Improving Outcomes through Quality and Performance Improvement

1. Improving Outcomes through Quality and Performance Improvement Susan Brandau NYS Office of Alcoholism and Substance Abuse Services SusanBrandau@oasas.state.ny.us

2. Presentation Objectives • Define Quality and Performance Improvement (QPI) and Key Principles • Define OASAS QPI Approach and Planned Activities

3. Interdivisional Quality and Practice Improvement Workplan • Acting Commissioner’s Charge: The Interdivisional Workgroup on Quality and Practice Improvement should develop concrete, attainable short and long term recommendations to incorporate PI approaches at two levels: within OASAS & throughout the provider system (including counties).

4. QPI LOGO

5. What Is Performance Improvement? Performance improvement is defined as a series of administrative and programmatic processes designed for the achievement of organizational and individual results. The goal of PI is to provide high quality, measurable and sustainable prevention and treatment services for all OASAS customers.  

6. Other Key Definitions Quality is defined as the degree to which the administration and delivery of chemical dependence and gambling services increases the likelihood of desired outcomes and are consistent with current professional knowledge.  [Adapted from IOM definition]

7. Other Key Definitions • Evidence-based practices are those clinical and administrative practices that have been proven to consistently produce specific, intended results. Turning Knowledge Into Practice, The Technical Assistance Collaborative, Inc., Boston (2003)

8. Key QPI Principles and Methods:Staff Involvement and Teamwork • Organizational performance improvement is the responsibility of all staff; all are expected to participate and contribute to the desired outcomes of the organization. The expected teamwork involves training of staff in various performance improvement techniques.

9. Key QPI Principles and Methods: Develop a Learning Culture • The development of a continuous learning culture is both the desired outcome of and results in continuous performance improvement.

10. Key QPI Principles and Methods: Leadership • All staff persons in positions of leadership are responsible to support performance improvement processes, and ensure that all staff are trained, participate, and contribute to the achievement of the agency’s strategic goals.

11. Key QPI Principles and Methods:Data and Analysis • Performance Improvement is based on the systematic collection and analysis of data using accepted performance improvement tools. It is through data collection and analysis that gaps between desired and actual performance are identified giving rise to performance improvement opportunities.

12. Key QPI Principles and Methods:Customer Satisfaction • Customer satisfaction is key to QPI. Customers can be both internal and external to the organization. For OASAS initiatives, customers could include our patients, staff, control agencies, provider agencies and coalitions, referral sources, or any individual or entity that receives or “consumes” services provided by the agency.

13. Key QPI Principles and Methods:Measurable Outcomes • Continuous improvement is measured in terms of clearly stated, measurable, or countable outcomes, consistent with an organizations’ mission, strategic direction and goals.

14. QPI Components at OASAS • Organizational Structure • Inter-Divisional QPI Workgroup • Performance and Practice Improvement Unit • The Practice Research Collaborative • Bureau of Prevention • Bureau of Treatment • Workforce Development • ATC’s • Field Offices • Bureau of Enforcement • MIS Support

15. QPI Improvement Initiativesat OASAS • Funding Support • Best & Promising Practices Fund • NIDA State Enhancement Grant • Prevention SIG-E • External Partners • NE Addiction Technology Transfer Center • New York’s Clinical Trials Networks • NIATx • Northeast Center for the Application of Prevention Technology (CAPT) • ASAP • SAMHSA – CSAT, CSAP

16. Current Studies/Improvement Activities • Statewide Roll-out of Modified Mini Screen (MMS) • Development of a Quality Improvement Tool-Kit • Pilot Studies of EBPs-Contingency Management, Behavioral Couples Therapy, Modified Therapeutic Community • Best & Promising Practices Studies • Peer Review • PIC Newsletter, Local Services Bulletins, CAPrI • Prevention Activity and Results Info System (PARIS) • NIATx, STAR • Patient Feedback • Managed Addiction Tx Services • Communities that Care

17. Workplan Goals • OASAS (Short-term) • To enhance the agency-wide knowledge of QPI approaches & established evidence-based practices (EBPs) • OASAS (Long-term) • To incorporate data-driven, evidence-based decision making into OASAS functions

18. Workplan Goals • Providers (Short-term) • To finalize a QPI improvement methodology & to implement selected EBPs within selected provider settings in conjunction with other units. • Providers (Long-term) • To establish a self-sustaining cycle of QPI improvement within all OASAS providers that includes a capacity to evaluate the effectiveness of these efforts.

