As providers become more accountable forprocesses and outcomes, measuring efficiencyand effectiveness in our organizations hasincreased importance. We will discuss the who,what, why, where and when of qualitymanagement and process improvement, as wellas ongoing monitoring and evaluation, makingspecial note of areas unique to the addictiontreatment industry.
The Responsibility of LeadershipCreate and maintain a culture of safety and quality – make them a priorityEstablish priority of performance improvement and outcomesAssess and prioritize improvements needed High risk or problem prone processes High risk or vulnerable populations High volume processesEvaluate the effectiveness of systems
Why? The Future of Healthcare More definitive research on what is effective treatment Move toward payment based on outcomes Expected to use objective tools to assess processes and outcomes Recovery Oriented Care Show that chemical dependency treatment is effective - measuring success by measuring individuals‟ recovery Patient-centered focus on care Expected to involve the patient. Not just in their care decisions but in the processes of the care they receive. Empower the patient
Why? Regulatory RequirementsReview and analyze incident reportsMonitor compliance with rules & other requirementsIdentify areas where quality is not optimalAnalyze identified issues, implement corrections, evaluate and monitor ongoing effectivenessEnsure appropriate client placement, adequacy of services provided and length of stay
Why? Regulatory RequirementsMission statement driven Goals and objectives that relate to the program purpose or mission statement Review the progress toward the goals Documented process to implement corrections or changes
What? Focuses on the „process‟ rather than the individual Recognizes both internal and external „customers‟ Promotes the need for objective data to analyze and improve processes 5 key systems that influence the effective performance of an organization Using data Planning Communicating Changing performance Staffing – qualifications & competency among other things
First, fix your problem areas -• Compliance issues• Revenue/Reimbursement issues• Documentation issues• Safety concerns• Waiting lists• Patient retention – Non-completion/Unsuccessful completion – Level of care transitions• Timeliness• Are people getting better?
Then move to improvement -• Quality• High risk processes (always, sometimes)• Proactive vs reactive• Prevention vs correction• Increased efficiency• Improved effectiveness• Workflows• Streamline processes
How?• Everything starts with asking the right questions! – What‟s important to you? – Are you satisfied with the quality of your service? – Are your customers satisfied?• Look at everything through the customers‟ perspective. – Who‟s your customer? – What does your customer experience? – What do you want your customer to experience?
How?Empower employees Leadership sets the stage Line staff generally has better pulse on things Encourage reportingUse statistical toolsBenchmarkingEvidence based practices – guidelines, literatureReflect your mission statement?
Data Collection• Chart audits (qualitative/quantitative)• Patient surveys• Staff surveys• Family member surveys• Alumni surveys• Referral source surveys• Continuing care provider surveys• AMA analysis• Patient outcomes• Risk management reports
Data Collection• Sample size• Statistical analysis – charts & graphs – Line graphs – show data change over time – Bar charts – show how many units have particular characteristic – Pie charts – show percentage of each contribution to the whole• Data should lead you to answers• Beware of conclusions without data
FOCUS – PDCA Model• F – Find an opportunity• O – Organize a team• C – Clarify the process• U – Uncover/Understand the issue• S – Start the PDCA process
FOCUS – PDCA Model• P – Plan the improvement• D – Do/implement the improvement• C – Check the results & lessons• A – Act (adopt, adjust, abandon)
Manage & Maintain• Don‟t assume• Accountability – Ongoing data collection & reporting – Visual representation – “in your face” & “on the radar” – Take action! – Regular meetings (Can they be fun?)• Automate all you can• Work across departments• Create, support, encourage a culture – QI program theme – Goals and objectives• Cooperate and collaborate• Mission – Vision – Values
Stay accountable - If it doesn‟t help our customers and we don‟t have to do it for the regs, why are we doing it? If we are not using data we are collecting why are we collecting it? Have we asked the important questions? Will this change result in improvement? Are we building an improvement program or are we looking to pat ourselves on the back?
• Successes tend to disappear from view.• Building on success is the secret to sustainability.