Presentation on theme: "CQI 101: Building and Sustaining an Effective Infrastructure"— Presentation transcript:
1 CQI 101: Building and Sustaining an Effective Infrastructure Kimberly Gentry Sperber, Ph.D.
2 Achieving QualityResponsibility for quality falls on both the organization and the individual.The individual and the organization should be linked in a formal framework designed to continually improve quality.
3 Quality Assurance (QA) Retrospective review processEmphasis on regulatory and contract complianceCatching people being bad leads to hide and seek behavior
4 Continuous Quality Improvement (CQI) CQI is a prospective processHolds quality as a central priority within the organizationFocus on customer needs; relies on feedback from internal and external customersEmphasizes systematic use of dataNot blame-seekingTrust, respect, and communicationMove toward staff responsibility for quality, problem solving and ownership of services
5 Objectives of CQI To facilitate the Agency’s mission To ensure appropriateness of servicesTo improve efficiency of services/processesTo improve effectiveness of directing services to client needsTo foster a culture of learningTo ensure compliance with funding and regulatory standards
6 Creating Infrastructure Dedicated positionUse of committeesWritten CQI planDesignated process requirementsInclusion in strategic planPositioning within agencyRole of external stakeholdersWill discuss Talbert House infrastructure as an example only; infrastructure should be tailored to each agency’s vision, needs, and resources.
7 Creating a CQI Infrastructure This is Talbert House structure; does not imply that every organization should look like this.
8 Written Plan Vision/purpose Definitions Authority to ensure compliance ObjectivesDefinitionsAuthority to ensure complianceCompliance procedures/definitionsDocumentation of processPeer ReviewCommitteesMembershipSatisfactionClientsEmployeesExternal stakeholdersChoosing indicatorsUse of dataHighlights from Talbert House CQI Plan
9 Why Examine Documentation? Clinical ImplicationsDocumentation is not separate from service delivery.Did the client receive the services he/she needed?Operational ImplicationsGood documentation should drive decision-making.Means of communicationRisk Management ImplicationsIf it isn’t documented, it didn’t happen.Permanent record of what occurred in the facilitySource of Staff TrainingReflection of the provider and organization’s competency:EBPOutcome of care
10 Peer Review Committees Requires standardized, objective method for assessing charts.Random selection of charts and monthly reviewsGoal is to identify trends and brainstorm solutionsThese staff serve as front line for corporate compliance, risk management, and quality documentation
11 Peer Review Measures Completeness of Records checks Quality Issues Assessment is present and complete.Service plan present and complete.Consent for Treatment present and signed.Quality IssuesServices based on assessed needs.Progress notes reflect implementation of service plan.Documentation shows client actively participated in creation of service plan.Progress notes reflect client progress.
12 Peer Review Process Identification of review elements Assigning staff responsibilitiesWorkload analysisCreating process for selecting files for reviewDetermining review rotationReporting and use of data
13 Establishing Indicators Relevant to the services offeredAlign with existing researchMeasurableNo “homegrown” instrumentsReliable and valid standardized measures
14 Examples of Indicators Process IndicatorsPercentage of clients with a serious MH issue referred to community services within 14 days of intake.Percentage of clients with family involved in treatment (defined as min. number of face-to-face contacts).Percentage of clients whose first billable service is within 72 hours (case mgt).Percentage of positive case closures for probation/parole.Percentage of high risk clients on Abscond Status for probation/parole.Percentage of restitution/fines collected.Percentage of clients participating in treatment services.
15 Examples of Indicators Outcome IndicatorsClients will demonstrate a reduction in antisocial attitudes.Clients will demonstrate a reduction in LSI scores.Clients will demonstrate an increase in treatment readiness.Clients will obtain a GED.Clients will obtain full-time employment.Clients will demonstrate a reduction in Symptom Distress.Client will demonstrate sobriety.
