Feedback Report Writing Rules Paul Grizzell Examiner Trainer

Learning Objectives • Discuss the purpose of Strength and Opportunity for Improvement (OFI) comments • Recognize writing rules conventions • Clarify well-written vs. poorly written comments

Purpose of Strength and OFI comments • Strengths – to acknowledge the effective practices that are in place at the applicant through the context of ADLI (Approach-Deployment-Learning. Integration) in the Process categories. • OFIs to identify the key areas identified by Examiners that, if implemented, would move the applicant to the next higher scoring range. • Overall – Strengths and OFI should help an applicant identify what they should keep doing (Strengths) and start doing (OFIs) to become a higher performing organization with improving results.

Strength and OFI considerations • The Writing Rules are provided for you in the Quick Reference Guide • The Writing Rules are not optional – they are mandatory. Following the Writing Rules when initially writing feedbackready comments will minimize rework later! • Learning and using the Writing Rules will make you a better business writer!

Strength Comment Writing Rules • Strengths should reflect all processes that meet Criteria and Scoring Calibration Guideline requirements Strengths should support the assigned score No more than one Strength comment per area to address • Strengths should provide enough detail so the applicant understands why the Examiner sees it as a Strength Typically includes a clear opening statement, then evidence to support that statement

OFI Comment Writing Rules • OFIs should reflect Criteria requirements, including scoring guidelines, that the applicant does not meet. OFIs should identify the vital few opportunities that prevent the applicant from scoring at the top of the scoring range or in the next scoring range. • OFIs should be relevant and actionable. OFIs should include a clear opening statement, then evidence of what is missing, and a clear “so what” that describes potential adverse consequences of not doing what the Criteria require.

OFI Comment Writing Rules • Key “blocker” OFIs are identified with an asterisk • OFIs are not prescriptive and are based on Criteria requirements The words “should” or “could” are good indicators of prescriptive comments • OFI comments are based on process or system deficiencies, not on poor writing Don’t use the word “how” in an OFI comment.

Writing Rules for ALL comments • Comments should not contradict other comments in the same or other Items • Comments don’t have more than one Strength and/or OFI per area to address (such as 1. 1 a(2)) • Comments must accurately reflect information from the applicant Double-check data (including figure references) in the comment • Comments use the applicant’s terminology and avoid the use of acronyms

Writing Rules for ALL comments • Comments stand alone with no vague modifiers Applicant should be able to read the feedback report without going back to the application No vague modifiers like “excellent, ” “good” or “inadequate. ” • Comments are grammatically correct • Comments are consistent with score and scoring guidelines Any Process Item scoring 30% or higher MUST have a comment that addresses Learning as a Strength and/or OFI Include references such as A-B, A-O, A-M, D, L, and I in the body of the comment

Writing Rules for ALL comments • Don’t “bury” a Strength in an OFI Include the Strength portion of the OFI as part of the “area to address” Strength • Comments are concise, but not cryptic - usually about 2 -4 sentences in length • The feedback report includes a notation of the area to address (such as 1. 2 b) next to each Strength and OFI comment

Final step in comment writing • Set aside the feedback report for a day, then review the report as if you were the applicant and consider: 1. Is each comment written in a manner that will be understandable to the applicant? 2. Do all comments support the scores that have been assigned? 3. Do the comments provide insights to help the applicant take the next developmental steps to performance excellence?

Sample poor comments “The applicant should consider using Lean methodologies as part of their Performance Improvement System (A-B). The use of Lean methodologies would help the entire workforce become engaged in performance improvement. ” Prescriptive comment “So what” statement addresses positive consequences “Although senior leaders have many excellent communication methods with their workforce, it is unclear what communication methods are used with key customers (AO). Without effective communication process in place with key customers, the applicant may not be aware of changing requirements from the different customer segments. ” Vague modifier is used - “excellent” Strength buried in an OFI

Sample poor comments “The applicant has a Strategic Planning Process (A-B). ” No evidence of Strength provided “The applicant does not have a method to assess their workforce capability and capacity (A-O). Their workforce turnover is 36%. ” No “so what” statement Grammar – an applicant should be referred to as “its”, not “their” Results should be referenced in Category 7

Sample poor comments “*The applicant promotes and ensures ethical behavior (A) by monitoring email, computer use, social media, observations, and ethical behavior (A) reviewed through a Code of Conduct provided at hire and annual training for Compliance. An approach to unethical behavior includes legal department review after investigation by the applicant's compliance officer, and a Quality Improvement hotline and email is posted for reporting, but it is not evident that the applicant systematically evaluates its ethical behavior (A) such as compliance breaches or survey results. ” Strength embedded in an OFI without a corresponding Strength No “so what” statement Unclear if it’s an Approach or Learning OFI

Sample well-written Strength comment “The applicant uses multiple methods to evaluate and improve the effectiveness of its workforce engagement processes (A-O, L). The employee engagement survey questions are reviewed each year to ensure that they address the key drivers of workforce engagement (L). Key drivers are assessed for changes each year through focus groups with each workforce group (A-O, L). ” Note the clear opening statement and evidence in second and third sentences. Note also that both Approaches and Learning are addressed in this Strength.

Sample well-written OFI comments “It is not evident that the applicant has a process by which it incorporates innovation into their strategic planning process, although “Innovation” is described as one of the applicant’s Values. As a result, the applicant may not address innovation from a strategic level, which is important in addressing the strategic challenge of ‘Changing healthcare environment. ’” Note the clear opening statement, and a “so what” connection to applicant Values and a strategic challenge.

Summary • Strengths identify practices the applicant is implementing based on what the Criteria require. • OFIs identify what the applicant is not doing that the Criteria require. • Feedback comments should identify what the applicant should keep doing – their Strengths – and start doing – their OFIs. • The AHCA/NCAL Quality Award program has a set of Writing Rules to ensure consistent feedback quality. These Writing Rules are provided in the Quick Reference Guide and following them is mandatory.

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