Objective 1.1 Toolkit Assuring Quality Improvement

1. Objective 1.1 ToolkitAssuring Quality Improvement Alliance Empowerment Coalition End

2. Table of Content Our Toolkit – An Introduction What’s in this toolkit? What this toolkit is not? Where did this toolkit originate? What is the purpose of this toolkit? Definitions of some statistical stuff. Theories, theories and more theories: a reason why? Theoretical Construct: the roots of quality improvement Instruments to Measure Capability Potentials Synergistic Comparison Motivation Toward Self Determination Structural Opportunities Group/Organizations’ Components Alliance Empowerment Coalition Toolkit 1.1

3. Our Toolkit – An Introduction What’s in this toolkit? The toolkit has three sections: 1. What is Quality Improvement and why do we need it? 2. Theories, theories and more theories: a theory as to how to better our work. 3. Outcome made of three pieces to measure and compare, triangularly that is: • the organization’s characteristics, • the local community’s opportunities • the motivation of self-determination of the organization The intention of this toolkit is to generate quality improvement discussions that will lead to the improvement in the work your group or organization is performing. What this toolkit is not? This Toolkit is not meant to replace present quality improvement procedures, nor is it a template to be copied and regurgitated. We hope this toolkit will generate a process of ongoing questioning and evaluating of the product supplied by the group or organization. It is meant to motivate the group to continually communicate with their customer who, what, where, when and how the service product needs to improve. This process must include management, front line staff, board members and most important people who are at the receiving end of the service product. If a group or organization is going to maintain a high quality service product it must be measuring, evaluating and changing its approach to meet the various needs of the people within their community. Where did the toolkit originate? This toolkit was created from the materials discussed at work group sessions convened to address assuring quality improvement in the service products produced by peer groups and organizations. The culturally diverse work group included people who have received mental health services, family members who have had love ones in the mental health system, research experts, educators, mental health service providers, people who have received mental health services leaders, and people in business. The topics discussed included abilities of an organization, the environment or community opportunities and the motivational direction and self-determination of the group or organization. What is the purpose of the toolkit? The purpose of this toolkit is to identify mechanisms by which stakeholder-run organizations can document their successful means by which they pursue their vision mission and strategic plan. The discovered mechanisms will be disseminated to groups throughout the state. In addition, this toolkit reviews existing quality assessment processes and recommends a framework for ongoing quality assessment and improvement activities. And, to review existing program data collection activities and recommend a framework for ongoing data collection and evaluation. This toolkit is a living product that will follow the same framework of continuous growth as mentioned above. It will undergo a variety of changes and rearrangements based on the obtained input from the continual review and evaluation by groups and organizations throughout New York State. Definitions: Work product – the support services provided by groups and organizations. Descriptive writing – observable and measurable record of services provided by groups and organizations. Quality Improvement – a process used by groups and organizations to deliver the greatest services possible based on review and evaluation of the descriptive, observable and measurable record of the work performed by groups and organization. Theory – an abstract conceptualization explaining a life phenomena. Theoretical construct - a theory with various descriptive components used as a rationale for some sort of action. Self-determination - freedom, autonomy, independence.

4. Theories, Theories and More Theories: A Reason Why? • It’s hard to find a guide or a theoretical construct that, if followed, will assure a high quality work product. The search is an ongoing adaptive process. As the needs of the community change so does a work product change. A work product needs to be flexible enough to meet changes, yet anchored strongly in a theoretical construct so as not to lose focus and direction. We asked a number of smart people to help in finding a theoretical construct that, if measured and evaluated, would assure quality improvement in a work product. • Economics Nobel prize winner A.K. Sen theoretical framework defining disability (Mitra 2003) is the foundation we have chosen to measure and evaluate quality improvement. The work product we are evaluating are the support services delivered by people who have been on the receiving end of mental health services. Under Sen’s approach, capability does not constitute the presence of a physical or a mental ability, rather it is understood as a practical opportunity. • Sophia Mitra interpreted Sen’s work (Mitra 2003), and suggests that the capability of the person is dependent on their characteristics, their community’s economy, and the person’s motivation for self-determination. Mitra’s theoretical construct when applied as a triangular comparison may formulate the most meaningful measurements of the capabilities found in people. We have applied the theoretical construct of this triangular comparison to the work products of groups and organizations in New York State. It is our hope that this application will provide an empirically sound measurement of the comprehensive capability and capacity potential of these groups and organizations: • Motivation Toward Self Determination • Groups & Organizations’ Components • Structural Opportunities • Each of the above opportunities, when observed, recorded, measured and evaluated will individually yield important information for groups and organizations to utilize in their strategic planning and quality improvement. It is significantly important to recognize the triangular comparison of the three components as the primary outcome to be evaluated. It is believed this comparison will yield the richest dimensional measurement. This measurement will enable groups or organizations to fully recognize their true capability or capability potential. Alliance Empowerment Coalition Toolkit 1.1

