The document outlines a training program for care managers. It discusses (1) developing action plans and problem-solving skills to analyze care management challenges, (2) leading quality improvement initiatives related to care coordination, and (3) improving patient satisfaction and minimizing healthcare costs. The two-day course covers topics like patient-centered care, care coordination standards and performance indicators, quality management methodologies, and international healthcare accreditation standards relating to care coordination.

1. Care Manager
Training
Aesculapius Healthcare
Consultants

2. About Us
• Certified Quality Managers by the American
Society of Quality.
• The only TeamSTEPPS Patient Safety Strategy
Provider in Nigeria.
• Lagos State Patient Safety Consultants
• AHIA- Aesculapius Hospital Improvement Advisory
Hospitals with Performance Management,
Organization Development, Process Improvement
and Idea Generation

3. Objectives of the Training
• Develop Action Plan and apply Problem-Solving Skills to analyse
Care Management Challenges and facilitate Organizational
Change in different Hospitals and Clinics to improve Care
Coordination and Patient Satisfaction
• Lead Quality Improvement Initiatives related to Care Coordination
• Care Managers should improve Patient Satisfaction and minimize
Overall Cost of Healthcare Service
• Care Managers should deliver end to end value for patients and
Hospitals with the ability to design and monitor Improvement
indicators for coordinating Care.

4. Course Outline- Day 1
• Patient-Centred Care and Care Coordination
• Patient Centred Care in the Nigerian Healthcare
Insurance Context
• Conceptual Frameworks in Care Coordination and
Care Coordination Standards
• Care Coordination Performance Indicators

5. Course Outline- Day 2
• Key Dimensions / Aspects of Healthcare Quality
• Providing Better Care at Lower Costs
• Deploying Quality Management Systems for Service Providers, with Care
Coordination Performance Indicators.
• Quality Management Methodologies and use of Quality Management
Tools
• Overview of International Healthcare Accreditation Standards relating to
Care Coordination.

6. Patient-Centred Care
Care organized around the Patient.
A model of Partnership between Service Providers and Patients with
their Families to identify and satisfy the full range of patient needs
and preferences.
The Institute of Medicine has identified Patient-centeredness as an
essential foundation for Quality and Patient Safety
Healthcare Convention Patient Centred Care
Providers Are The Experts
Provision of Consumer-Focused Health
Care Information
Family Are Visitors
Opportunities for Family Member
Involvement in Patient Care
Patients Are Body Parts To Be Fixed. Healing Physical Environment

7. Patient-Centred Care
• Patients are encouraged to be actively involved in their care
• Physical environment promotes patient comfort
• Staff who are dedicated to meeting the Physical, Emotional, and
Spiritual Needs of patients.
• Patient-centeredness is not a check-list, a dashboard or an action
plan.
• Patient-centredness is a Culture Change that requires buy-in and
engagement from all levels of the organization, long-term
commitment, and a willingness to routinely challenge the
―that‘s the way we‘ve always done it mentality.

8. Attributes of Patient-centred Care Model
• An organizational culture that encourages staff to be sensitive to a
patient’s needs during his or her hospital stay
• An architectural and interior design that gives a “homelike”
feeling and encourages patient mobility, involvement of family
in the care process, and space for both solitude and social
activities
• Emphasis on patient and family education
• Recognition that nutrition is an integral part of health as well as a
source of pleasure, comfort, and familiarity

9. Patient Centred Care in the Nigerian
Healthcare Insurance Context
• Collaboration of Health Insurance Service
Provider and Hospital Service Provider.
• Health Insurance Managers to transmute to
Change Agents, Facilitators and Coaches
• Data Driven Culture Change
• Cost

10. Benefits of Patient-Centred Care
• Increased Patient Satisfaction
• Increased Staff Retention
• Enhanced Staff Recruitment
• Decreased Length Of Stay
• Decreased ED Return Visits
• Fewer Medication Errors

11. Care Coordination
• Deliberate organization of Patient Care Activities between two or more
participants (including the patient) involved in a patient’s care to facilitate the
appropriate delivery of Health Care Services.
• Organizing care involves the marshalling of personnel and other resources
needed to carry out all required patient care activities.
• Care Coordination is managed by the exchange of information among
participants responsible for different aspects of care.
• Evaluating Patient's Needs and Resources to determine appropriate services
with available funding sources and monitoring care provided over an
extended period of time.
• Care Coordination should focus on Prevention as well as Rehabilitation
and Health Maintenance

12. Responsibilities of Care Coordinators
• Care coordinators arrange for and authorize services
• Control payment for those services
• Improve availability and quality of services
• Contain costs by ensuring appropriate use of services
• Justify expenditure of funds

13. Responsibilities of Care Coordinators
• Ensure that only appropriate enrolees utilize Health
service.
• Evaluation of Patient Outcomes, Connection To
Services, Adherence To Medication, Service
Utilization and Cost of Service.
• Monitor Patient Satisfaction and provide appropriate,
comprehensive, and coordinated response to Patient's
needs.

