OASIS Alert

Management-only OBQI is doomed to fail.

Remember the old computer saying: "Garbage in -- garbage out"? The same thing is true for OBQI.

If you're trying to ensure the success of your outcome based quality improvement efforts by keeping them tightly controlled under a management team or a quality improvement staffer, you're shooting yourself in the foot.

OBQI success depends on changing care behavior, emphasizes OASIS expert Linda Krulish with Redmond, WA-based Home Therapy Services. And for that you must have staff buy-in.

Field staff are the most important people to involve, Krulish told listeners to a recent teleconference sponsored by the Texas Medical Foundation. "Visit staff buy-in can make or break" your OBQI efforts, she warns -- yet many field staff have never even seen an outcome report.

Field staff are critical because they collect the OASIS data, develop the plan of care, identify changes, determine the need for change in approach, and influence the decision to discharge the patient from home care, Krulish explains. But they may resist devoting time to something that seems to take them away from patient care -- especially if they don't understand why they need to bother.

Because visit staff have a common goal of helping patients get better, these three approaches may encourage buy-in, Krulish suggests:

1. Education. If you can ensure the visit staff leave the educational session knowing something new and motivated to try it -- perhaps even with something concrete to do -- you'll find it easier to tear them away from patient care for the education they need.

Show the staff the overview of the OBQI process and where they fit into each step of it. Be sure they understand how their OASIS assessment results in the outcome measures (see chart "Show Your Staff How Their Answers Lead to Outcomes").

2. Involvement. Communicate in every way possible that field staff are critical to OBQI. Include members of the multidisciplinary team in the OBQI process from the beginning. Make sure staff know how to access outcome reports and encourage staff to look up your outcomes as part of OBQI training, Krulish says.

3. Recognition. "If you're involved in a project, you want it to succeed," Krulish notes. Include team members' names and their disciplines on the material passed out to their peers and acknowledge staff members as experts in specific clinical areas, she adds.