QUALITY IMPROVEMENT: UNDERSTANDING THE

PROCESS

House of New Hope

1/2008

Benefits of a QI Process

Old View of QI:• Adversarial: “what’s wrong”• “No news is good news”• Use process to catch mistakes and

omissions early• Do it because required to• Helps to improve audit results

1/2008

Benefits of a QI Process

New View:• “Nobody is perfect”-information on “how we are doing”

is essential• Identifies patterns and trends • Eliminates gaps• Reduces agency risks• Assists in establishing priorities in service delivery• Defines “best practices”• Helps to define training needs• Provides data to make management decisions around

services

1/2008

What is Quality Improvement?

• Quality Improvement: a structured process that selectively identifies and improves all aspects of care and service on an ongoing basis through the use of disciplined inquiry, teamwork and targeted actions.

1/2008

Agency Quality Improvement PlanElements:• Records Review: compliance and quality• Health and Safety• Input from Persons Served: Satisfaction

surveys• Utilization Review (efficient use of services)• Risk Management• Outcomes: Performance Indicators

1/2008

What Makes Quality Improvement Plans Effective?• Staff and Administrative Ownership

o It’s everyone’s responsibilityo Belief in the process: use of data to make

decisions• Feedback on the process

o Ability to see it’s effectiveness• Strategic Planning

o Ability to apply what’s been learned to present and future decisions

1/2008

Compliance Focus

ODJFSo Is it in the record?o Did you complete it on time?

ODMHo Is the service necessary?o Are your interventions appropriate?o Are your interventions effective?

1/2008

Compliance FocusCARF• How are you doing? (Data Collection)• How do you know?

(Performance Indicators)• Can you demonstrate why you made a

particular decision? (Evidence based practices; management by data)

1/2008

Types of Review

• Clinical Records Reviewo Assures completion of required documents

• Qualitative Peer Review Assures quality documentation Addresses Medical Necessity (established

need for services)o Addresses principals of good practice

Continuity of Care Integrated Services

1/2008

Selection Criteria

• Length of Care: 30 to 60 days 90 to 270 days 270 days or more Discharge Hospitalization

o Representative of all staff and programso Randomo Integrity: Prohibition of self review

1/2008

QI ProcessForms • Each record will be reviewed for clinical

completeness and quality of documentationReviewer Teams• no less than two persons to a team; • no reviewing of own recordRecord Review • Agreement on ratings• Positive Constructive Feedback

1/2008

Clinical Records Review

Compliance categories needing Correction• C/C: Compliant and Complete-(contains all

required elements and completed within required time frames

• C/I: Compliant/Incomplete-Compliant, such as form is present, but may be missing elements.

• N/I: Non-compliant/Incomplete-information is not present, requires completion

1/2008

Compliance Categories not able to be Corrected

N/C: Non-compliant, complete-form is present but not completed within required timeframe (i.e. cannot be corrected)N/A: Not applicable-use ONLY when time frames or circumstances do not require completione.g. Assessment not complete: youth in care for 20 days—rating is N/A

1/2008

Data Collection Process

• Reviewer Team completes record review• Completed review is turned in to Director of

Care Management• Staff requested to make corrections as

indicated• Corrections completed by designated time

frame• Identify next set of records for review

1/2008

Reporting Process

• Results of reviews are reported in aggregate on a quarterly basis

• Action steps for system improvement are identified

• Reviewed by staff, management, board of trustees

• Results are continuously monitored to identify effectiveness of changes

• If no improvement, identify new action steps

1/2008

Continuous Quality Improvement

• Performance improvement will highlight processes and systems that need to be improved and follow-up with a plan of action to improve the outcomes.

• The process is continuous.• Data continues to be collected and analyzed.• Services continue to identify performance

concerns or goals: “performance indicators”

1/2008

Agency Mission Statement Helps to:• Establishing a Common Value and Philosophy of Care“The mission of House of New Hope is to transform the lives of vulnerable children in need of safe and permanent families, by providing treatment-oriented, culturally sensitive and cost effective community based services.”

1/2008

Performance IndicatorsHelp to:

• Establish a Common Focus• Establish a Common Definition of:

o Good Businesso Good Practice o Good Service Delivery

1/2008

Defining Service Performance Indicators• Outcomes: How do you know you are doing a

good job with your clients?• Responsiveness• Satisfaction• Effectiveness

o Improvement in functioningo Reduction in symptoms

• Permanenceo Reduced disruptions

1/2008

Defining Agency Performance Indicators• Licensing

o Recruitmento Annual Number of Completed Home studieso Reduced withdrawals

• Transportationo Safetyo Met all appointments

• Training o Applies knowledge gainedo Rule violations o Satisfaction with training

1/2008

Defining Agency Indicators• Fiscal

o Contract complianceo Billing hours budgeted met

1/2008

What measures do you use to determine that you are effective in your work?

1/2008