Aaron Surma, MSW, MSA Jeff Capobianco, PhD, LLP

1. Strategies for Improving Assessment & Reassessment Rates using Rapid Cycle Improvement/PDSA Cycles & Dashboards Aaron Surma, MSW, MSA Jeff Capobianco, PhD, LLP May 18, 2012

2. Goals for Our Hour Together! • Review Continuous Quality Improvement (CQI) approach using Plan-Do-Study-Act (PDSA) method in the context of responding to Enrollment & Reassessment Dashboard Metrics • Review best practice approaches to Enrollment & Reassessment • Discuss & Share Ideas!

3. What is a Continuous Quality Improvement? • …an approach to the management of organizational processes that emphasizes meeting (and exceeding) consumer needs and expectations, use of scientific methods to continually improve work processes, and the empowerment of all employees to engage in continuous improvement of their work processes. • Tindill, B. S. and Stewart, D. W. (1993) Integration of Total Quality and Quality Assurance. In Al-Assaf, A. F. and Schmele, J. A. (eds) The Textbook of Total Quality in Healthcare. St Lucie Press, Delray Beach, FL, pp. 209–220.

4. So what does data collection have to do with CQI? • Understand variation in processes • Monitor process over time • See the effect of a change in the process • Provide a common reference point for process • Provide a more accurate basis for predicting the outcome of a process

5. The Data Dashboard… • The best way to monitor processes. • Helpful to have point-in-time data & • data over time descriptions. • The simpler the better!

6. Our PBHCI Dashboard • Enrollment & Reassessment • Demographic Data • Functioning • Stability in Housing • Employment & Education • Crime & Criminal Justice Status • Perception of Care • Social Connectedness • Services Received • Physical Health Indicators

7. Data are the Building Blocks for Knowledge • What is data? • Granular or unprocessed bits of information • What is information? • Information is data that have been organized & communicated in a coherent & meaningful manner (e.g. dashboard or registry) • What is Knowledge? • Information evaluated and organized so that it can be used purposefully to understand how a process leads to an outcome(s)

8. Data explains processes that produce Outcomes • Outcomes are an important means of establishing value and accountability in healthcare. • Outcomes are dependent on processes. • Replicable outcomes are dependent on consistent processes. • Process variance creates a challenge in ability to determine reasons for successful outcomes.

9. Unchecked process variation

10. The Rapid Cycle PDSA

11. Plan • The first step in a PDSA cycle is to figure out what process you wish to improve, observe or change? • State the aim of the test/PDSA cycle • Predict the possible outcome • Develop a plan to test the changes • Once you’ve chosen the process to explore, give some thought to: • Which actions need to happen & in what order? • Who will be responsible for each step? • Who needs to be informed or consulted? • Which data will be collected & how?

12. Do • Undertake the test which allows you to: • • Document the process, taking note of practice staff & • consumers’ reactions, any problems, or unexpected • observations • • Collect all measurements, data, & observations • • Substantiate the probability that a change in this area • is possible • • Decide whether the change will produce an • acceptable outcome

13. Do cont. • • Decide on the scope of the change & if it is viable in the actual practice setting • • Decide if a combination of process changes is required to achieve the outcome • • Understand the cost, resources and patient/practice staff impact

14. Study • The third step is to review & analyze the data: • • Set aside time for all persons involved in the process to discuss the outcomes of the small scale test • • Review all data & observations against expected outcomes. Did the practices’ expectations match what really happened? • • Consider what could be done differently • • Reflect on what has been learned • • Reach a consensus on subsequent action(s)

15. Act • The ‘act’ step is to make the necessary adaptations or improvements to improve the process you studied • Allows the team time to acknowledging & celebrate successes • It allows the team to use the information to target another rapid series of PDSA processes.

16. The Rapid Cycle PDSA • Plan • Identify a process in need of improvement & develop an plan based on a hypothesis • Do • Try out the plan • Study • Evaluate the test run • Act • If it worked great! Start using the new process! • If not then create a new plan & rapid cycle again

18. Best Practices for the NOMS Data Collection Process • Map Enrollment & Reassessment Service Flow • Clarify NOMS enrollment & reassessment team assignments/roles (PBHCI & other staff) • If possible have dedicated staff collecting NOMS data • Train staff in the use of Motivational Interviewing Approaches • Pre-fill as much data as possible

19. Best Practices for the NOMS Data Collection Process • Assume no one will return for a reassessment • Assess & communicate to other team members the consumer’s “barrier to reassessment profile” • Use dashboard approach to keep team aware of current Enroll/Reassess rates & to identify consumers needing reassessment • Use incentives (for both consumers & staff) to insure enrollment & reassessment • Other ideas???