Engaging Staff in
Individualizing Care
Your Systems Create Your Outcomes
Lynda Crandall
Executive Director
Pioneer Network
lynda.crandall@pioneernetwork.net
Pioneer Network’s National Learning Collaborative
on Using MDS 3.0 as the Engine for High Quality Individualized Care
Incubator Care Practices
Four Foundational Relational Practices:
•Consistent Assignment
•Huddles
•Involving CNAs in care planning
•QI huddles closest to the resident
Are conduits for……
Clinical Applications:
•Promoting mobility, reducing falls and alarms
•A good welcome: the first 24 hours
•Reducing off-label use of anti-psychotic medications
Because they enable staff to bring individualized
approaches to clinical situations……
Operationalizing Individualized Care:
•Individualized mornings
•Flexible dining services
•Individualized night time routines
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Incubator Process
Pioneer
Network/B&
F Consulting
9 Conveners
49
Incubator
Homes
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Consistent Assignment
What it is: Consistent assignment means residents
have the same CNAs and nurses caring for them
every day whenever these staff are working
Why it is important:
•Consistent assignments transform caregiving from
"tasks" to relationship-based care
•Consistent assignments are the foundation for
high quality individualized care and good teamwork
•Consistent assignments provide stability – for
residents and for staff
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Collaborative Consistent Assignment
Adoption Improvements
Consistent Assignment Adoption Rating
Beginning of Collaborative (% of homes)
End of Collaborative (% of homes)
Low
Mid
High
10%
45%
45%
0%
11%
89%
•
Greater % of staff/residents affected by consistent
assignment (including more roles)
•
Handling call-offs and logistics
•
More of a focus on relationships
•
Capturing CNAs knowledge of residents
•
Communication between consistently assigned CNAs
•
Use of CNA knowledge in quality improvement
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on
Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement
Research Foundation
Huddles
What it is: information exchange and problem
solving in structured, efficient and routine
manner
Why it is important:
•Information sharing is key to continuity
•Care-partnering is not a one person job
•It is empowering
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Huddle Tips
• If you don’t have them yet, consider starting
with huddles to prepare for new residents and
hear about their first 24 hours
• Make sure to provide coverage for short time
while huddles are occurring
• Keep them short
• Guide staff on what to share
• Use Just in time teaching to problem solve
• It’s a skill – the more you do it the better you get
• Mentor staff on how to keep huddles moving
and constructive
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
CNAs in Care Planning
What it is: Involving CNAs in care planning means
having them as true members of the care team, able to
provide timely, actionable information about residents
that can have profound effects on the care provided
Why it is important:
•
•
•
•
Up-to-date information about residents
Knowledge of likes and their dislikes and resident
customary routines
Details of residents' day-to-day life and activities
Relationships and trust
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Collaborative CNAs in
Care Planning Adoption
CNA Involvement in Care Planning Rating
Low
Mid
High
Beginning of Collaborative (% of homes)
50%
39%
11%
End of Collaborative (% of homes)
22%
38%
40%
• Leadership support – “cheerleading” to keep the process
going
• Understanding logistics (e.g., meetings schedule,
coverage, communication, location)
• Mentoring on communication
• Clinical team buy-in
• Following up on CNA input/observations
• Use of care plan as a dynamic document
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on
Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement
Research Foundation
Start with Staff
Training
•The Care Conference Team met with both day and
evening shifts
•The Team role played a care conference to give the
CNAs an idea of what is discussed in care conferences
•Questions/thoughts were shared among the CNAs and
the rest of the team
•This training is offered to CNAs twice a year
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Scheduling
• The social worker and the medical records
specialist coordinate the order of care
conferences each week
• Care conferences are offered in the morning
to those families that are able to attend.
Other care conferences are offered in the
later afternoon to accommodate the
schedules of family members who are
working
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Communicating the
schedule to the CNAs
each week
• Schedule of care
conferences is placed in
breakroom each week;
Also includes list of
suggested topics for CNA
to discuss at care
conference
• Care conference schedule
is also noted on the CNA
daily assignment sheet
• Each CNA works with
their hall partner to
communicate what time
they will be away at the
care conference
Care Conferences for this week:
Thursday, January 31st :
10:00am Mrs. A
10:20am Mrs. B
3:30pm Mr. C
If you are the caregiver for any of these
residents, please meet us in #41
Friendship Room at the designated time.
In the last 3 months, have you noticed:
Activities of daily living—any change in
the person’s ability to participate in care?
Mood & Cognition—does the resident
seem content? Agitated? More or less
confused?
Dining—change in appetite? Change in
the amount of assistance needed for
dining
QI Closest to the
Resident
What it is:
Inclusion of CNA in prevention and improvement efforts.
QI closest to the resident means moving
meetings traditionally held in the conference room out
to where residents live in order to involve the staff who
know residents best, and whenever possible, the
residents themselves, in finding workable solutions
Why it is important:
•
•
•
•
Up-to-date information about residents
Knowledge of likes and their dislikes and resident
customary routines
Details of residents' day-to-day life and activities
Relationships and trust
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Consistent Assignment
Mary is 85 year old woman in the
middle to later stages of dementia.
How could consistent assignment
help Mary?
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Consistent Assignment
What might happen WITHOUT consistent
assignment to help Mary?
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Consistent Assignment +
Huddles
How did consistently assigned CNAs
communicating help Mary?
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Mary: Environment with
High-Engagement Shift
Change Huddles
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Mary: Environment
without High-Engagement
Shift Change Huddles
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
CNAs Involved in Care
Planning
How does involving CNAs in care
planning help Mary?
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
CNAs Involved in Care
Planning
What might happen WITHOUT CNAs involved
in care planning for Mary?
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Building your Internal
Communication Network
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Outcomes
Improvements in:
•Quality of life - “happy residents, happy
staff”
•Teamwork and staff participation
•Communication and relationships
•Problem solving
•Five-Star ratings
Reductions in:
•Restraints/alarms
•Antipsychotics
•Falls
•Incidents
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation
Free Starter Toolkit
http://www.pioneernetwork.net
/Providers/StarterToolkit
Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as
the Engine for High Quality Individualized Care funded by the Retirement Research Foundation