14. Care Coordinators as Facilitators
• Direct communication
between the Provider and
Enrollee/family
• Member and family
education
• Facilitate communication
among Different Healthcare
Units or Organizations
• Coordination of resources
to meet Individual Care
Plan (ICP) goals.
•Development of an ICP specific to
individual needs and updating of
these plans at least annually.
•Assessment of clinical risks and
needs
•Enhanced self-management
training and support
•Frequent Member contact
•Promotion of co-location of
service delivery

15. • Refer Enrollees outside the Plan's responsibilities
• Facilitate timely access to primary care, specialty care,
medications, and other health services needed by
Enrollees
• Such timely access include referrals to appropriate Centers
for needed medical services
• Resolve any barrier to Healthcare Access.

16. Financing Care Coordination
Cost Centre
OR
Profit Centre

17. Need for Care Coordination
• Developing Improvement solutions for Effective and Efficient
Health Care System
• Care coordination is a key strategy for improving Quality problems
and spiralling costs (IOM)
• Focus on is on high-risk, high cost members with complex
conditions
• Care Coordination consists interdisciplinary team, Care
Managers, Peer counsellors and Provider
Collaboration/Partnership

18. Identifying Needful Patients
• In all Healthcare Systems, a small
percentage of Patients drive cost
with Service Utilization compared
to Remaining Members, with more
Emergency Room Visits, Inpatient
Admissions and Readmissions
• Care Coordination focuses on
Quality improvement and Cost
Control, with decreased hospital
readmissions and improved
transitions of care
• Reducing Uncoordinated Care
Reduces Costs, Improves
Quality
• Chronic diseases, multiple co-
morbidities
• Patients Not Utilizing Care Efficiently
• Patients that require multiple
Providers, settings, and levels of care
• Unnecessary ER use
• Avoidable admissions and re-
admissions
• Poly-pharmacy

19. Risk Based Interventions

20. Conflict in Care Coordination
• The Client and the Care Coordinator do not agree on the
Problem, the Need, or Appropriate Service
• Family Member and Patient do not agree with the Care
Coordinator on the Problem, the Need, or Appropriate Service
• Ability to be Responsive to Client Needs and Preferences may be
limited by Cost Containment
• Resources to meet the Patient's Needs do not exist
• Program Goals do not correlate with the Patient’s Desire.

21. Conceptual Frameworks related to Care
Coordination
• Andersen’s Behavioural Framework
• Donabedian’s Structure-Process-Outcome
Framework
• Gittell’s Relational Coordination Framework

22. Andersen’s Behavioural Framework
• The purpose of this framework is to discover
conditions that either facilitate or impede Care
Coordination
• The goal being, to develop a behavioural model that
provides measures of Care Coordination.
• An individual's access to and use of Care Coordination
is considered to be a function of 3 characteristics

23. Predisposing Characteristics Enabling Resources Need For Coordination
Participants atitude toward or
knowledge about their role in
coordinating care, which are not
easily altered.
Availability and access to the
requisite information systems,
organizational structures, or
productive relationships with others
providing care to the same patient.
Healthcare Professionals must
perceive need for coordinating
care in order to trigger actual
coordination behaviors by the
participants
Medical Profession set certain
expectations about who has
responsibility for specific care
activities.
Introduction of a protocol for
handoffs
Such Behaviours include
exchanging information between
two clinicians at the delivery level
Shifting major responsibility to the
patient for coordination of their
own care, would go against the
norms of some care professionals.
Designating a nurse as a patient
navigator at the service delivery
level
Such Behaviours include setting
up a registry to flag more
complicated patients for intensive
case management at the delivery
or systems level.
Incentives, climate and culture,
staff expertise, commitment of
Leadership to Quality
Improvement, pre-existing team
or interclinician factors like team
structure, collaborative practice
and individual clinician
characteristics like knowledge,
attitudes, and skills.
Enabling resources affect the ability
of a participant to respond to the
need for coordination.
Patients whose health require
participation of multiple
participants like several doctors
for multiple chronic conditions, a
rehabilitation therapist for post-
stroke care, a social worker for
connecting the patient to
community resources and a
pharmacist need more
coordination of their care.
Predisposing characteristics are
difficult to change, hence more
creativity is needed to reduce a
barrier.
Enabling resources are easily
changed by systems- or service-
level decisionmakers compared to
predisposing characteristics
Andersen's Behavioral Framework

