Don't skimp when hiring quality improvement staff
Don't skimp when hiring quality improvement staff
Now your success depends much more on QI
Your company has decided to expand its quality improvement (QI) department, and you're interviewing candidates for the new positions. They all have strong credentials and solid nursing backgrounds. But how do you know which of them will make the best QI staff members?
Whether you are hiring a QI manager or QI department staff members, QI staff need to like spending a lot of time with numbers and charts, home health managers say.
Consider these 11 issues pinpointed by home health care managers as being critical to hiring the best talent for your QI department:
* Aim to hire staff who have the "QI mentality."
QI staff have to be detail-oriented, but not so much that they can't see the larger picture, says Laura Waltrip, RN, the administrator and chief operating officer (COO) of the home care division at SantaFe HomeCare in Gainesville, FL.
But if you're hiring the manager of your entire QI department, you need a person who sees more of the big picture and less of the detail, says Robin Will, RN, the director of support services in home care at SantaFe HomeCare.
You should look for creativity, vision, and an ability to suggest innovative solutions to problems, Will says.
Ask applicants: Why is QI necessary?
Will gives the following as an example of innovative problem solving: The QI department at one of SantaFe HomeCare's branches noticed that medication errors were increasing. The QI staff members thought that if this was a problem in one agency, it could also become a problem in the other branches. So they put on an inservice for the employees at the first branch, videotaped it, and showed it to all the others later. The trend reversed and never showed up at the other branches.
Look for candidates who have the "QI mentality" and can handle such problems proactively, advises Waltrip. Having applicants explain why they think QI is necessary can help you ascertain whether they fit this profile, Waltrip says. She asks candidates, "What are the components of a good QI program?" to get them to show her the scope of their vision. (SantaFe HomeCare uses an interview tool to guide interviewers through the process. See pp. 3-5.)
Asking these types of questions will also show whether the candidates will support your company's
mission and values, says Patty
Ham, RN, the director of the Saint Francis Medical Center Home Health Department in Peoria, IL.
QI staff members also should be self-starters, Ham says. They cannot be the types of people who prefer being told what to do, rather than figuring out what to do themselves.
"The ideal QI person needs little direction," Ham says. "You just tell them what you want, and they do it all." (Good communication skills are a must for QI professionals, managers say. See story, p. 6.)
* Ask for the educational degrees that suit your needs.
Some home health company directors say that QI staff members should have master's degrees, to guarantee that they will have taken statistics courses.
"Most people with master's degrees have had some statistics courses, and that's what a QI person needs to have," says June Cosnotti, RN, MBA, MS, the director at RMH Home Health Services in Roanoke, VA.
Affinity for statistics helpful
Others say experience and interest in statistics count more than the degree. Those directors who do prefer their QI staff members to have master's degrees say that any type of health-related masters degree is good, such as nursing, home health administration, community health, public health, or health care administration.
"They need to be an RN, but they don't necessarily have to have an MS [master's degree in science]," says Waltrip. "They need practical experience more than anything."
Ham says she prefers her QI staff members to have master's degrees.
"There is a certain amount of knowledge that comes with a master's degree," she says.
But if candidates don't have master's degrees and their other qualities are good, she'll overlook the lack of a master's, Waltrip says.
Also, Ham looks for QI staff members who are certified by the National Committee for Quality Assurance (NCQA), and encourages her current employees to get certified by the NCQA. (See editor's note at end of article for more information on the NCQA.)
* Look for candidates who are clinically adept.
A QI manager or nurse doesn't necessarily have to have field experience in home care, but should be clinically strong, so that she or he will catch everything that's going on, Will says. Others disagree, saying that home care experience is crucial.
"You need someone with home care experience, because a hospital QI person won't understand home care," Ham says. She says she prefers that QI department candidates have at least two years of home care experience.
If you do hire someone who doesn't have a background in home care, remember that training and orientation will take longer, Cosnotti notes.
* Candidates should know Medicare regulations and accreditation standards well.
If candidates don't already know these regulations and standards, they have to be willing and able to learn them quickly, says Ham.
* Check for critical thinking skills.
