1. Quality Assurance or Quality Improvement: What’s the Difference? Johanna Buck* Title I Mental Health Providers Quality Learning Network Quality Learning Network October 3rd, 2005 *With thanks to Lori DeLorenzo, Susan Weigl and others

2. Quality Alphabet Soup

3. Quality Assurance “The planned and systematic activities implemented in a quality system so that quality requirements for a product or service will be fulfilled.” American Society for Quality

4. Examples of Quality Assurance Activities Annual child abuse and domestic violence training Annual child abuse and domestic violence training Chart review for patient's signature on consent forms Chart review for patient's signature on consent forms Utilization Review process Utilization Review process Activities that are based on public health standards, licensing standards, institutional policies, etc. Can help identify a problem, but are more often used to comply with the standards.

5. Quality Improvement “Continuous improvement is an ongoing effort to improve products, services or processes. These efforts can seek “incremental” improvement over time or “breakthrough” improvement all at once.” American Society for Quality

6. Goals of Quality Improvement The goals of QI are to understand the process, reduce the unintended variation in care, eliminate errors, remove unnecessary steps, and improve communication and accountability. The goals of QI are to understand the process, reduce the unintended variation in care, eliminate errors, remove unnecessary steps, and improve communication and accountability. The process is designed toward outcomes. Quality improvement depends on measurement. The process is designed toward outcomes. Quality improvement depends on measurement.

7. Core Concepts of CQI Core Concepts of CQI Quality is defined as meeting and/or exceeding the expectations of our customers. Quality is defined as meeting and/or exceeding the expectations of our customers. Success is achieved through meeting the needs of those we serve. Success is achieved through meeting the needs of those we serve. Most problems are found in processes, not in people. CQI does not seek to blame, but rather to improve processes. Most problems are found in processes, not in people. CQI does not seek to blame, but rather to improve processes.

8. CORE CONCEPTS OF CQI Unintended variation in processes can lead to unwanted variation in outcomes, and therefore we seek to reduce or eliminate unwanted variation. Unintended variation in processes can lead to unwanted variation in outcomes, and therefore we seek to reduce or eliminate unwanted variation. It is possible to achieve continual improvement through small, incremental changes using the scientific method. It is possible to achieve continual improvement through small, incremental changes using the scientific method. Continuous improvement is most effective when it becomes a natural part of the way everyday work is done. Continuous improvement is most effective when it becomes a natural part of the way everyday work is done.

9. Comparison of QA & QI QAQI Motivation Measuring compliance with standards Continuously improving processes to meet standards MeansInspection Prevention, monitor over time Attitude Required, defensive Chosen, proactive Focus Outliers or “bad apples”, individuals Processes, systems, majority Players Selected departments Organization wide, benchmarking Disciplines Within profession Multidisciplinary approach Scope Medical profession focused Patient care focused ResponsibilityFewAll

10. QA versus QI

11. CQI vs. RESEARCH Quality Improvement Aim: make changes that result in improvement Aim: make changes that result in improvement Methods: Methods: Test observable Test observable Stable bias Stable bias Just enough data Just enough data Adaptation of the changes Adaptation of the changes Sequential tests Sequential tests Research Aim: gain new Aim: gain newknowledge Methods: Methods: Test blinded Eliminate bias More data, just in case Fixed hypotheses One large test

12. What is Quality? Quality is a never-ending cycle of continuous improvement. - Deming

13. Final Thought… If you don’t have time to do it right, when will you have time to do it over?