Quality Assurance: Continuous Quality Improvement

Quality Assurance: Continuous Quality Improvement 2010 Texas Behavioral Health Institute Rhonda G. Patrick, MPA, LCSW Blue Basin, Inc.

Course Objectives • Participants will understand what quality assurance means and it purpose. • Participants will understand how to develop and implement a quality assurance program. • Participants will have knowledge quality assurance practices. • Participants will learn how to utilize a quality assurance program to make management and organizational changes.

Quality Assurance Is…. • Meeting the customer needs • Identify the customer and what they need • Improve the process to fully meet this need.

Continuous Quality Improvement • Continuous quality improvement (CQI) is a concept in which the focus is on a team approach to improvement. • Rewards the group when things get better. • A shift in focus from the end product or service to the process. • CQI evaluates the entire client care delivery system to identify opportunities for improvement. • It asks “how can the system be changed to improve quality organization wide?”

Continuous Quality Improvement • CQI requires people to look at their work in terms of being part of a continuous process. • CQI is a relentless effort to add value for the customer. • The CQI process should be driven from the top, but implemented from the bottom. • Problem areas must be prioritized, critical processes selected for improvement, and improvement goals set for the project team. • Problem solving and implementation is done by teams which include staff at the working level.

Continuous Quality Improvement • FOCUSon a particular issue: • Find a process to improve • Organize to improve a process • Clarify what is known • Understand variation • Select a process improvement

Continuous Quality Improvement, Cont…. • Move through a process improvement plan, PDCA • Plan: create a timeline of resources, activities, training and target dates. Develop a data collection plan, the tools for measuring outcomes, and thresholds for determining when targets have been met. • Do: implement interventions and collect data.

Continuous Quality Improvement, Cont…. • Check: analyze results of data and evaluate reasons for variation. • Act: on what is learned and determine next steps. If the intervention is successful, work to make it part of standard operating procedure. If it is not successful, analyze sources of failure, design new solutions and repeat the PDCA cycle.

Principles of CQI • Quality improvement is oriented towards meeting the needs and expectations of the patients and the communities. • Quality improvement focuses on systems and processes. • Quality improvement uses data to analyze service delivery processes. • Quality improvement encourages a multi-disciplinary team approach to problem solving and quality improvement.

Benefits of CQI • Shared leadership and governance • Total quality management principles applied throughout the organization • Empowered staff and organizations • Better patients (clients) outcomes • Staff morale improved • Customer satisfied • Quality improvement institutionalized • Accredited Facilities

CQI Model

CQI Approaches Comprehensive Approach • Quality improvement policies, procedures and processes are implemented simultaneously, starting at the top and moving down the organization. • Begin with a thorough review of standards and specifications. • Assessment of health care and support services through either an existing management information system or a monitoring system specifically designed to measure service quality. • Identification of priority areas for quality improvement. • Must have system wide commitment to addressing quality of care and availability of necessary resources towards large scale implementation.

CQI Approaches The Problem-oriented Approach • Emphasis on practical, small-scale quality related activities that produce incremental quality improvements. • Based on the assumption that a monitoring system and a more systematic approach can be developed over time, once problem solving has become part of the organizational culture. • Allows an organization to modify and adopt the a problem-solving strategy before wider implementation.

Developing a CQI Program Defining and Operationalizing Organizational Goals • Mission of Organizations • Goals of Organization • Operationalize goals through objectives and strategies.

Developing a CQI Program, Cont.. • Goals should be based on the organizations strategic plan for growth. • Goals should encompass: • Administrative and Management Operations • Personnel • Treatment or Services (program evaluation) • Fiscal

Strategic Plans Strategic planning is a multi-step process that includes: • A review of stakeholders and customers • Conducting a needs assessment • Definition of the program's: Purpose and values Mission, vision Service delivery model Goals and objectives, and strategies and tactics Strategic Decision Points

Developing a CQI Program Parameters for Model Development • Must identify Standards • Must develop Policies and Procedures

Developing a CQI Program Parameters for Model Development • Model needs to Include: • Evaluation of Administrative Processes • Strategic Planning • Reporting • Contracting • Regulatory Compliance • Fundraising • Evaluation of Personnel Processes • Hiring Practice • Documentation • Benefit Utilization • Staff Growth and Development • Performance

Developing a CQI Program Parameters for Model Development • Evaluation of Program Effectiveness • Formal program evaluation of program design • Performance Measures • Customer satisfaction • Regulatory compliance • Utilization Review Process

Developing a CQI Program Parameters for Model Development • Evaluation of Fiscal Practices • Adherence to GAAP • Contractual requirements • Billing Controls • Revenues Development • Budgeting

Developing a CQI Program Data Management • What to measure • How to measure • When to measure • How to use what is measured • Information Systems

Developing a CQI Program Measurement Tools • Develop your own • Ask your oversight agency for a copy of their tools • Self development tools, ask yourself: • How would I measure this? • What would I need to look at to know? • What do my oversight agencies look at? • Tools for these areas, can be multiple, or one: • Administrative • Personnel • Treatment • Program Evaluation (pre-test/post-test) • Compliance Checklists • Fiscal

