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New Direction for CDPH’s Center for Health Care Quality SeminarNovember 19, Sacramento
Access seminar materials by visiting www.calhospital.org/cdph-district-updates-resources
Ask questions online at www.menti.comUse code 11 63 86
California Department of Public Health
Transforming CDPH’s Center for Health Care
Quality
California Department of Public Health
Improving the Management of Regulation Packages
Chelsea DriscollActing Chief of Policy and Planning
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California Department of Public Health
Project Goals
Streamline regulation development and approval process• Decrease redundancy • Increase the ease of package movement• Decrease timeframe to complete regulation
packages Quality product in less time Increase stakeholder engagement Future: regulations are kept consistent with
current standards of practice
California Department of Public Health
October Kickoff Meeting
Performance Improvement Management (PIM) Team
CHCQ Regulations Unit Office of Regulations Office of Legal Services Department of Finance Health and Human Services Agency
California Department of Public Health
Action
1. Understand the process and identify time lags2. Develop solutions that address root causes of delays3. Map out future state and develop implementation4. PIM Operations Committee approval of future state
map5. Complete implementation plan6. PIM Operations Committee and Executive Steering
Committee implementation plan approval7. Execute implementation plan
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California Department of Public Health
GACH Packages
• Adverse Events• Medical Information Breach• GACH - Clinical Laboratories,
Pharmaceutical, and Dietetic Services Regulations
• GACH – Infection Control and Physical Plant
• GACH – Emergency/Specialized Services/ Medical Imaging Regulations
California Department of Public Health
GACH Packages Continued
• GACH – Administration/ Records and Reporting
• GACH – Rehab, Outpatient, and Supportive Services Regulations
• GACH – Nursing/Surgery/Anesthesia/Cardiac Cath Lab
• Change of Ownership Regulations
California Department of Public Health
Stakeholder Engagement
We will be hosting stakeholder meetings for regulation package
Stakeholder Meeting Date Regulation PackageAugust 30, 2019 Clinical Laboratories,
Pharmaceutical, and Dietetic Services Regulations
September 10, 2019 GACH - Diagnostic Medical Imaging and Interventional Radiology Services Regulations
October 10, 2019 GACH - Dialysis and Organ Transplant Center Services Regulations
October 15, 2019 GACH - Rehab, Outpatient, and Supportive Services Regulations
November 1, 2019 Change of Ownership RegulationsDecember 6, 2019 GACH Pediatric Services
Regulations
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California Department of Public Health
Stakeholder Engagement (cont.)
Please join our stakeholder distribution list to keep informed about upcoming opportunities to participate in regulation development.
California Department of Public Health
SB 227 Hospital Staffing Penalties
SB 227 - Hospital Inspections and Penalties• Specifies that L&C must verify
compliance with mandatory nurse-to-patient staffing ratios during periodic, unannounced inspections of GACHs.
• Establishes administrative penalties for violations of nurse-to-patient staffing ratios.
California Department of Public Health
Performance Improvement Management Office:
Governance, Accountability, and Workstreams
Michelle Vinnicombe Bell, MBAPerformance Improvement Manager
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California Department of Public Health
Project Proposal
California Department of Public Health
California Department of Public Health
Complaint & FRI Backlog Reduction
Blessilda CanlasProject Manager
Performance Improvement Management Team
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California Department of Public Health
Complaint/Facility-Reported Incident (FRI) Backlog Reduction
CDPH’s Center for Health Care Quality (CHCQ) statewide backlog of open complaints/FRI:
22,919(July 1, 2019)
California Department of Public Health
Complaint/Facility-Reported Incident (FRI) Backlog Reduction (cont.)
“Backlog” is defined as:
California Department of Public Health
Complaint/Facility-Reported Incident (FRI) Backlog Reduction (cont.)