24. Donabedian’s Structure-Process-Outcome
Framework
Structure Process Outcome
This denotes the attributes of the
settings in which care occurs
It denotes what is done in giving
and receiving care.
Refers to what results are achieved
(performance).
Organizational structure (medical
staff organization, methods of
peer review, methods of
reimbursement).
Process includes the patient’s
activities in seeking care and
carrying it out as well as the
practitioner’s activities in making
a diagnosis and recommending or
implementing treatment
Human resources (number and
qualifications of personnel)
Material resources (facilities,
equipment and money)
Avedis Donabedian

25. Activating a Paradigm Shift in Nigerian Healthcare
Updated Framework Highlighting Importance of
Organizational Attributes
Glickman S W et al. Int J
Qual Health Care
2007;19:341-348

26. Activating a Paradigm Shift in Nigerian Healthcare
Relationships of shared goals, shared knowledge and
mutual respect enable providers to form a common
identity across functional and organizational boundaries
Relational Coordination provide the cultural or relational
underpinnings for Quality Improvement and Process
Improvement Strategies
Relational Coordination allow Teams to coordinate work
“on the fly” and improve over time.
Gittell’s Relational Coordination Framework

27. Activating a Paradigm Shift in Nigerian Healthcare
Case
Managers
Nurses
Attending
Physicians
Physical
Therapists
Nursing
Assistants
Social
Workers Technicians
Referring
Physicians
Residents
Work Practices Connect All Care Providers Around Patient
Patient

28. Gittell’s Relational Coordination Framework
28

29. Activating a Paradigm Shift in Nigerian Healthcare
Invest in frontline leadership
Resolve conflicts proactively
Reward team performance
Select for teamwork
Measure team performance
Design jobs for focus
Make job boundaries flexible
Support boundary spanners
Connect through pathways
Develop shared info systems
Partner with suppliers
Relational
Coordination
Communication
Frequent
Timely
Accurate
Problem-solving
Relationships
Shared goals
Shared knowledge
Mutual respect
Quality
Performance
Efficiency
Performance
Broaden participation in
patient rounds
Strengthening Relational
Coordination
Job
Satisfaction
High Performance Work System
 reduces turnover,
burnout
 increase employee
engagement

30. Activating a Paradigm Shift in Nigerian Healthcare
Gittell’s Relational Coordination Framework

31. Care Coordination Standards
• Care Coordination Services is
provided to all Enrollees, as
needed, in accordance with
Individual Preferences, and in a
way that meets the needs of
Enrollees with disabilities.
• Enrollees have the right to self-
direct provision of long-term
Care
• Enrollees can determine the
appropriate involvement of his
or her health care providers
and caregivers.
• Enrollee’s care is coordinated across
the full continuum of service providers,
including facilitating access to
appropriate community-based resources
and monitoring skilled nursing utilization
• Focus on providing services in the least
restrictive setting and transitions
between facilities and the community.
• Care Coordination Services should be
Person-centered, Outcome-based
Approach

32. Care Coordination Standards
• Care coordination will be
performed by Skilled
Healthcare Professionals
• There is a Health Assessment
Process that includes an Initial
Risk Stratification and Health
Risk Assessment Survey
• The Health Assessment
Process reviews both health
and functional status of
Patients
• Development of Individual Care
Plans (ICP) that comply with
continuity of care provisions.
• There should be Access to
Interdisciplinary Care Teams
(ICT), as necessary and as
requested.
• Ongoing care management that
includes case management, as
necessary conducted by
appropriate medical
professionals.

33. Elements of Care Coordination
• Smooth exchange of information
• Efficient planning and delivery of disparate services
• Education of patients about the care plan
• Adherence to treatment
• Mapping out what behaviours need to change
• Care Coordination Behaviour include Support Staff person taking
responsibility for effectively linking the patient to the appropriate
non-medical resources and Physician describing needed non-
medical service to patient and support staff

34. Care Coordination Performance Indicators
• 5 types of Care Coordination Assessments:
• Patient Outcomes: mortality, morbidity, functional status
• Cost Outcomes
• Care Delivery Process Measures: patient follow-up visits,
intensification of medication
• Coordination Mechanism Measures: Communication, Care
Transition
• Patient/Family Perception Of Coordination: Client Perception,
Patient Satisfaction