16 Client Satisfaction Identify the dimensions AccessInvolvement in treatment/case planningEmergency responseRespect from staffRespect from staff for cultural backgroundAll programs use the same surveyItems are scored on a 1-4 Likert scaleFalling below a 3.0 generates an action plan
17 Operationalizing the Process Distribution and collection of surveysCoding, analysis, and reporting of dataUse of data
18 Establishing Thresholds Establish internal baselinesCompare to similar programsCompare to state or national data
19 Action Plans Plan of correction Proactive approach to problem-solving Empowers staffUsing objective data to inform decision making
20 Who Creates Action Plans? Anyone and everyone can create action plansFocus should be on who has knowledge or expertise to contributeFocus should not be on the person’s title
21 Focus on Causes not Symptoms Focus on processes/systems rather than individuals or specific errorsIdentification of risk points and their contribution to the problemIdentify changes in these processes that reduce risk of re-occurrence
22 Process Evaluation Are we serving our target population? Are the services being delivered?Did we implement the program as designed (tx fidelity)?Are there areas that need improvement?
23 Outcome Evaluation Are our services effective? Do clients benefit (change) from the services?Intermediate outcomesReduction in riskReduction in antisocial valuesLong-term outcomesRecidivismSobriety
24 Minimum RequirementsBuy-in from staff at all levels of the organizationSufficient resources allocated for staff trainingSufficient resources allocated for staff to participate in the processPeer Review MeetingsOther relevant committee meetingsData collectionSufficient information systems
25 Barriers to Implementation Agency cultureThe “black hole” of data that leads to staff cynicism and burnoutConflicting messages about targets/goals in various work domainsProblem letting go of old ways“We’re clinicians not statisticians”CostsStaff timeIS capabilitiesData collection instrumentsCoordination of the process and dissemination of the dataMultiple and sometimes conflicting demands of multiple fundersDifferent prioritiesDon’t speak the same language causing confusion for line staff
26 Overcoming Resistance Administration must walk the walkInsure early successes to increase buy-inRecognition of staff for using the processOpenly acknowledge the extra work requiredDemonstrate front-end planning to minimize workload issues
27 Benefits of Program Evaluation Proof of effective servicesMaintain or secure fundingImprove staff morale and retentionEducate key stakeholders about servicesHighlights opportunities for improvementData to inform quality improvement initiativesEstablish/enhance best practicesMonitor/ensure treatment fidelity
28 Why Invest in CQI? A CEO’s Perspective: Because it’s the right thing to do!Better for clients (i.e., better outcomes)Mission-drivenIncreased staff satisfactionIncreased staff retentionImproved referral source satisfactionMore business for related projectsOutcomes to sell to business community and other payersDemonstrates fiscal responsibility (i.e., effective use of dollars)
29 Strategic Use of CQI Data CQI data used to provide testimony before legislatureCQI data and infrastructure used to secure new contracts and grantsCQI data used in newsletters, media relations, levy campaigns, etc.CQI data used to negotiate programmatic changes with stakeholders
30 The Role of QA/QI in Community Corrections (based on UC Halfway House and CBCF study)
31 NPC Research on Drug Courts Significant at p<.05
33 Looking at Infrastructure Identification of those with powers for decision making and resource allocationCurrent capabilitiesIdeas for infrastructurePlanned needs
34 Documentation Review Feasibility of documentation review Identify sources of review elementsOperationalize routine file reviewsWhoWhenHow many
35 Choosing Indicators Identify possible measures Value of measures Methods of measurementOperationalize data collection
36 Creating a Client Satisfaction Process Identify sample survey itemsPrioritize itemsOperationalize distribution and reportingIdentify staff responsibilitiesMechanisms for sharing results
37 Program Evaluation Examples of past projects Were they beneficial?Ideas for new process and outcome evaluation projectsAvailable dataRequired resources
38 Creating a Work PlanIdentify all questions that need answered and who has the authority to answer themIdentify beginning tasksAssign responsible parties and deadlinesCreate written implementation plan