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CQI 101: Building and Sustaining an Effective Infrastructure. Kimberly Gentry Sperber, Ph.D. Achieving Quality. Responsibility for quality falls on both the organization and the individual.

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Cqi 101 building and sustaining an effective infrastructure

CQI 101:Building and Sustaining an Effective Infrastructure

Kimberly Gentry Sperber, Ph.D.

Achieving quality
Achieving Quality

  • Responsibility for quality falls on both the organization and the individual.

  • The individual and the organization should be linked in a formal framework designed to continually improve quality.

Quality assurance qa
Quality Assurance (QA)

  • Retrospective review process

  • Emphasis on regulatory and contract compliance

  • Catching people being bad leads to hide and seek behavior

Continuous quality improvement cqi
Continuous Quality Improvement (CQI)

  • CQI is a prospective process

  • Holds quality as a central priority within the organization

  • Focus on customer needs; relies on feedback from internal and external customers

  • Emphasizes systematic use of data

  • Not blame-seeking

  • Trust, respect, and communication

  • Move toward staff responsibility for quality, problem solving and ownership of services

Objectives of cqi
Objectives of CQI

  • To facilitate the Agency’s mission

  • To ensure appropriateness of services

  • To improve efficiency of services/processes

  • To improve effectiveness of directing services to client needs

  • To foster a culture of learning

  • To ensure compliance with funding and regulatory standards

Creating infrastructure
Creating Infrastructure

  • Dedicated position

  • Use of committees

  • Written CQI plan

  • Designated process requirements

  • Inclusion in strategic plan

  • Positioning within agency

  • Role of external stakeholders

Written plan
Written Plan

  • Vision/purpose

    • Objectives

  • Definitions

  • Authority to ensure compliance

  • Compliance procedures/definitions

  • Documentation of process

  • Peer Review

  • Committees

    • Membership

    • Objectives

  • Satisfaction

    • Clients

    • Employees

    • External stakeholders

  • Choosing indicators

  • Use of data

Why examine documentation
Why Examine Documentation?

  • Clinical Implications

    • Documentation is not separate from service delivery.

    • Did the client receive the services he/she needed?

  • Operational Implications

    • Good documentation should drive decision-making.

    • Means of communication

  • Risk Management Implications

    • If it isn’t documented, it didn’t happen.

    • Permanent record of what occurred in the facility

  • Source of Staff Training

  • Reflection of the provider and organization’s competency:

    • EBP

    • Outcome of care

Peer review committees
Peer Review Committees

  • Requires standardized, objective method for assessing charts.

  • Random selection of charts and monthly reviews

  • Goal is to identify trends and brainstorm solutions

  • These staff serve as front line for corporate compliance, risk management, and quality documentation

Peer review measures
Peer Review Measures

  • Completeness of Records checks

    • Assessment is present and complete.

    • Service plan present and complete.

    • Consent for Treatment present and signed.

  • Quality Issues

    • Services based on assessed needs.

    • Progress notes reflect implementation of service plan.

    • Documentation shows client actively participated in creation of service plan.

    • Progress notes reflect client progress.

Peer review process
Peer Review Process

  • Identification of review elements

  • Assigning staff responsibilities

    • Workload analysis

  • Creating process for selecting files for review

  • Determining review rotation

  • Reporting and use of data

Establishing indicators
Establishing Indicators

  • Relevant to the services offered

  • Align with existing research

  • Measurable

    • No “homegrown” instruments

    • Reliable and valid standardized measures

Examples of indicators
Examples of Indicators

Process Indicators

  • Percentage of clients with a serious MH issue referred to community services within 14 days of intake.

  • Percentage of clients with family involved in treatment (defined as min. number of face-to-face contacts).

  • Percentage of clients whose first billable service is within 72 hours (case mgt).

  • Percentage of positive case closures for probation/parole.

  • Percentage of high risk clients on Abscond Status for probation/parole.

  • Percentage of restitution/fines collected.

  • Percentage of clients participating in treatment services.

Examples of indicators1
Examples of Indicators

Outcome Indicators

  • Clients will demonstrate a reduction in antisocial attitudes.

  • Clients will demonstrate a reduction in LSI scores.

  • Clients will demonstrate an increase in treatment readiness.

  • Clients will obtain a GED.

  • Clients will obtain full-time employment.

  • Clients will demonstrate a reduction in Symptom Distress.

  • Client will demonstrate sobriety.