35. Day 2

36. Key Dimensions / Aspects of Healthcare
Quality
Palmer
(1983)
Donabedian
(1988)
Nutting et al
(1990)
Maxwell (1992)
European
Commision
(1998)
NHS (1999) JHACO (1999) IOM (2001)
Effectiveness Effectiveness Effectiveness Effectiveness Effectiveness Effectiveness Effectiveness Effectiveness
Efficiency Efficiency Efficiency Efficiency Efficiency Efficiency Efficiency Efficiency
Access Access
Distribution of
Assistance/
Integrity
Access Access Fair Access Access -
Technical
Competence
Health
Improvement
Technical
Competence
Technical
Competence
Efficacy
Health
Improvement
- -
- Equity - Equity - - - Equity
- Appropriateness - Appropriateness Appropriateness - Appropriateness -
Acceptability
/ Satisfaction
- - Acceptability Acceptability - Availability -
- Safety - Respect Safety - Safety
Respect/
Safety
- - - - - Timeliness Timeliness Timeliness
- - -
Choice/
Availability of
Information
Patient
Satisfaction
Patient/ Care
Experience
-
Responsiveness
to Patients/
Patient
Centredness
- -
Continuity/
Coordination
- - - - Continuity
- - - - Assessment -
Prevention/ Early
Detection
-

37. Key Dimensions / Aspects of Healthcare
Quality
Safe
Effective
Patient Centred
Timely
Equitable
Efficient

38. Providing Better Care at Lower Costs
• Focus is developing Patient-
centred System that Reward
the Quality Of Care Delivered
and not just the Quantity Of
Services Provided.
• Develop Performance Based
and Improvement Based
Payments for Hospitals
• Physicians. Provide
physicians with incentives to
voluntarily report quality
measurement data to the Plan.
• Identify and Spread Best Practices
proven to prevent infections in
hospitals and other Patient Safety
Measures
• Coordinate care for an individual
patient across care settings—
including hospitals and Laboratories.
• Develop an Electronic Health
Records (EHR) across the
Provider Network making it easier
for physicians and hospitals to
assess a patient’s medical status and
ensure appropriate care.

39. Providing Better Care at Lower Costs
• System-wide Quality
Improvement Program for
Providers, with support of
patients and practitioners to
reconfigure the current delivery
system into Patient-centred Care.
• Saving Lives by Focusing on
Prevention. free prevention
services from their doctor, including
annual wellness visits to prevent
harmful, costly diseases that are
identified at the earliest, most
treatable stages by ensuring
Enrolees get routine services they
need, when they need them.
Using decision support systems to
promote appropriate use of imaging
technology, to reduce Unnecessary
Utilization.
Users like Enrolees and Health
Insurance Companies should have
access to Quality Information,
which helps consumers and
employers make better health care
decisions and promote competition
Emphasize the importance of
engaging patients in decisions about
their care

40. Deploying Quality Management Systems for
Service Providers
Plan Quality
• Identifying quality requirements and standards for the Hospital, and
developing a Quality Plan that will demonstrate compliance
Perform Quality Assurance
• Auditing Quality Requirements and Quality Control measurement results
to ensure appropriate Quality Standards and operational definitions are
used. Also focuses on Continuous Process Improvements
Perform Quality Control
• Monitoring and recording Organizational Results to assess performance
and recommend necessary changes. Causes of poor Service Delivery
are identified and eliminated

41. Quality Management Committee
• The Chief Executive should appoint a Quality Manager that heads Quality
Management Committee.
• Quality Management Committee build the Hospital’s capacity and
capability for quality improvement. Some of the same people identified as
leaders or key stakeholders may also serve on the Quality Committee.
• The major task of a Quality Management Committee is to help ensure
everything is in place at Hospital for the improvement efforts to succeed
and be sustained over time.
• The Quality Committee plans and oversees all quality program activities
at the facility, particularly the quality improvement projects completed by
individual project teams.

42. Responsibilities of the Quality Committee
 Strategic Planning
 Facilitating Innovation and Change
 Providing Guidance and Reassurance
 Establishing a Common Culture
 Allocating Resources

43. Other Responsibilities
• Develop the Quality Management Plan
• Capacity Development of Quality Managers
• Review of Hospital Processes and Procedures
• Development of Performance Indicators
• Review of International Healthcare Standards

44. Quality Management Plan
QM Plan provides the framework and tools to continuously and
systematically improve performance related to clinical quality.
Confidentiality
• The confidential nature of Quality data must be respected. Patients
information will be obscured or will be identified by confidential codes,
when and where appropriate.
Approval of Plan
• The Quality Management Plan should be approved by the Executive
Management
Annual Evaluation
• The Quality Management Plan is reviewed annually to assess the
Hospital's success in achieving the goals and objectives of the Plan.