Work group of representatives from all CHCQregional offices and central officedeveloped backlog reduction strategies:
Preliminary steps –
1. Clean up database to determine “true backlog universe” (mid-Oct. through mid-Nov. 2019)
2. Conduct comprehensive inventory of open intakes(1st week of Nov. 2019)
3. Prioritize open intakes (2nd week of Nov. 2019)
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California Department of Public Health
Complaint/Facility-Reported Incident (FRI) Backlog Reduction (cont.)
OPTION A OPTION BReassign backlogged open cases equitably among all surveyors in each regional office to even out the workload.
Keep cases with current surveyor.
Limit number of backlogged cases on each surveyor’s desk (4-10 at a time)
Focus on 4-5 cases at a time, based on order of priority.
Supervisor assigns target date for completion of each case.
Backlog reduction strategies:(Starting Dec. 1, 2019)
California Department of Public Health
Complaint/Facility-Reported Incident (FRI) Backlog Reduction (cont.)
Backlog reduction strategies:(Starting Dec. 1, 2019)
Prioritize investigations –
1. Starting with the oldest year:• Offsites/admin closures first, then simpler FRIs, then
simpler complaints, then more difficult FRIs, then more difficult complaints.
2. Proceed to next oldest year, in the order listed above.
3. Continue moving on to the next oldest year, and the next, until all backlogged open cases have been assigned and completed.
California Department of Public Health
Complaint/Facility-Reported Incident (FRI) Backlog Reduction (cont.)
Backlog reduction strategies:(Starting Dec. 1, 2019)
• Streamline investigations using decision trees developed based on guidance from CMS.
• Administrative review for simpler cases.• Post-investigation: Utilize more efficient, standardized method
to review, approve, and process cases.• Streamline investigation packets to include only the essential,
relevant documents to substantiate allegations.• Prevent future backlog by utilizing short-term future state
decision trees for streamlined investigations.
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California Department of Public Health
Complaint/Facility-Reported Incident (FRI) Backlog Reduction (cont.)
Eliminate backlog by December 2021.
California Department of Public Health
Centralized Applications Branch
Kelly Abel, Branch ChiefRose McDowall, GACH/APH Unit Chief
Kelly Abel, Branch ChiefRose McDowall, GACH/APH Manager
Centralized Applications Branch (CAB)9
California Department of Public Health
• CAB Data Metrics
• Online Application
Agenda
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California Department of Public Health
Open GACH & APH Applications
California Department of Public Health
Open GACH & APH Applications
82 59 71 73 56 50 51 43 35 38 35 58 63
334314 278 278 294 308 306 337
320285
261 219 200
416
373349 351 350 358 357
380355
323296
277 263
0
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200
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350
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450
Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19
Open with CAB Open with Applicant Total Open
California Department of Public Health
0
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Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
2018 2019
Received Completed
Monthly Count of GACH & APH ApplicationsReceived vs. Completed
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California Department of Public Health
Online Application
California Department of Public Health
Online Application Processing (Coming Soon)
California Department of Public Health
Adobe Experience Manager (AEM) online application for GACH/APH• Purpose: HS 1272 mandated that CAB create an
automated application system to process GACH/APHapplications by December 31, 2019.
• Kickoff: online project in February 2019.• Status: Sprint 10 is underway. CAB is working on final
user stories for backend integration, • User Acceptance Testing: First round of UAT was done
with members of CHA in October. Second round of UAT in progress with CHA, stakeholders and internal users.
• The project is on target to be completed by December 31, 2019.
