decision-Making In Healthcare
LUIS ARABIT, OTD, MS, OTR/L, BCN, BCPR, C/NDT, PAM, FAOTA
WEEK # 13
NOVEMBER 18, 2024
Objectives
 Define risk management and its relevance in healthcare
 Learn about the 8 domains of Risk Management and identify risks as
applied in OT practice
 Learn about contingency planning in healthcare organizations
 Define quality improvement in healthcare settings
 Learn about quality improvement models and processes
 Learn about relevance of data and its uses to inform decision making
 Identify a quality improvement need in practice or mgt and follow QI
models for measurable outcomes
 Analyze your own organizational change project and needs for data to
inform decision-making.
 What is Risk?

Risk is defined by a possible or uncertain

event to occur.

Risk Management is the practice of

identifying, analyzing, controlling,
reporting, and monitoring the potential
impact of an event to occur.
Eight Areas of Enterprise
Risk Mgt. Domains:

Operational
Client/Patient Safety
Strategic
Financial
Human Capital
Legal/Regulatory
Technology
Hazard
Operational

 Delivery of care- safe, timely, effective, efficient, and client-

centered within diverse populations.
 Relate to those risks resulting from inadequate or failed internal
processes, people or systems that affect business operations.
Clinical Patient/Client Safety

 Risks associated with Delivery of care – residents, patients, clients

and other healthcare customers
 Risks include that are clinical in nature are: failure to follow EBP,
medication errors, hospital acquired conditions, and other serious
safety events
Strategic

 Associated with the focus and direction of the organization

 Risks associated with branding, reputation, competition, adapting to
changing times, health reform, or customer priorities
Financial

 Risks with decisions that affect the financial sustainability of the

organization
 Risks include costs associated with malpractice, litigation, and
insurance, capital structure, credit and interest rate fluctuations
Human Capital

 The organization’s workforce (staff and employees)

 Risks include employee selection, retention, turnover, staffing,
absenteeism , on the job related injuries ( Work Comp), work
schedules and fatigue, productivity and compensation
Legal/Regulatory

 Risk involves failure to identify, manage and monitor legal,

regulatory, and statutory mandates on a local, state, and federal
level
 Risks associated with fraud and abuse, licensure, accreditation,
product and management liability, CMS and other regulatory
agencies, issues with intellectual property
Technology

 Covers machines, hardware, equipment, devices and tools

 In addition, it includes techniques, systems and methods of
organization
Hazard

 Covers assets and their value in the organization

 Insurable risk hazards related to natural exposure and business
interruption
Risk Management Team

 Organizations have risk management teams depending on its size and

structure
 May appoint a person or a team of people to conduct risk
management
 Responsibilities include:
 Identifying critical risks
 Learning industry’s standards and regulations
 Creation of policies to increase safety
 Educating staff about potential risks and plans
 Investigating complaints
 Working with legal matters
 Tracking data
 Reporting risk related information
5 Risk Management
Steps and Strategies &
Guiding Questions

 Plan
 Assessment
 Analysis
 Responses
 Reporting and
Monitoring
OT Skills and Risk Mgt. Strategies

 Systems-oriented approach (risk assessment)

 Activity analysis (risk analysis)
 Knowledge of performance patterns (risk
response)
 Clinical reasoning and therapeutic use of self
(risk reporting)
 Adaptation (contingency planning)
Class Activity:
Divide into pairs in
breakout rooms.

Each pair is will be

assigned one risk
domain. Please
identify a risk
associated with that
domain in OT
practice.

Take 5 minutes then

Report what you have
discussed in the Main
room
Root Cause Analysis
Contingency Planning

 A pre-determined course of action to guide an

organization’s response to and recovery from a
negative or unexpected event to resume
normal operations (CDC, 2008)
Risk
Management versus
Quality Improvement

Adverse Events
https://youtu.be/99PFILdVOZs?si=A-9oeerMHaLgZKDw
6 Dimensions of Healthcare Quality
https://youtu.be/QexTk38euzY?si=FgnrjPjUIwaG3v0I
Why is Quality important?

 Healthcare environment
 Individual accountability for health
 Public reporting of provider process and outcomes
 Evidence-based practice
 Organizations
 Feedback on practice patterns to practitioners
 Individual practitioners
 Critically appraise practice
 Recognize/acknowledge achievement
 Identify areas for improvement
Continuous Quality Improvement

 a process of creating an environment in which

management and workers strive to create
constantly improving quality.
Continuous Quality Improvement in
Healthcare
 The purpose of continuous quality improvement
programs is to improve health care by
identifying problems, implementing and
monitoring corrective action and studying its
effectiveness.
Value Based Healthcare
 Improving patient experience of care including quality and
outcome
 Improving the health of populations
 Reducing the per capita cost of health care
Value based reimbursement

 Based on
 Provider’s achieved rates of pre-specified patient
outcomes
 Adherence to client-centered, scientifically-grounded
best practice guidelines
Accountability

 Individual responsibility for health

 Empower patients with knowledge to make
informed health care decisions (assess health
literacy)
 Occupational therapists must demonstrate how
their practice minimizes the risk of poor
outcomes
Quality care
 Quality Improvement
 Work done to improve healthcare and health of
individuals and populations
 Systematic and ongoing
 Quality Care
 Defines minimum standards of care
 Evidence based
 Theright services, at the right time, and in the way to
achieve the best possible health
Quality Indicators (QI)
 Measures that assess a particular health care process or
outcome

 Quantitative measures that can be used to monitor and

evaluate the quality of important governance,
management, clinical, and support functions that affect
patient outcomes

 Measurement tools, screens, or flags that are used as

guides to monitor, evaluate, and improve the quality of
patient care, clinical support services, and organizational
function that affect patient outcomes

