Organizational Quick-Start Guide

Assess your Organization (Staffing, HIT)

The first step in implementing the QOL.SRI/CP is to assess your organization. How ready is your facility to begin addressing QOL in a formal, systematic way? If there is support from top management and a broad consensus that it is important to integrate person-centered care planning into the day-to-day operation of the facility, then the conditions for success are present.

Who will do the Assessment?

The original assessment has been divided into separate assessment packets for each group of staff that are conducting resident voice sections of the MDS 3.0: nursing, social service and activities.  There are additional brief assessments for dietary and an edited activities assessment for a chaplain to complete (if one is on site consistently). 

An example of how the components of the assessment might be assigned to different people is shown in the following workflow diagram. The advantage of this approach is that the burden on any individual staff person is reduced. In addition, each component will be conducted by the person with the most appropriate disciplinary training. 

Training Requirements

The implementation plan needs to identify training needs for both the assessors and the direct care workers. Detailed training materials can be found under the Assessor Quick-Start Guide.

Make a Plan and Follow-Through

The overall implementation of the program can take anywhere from 5-8 weeks depending on whether you  choose to roll out the decentralized assessment one department at a time or to implement the first round of interviews for all departments at the same time.

We recommend using the Plan-Do-Study-Act framework taken from the CQI literature. There are many aspects that should be carefully examined and covered in any plan. In general, the first step is to develop a careful and specific plan for who in each department will conduct the assessments. Next, it is important to determine who will implement the care plan tasks and where the care plans will be placed.

The assessment component and the care planning component can be implemented on separate tracks. In order to successfully implement the QOL.SRI, the facility will need to develop a process to identify which residents are due for an assessment, transmit that information to the designated assessor, then be able to capture the data from the assessment forms. Since the QOL.SRI is triggered by the Quarterly MDS assessment, the facility will have a built in rolling start of five resident assessments at a time that will enable staff to begin using the system without being overwhelmed by the need to assess everyone in the facility at one time.

The care planning component should be implemented in batches of five residents at a time. This will allow unit managers and direct care workers to gain familiarity with the care plan tasks. In particular, it is important for the QOL.CP to become part of the residents chart and orders. The orders have to be transmitted to direct care workers, and there needs to be clear documentation and accountability.

After each batch of five residents, staff needs to study the experience of attempting to implement this new type of care plan. The workflow should be modified as needed to address any problems observed. Then care plans for the next five residents should be developed and implemented. In this way, the facility can phase in the part of the system that has an impact on the direct care workers, but do so in the context of constant monitoring.

For more information about the PDSA cycle and implementation process please visit the Institute for Healthcare Improvement.

How is it integrated with EMR/EHR

The assessment of organizational readiness needs to address whether any EMR/EHR systems are in place, and, in particular, how the QoL.SRI/CP will be incorporated. There are several alternatives that can be considered. The path taken by any facility will be determined by the technology in place and the level of expertise of the users. The following lists several alternatives:

• Stand-alone, paper-based approach to QoL.SRI/CP
• QoL.SRI conducted on paper, summary placed into EMR/EHR as a ‘note’
• CP tasks entered into electronic order system accessible to all disciplines and direct care workers
• QoL.SRI conducted using electronic forms (e.g., tablet PC, handheld or iPad)

Click here to see how each of these systems interacts with QoL Care Planning

Implementation Worksheets

To monitor where your facility is in the process of implementation of Quality of Life care of residents make use of the Process Review Worksheet.

This worksheet consists of four different steps in the implementation process, the Appraisal - how the facility assesses resident’s quality of life, Quality of Life Identification – how the nursing home identifies and records the quality of life of each resident, Quality of Life Management – what actions the facility takes to improve the quality of life of the residents, and Maintenance – how the nursing home continues the process of assessment, recording and improvements of the quality of life system. The checklist is available for download here.

download the Process Review Worksheet

The second implementation worksheet is a departmental implementation form.  Use these forms as a part of the planning process to customize the assessment process to the needs of your facility.  This form allows each department to note:

• who will be the assessors
• domains the department will be responsible for
• where care plans will be stored
• where care plan tasks will be located
• how those care plan tasks will be communicated with staff

Additionally each department can fill in target dates for each step of the PDSA implementation cycle.  Copies of each departmental form should be given to the facility champion for easy reference when needed. These forms can then be used as the policies and procedure documents for the QoL program.  

To download the departmental forms, select the appropriate department below.  For reference, the domains that have been pre-assigned in the packets available for download are shaded grey on the implementation forms for each department:

• Nursing
• Social services
• Activities
• Chaplain
• Dietary