1. Trends in Quality Assurance
Achieving Safety, Health and Valued Outcomes

2. Signs of Change in Performance Management
No longer just better than the institution
Rooted in outcomes
Emphasis on enhancement
Changing role of the state
Changes in experiences of families and people with mental retardation
Changes in accreditation approaches
Outcomes
Expectations
Inclusion

3. More Signs of Change Movement away from prescriptive standards
Emphasis on CQI
Exploration of self-assessment
Collaborative development of standards
Inclusion of customer satisfaction
Satisfaction
Consensus
CQI

4. Person-Centered Systems:
Facilitate individual choice
Support relationships and community membership
Encourage natural supports
Encourage health, well-being and safety
Foster productivity and participation in meaningful work
Maximize self-determination
Support families
Build staff and provider capacity

5. Public Quality Assurance Responsibilities
Assuring that individuals are free from abuse, neglect, and exploitation;
Protecting the rights of individuals and families;
Assuring accountability in the use of public dollars;
Assuring that individuals have access to necessary professional services;
Evaluating the effectiveness if service and supports;
Assessing the performance of service providers

6. Changing Quality Landscape
Exposure of fault-lines in the system (e.g., HCFA and the press)
Expansion of supports to individuals on the waiting list
Emergence of self-determination
Olmstead decision
Struggles with MIS applications
Direct support staff shortages

7. Critical Constraints Consolidation of providers
Management of multiple systems
“Generic” approaches to quality
Increasing gray areas in public jurisdiction
Pressure from HCFA
Lack of collaboration with sister agencies

8. Emergence of Performance Indicators
First appeared in behavioral and acute care
Provide some “cues” for managing these complex systems
Highlight impact of cost containment
Illuminate what’s working
Provide early warning signs
For more information:
(Core Indicators Project)

9. Project Beginnings NASDDDS and HSRI collaboration Launched in 1997
Seven field test states + steering committee
~60 candidate performance indicators
Development of data collection instruments

10. Current Participating States
Arizona
Connecticut
Delaware
Hawaii
Illinois
Iowa
Indiana
Kentucky
Massachusetts
Montana
Nebraska
North Carolina
Oklahoma
Pennsylvania
Rhode Island
Utah
Vermont
Washington
West Virginia
Wyoming

11. What will CIP accomplish?
Nationally recognized set of performance and outcome indicators for developmental disabilities service systems
Benchmarks of performance
Trend data at the state level
Broad dissemination to all stakeholders

12. What are the Core Indicators?
Consumer Outcomes:
Satisfaction, choice, employment, community inclusion, natural supports, family supports…
System Performance:
Service expenditures and utilization, access…
Protection of Health and Safety:
Injuries, crime victimization, mortality data…
Provider Agency / Workforce Stability:
Staff turnover…

13. Data Sources Consumer Survey
Family Support Survey (plus new version for families with kids)
Family/Guardian Survey
Provider Survey (limited)
DD System MIS

14. Consumer employment data
Where people work:
Duplicated counts
Aggregate N = 3900 (11 states)
27.7% -- supported employment
21.7% -- group employment (enclave/crew)
40.4% -- facility-based employment
36.8% -- non-vocational day supports

15. Types of Employment Supports by State

16. Community Inclusion

17. Choice and Decision-Making

18. Consumer Outcomes Access Safety
81% of respondents reported that they almost always have a way to get where they want to go
Safety
93% of respondents report feeling safe in their neighborhoods
96% report feeling safe at home

19. Health Outcomes

20. Health Outcomes

21. Health Outcomes

22. Family Survey Comparisons
More positive responses on Family/Guardian Survey (this group was generally older and received more supports)
Out-of-home families more satisfied with individual supports than those with family members living at home (84% vs. 64%)
Much greater variation on satisfaction ratings for the in-home group (50% to 70%)

23. Staff Stability Day support providers report:
Lower turnover
Current staff have been employed longer
Half as many vacant positions (both FT and PT)
Both types of agencies report:
Staff who left within the last year were employed on average about 19 months
Part-time position vacancies are much higher than full-time position vacancies

24. For more information…
Visit HSRI’s website:

25. Important Next Steps
Get serious about uniform reporting of critical health and safety events
Develop staff credentialing and expand training options
Reassess roles of case managers
Refine performance contracting
Expand understanding of person-centered planning
Place individual outcomes at the center of the system
Enlist assistance of consumers and families
Identify key areas of performance
Link technology with need for information
Look at the costs and benefits of existing approaches
Make results available and accessible

26. Final Words
“Beware the Continuous Improvement of Things Not Worth Improving”
W. Edward Deming
CAUTION