 Things that clinicians do that can be observed, recorded,

counted, and measured
QIs

 Measures which characterize high quality care

using clinical data (e.g., electronic medical
records, Medicare administrative data)

 Process Measure QIs: things that clinicians do

that can be observed, recorded, counted, and
measured
Performance measures

 Process Measure: assess steps that should be followed to

provide good care
 Example: Percentage of patient's total hip replacement
clients who are given therapy related to hip precautions,
dressing, toileting, bathing, car transfers and simple meal
preparation
 Example: Assessment of health literacy of all clients as a
part of education process.
Performance measures

 Outcome Measure: Assess the results of care

that are experienced by the patients/clients.
Includes endpoints such as well-being, ability to
perform ADL
 Example: percentage of patients who can list
total hip precautions
 Example: discharge GG scores
 Example: Rate of falls per 1000 patient days
Performance measures
 Patient Engagement and Patient Experience
Measure: feedback from patients/clients and
caregivers about the experience of receiving
treatment.
 Often collected with surveys (phone, letter,
electronic)
 Example: percentage of patients who said they
were as involved as they wanted to be in
making decisions about treatment
Fundamentals of Quality
Improvement
 Choose a problem that is:
 High volume – services offered frequently or to
high numbers of patients
 High risk – vulnerable, fragile, or unstable
patients
 Problem prone – historically, procedures or
processes have produced unsatisfactory
results
Fundamentals of QI
 Goal of using data is for learning – not judgment
 If a change isn’t working, adjust it
 Accept that bias can exist in the data
 Clearly define:
 The measure
 Goal of the measure
 Data collection plan
 Graph to display the data
Other considerations

 Is the study feasible (cost)?

 How much time will it take?
 Is reliable and valid data available?
 Are resources available (e.g., staff)
Quality improvement models

Logic Model
Plan-Do-Study-Act (PDSA)
DMAIC
Lean Six-Sigma
Logic Model
Logic models can assist you in program evaluation by providing
a picture of how your program is intended to work. It identifies
your programs main components and how they should relate to
one another. Logic models include process and outcome
components.
Logic Models are useful to…

 To build understanding and clarity about your program

 To identify resources needed for your program

 To identify the sequencing of activities that should be

implemented

 To serve as a basis for program evaluation

 Logic models are a good tool to help focus an evaluation

and to determine what to measure
Sample Logic Model
Need Inputs Activities Outputs Inter-mediate End
Outcomes Outcomes

Increased Staff Individual and 10 additional Teachers Improved

number of Books/ group therapy children practice with handwriting as
children Supplies enrolled in children for 15 measured by…..
referred to Space Teacher education “Handwriting minutes each day
OT needing and training Without
“Handwriting Without Tears” Students complete Successful
Tears” Family program one module per completion of 1st
education month grade writing
and training competence
Plan-Do-Study-Act
Iterative four-step
model to promote
continuous improvement
DMAIC model

 Define problem, improvement activity, opportunity for

improvement, project goals, customer
 Measure - process performance
 Analyze the process to determine causes of variation or poor
performance
 Improve – address root causes
 Control future process performance
What is the DMAIC Model?
https://youtu.be/mv-dqrvO4tI?si=y59Vhym_bpfveMOD
Example of DMAIC

 Pt falls: define
 Measure: how often, where, why, how?
 Analyze: ex: most falls in the bathroom, when?
 Implement: environmental and staff changes,
standard work, toilet paper rolls, step stools,
Red/Yellow/Green visual system
 Control: ensure gains are kept, who is following
up on the process?
Lean Six Sigma Model/Concept
 A methodology that combines Lean and Six Sigma to reduce waste and variation
in processes. Lean Six Sigma can help reduce costs and gain customers.
 The Lean Six Sigma DMAIC methodology provide a framework to assist
organizations in attaining superior quality, sustainable results, and
financial returns. They do this by:
1. Assuring that quality thinking becomes the way of doing business, creating a
focus on customers and building customer loyalty.
2. Applying proven quality tools to improve goods and services and
achieve breakthrough performance.
3. Defining quality process performance metrics that tie to organizational goals.
4. Creating a quality culture that is fun and provides a pragmatic way to achieve
greater levels of process quality.
5. Identifying projects to drive the improvement that will yield superior quality and
sustainable results.
Introduction to Lean & Six Sigma in Healthcare
https://youtu.be/t0xoNr6e6uw?si=59NI3oDPfT-p7Xo8
Program Evaluation Summary

 Systematic method for collecting, analyzing, and using information

to answer questions about projects, policies and programs,
particularly the effectiveness and efficiency.
Why do you think
we are talking
about data?
Using Data
to Make
Changes
The Research Process in Using Data:

 Identify the Problem

 Scan the Literature
 Plan
 Collect Data
 Prepare Data
 Analyze Data
 Report Findings
 Assess the Process
What kind of
data would you
need to develop
your new org
change project
program?
Class Assignment
 Identify a potential problem area (related to client care
or administration/mgt) from your Level 1 internship that
you feel can benefit for a quality improvement program.
 What is the QI in the identified problem area?
 Use one of the models presented in class to develop a
quality improvement program. Provide clear examples
for each section of the model you utilized.
 Be sure to state measurable outcomes and describe
how you will measure the outcome.
 Post in Assignment Section by Dec 2, 2024, by 1:30 PM
Improving the Quality & Efficiency of U.S. Healthcare

https://youtu.be/OPWtIAoBDtE?si=XHyIEjJnwq1JTwQ2
References:

 Corcoran, S. (2019). In Jacobs, K., & McCormack, G. (2019). The occupational

therapy manager, 6th edition. AOTA Press. ISBN: 9781569003909