QI staff members should be able to focus on problems and issues, not people, says Waltrip. To look for these qualities, she asks candidates this question: "Give me an example of a time when you were involved in discovering a problem, and tell me how you solved it.
"This will give you a good feel for their competency," Waltrip says.
Asking candidates to explain the QI projects they have spearheaded in the past also will give a good picture of their critical thinking skills, Cosnotti says.
When you ask candidates to explain how they would handle a situation, you can see how they identify the issues and the problems, Ham says.
For example, Ham gives candidates a scenario such as a congestive heart failure (CHF) patient whose
chart showed that he had gained 15 to
20 pounds in four weeks, or that the patient wasn't weighed consistently by nurses, and the patient's
physician wasn't called. She then asks the candidates how they would approach the problem.
This allows Ham to see whether the candidates try to address the problem by themselves, or whether they would speak to their manager about it.
* Look for leadership ability.
QI staff should be able to foster team thinking, Waltrip says.
One way that Will looks for this skill is by asking, "Give me an example of a time when you were on a team and someone disagreed with your decision."
"You can't ask, 'How do you feel when someone disagrees with you?' They'll put their best foot forward," Will says.
* Look for good organizational skills.
Time management skills are crucial to QI staff members, who must work on multiple projects at once, Waltrip says. Candidates should demonstrate that they can organize their time well, and that they can be flexible.
They have to be able to prioritize multiple tasks simultaneously, including such different tasks as risk management and infection control, Ham says.
"They have to feel comfortable with 10 things on their plate," she says.
* Introduce candidates to their potential colleagues.
After interviewing the candidates yourself, have the team of people the candidates will be working with interview them too, Ham says. This way your colleagues can help identify potential strengths or weaknesses in candidates that you might have missed, she says. Also, you should give your other employees some say in who their new colleague will be, she says. Ham introduces candidates to her company's department heads, and to the other QI staff members with whom the candidate would be working.
Get staff evaluation of candidates
Cosnotti says she likes to interview candidates alongside her clinical services manager and her home health manager, so they can help her analyze the candidates' skills and personalities.
* Hire from within, if possible.
Because QI is so important, it is critical to know as much about a candidate as possible. The best way to learn about a candidate is to work with them, Waltrip says. She hired her QI manager from within her company markedly shortening the manager's learning curve, Waltrip says.
* Look for someone who commands respect.
Determining who commands respect comes down to the gut feeling you get from a candidate. Waltrip says she determines whether a candidate commands respect by talking to references, but other home health care company directors say that candidates' past employers rarely say anything except to confirm the employee used to work there.
* Ask for computer skills.
Home health care professionals also differ on what level of computer literacy to require in QI staff members. Waltrip says she doesn't need them to be total experts, but they do need to be comfortable using computerized databases and spreadsheets. In the future, though, QI staff members will need to be even more computer literate, she says.
"Three years from now, advanced computer skills will be crucial," Waltrip says.
For now, QI department candidates need to be able to computerize data in a way that conveys useful information, Waltrip says. For example, candidates should know how to graph information to use in educating colleagues about analysis and trends. They need to be able to think visually and to use visual information, not just narrative information, she says.
"Don't get someone who says, 'I hate computers!'" Waltrip warns.
[Editor's note: The National Committee for Quality Assurance is based in Washington, DC, and can be contacted at this telephone number: (202) 955-3515.]
* Laura Waltrip, Administrator and Chief Operating
Officer, Home Care Division, SantaFe HomeCare,
801 S.W. Second Ave., Gainesville, FL 32601-6298.
Telephone: (904) 338-2189.
* Robin Will, Director of Support Services in Home
Care, SantaFe HomeCare, 801 S.W. Second Ave.,
Gainesville FL 32601-6298. Telephone:
(904) 338-2189.
* Patty Ham, Director, Saint Francis Medical Center
Home Health Department, 530 N.E. Glen Oak Ave.,
Peoria IL 61637. Telephone: (309) 637-0202.
* June Cosnotti, Director, RMH Home Health Services,
Roanoke Memorial Hospital, P.O. Box 13367, Roanoke,
VA 24033. Telephone: (703) 981-7000. *
Source: SantaFe HomeCare, Gainesville, FL.
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