Quality assessment and quality improvement in support services for persons with intellectual disability. Assumptions, theoretical framework, method, examples, improvement strategy. This presentation: for Aprosub, Cordoba (Spain) 2010.

1. Dr. W.H.E. BUNTINX Associate Research Professor Health Organization, Policy and Economics Governor Kremers Center on Intellectual Disability Director of Buntinx Training & Consultancy Cordoba May 6, 2010 Quality Assessment and Quality Improvement in Intellectual Disability Services

12. Content Facilitators Relationships Primary Cliënts Family / Significant others Staff Team Division Organization On the basis of this model, a modular approach to client perceptions is possible The Quality Cube Perspective Quality dimension Level of report

15. How satisfied are you with the staff’s support in promoting your health? How satisfied are you with the meals? How well are you involved in making your Individual Support Plan? Has the ISP been formulated in clear and understandable language? How prompt do staff respond to your needs and questions? Examples Format for questioning / interviewing Clients 1 2 3

16. Examples Format for questions to Family / Staff Importance Perception Experience    Very important Some important Less important How important is [indicator] for your relative?        Agree completely Agree Rather agree Unsure Rather disagree Disagree Disagree completely How would you agree with the statement that [Organization] is offering choices to the client in leisure activities?

19. Example Ranking indicators on the basis of Importance Ranking Indicators of Support Quality (Family perceptions) 1,0 2,0 3,0 Choice & empowerment Developing social network Learning new things Social activities / leisure Participation in society Realizing personal goals Maintaining health condition Using one's competences Balance between competence and demands Health and body care Relationships between clients Safety in home Relaxed social atmosphere Treatment of behavior problems Respectful staff-client relations Indicator importance

20. Ranking satisfaction with indicators (Content component) (Family respondents) 1,0 2,0 3,0 4,0 5,0 6,0 7,0 Development of personal social network Choice and decisions Learning new things Health and condition In home comfort Personal goals as in ISP Self development Meals Social activities / leisure Healthy food Building Participation in society Balanced competences and demands Social relations between clients Health and body care Treatment of behavior problems. safety Feeling at ease in home Respectful staff – client relationships indicator satisfaction Example Ranking indicators on the basis of Family satisfaction

21. Satisfaction with Facilitating conditions for Support (Family versus Staff) 1,0 2,0 3,0 4,0 5,0 6,0 7,0 Staff competences Staff continuity ISP up to date Family involvement in ISP In home safety Social safety Information about activities Information about services accessibility Knowing how to contact the teamleader onderwerp Satisfaction Family Staff Example Comparing Family and Staff ratings of satisfaction with Facilitators

22. Example Comparing Client, Family and Staff ratings of satisfaction with 18 indicators Satisfaction with 18 quality indicators (content and facilitators) Clients – Family - Staff 1,0 2,0 3,0 4,0 5,0 6,0 7,0 Health care Meals Room comfort comfort bathroom Sufficient day activities Variation in day activities Opportunities for choice Social contact Group harmony Manager Leisure Community activities ISP In home safety Safety outside religion Opportunities for learning volunteers Indicator Satisfaction Client Family Staff

23. Example Confrontation matrix Staff <-> Family perceptions Family Satisfaction high low Maybe staff should invest energy in other items Improve! low . Keep! Find out why family is not satisfied? high Staff Satis-faction

24. Example Position of TEAMS with respect to satisfaction with indicator ‘ client involvement in Individual Support Plan’ Staff <-> Client perceptions Client Satisfaction high low T6 T3; T2 T1; low T4;T7;T8 high Staff Satis-faction

25. Example of a quality profile on the basis of QUALITATIVE response analysis of answers to the simple question: ‘How could the client’s support be improved?’ Quality of Life Facilitators Relationships Clients=yellow Family=green Staff=bleu

26. Example of a quality profile on the basis of QUALITATIVE response analysis of answers to the simple question: ‘How can support performance be improved?’ Clients=yellow Related to home comfort!

27. Example of a quality profile on the basis of QUALITATIVE response analysis of answers to the simple question: ‘How can the clients’ support be improved?’ Staff=bleu More direct support staff!

28. Example of a quality profile on the basis of QUALITATIVE response analysis of answers to the simple question: ‘How could the clients’ support be improved?’ Family=green More information about our child’s functioning

30. Simplified example of a Quality Improvement Card Cliënts (14 respondents; 16 OK! and 21 Improve! suggestions) Appraisal of over-all satsifaction with service: 8,4 (company average:7,5) Family / significant others (15 respondents; 21 OK! and 17 Improve! suggestions) Appraisal of over-all satisfaction with service: 7,8 (company average: 7,4) Group atmosphere should improve; there is a lot of snapping in the group (7) Clients find staff is helpful when there is a question or special request in home living (5) CLients want more assistance in cleaning their rooms (11) Clients are satisfied with room comfort (8) Improve! (13/21) OK! (14/16) Meals should get more attention; more menu variation (5) Thoughtful care. Staff responds promptly if family has any questions. (5) Communication with the company’s management should improve; more information is wanted about building renovation. (8) Staff keeps family well informed about clients’ daily lives (8) Improve! (12/17) OK! (12/21)

31. Example of a Quality Improvement Card Front Back Instructions Summary of relevant suggestions for improvement

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36. Information: dr. W.H.E. Buntinx [email_address] See also: www.buntinx.org Handouts available from this website This presentation: May 6, 2010 Cordoba (Spain)