Quality Improvement 101

1. Quality Improvement 101 • National Council for Behavioral HealthMontefiore Medical CenterNorthwell HealthNew York State Office of Mental HealthNetsmart Technologies

2. What Is Quality Improvement? The Gap What Should Be What Is A systematic approach to analyzing (current) performance in an organization and designing, testing and monitoring interventions that bridge the gap

3. Quality Improvement is not Quality Assurance Quality Assurance Quality Improvement Raises quality Emphasizes prevention Uses a proactive approach Requires continuous effort Focus on teamwork Examines processes or outcomes • Guarantee quality • Relies on inspection • Uses a reactive approach (ex: adverse event review) • Looks at compliance with standards • Focus on individuals • Examines criteria or requirements

4. Principles for Quality Improvement

5. Identifying Improvement Opportunities • Where does your practice need to improve patient care? • Potential sources: EHRs, registries, clinical quality data, claims data, performance against state/national standards • Where is your practice less efficient than it should be? • Potential sources: Staff discussions or surveys, assessment tools • What about the day is most frustrating for your team and/or patients? • Potential sources: Staff discussions or surveys, patient surveys or advisory boards

6. The Model for Improvement What are we trying to accomplish? AIM. Determine what specific outcomes you are trying to change. How will we know that a change is an improvement? MEASURES. Identify appropriate measures to track your success. What change can we make that will result in an improvement? CHANGES. Identify key changes that you will test.

7. Rapid Cycle Change

8. Plan • Select your improvement initiative • Identify your team • Develop your plan • What activities be completed? • What staff will be involved? • What resources (money, people, technology) are needed? • What are the anticipated barriers? • Develop your data collection plan • What metrics will be tracked on? • What data needs to be collected? • Who is responsible?

9. Do • Implement your workplan • Document observations • Record data • Communicate your progress

10. Study • Ongoing monitoring and evaluation of progress • Complete analysis of data • Comparison of results to predictions • Identify areas for improvement/refinement

11. Act • Adjust – if not getting the results you expected • Scale – if you’ve identified a replicable model • Communicate – share successes and failures • Identify – another area for improvement

12. Select your improvement initiative • Identify your team • Develop your plan • Adjust – if not getting the results you expected • Scale – if you’ve identified a replicable model • Communicate – share successes and failures Rapid Cycle Change • Ongoing monitoring and evaluation of progress • Analyze results • Identify areas for improvement/refinement • Implement your workplan • Communicate your progress

13. Root Cause Analysis Understanding and overcoming challenges and inefficiencies

14. What if things aren’t going as planned? • Root cause analysis is a process for identifying the underlying causes of a problem • Purpose: Understand what happened, why it happened, and determine how it can be avoided in the future (what changes need to be made) • When to utilize root cause analysis: • When designing an intervention, project or program • To analyze adverse events or individual patient cases • When projects or interventions aren’t going as planned

15. How does this tie to VBPs? • Value-based payments require quality improvements • Root cause analysis addresses systemic problems – making long-lasting quality improvement attainable • Root cause analysis should be a routine part of quality improvement efforts

16. Determining the Root Cause • Tool: Fishbone Diagram • Process: The 5 Whys • Identify the specific problem you want to address • Ask why the problem happens (potential causes) • Repeat – continue to ask why until you come to the root cause of the problem • Focus on the CAUSE and not the SOLUTION (we will get there!)

17. Common Cause Areas People Processes Materials Environment Management Problem (Effect)

19. Thank you! www.CareTransitionsNetwork.org CareTransitions@TheNationalCouncil.org The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.