45. Components of Quality Management Plan
• Quality Statement
• Quality Improvement
Infrastructure
• Performance
Measurement
• Annual Quality Goals
• Participation of
Stakeholders
• Evaluation
A Quality Management Plan defines a Quality Program’s Strategic
Direction and provides a blueprint for upcoming improvement activities
for the Hospital:

46. Quality Management Dashboard
The Quality Management Department receives all quality data and
information collected throughout the organization.
Data is compiled, evaluated for trends, and entered into a dashboard
format, which:
• Focuses on Patient Outcomes and
Satisfaction
• Facilitates Communication and
Understanding of the Business
Goals.
• Concentrates on Continual
Assessment and Improvement of
Key Processes
• Provides Strategic Feedback and
Learning for Management and
Employees
• Helps align Key Performance
Measures with Key Organizational
Strategies at all Levels of the
Organization
• Provides a Comprehensive Picture
of the Success of the Organization

47. Healthcare Quality Improvement Strategies
Process IssuingOrganization
Objectof
Evaluation
Standards Components
Licensure Mandatory Government
Individualand
Organization
MinimumStandardstoensurea
MinimumRiskEnvironmenttoHealth
andSafety
RegulationstoensureMinimum
Standards,CompetenceandOn-
siteInspection
Certification Voluntary AuthorizedBody
Organizationor
Component
ISO9001Standardstoensure
ConformancetoIndustryStandards
Organizationtodemonstrate
Services,TechnologyorCapacity
Accreditation Voluntary
UsuallyNonGovernmental-
RecognizedTools
Organization
MaximumAchievableLevelto
stimulateImprovementovertime
CompliancewithPublished
StandardsandOnsiteEvaluation
ComparingHealthcareQualityImprovementStrategies

48. Modern Quality Management Methodologies
Customer Satisfaction
Prevention over inspection i.e. quality is
planned, designed, and built in– not
inspected in
Continuous Improvement- the PDCA cycle
with process improvement models like ISO,
TQM, Six Sigma
Management Responsibility

49. Quality Management Methodologies
• Total Quality Management
• Lean Six Sigma
• ISO; QMS Certification

50. TQM Principles
• Customer Focused Organization
• Leadership
• Involvement of People
• Process Approach
• System Approach to Management
• Continual Improvement
• Factual Approach to Decision Making
• Mutually Beneficial Supplier Relationships

51. • Cause and Effect Diagrams/
Ishikawa/Fishbone diagrams
• Pareto Chart/Diagram
• Control Charts
• Flowcharting
• Histogram
• Run Chart
• Scatter Diagram
• Statistical Sampling
• Inspection
Quality Management Tools

52. Management and Planning Tools
Affinity Diagrams- used to produce numerous
possible answers to an open question.
Interrelationship Digraphs- used to identify cause
and effect relationships
Tree Diagrams- helps break a general topic into
activities that contribute to it
Prioritization Matrices- aids in deciding among
several options

53. Management and Planning Tools
Matrix Diagrams- used to discover and illustrate
relationship between 2 groups of items
Process Decision Program Charts (PDPC)- a
tree diagram used to illustrate anticipated
problems and list possible solutions
Activity Network Diagrams- used to depict
activities sequentially in a Process

54. Quality Assessment Methods
System Performance
• Health Priorities, System Planning, Financing And Resource
Allocation done at National Level & Global Level.
• General Environment Of The Country, Legislation & Other
Regulatory Mechanisms, Professional Recognition and Overall
Quality Management.
Institutional and Clinical Performance
External Assessment
• ISO, Accreditation, Licensing, EFQM, Peer Review
Internal Self-assessment
• Patients Rights’, Risk Management, Clinical Governance, Clinical
Audit, Performance Indicators and Benchmarking

55. Overview of International Healthcare Accreditation
Standards relating to Care Coordination
International Healthcare Standards are benchmarked against ISQUA Standards
Key care and service processes and outcomes be measured through the use of
Performance Indicators, Patient/Service User Satisfaction Surveys/Assessments
and Other Performance Measures.
Standards are designed with a focus on patients/service users and reflect the
patient/service user continuum of care or service.
The standards require staff to involve patients/service users in their own care and
services and respect their cultural and spiritual
The standards require that the assessments of patients/service users:- medical,
physical, mental, behavioural and emotional, nutritional, functional
The standards require that individual care/service plans are prepared and
documented

56. Contact Us
 Phone- +234-8052064317| +234-8023277559
 Website- www.aesculapiusvn.com
 Facebook: Aesculapius Healthcare Consultants
 LinkedIn- Aesculapius VN
 Twitter- @AesHealthCon
 Email- aesculapiusvn@gmail.com

57. Thank You