Developing a CQI Program Finding and Training Staff • In-House Staff • Look at your own staff, what strengths do they have, where have they worked. Do they have aptitude. • Hire Credentials • Certified QA Specialist • CHCQM- Certified Healthcare Quality Manager • LHCRM- Licensed Healthcare Risk Manager • Hire Experience • CQI Experience • Quality Management

Developing a CQI Program • Training • Certificate Programs • Workshops • On-line Instruction • In-House Training • Consultants • Use to help set-up programs and train, not as full-time CQI coordinator

Implementing CQI There are many ways to carry out a Continuous Quality Improvement project. A generic approach is described here which should suit most situations. No projects are the same and so the approach should be tailored to fit the job.

Set up the Project Team Define the scope Set the goals Understand the process Flow Charts Plan the project Determine Information Needs Chose the tools for the job Identify the root causes Develop solutions Implement the solutions Review the results Standardize the Change Implementing CQI

Implementing CQI Set up the Project Team • A team can draw on a wider range of experience and skills. • Chose team members to ensure the team is knowledgeable in every aspect of the process being studied. • Major stakeholders and customers should be represented. • Lower level process teams should have people from the working level. • Higher level process teams should include managers. • Team members must be knowledgeable in team building skills and understand the tools and strategies that can be used for problem solving.

Implementing CQI Define the scope • The Project Team should review the scope of the project. • Negotiate changes with the Steering Team. • Get input from the customer and end user to determine problems and expectations. • The scope of the project should include: • the statement of the problem • a definition of the boundaries • the magnitude of improvement goals • a target date for completion • resources available

Implementing CQI Set the goals • Determine what the customer and the end user want. • The goal should be to find out expectations and meet them. • Determine how the customer/end user: • use the product or service • what problems they have with it • how it can be enhanced • The information should be analyzed. • The team should define the project goals. • The team should develop a very clear understanding of what is expected from the project.

Implementing CQI Understand the process • Have a process description. • The team should ask and answer key questions: • What does the process do? • What are the stages of the process? • What are the starting and finishing points of the process? • What are the inputs and outputs from the process? • Who are the suppliers and the customers of the process? • Who uses the product and who pays for it? • Are there obvious problems with the process?

Implementing CQI Flow Charts Create a visual understanding of how the process works. Useful CQI Flow Charts: • A Top Down Flow Chart • Deployment Matrix Chart

Implementing CQI Plan the project There is no 'right' way to tackle a project. There are many ways and some will work better than others. The basic plan of action will be to: • identify root causes • develop solutions • implement the changes • review the results

Implementing CQI Determine Information Needs The team should review what information is needed to analyze the problem. For each goal the team should: • determine what information is needed to understand how well the process is working • what information is available and what is not available • and how to collect the information that is not presently available

Implementing CQI Chose the tools for the job The tools include: • Time Plots • Control Charts • Brainstorming • Consensus Building • Cause and Effect Diagrams • Structure Trees • Pareto Charts • Six Questions

Implementing CQI Identify root causes • Define the problem • Develop a list of possible causes • Generate ideas as to the root cause • Ask what and why questions until the team cannot think of another question to ask. • Verify the conclusions with data • Why collect data • What data is needed to verify the conclusions • Take action to fix obvious root causes immediately

Implementing CQI Develop solutions • Define the characteristics of an ideal solution. • Identify the criteria that must be satisfied and the criteria that are desirable but not absolutely necessary. • Constraints should be identified. • Each possible solution should be evaluated against the criteria for selection. • When the team identifies constraints which in fact are not real constraints, the team may find some flexibility if it pushes hard enough to have constraints removed. • Feedback should be obtained from those that are most affected by the changes. • Changes may be able to be implemented immediately, others may need to presented to the Steering Team to obtain approval before they can be implemented.

Implementing CQI Implement the solutions • To implement changes, the team should: • Plan • Do • Check • Act • Define exactly what changes are to be made. • Generate a list of activities that need to be done. • Determine the sequence of steps that are required to implement the changes. • A schedule of activities should be prepared and milestones defined. • Responsibilities for each of the action steps should be defined. • All who are affected by the changes are properly informed, briefed and understand how the changes will take place. • Implement changes on a pilot basis.

Implementing CQI Review the results • Monitor the effectiveness of the changes. • Compare the results of the changes with the original goals of the study. Ask the following questions: • Did the team achieve the expected benefits? • Where there any unexpected benefits or problems? • What can the team learn from these? • What can be done to fine tune the solution so that it can be applied on a wider basis?

Implementing CQI Standardize the Change If the improvement project has been successful with one process it should be refined and applied to other processes which are similar. One should not waste time setting up further improvement teams to re-invent the wheel.

Implementing a CQI Program Management Report • Identifies area of strength • Identifies liabilities • Makes corrective action recommendation • Addresses corrective action taken • Effect of corrective action • Monthly reports will be fluid • Annual report to Executive Management and Governing Board to be final product.

Quality Assurance: Continuous Quality Improvement