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The Role of the Quality Improvement Process in Service Delivery
MATHEW ROOSA, LCSW-R
[email protected] , [email protected]
315-435-3355 X4969 , 315-727-4565
Housekeeping:
• Slides are posted at MCTAC.org
• Questions not addressed today will be:
• Reviewed and incorporated into future trainings and presentations
• Added to Q&A resources when possible
• Feedback forms
Reminder: Information and timelines are current as of
the date of the presentation
Introduction & Housekeeping
What is MCTAC?
MCTAC is a training, consultation, and educational resource
center that offers resources to all mental health and
substance use disorder providers in New York State.
MCTAC’s Goal
Provide training and intensive support on quality
improvement strategies, including business, organizational
and clinical practices to achieve the overall goal of
preparing and assisting providers with the transition to
Medicaid Managed Care.
CTAC & MCTAC Partners
3/21/2014
Small Business Initiative Partners
About the PresenterMathew Roosa, ACSW, LCSW-R is the Director of Planning and Quality Improvement for the Onondaga County Department of Adult and Long Term Services, providing support to mental health, substance use, Corrections, Ageing, and other service systems. Mr. Roosa is the former Clinical Director of Central New York Services, a Non-Profit Agency providing residential, forensic, and treatment services, and specializing in services for people with co-occurring chemical dependency and mental illness.
Mr. Roosa’s experiences also include the maintenance of a private psychotherapy practice, and teaching as an adjunct faculty member of the Human Services Department at Cazenovia College and the Syracuse University Social Work Program. He also works as a consultant, trainer, and coach, providing organizational and systems level support for program development, quality improvement, and strategic planning.
Agenda‣ Discussion of the core elements of the rapid cycle
plan-do-study-act approach to quality improvement
‣ Explore how to use this PDSA model to:
• Develop goals,
• Measure your progress,
• Achieve results.
10 Steps to Change
STEP 1: Choosing a Goal
Pre-Change Steps
STEP 2: Choosing a Change
STEP 3: Planning to Measure
Progress
Change Steps
STEP 4: Plan the Change
STEP 5: Do the Change
STEP 6: Study the Results
STEP 7: Act on the Data & Lessons
Learned
STEP 9: Sustaining the Change
Post-Change Steps
STEP 10: Spreading the Change
Step 8: Multiple
PDSA Cycles
(as needed)
10 Steps to Change
Adapted from
*Langley, et al
*NIATX workbook
*IHI
Choosing Goals:‣ How do we define what we want to change/ improve?
‣What are the tools we can use to plan our goals & the
changes to achieve them?
Environmental Scan
Macro Trends
(State/ National--
broader culture)
Micro Trends
(Local--
your industry)
Social/ Demographic
Trends
Economic Trends
Political Trends
Technological Trends
SWOT/SOAR Analysis
SOAR. Appreciative Inquiry, strength based alternative to SWOT
‣Strengths: What makes us proud?
‣Opportunities: How do we make sense of the
opportunities in our environment?
‣Aspirations: What do we care deeply about?
‣Results: How do we know we are succeeding?
Cause and Effect Diagram
Finding the root causes
Problem CC
C
C
C
CC
C
C
C
CC C
Why does
that
happen?
Walk ThroughA Structured role play that allows you to experience
the clients perspective, and reveal change opportunities.
‣ Inform staff
‣ 2 participants
‣Do a piece, do it all
‣Plan your role
‣Stay in role
‣ Take notes
‣ Focus on emotional experience
With each step ask:
Is this step needed?
Is this step the best it
can be?
Source: IHI
Flow Chart
Steps Transitions
Flaws
Fixes
Nominal Group Technique
‣ 4 STEPS of NGT:
1. Silent Generation of
ideas based on a
strong question.
2. Round Robin Report
and Record.
3. Discussion for
Clarification.
4. Voting. (force choice)
Good Brain storming IS…
‣ structured/facilitated by a
leader.
‣ focused on a specific
question or problem.
‣ Includes all participants.
‣ Encourages all ideas.
‣ Engages individuals in a
team effort.
‣ Generates a wide range of
new ideas.
Surveys
‣ Search for strong questions
‣ Minimize Likert point scales
‣ Rank order to force choice
‣ Open ended responses, sort for themes
‣ Top 3 responses
‣ Keep it short
‣ Engage for high response rate
3 Q survey:
1. What is the Best
part?
2. What is the Worst
part?
3. How can we fix the
worst part ?
Choosing Measures‣ How will we measure our progress to understand if we
are having an impact?
‣ Use existing sources
‣ Keep it simple, be practical: The do-ability test
‣ “Counting stuff” (pre-post, trends over time)
‣ Can you manage it?
‣ Can you sustain it?
Data
If you want to change something,
measure it.
The Data
is the
Compass
The
Data is
the Wind
DATAUnderstanding
Connectedness
Understanding
Patterns
Wisdom
Knowledge
INFO.Understanding
Relationships
Understanding
Principles
PDSAAct
• What changes
are to be made
in next cycle?
Abandon
Adapt
Adopt
Plan
• Objective
• Questions and
predictions (why)
• Plan to carry out
the cycle (who,
what, where, when)
Study• Complete the
analysis of the data
• Compare data to
predictions
• Summarize
what was
learned
Do• Carry out the plan
• Document problems
and unexpected
observations
• Begin analysis
of the data
Multiple Cycles
Week Week Week Week Week Week Week Week Week Week Week Week
1 2 3 4 5 6 7 8 9 10 12 13
100
90
80
70
60
50
40
30
20
10
% of
Clients
who
show
for
Intake
Session
Baseline Period Change Cycle #1 Change Cycle #2 Sustain Period
A P
S D
A P
S D
Teams
If you want to go
fast, go alone…
If you want to go
far, go together.
African proverb
…
Team as Verb
To team…the act of
Teaming…
To put together in
order to do something
or to achieve a
particular effect.
Questions and Discussion
Please email additional questions [email protected] and register for future events at
http://www.mctac.org under “Upcoming Events.”
