Preparation

• Overview
• Organize a Quality Team
• Prepare for Change
• Conducting an Organizational Self-Assessment
• Review Your Agency's Documentation Process
• Utilize Standardized Rating Scales
• Introduce AIM Process to Staff
• References and Resources

Overview

This section provides explanation for how an agency should prepare to effectively utilize the AIM Quality Measures.  In this section we outline steps to follow before beginning your quality initiative.  Careful completion of each of these elements will put your agency in a position to effectively implement the AIM Process.  It is important to note that these steps are not linear and may be done out of the order presented below or several steps may occur simultaneously.

Organize a Quality Team

Assemble a multi-disciplinary team that includes key agency personnel who are active in the following roles: leadership, nursing, medical physician, social work, spiritual, bereavement, quality improvement, education, and administrative support.

Two key members of your team are the Agency Sponsor and the Project Leader.  The Agency Sponsor is responsible for supporting the quality team at the agency level. The Project Leader provides oversight to the AIM Process and is the person that staff identify with when confronted with questions or issues. 

Quality Team Members

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Prepare for Change

Before implementing a large organizational change, it is important to take stock of how change has occurred in your organization in the past in order to find areas of strength to assist with this change and areas of weakness that may make implementation difficult or less effective.

It is critical when making changes to remember that people learn in various ways and it may take time before all staff adopts the changes.

One activity you may want to consider completing prior to implementing the AIM Process is an evaluation of your agency's readiness to change.  While we include a Readiness to Change Questionnaire in this toolkit, there are many others available that could also be used.

Suggestions for Preparing for Change
Managing Transitions
Agency Readiness to Change Questionnaire
Adult Learning
Principles of Adult Learning

Conducting an Organizational Self-Assessment

One of the first activities to do with your quality team is to conduct an organizational self-assessment designed for addressing the AIM Quality Measures.  The answers are used to review and discuss current agency structure and processes and to help your team decide on quality of care priorities for your Agency.

Organizational Self-Assessment Instructions
Organizational Self-Assessment Tool

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Review Your Agency's Documentation Processes

The AIM Quality Measures are calculated based on data collected from patients' clinical records, family satisfaction surveys and adverse event logs.  Learning where essential clinical care processes are documented in your clinical record system will allow your data collection efforts to be timely.

Enforcing consistent documentation efforts are critical to attaining accurate information.  If changes need to be made to your documentation process, they should be done before data collection efforts begin.  Keep documentation needs in the forefront with staff. The rule of thumb is: If it was not documented in the patient's clinical record, it was not done!

Suggested Clinical Record Sources for Locating Data Elements
Agency Location of Data Elements
Paint a Picture Documentation Campaign (flier)
Documentation Problems and Solutions

Utilize Standardized Rating Scales

For quality measures to be valuable, the data must be collected in the same way for all patients.  One of the first efforts an agency can do is utilize standardized rating scales as a part of your assessments.  Standardized rating scales are designed in such a way that the questions, conditions for administering, scoring procedures, and interpretations are consistent, and are administered and scored in the same way every time for every patient. Standardized rating scales offer an accurate way to quantify patient symptoms. When patient symptoms are not quantified, it may not be possible to know whether the patient is improving, especially when the changes are subtle.

Hospice providers are just beginning to integrate the use of standardized rating scales for symptoms other than pain. It is very important to understand the limitations of current clinical instruments and to realize that there may not be instruments available that fit your clinical needs. A list of assessment instruments by domain was created by the PEACE Project and is included in the toolkit.

Assessment Instruments for End-of-life Care by Domain

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Introduce AIM Process to Staff

It is now time to introduce the AIM Process to the rest of the staff.  However, using a cookie cutter approach will not be sufficient at this stage in the game.  In order to be sure that the tools are implemented in a useful and efficient manner the process must take into account individual agency specific needs and resources.

The AIM Quality Measures cut across all disciplines; therefore one of the best ways to be sure that specific needs are met at your agency is to orient all staff members to the AIM Process. The Project Leader or another member of the Quality Team should provide both an overview of the AIM Process as well as an overview of the tools used in the AIM Process. 
A slide presentation is provided for use with your staff along with a list of presentation reminders for the Facilitator.

Overview of the AIM Process (slide presentation)
AIM Process Overview Presentation Notes
AIM Acronyms

References and Resources

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IPRO Staff Access