1. How to Work with Your Subrecipients on Joint Quality Improvement Goals
Clemens Steinbock and Nanette Brey Magnani
National Quality Center
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2. Communities of Learning: collaborative, QI campaign, Regional Groups
Consultation: On/off-site coaching of recipients to advance their clinical quality management programs
Together, we can make a difference in the lives of people with HIV. NQC provides assistance to RWHAP recipients to improve HIV care since gaps in HIV care still exist and advances are uneven across HIV populations.
250 recipients (or over 700 individuals) participated in 25 Regional Groups
51% of all recipients joined the largest HIV QI campaign; viral suppression increased from 70% to 76%, a statistically significant improvement
Training and Educational Fora: monthly webinars, advanced trainings, online QI tutorials
40% of RWHAP recipients received TA and 95% would recommend TA to others
40 online QI tutorials are available; over 35,000 have been taken so far
Intensity
Information Dissemination: monthly newsletters, websites, publications, exhibits, QI awards
over 90% of the 587 RWHAP recipients accessed NQC services
~1,300 individuals (61% of recipients) graduated from 45 three-day advanced trainings
NationalQualityCenter.org |

3. Why Subrecipients Need a Clinical Quality Management Program?
It’s the responsibility of the recipient to manage the clinical quality management program with all funded organizations
All organizations must comply with the guidelines for improvement in the access to and quality of HIV services
Clinical quality management is stressed in the National HIV/AIDS Strategy and part of HAB expectations

4. HAB Policy Clarification Notice – PCN#15-02
Recipients need to ensure that their subrecipients that provide services have the capacity to contribute to the recipient’s CQM program, have the resources to conduct CQM activities in their organizations, and implement a CQM program in their organizations, as identified in the written agreements between the recipient and subrecipient.
Recipients are expected to provide guidance to subrecipients on prioritizing measures and collecting data.
Recipients need to work with subrecipients to identify improvement opportunities and monitor quality improvement activities at the subrecipient locations.
Prioritization of CQM activities should be coordinated across RWHAP recipients within service areas and subrecipients funded through the recipient.

5. Does Clinical Quality Management mean the same to recipients and subrecipients?

6. Exercise: Looking Through Lenses (Recipient)
Assumption: You are recipients. There are expectations from HRSA to have a successful CQM program to achieve NHAS goals. From your “lense….”
What do you need from subrecipients to help you achieve those goals?
What are the challenges?

7. Exercise: Looking Through Lenses (Subrecipients)
Now, put yourself in the shoes of your subrecipients. Visualize who they are and their work environment. They have expectations from their funder(s) to now have a successful CQM program to achieve high rates of improved patient care. From a subrecipient “lense….”
What do you need from your recipient to help you achieve those expectations?
What are the challenges?

8. Forging Successful Partnerships with Subrecipients
Have clear expectations for their involvement on system and subcontractor levels
Communicate those expectations clearly
Be consistent in reinforcing those expectations
Provide data that is easily understood and indicate areas for improvement

9. Clear Expectations
As a recipient, be very clear in your current and desired quality management requirements for subcontractors
Set concrete goals for subrecipient engagement in quality improvement activities such as:
Possible quality improvement projects
Establishing training curricula and provide quality improvement trainings
Emphasize the importance of data and provide feed back
Assist the subrecipient in understanding the goals of the recipient and monitor their achievement of these goals

10. Communicate Expectations Clearly
Subrecipients should understand the legislative requirements of the Ryan White HIV/AIDS Program
Engage senior leadership at the subrecipient level to obtain organization-wide buy in for the quality improvement goals
The recipient should supply the subrecipient with the agency Strategic Plan and hold yearly review meetings
Contract language must be clear and concise and specify the subrecipients responsibilities and expectations to have a CQM program

11. Be Consistent in Reinforcing Those Expectations
Review the subrecipient’s workplans and provide consistent feedback
Act as the quality improvement coach for the subrecipient; support them as they develop their programs
Remember, data are the key; keep providing feedback and redirect them to the recipient’s goals when necessary

12. Provide Data that Are Easily Understood and Indicate Areas for Improvement
Its important to understand the subrecipients data collection infrastructure; if they can’t collect it, they can’t improve it
Guide the subrecipient in presenting their data in an easy to read format
Encourage the subrecipient to share their data will all staff to foster staff buy-in for quality improvement

13. Coaching the Subrecipients
It is the role of the recipient to establish and manage their jurisdictions clinical quality management program
Therefore the recipient must be ready to provide assistance to subrecipients in achieving an effective clinical quality management program

14. NQC Guide: Partnering with Subcontractors
Step 1: Integrating Subrecipient Partnerships into the Recipient CQM Program
Obtain leadership support for partnering with subrecipients
Assess current quality improvement (QI) activities with subrecipients
Develop a plan for increasing subrecipient engagement in quality improvement
Implement the written plan
To access this resource visit our NQC website | NationalQualityCenter.org

15. NQC Guide: Partnering with Subcontractors
Step 2: Building Capacity among Subrecipients to Improve the Quality of HIV Care
Integrate the CQM requirements of subrecipients into contracting processes
Identify subrecipients’ needs for training and technical assistance
Develop, implement, and evaluate an educational training plan
Develop and conduct quality improvement trainings
Coach subrecipients to develop capacity for quality improvement
Use strategic interventions to increase subrecipients’ participation in quality improvement activities
To access this resource visit our NQC website | NationalQualityCenter.org

16. NQC Guide: Partnering with Subcontractors
Step 3: Working Across Subrecipients to Improve HIV Care
Foster collaborative relationships among subrecipients
Create a structure to improve quality across subrecipients
Engage subrecipients in developing and implementing common performance measures
Collaborate to develop performance measures for subrecipient improvement projects
Sustaining the gains; keeping subrecipients focused on continual improvements
To access this resource visit our NQC website | NationalQualityCenter.org

17. Exercise
Share one strategy from your experience working with subrecipients
to build and maintain sustainable clinical quality management programs, or
to increase buy-in for quality management among your subrecipients

18. NQC is excited to offer a variety
of learning opportunities for you during the RW Conference.
Think big and start small.
NationalQualityCenter.org |

19. Clemens Steinbock, NQC Director
Nanette Brey, NQC Coach