Employee meeting
Questions to ask your team when performing a quality check-up
by Barbara A. McCann

In today’s health care climate, the success of your organization depends on the results of the patient care your team provides and on identifying internal capabilities you can leverage in your market. Accreditation and certification offers an intense, third-party assessment of how well your organization functions in the delivery of patient care and compliance with related federal and state regulations. Accreditation should be the public statement of what you as management already know about your organization’s quality of care.

These three quality checks will offer you a valuable look into your organization and do not require a clinical background; just ask questions and listen to the answers your team gives. It may take 90 minutes each quarter—time well spent.

Quality Check 1: Staffing

Sit down with the person who provides day-to-day oversight of care delivery and care plan implementation. In home health agencies this role is assigned to the clinical coordinator; in hospice and palliative care it is the responsibility of the interdisciplinary team, with a nurse in the lead to manage care and staffing roles. Either way, your chief care coordinator is key to your organization as they can offer insight into the delivery of care.

Start by asking the lead coordinator how many staff are coordinating care in your organization (or at a specific location). Are there current job openings? If so, how long have these positions been open? How are patients being cared for while positions are unfilled? How many patients are coordinators managing? What is an ideal patient management level?

Ask how they do their job. You are working with the person who has oversight and input into what your clinical team is doing to manage patient outcomes, and how your most expensive resource—your staff—are used daily to achieve those outcomes.

Now you have some important insight into taking the next step in looking at your organization’s quality of care and outcomes—increasingly the basis of your payment as value-based purchasing advances.

Quality Check 2: Patients

Ask your coordinator the following questions: Who are our patients? What is their age and diagnosis and what care do we provide to them? What type of patients do we do well with (e.g., post-hip or knee replacement, heart failure, etc.)? Who are our most challenging patients?

Do you hear a reasonable, general description of commonalities? For example, do you tend to work with senior patients with congestive heart failure or chronic obstructive pulmonary disease who are just home from the hospital, with the goal of stabilizing them and preventing readmission? Or is the profile different?

Ask if what your team does works. Do you keep people out of the hospital or emergency room? Does the assessment you hear make sense to share with referral sources and payers? Most clinical coordinators can provide this overview. Their role in care delivery in the home is not new. If there is an issue in the delivery of care, talk to your clinical management team. Ensure the coordinator knows the outcomes of patients.

Ask the coordinator to pull an assessment of their toughest patient. Walk through the assessment and discuss why the patient is a challenge. Ask why they believe a finding in the assessment is important. You are listening for critical thinking and gaining knowledge of a patient population that may take more resources to achieve desired outcomes. This is critical as you consider taking risks, including managing your current reimbursement. The coordinator’s response as to why more resources may be needed for that patient should make sense. For example, perhaps the patient’s wound requires expensive supplies or a staff member with wound care expertise.

Remember the current emphasis on social determinants of health that directly impact patient outcomes. For example, you may learn that a wound care patient needs nutrition to heal, but the patient does not have a source of regular meals. This should lead to planning for a referral to a resource for those meals such as coordinating community resources to support the patient’s healing.

Quality Check 3: Care Plan

Your professional team (nurses, therapists, etc.) practice according to state and federal laws and regulations. With few exceptions, they need doctor’s orders to provide intervention. Your organization needs evidence of those orders in order to be paid. You have heard and reviewed the assessment of the toughest patient; now ask the clinical coordinator to walk you through the signed physician care plan for that patient.

Ask the coordinator to connect the problems in the patient assessment to the doctor’s orders. Ask them to describe what happens if a staff member cannot make a patient visit. In home health there is a very defined documentation process according to regulations. Your question—whether in home health, hospice or palliative care—is how they know that a delayed or skipped visit did not put the patient at risk. These questions are also the starting point of any Centers for Medicare & Medicaid Services audit and accreditation or certification review of client records.

Ask how the coordinator ensures that physician orders are followed. How are changes in orders due to changes in patient condition handled? You want to hear the process and see the changed orders. Ask how those changes are communicated to the whole team caring for the patient.

Ask the coordinator to walk you through how they ensure that the orders, including the plan of care, are signed by the doctor. You may or may not see signed orders as you talk with the coordinator. Be prepared to hear that may be someone else’s job. However, it is important that you know the process for ensuring signatures, as without signed orders you jeopardize not only payments, but also the licensing of your professional staff. Are there doctors who put your organization at risk by taking too long to return signed orders? How often is your team ending intervention without signed orders?

Assessing Results

Now you know a good deal about what an accreditation or certification review may find. As a bonus, if you find some great coordinators, you are also finding a capability that you can leverage with physician groups and payers—the ability to manage patients efficiently and effectively.

Are you ready for survey? If you find yourself concerned, know that the second meeting with the coordinator will not be the same as the first. Word will spread that as leadership, you are interested in what is happening at the patient care level—where the organization’s health is best assessed.

An unannounced accreditation visit will always be somewhat tense, but in the end will only be a reinforcement of what you already know about your team and the patient care they provide.