5. Theoretical Construct the Roots of Quality Improvement Motivation Toward Self Determination Synergistic Comparison Group/ Organization Components Structural Opportunities Figure 1.1 Alliance Empowerment Coalition Toolkit 1.1

6. What is Quality Improvement and Why Do We Need It? What Is Quality Improvement And Why Do We Need It? Making decisions in today’s environment is not easy: further complicating our jobs, we are faced with Budgetary constraints; utilization of tried and not always true models; staffing concerns; cost effectiveness; bridging gaps between our organization and the community at large; how to maintain the level of integrity we envision to ensure a quality reputation and name; and most important, to provide the best possible services to those we serve. Quietly paving its way through the corporate world, not-for-profit organizations, and interfacing with every facet of our world to enrich the human condition is Quality Quality Improvement in health care as defined by The University of Missouri at St. Louis: “an ongoing process of methodologies that are designed to improve the delivery of preventative, diagnostic, therapeutic, and rehabilitative measures in order to maintain, restore and/or improve health outcomes of individuals and populations”. Quality Improvement as presented in this toolkit, provides measurements of a methodological process that uses a synergistic comparison of three capability potentials as applied to groups and organizations. Capability potential finds its roots in the attempt to define disability. The two popular two schools of thoughts that have attempted to define disabilities are the social model and the individual model according to Sophia Mitra (2003). According to Sen these models failed to accurately define the term disability. Sen introduced a third model in his noble prize work on theoretical framework defining disability. Sen describes motivation to self-determination as the third factor in a three point framework that describes disability. According to Sen this theoretical construct not only defines disability but inversely the potential capability of an individual. We have applied Sen’s and Mitra’s understanding of an individuals capability to the capability of groups and organizations. Using the capability potential as described by Mitra and Sen we have found measurements of these theoretical constructs as the frame work by which to work with groups and organizations will use to practice high quality improvement and achieves it fullest potential. The table below presents the capability potential and the instruments we have to measure these potentials. The copious data is derived from the comparison of each of the three capabilities we call this the synergistic comparison.

7. Instruments to Measure Capability Potentials Synergistic Comparison Structural Opportunities Measurements, ABCD Measurement, Asset Base Community Development Group/ Organization Components Structural Opportunities Motivation To Self- Determination ROPI, ROSI, Measuring the Promise, Can we Measure Recovery, Ridgeway, Corporate Components Adobe 7.0 Figure 1.1 Alliance Empowerment Coalition Toolkit 1.1

8. Synergistic Comparison: Comparing the Three Capability Models We have generated an approach groups and organizations may use to assess the quality of their organization. We researched and have presented a theoretical construct organizations could use to establish quality assurance. The construct outlines the three major components that make up a successful organization. We provided the instruments to use to measure each of these components. Once a group or organization is aware of a theoretical basis for its activities and has developed the instruments to measure these areas then the organization needs to follow a plan to move from abstract to concrete. There are three phases an organization can use to infuse quality assurance into their organization: 1. Assess Phase 2. Measurement Phase 3. Make Changes Phase. First, a group must assess and categorize the activities of the organization into the three components offered by Sen’s theory. Second, a group is able to assure the quality of their organization by measuring the three areas that make up a sound organization: Motivation to Self Determination, Groups and Organization’s Components and Structural Opportunities. Third, the organization makes changes according to the data they acquired when measuring their strengths. An organization that learns how to balance these three components will enjoy success beyond the individual parts. A synergistic result bigger than its parts will results on many dimensions. Specifically the organization, when well balanced will experience contribution to the people involved or on a personal level, organizational level and on a community contribution level.