Client satisfaction
Client Satisfaction

  • Identify the dimensions

    • Access

    • Involvement in treatment/case planning

    • Emergency response

    • Respect from staff

    • Respect from staff for cultural background

  • All programs use the same survey

  • Items are scored on a 1-4 Likert scale

  • Falling below a 3.0 generates an action plan

Operationalizing the process
Operationalizing the Process

  • Distribution and collection of surveys

  • Coding, analysis, and reporting of data

  • Use of data

Establishing thresholds
Establishing Thresholds

  • Establish internal baselines

  • Compare to similar programs

  • Compare to state or national data

Action plans
Action Plans

  • Plan of correction

  • Proactive approach to problem-solving

  • Empowers staff

  • Using objective data to inform decision making

Who creates action plans
Who Creates Action Plans?

  • Anyone and everyone can create action plans

  • Focus should be on who has knowledge or expertise to contribute

  • Focus should not be on the person’s title

Focus on causes not symptoms
Focus on Causes not Symptoms

  • Focus on processes/systems rather than individuals or specific errors

  • Identification of risk points and their contribution to the problem

  • Identify changes in these processes that reduce risk of re-occurrence

Process evaluation
Process Evaluation

  • Are we serving our target population?

  • Are the services being delivered?

  • Did we implement the program as designed (tx fidelity)?

  • Are there areas that need improvement?

Outcome evaluation
Outcome Evaluation

  • Are our services effective?

  • Do clients benefit (change) from the services?

  • Intermediate outcomes

    • Reduction in risk

    • Reduction in antisocial values

  • Long-term outcomes

    • Recidivism

    • Sobriety

Minimum requirements
Minimum Requirements

  • Buy-in from staff at all levels of the organization

  • Sufficient resources allocated for staff training

  • Sufficient resources allocated for staff to participate in the process

    • Peer Review Meetings

    • Other relevant committee meetings

    • Data collection

  • Sufficient information systems

Barriers to implementation
Barriers to Implementation

  • Agency culture

    • The “black hole” of data that leads to staff cynicism and burnout

    • Conflicting messages about targets/goals in various work domains

    • Problem letting go of old ways

    • “We’re clinicians not statisticians”

  • Costs

    • Staff time

    • IS capabilities

    • Data collection instruments

    • Coordination of the process and dissemination of the data

  • Multiple and sometimes conflicting demands of multiple funders

    • Different priorities

    • Don’t speak the same language causing confusion for line staff

Overcoming resistance
Overcoming Resistance

  • Administration must walk the walk

  • Insure early successes to increase buy-in

  • Recognition of staff for using the process

  • Openly acknowledge the extra work required

  • Demonstrate front-end planning to minimize workload issues

Benefits of program evaluation
Benefits of Program Evaluation

  • Proof of effective services

    • Maintain or secure funding

    • Improve staff morale and retention

    • Educate key stakeholders about services

  • Highlights opportunities for improvement

  • Data to inform quality improvement initiatives

  • Establish/enhance best practices

  • Monitor/ensure treatment fidelity

  • Why invest in cqi
    Why Invest in CQI?

    • A CEO’s Perspective:

      • Because it’s the right thing to do!

      • Better for clients (i.e., better outcomes)

        • Mission-driven

      • Increased staff satisfaction

      • Increased staff retention

      • Improved referral source satisfaction

      • More business for related projects

      • Outcomes to sell to business community and other payers

      • Demonstrates fiscal responsibility (i.e., effective use of dollars)

    Strategic use of cqi data
    Strategic Use of CQI Data

    • CQI data used to provide testimony before legislature

    • CQI data and infrastructure used to secure new contracts and grants

    • CQI data used in newsletters, media relations, levy campaigns, etc.

    • CQI data used to negotiate programmatic changes with stakeholders

    The role of qa qi in community corrections based on uc halfway house and cbcf study
    The Role of QA/QI in Community Corrections(based on UC Halfway House and CBCF study)

    Getting started

    Getting Started

    Identifying Key Decision Points

    Looking at infrastructure
    Looking at Infrastructure

    • Identification of those with powers for decision making and resource allocation

    • Current capabilities

    • Ideas for infrastructure

    • Planned needs

    Documentation review
    Documentation Review

    • Feasibility of documentation review

    • Identify sources of review elements

    • Operationalize routine file reviews

      • Who

      • When

      • How many

    Choosing indicators
    Choosing Indicators

    • Identify possible measures

    • Value of measures

    • Methods of measurement

    • Operationalize data collection

    Creating a client satisfaction process
    Creating a Client Satisfaction Process

    • Identify sample survey items

    • Prioritize items

    • Operationalize distribution and reporting

    • Identify staff responsibilities

    • Mechanisms for sharing results

    Program evaluation
    Program Evaluation

    • Examples of past projects

      • Were they beneficial?

    • Ideas for new process and outcome evaluation projects

    • Available data

    • Required resources

    Creating a work plan
    Creating a Work Plan

    • Identify all questions that need answered and who has the authority to answer them

    • Identify beginning tasks

    • Assign responsible parties and deadlines

    • Create written implementation plan