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National Learning Collaborative Webinar Series on Using MDS 3.0 as an Engine for High Quality Individualized Care

SERIES 5: Working Together for Better Outcomes – Relational Coordination for Quality Improvement

When staff work well together, they are better able to meet residents' individualized needs. But good teamwork doesn't just happen by itself. The theory of relational coordination says that when co-workers have systems for frequent, timely, accurate, problem-solving communication, they are able to share knowledge and work better to achieve shared goals. The relationships closest to the resident matter most because staff who work consistently with the same residents develop deep knowledge that allows staff to recognize the slightest signs of concern and know immediately and individually how to address them to prevent negative occurrences and promote positive results.

In Webinar Series Five of our National Learning Collaborative, teams of practitioners share how they have achieved better outcomes through key systems for relational coordination – consistent assignment, huddles, CNAs involvement in care planning, and Quality Improvement huddles among staff closest to the residents. In Part 11, staff from two homes will explain how they prevent and heal pressure ulcers by working better together. In Part 12, staff from several homes that have participated in the National Learning Collaborative will share how engaging staff in individualizing care has led to better quality of care and quality of life for their residents.

 Part 11

It Takes a Team to Prevent and Heal Pressure Ulcers
Presenters: Teams from Glenridge Living Community, Augusta, Maine, and Oakview Terrace, Freeman, SD.

When CNAs interviewed for this webinar were asked what was the most important factor in preventing and healing pressure ulcers, they uniformly said, "Teamwork!" There are many sources of information about the clinical protocols for pressure ulcer prevention and healing. This webinar focuses on the communication and problem-solving systems needed to implement these protocols. Hear from teams at two nursing homes how they work together to identify residents at risk and implement effective interventions to prevent pressure ulcers from occurring and to heal those that do. They use four key "relational coordination" practices: consistent assignments, shift huddles, CNA involvement in care planning, and QI among staff closest to the resident. Clinicians use these everyday "get togethers" to hear what the CNAs are observing, determine together the underlying causes and effective interventions, and then monitor continuously. With the right systems in place for staff to work together, and with support from management and all departments, staff closest to the resident are able to individualize care to each resident's customary routines, and prevent or heal pressure ulcers. The outcomes are great because, as one CNA said, "If it's a sore, it's everybody's sore. We want to get rid of it…We all work together to make sure we get to that goal quicker." Relational coordination in action: frequent, accurate, timely, problem-solving communication for shared goals, shared knowledge, and mutual respect.

Click here for a video preview of Part 11.

Facilitaor Guide

Five Elements
QC + QL = Better QC and QL
Quick Organizational Self-Assessment

 Part 12

It Takes a Team to Provide High Quality Individualized Care
Presenters: Barbara Frank, B& F Consulting; Amy Elliot, Pioneer Network; and teams from nursing homes participating in the National Learning Collaborative on Using MDS 3.0 as the Engine for High Quality Individualized Care

People matter most. The relationships of kind, caring, empowered staff with residents are the foci of successful teamwork. Consistent assignment is the silver bullet for quality care because it makes the relationship between residents and their caregivers deep and personal. Staff then know residents so well that they recognize the slightest changes and know just how to respond as a team. While many homes intend to implement consistent assignment, they run into snags operationalizing it.

Through the National Learning Collaborative, sixty nursing homes in 10 states volunteered to be "incubators" and to spend one year implementing consistent assignment and then tapping into the wisdom of their dedicated CNAs through daily huddles in which staff discussed their observations about residents' needs and made plans of care to meet those needs. This webinar will detail the experiences of these incubator homes through the experiences and outcomes of participants. Learn from incubator participants the "how-to" of implementing the foundational organizational teamwork practices of:
  • Strengthened consistent assignment and huddles
  • Involvement of dedicated CNAs in care planning and unit-based QI
  • Problem-solving among staff closest to the residents to make adjustments in care routines to honor residents' customary routines for daily living from Day One
  • Using residents' customary routines as the guide to reducing inappropriate anti-psychotic medications, alarms, and rehospitalizations

We'll also explore the "why" of these changes by highlighting the results and outcomes of these 60 nursing homes as they progressed on their path to providing individualized and quality care for residents. Their experiences provide a blueprint for any nursing home hoping to promote high performing teams, so come and share in their journey!

Facilitator Guide

Quick Organizational Self-Assessment