19. Planned Workgroup Activities: OASAS (Short-term) • Reorganize QPI Workgroup to include reps from each Division and establish an infrastructure that coordinates all QPI activities within OASAS. • Develop and disseminate marketing/informational materials to inform OASAS staff about the value and intent of the effort. • Develop an inventory of EBPs to be implemented by OASAS and providers. • Conduct briefings for Executive Staff and bureau/unit level briefings on QPI.

20. Planned Workgroup Activities: OASAS (Long-term) • Divisions conduct reviews of role relative to QPI; develop division level QPI plan. • QPI Workgroup reviews OASAS regulations, policies to identify barriers/supports for QPI implementation (e.g. defining the QI regulation). • QPI Workgroup coordinates selection of Best/Promising Practices dedicated fund projects. • QPI Workgroup develops/issues Practice Improvement newsletter, LSBs and other QPI information to OASAS staff and the field.

21. Planned Workgroup Activities: Providers (Short-term) • Meet with provider groups/coalitions to describe effort. • Establish OASAS/Provider Joint QPI Task Force and provider communication linkages • Define statewide QPI priorities based upon assessed needs. • Identify QPI methods /EBPs for each major service • Develop EBP inventory and process for dissemination; enlist support of federal agencies. • Identify structures to promote QPI/EBPs on an ongoing basis

22. Planned Workgroup Activities: Providers (Long-term) • Implement selected EBPs. • Incorporate QPI/EBPs in provider work scopes, CRISP and other OASAS review systems. • Develop systems for monitoring and reporting on provider QPI/EBP progress. • Continue to assess and refine existing practices; replicate in new locations/programs. • Continue identifying EBPs and QPI areas based on OASAS priorities and provider needs.

23. Related Strategic Plan Goals • Strategy 1.6 Increase the use of evidence-based practices and performance improvement strategies by OASAS, counties, and providers. • Enhance the agency-wide knowledge of QPI approaches and EBPs. • Implement evidence-based practices in selected provider settings. • Produce a “tool-kit” of evidence-based practices and quality/performance improvement materials. • Analyze results of the first round of the Best and Promising Practices Project studies; initiate second round • Oversee an Independent Peer Review Process that uses a process improvement approach • Develop regional learning collaboratives on specific topical areas

24. Learning Collaboratives • Identify topical areas based upon provider responses to LSP survey • Involve statewide provider association • Recruit participants, interdisciplinary teams with an expressed commitment to improve services within a temporary learning organization • Focus on one clinical or administrative improvement

25. Learning Collaboratives • Identify content area “experts”-academic/research/peer providers • Participants learn from experts and their peers-includes change concepts, QI and practical “real-world” changes that worked at other sites • Participants use a change testing model to plan, implement and evaluate changes in rapid succession

26. Learning Collaboratives • SSA utilizes Best and Promising Practices Fund to award via RFP small “mini-grants” to jump- start process • Teams set measurable targets and collect data to track performance • Participants regularly meet to learn methods, report out on experiences, change processes, results, discuss dissemination of innovations

27. Learning Collaboratives • Between meeting activity: creation of list servs to exchange ideas, e-mail support, conference calls • SSA initially externally manages process, arranges logistics, and FOOD with the goal of cultivating local leadership and ownership to assume these responsibilities

28. Recommendations for Starting Learning Collaboratives • Choose the right subject: Relevance, Timeliness, Credibility, Flexibility, Bi-directionality • Define objectives • Define roles/expectations • Conduct team building exercises • Emphasis is on mutual learning, not teaching

29. START-UP ISSUES (cont’d) • Motivate and incentivize teams-strive for inclusiveness! • Assist with the development of measurable and achievable targets • Provide TA re: data and change challenges • Plan early for sustaining improvement • Plan for dissemination and recruitment of new participants

30. Strategies to Assist with Implementation (Backer) • Inter-personal Contact • Planning and Conceptual Foresight- for Implementation and Contingencies as they emerge • Outside Consultation on the Change Process • User-oriented Transformation of Information • Individual and Organizational Championship • Potential User Involvement

31. NATIONAL OUTCOME MEASURES (NOMS) for Prevention & Tx Programs 1) Abstinence from Drug and Alcohol Use 2) Employment/Education 3) Criminal Justice/Juvenile Justice 4) Family and Living Conditions 5) Social Connectedness 6) Access/Capacity 7) Retention 8) Client Perception of Care 9) Cost Effectiveness 10) Use of Evidence-based Practices

32. QPI Cycle