Restraint Reduction Initiative
In this case, the impetus for the improvement effort comes from a government-supported program aimed at providing better services to its beneficiaries rather than internally generated quality-improvement efforts. Clemson’s Nursing Home was selected through a mandated data-collection process, which was then mined to identify outliers on specific dimensions, apply CQI, and bring outliers in line with targets established statewide and nationally. The program is “voluntary” for nursing homes that are in compliance with current licensing standards, but it is not hard to envision that standards too will change as new levels of performance are proved feasible. However, in the regulatory environment applied to nursing homes one usually is willing to pay almost any price to stay on the good side of the regulators. Upon reading Case 3 (McLaughlin, Johnson, & Sollecito, 2011), please answer the follow case assignment questions: 1. The concept of a Quality-Improvement Organization (QIO) will be new to many of you. Share your knowledge of what one is and what it does. Is this a regulatory agency? 2. Contrast and compare the approach used in the workshop with that followed in the prior two cases. Here, the facilitator is outside the organization. How is the team facilitation best handled once the implementation team is formed on site? 3. Clemson’s Nursing Home is a relatively small home. How might a chain of five or six nursing homes best respond to the challenges presented by the restraint-reduction initiative? 4. The concept of the QIO is linked to the Medicare program, but it seems to be applicable in other settings. What are some alternatives for external facilitation of continuous improvement across a broad range of care-delivery units? 5. How might one go about making a business case for a restraint-free environment at a national program level? At an individual care-delivery unit level? References McLaughlin, C. P., Johnson, J. K. & Sollecito, W. A. (eds.) 2011. Implementing continuous quality improvement in health care: A global casebook. Sudbury, MA: Jones and Bartlett Publishers.