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California Department of Public Health
Online Application Benefits
• Application checklist• Visual Application
Progress
Initial Application
• Facility detail display
• Pre-populate facility data
• Online dashboard status
• Reduce/eliminate back and forth with CAB analysts
• Faster corrections turnaround
Application Corrections
GACH/APH Online Application
• Easy navigation • Data entry validation • Streamlined process • Upload and attach
documents • Help text and guidance • Save and exit feature • ADA compliant
GACH/APH Online Application Benefits
Report of Change Applications
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California Department of Public Health
Online Application Preview
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California Department of Public Health
Contact Information
Please send questions to:
[email protected]@[email protected]@[email protected]
California Department of Public Health
Transforming…The Center for Health Care Quality
CHA 2019Heidi W. Steinecker
Deputy Director
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Why I Am Here
California Department of Public Health
Why We Are Here
California Department of Public Health
Culture
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California Department of Public Health
How We Serve
California Department of Public Health
Who We Are
Regu
lato
ry F
ield
Ope
ratio
ns • State Licensing• Federal
Certification
Licen
sure
& C
ertif
icatio
n Fu
nctio
ns
• Central Applications
• Provider Certifications
• CNA Oversight• Criminal
Investigations• Medical
Breach• Staff Audits• Emergency
Preparedness
Publ
ic Po
licy
and
Prev
entio
n • Legislative Analysis• Regulation
Development• Policy Governance• Healthcare
Associated Infections
• Research Data and Informatics
• External Communications
Inte
rnal
Ope
ratio
ns • Fiscal• Contracts and
Grants• Personnel • Training• Capital Asset
Management
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California Department of Public Health
California Department of Public Health
Overall Scope and Severity RetentionAdmin ProcessesCulture of DistrustHierarchy StructureManual Processes
RecruitmentOld RegulationsUneven WorkloadLack of standardization
Missing Functions-PIM-LGA/OPA -Internal Com-LAC Manager
California Department of Public Health
Performance Improvement Management Governance Structure
Project Proposal
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California Department of Public Health
Performance Improvement Achievements
Enterprise-wide automated
systems
Stakeholder Customer Service
Portal system and Web based
Automated Processes
Electronic Roadmap
Packets
Website upgrades
Online
Applications
Myfi Wireless Routers
Smart Phones
Tablets
Mobile Technology
Re-Organization of the Center
Performance Improvement Management
(PIM) Office
External Communications
Manager & Internal
Communications Manager
Operation Structure
California Department of Public Health
Performance Improvement Initiatives
Phase 1: Adoption/Training Existing Resources
•Scanning, PDFs, Hardware
Phase 2: Robotic Process Automation
(RPA)
Phase 3: Survey/Investigation
Pilots
Paperless
Diversify the Workforce
Telework
Internal Communication
Recruitment and Retention
Re-engineer State-wide Survey Training
Center- wide Training and
Onboarding Program
High Tech/High Touch Approach
Training
Debt Free 2021
State-wide Triage System
Strategic Surveyor Usage
Complaint/FRI Backlog
Regulatory Interpretation
Section
Policy and Procedure
Governance
Centralized Program Flexes
Standardization
California Department of Public Health
Former Organizational Structure
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California Department of Public Health
The Proof is in the Process
California Department of Public Health
Proposed Organizational Structure
California Department of Public Health
Former District Based Workload
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California Department of Public Health
Current Workload in the Field
California Department of Public Health
Future Regional Workload
California Department of Public Health
Vacancy Rate
3.9%
2.7%
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California Department of Public Health
Debt Free 2021 Campaign
California Department of Public Health
The Blue Line Lesson
California Department of Public Health
Fees
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Emergencies and Unusual Occurrences
Update Emergency Contacts
Program Flexes & 1135 Waivers
Communicate Data & Impacts
Evacuations & Re-populating
Top Tips
Surveyor InteractionDo… remember you have mutual goal of safety and quality
Do not… make them wait for 30+ minutes- make sure your staff know where to navigate the team
Do… provide a confidential area to work and discuss
California Department of Public Health
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Questions?
Raise your hand or submit a question at www.menti.com and enter code 11 63 86
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Thank You
Hosted Luncheon
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CDPH District Office Breakouts with Hospital Members1:00 – 2:30 p.m.
Wrap Up
Thank You
BJ Bartleson, RN, MS, NEA-BCVice President, Nursing & Clinical ServicesCalifornia Hospital [email protected]
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