1. Funded by HRSA HIV/AIDS Bureau Titles I & II Technical Assistance (TA) Webex January 11, 2007 Donna Yutzy, NQC Consultant Quality Management 101

2. Funded by HRSA HIV/AIDS Bureau Presentation Overview Definitions Key characteristics of QM Programs HRSA’s 9-step Model to Quality Model for Improvement Quality Assurance vs. Quality Improvement TA Resources

3. National Quality Center (NQC)3 Quality = degree to which a health or social service meets or exceeds established professional standards and user expectations. Definitions

4. National Quality Center (NQC)4 Quality Assurance (QA) = a broad spectrum of evaluation activities aimed at ensuring compliance with minimum quality standards. Definitions

5. National Quality Center (NQC)5 Quality Improvement (QI) = refers to activities aimed at improving performance. Definitions

6. National Quality Center (NQC)6 Continuous Quality Improvement (CQI) = describes the ongoing monitoring, evaluation and improvement processes. Definitions

7. National Quality Center (NQC)7 Indicator = measure used to determine, over time, an organization’s performance of a particular element of care. The indicator may measure function, process or outcome. Definitions

8. National Quality Center (NQC)8 Outcome = Benefits or other results (positive or negative) for clients that may occur during or after their participation in a program. Outcomes may be client-level or system-level. Definitions

9. National Quality Center (NQC)9 A systematic process with identified leadership, accountability and dedicated resources. Key Characteristics of QM Programs

10. National Quality Center (NQC)10 Use of data and measurable outcomes to determine progress toward relevant, evidence-based benchmarks. Key Characteristics of QM Programs

11. National Quality Center (NQC)11 Focus on linkages, efficiencies, and provider and client expectations in addressing outcome improvement. Key Characteristics of QM Programs

12. National Quality Center (NQC)12 Continuous process that is adaptive to change and that fits within the framework of other programmatic QA and QI activities. Key Characteristics of QM Programs

13. National Quality Center (NQC)13 Data collected is used to provide feedback into the process and to assure that goals are accomplished and that they are concurrent with improved outcomes. Key Characteristics of QM Programs

14. National Quality Center (NQC)14 HRSA’s 9-Step Model to Quality Goal of Manual: provide the tools to develop and implement a quality management program outline a step-by-step process that can be applied in any care setting applicable for both the experienced and non-experienced grantee Developed by HIV/AIDS Bureau Quality Institute

15. National Quality Center (NQC)15 HRSA’s 9-Step Model to Quality 1.Commit Leadership & Supportive Organizational Structure 2.Establish Quality Management Plan 3.Determine Performance Measures & Collect Data 4.Analyze Data 5.Develop Project-Specific CQI Plan 6.Study and Understand the Process 7.Develop and Implement an Improvement Plan 8.Re-measurement 9.Celebrate Success

16. National Quality Center (NQC)16 ‘QI is not QA’ Quality AssuranceQuality Improvement Motivation Measuring compliance with standards Continuously improving processes to meet standards Means InspectionPrevention Focus Individuals, “bad apples”Processes and Systems Responsibility FewAll

17. National Quality Center (NQC)17 How can we accelerate change and improvements in HIV programs? Model for Improvement

18. National Quality Center (NQC)18 What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? ActPlan StudyDo Model for Improvement Model for Improvement

19. National Quality Center (NQC)19 Act What changes are to be made? Next cycle? Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) Study Complete the analysis of the data Compare data to predictions Summarize what was learned Do Carry out the plan Document problems and unexpected observations Begin analysis of the data The PDSA cycle for learning and improvement

20. National Quality Center (NQC)20 PDSA Cycle to incorporate the use of a new CM form Introduce new CM Intake/ Assessment Form Improve Access to HIV Primary Care AP SD A P S D AP SD D S P A DATA D S P A Cycle 1A: Adapt new CM form and test with one of Joanne’s patients Cycle 1B: Revise tool and test with Karl’s clients next Monday Cycle 1C: Present refined tool to all 3 case managers and document feedback Cycle 1D: Revise and test tool with all clients for one week Cycle 1E: Implement and monitor the standards

21. National Quality Center (NQC)21 Developing Measures The QM Plan should be the vehicle for examining how well your agency is doing in executing your program’s priorities and strategies. The focus is not on the performance of individuals or individuals agencies/contractors, but rather focuses on how the the statewide systems are working together to improve HIV care.

22. National Quality Center (NQC)22 Developing Measures The QM Committee should develop a core set of measures that provide a snapshot of the overall quality of care provided by your program. When possible, it’s smart to start with measures that are already being collected and used in the system.

23. National Quality Center (NQC)23 Building Quality into Daily Work Make QM part of contracts with providers. Make QI part of job descriptions. Incorporate quality concepts into new employee training. Provide ongoing quality training to internal staff and to contractors. Provide opportunities for internal staff and contractors to participate in QI projects. Incorporate best practices into your service delivery.

24. National Quality Center (NQC)24 Quality Improvement Resources: Websites, Publications, Technical Assistance

25. National Quality Center (NQC)25 Key Quality Improvement Resources FAQ’s on Developing an Effective QM Program QM Program Assessment Tool QM Plan Review Checklist

26. National Quality Center (NQC)26 Websites for Quality Improvement NationalQualityCenter.org HIV measures Change ideas Best Practices Tools/Resources Literature FAQ

27. National Quality Center (NQC)27 Websites for Quality Improvement www.hivqual.org HIV QI publications Measures Best Practices HIVQUAL Project Title I/Title II specific QI Materials and Indicators

28. National Quality Center (NQC)28 Websites for Quality Improvement hab.hrsa.gov HRSA QI expectations QI Tools TA Resources

29. National Quality Center (NQC)29 Key Quality Improvement Publications

30. National Quality Center (NQC)30 Key Quality Improvement Publications

31. National Quality Center (NQC)31 Key Quality Improvement Publications

32. National Quality Center (NQC)32 New Publications

33. Funded by HRSA HIV/AIDS Bureau National Quality Center (NQC) 888-NQC-QI-TAInfo@NationalQualityCenter.orgNationalQualityCenter.org