Engaging Stakeholders Through Quality Management National Latino - - PowerPoint PPT Presentation

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Engaging Stakeholders Through Quality Management

National Latino HIV and HCV Conference – San Antonio, TX May 19, 2018

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Disclosures

The presenter has no financial relationships to disclose.

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Learning Objectives

• Describe the framework for clinical quality management in HIV

programs

• Use available performance measurement data to identify disparities in

HIV care using an evidence-informed tool

• Identify evidence-informed improvement interventions appropriate to

improve health equity leveraging stakeholder input

• Use available performance measurement data

for public relations and marketing purposes

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Clinical Quality Management Framework

Policy Clarification Notice 15-02

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HRSA-HAB Policy Clarification Notice 15-02

• The HIV/AIDS Bureau’s requirements regarding clinical quality

management based on the Ryan White HIV/AIDS Program legislation

• Applies to recipients of all Parts funding and their subrecipients
• The focus is on improving HIV health outcomes
• Available at: https://hab.hrsa.gov/sites/default/files/hab/clinical-

quality-management/clinicalqualitymanagementpcn.pdf

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Components of a CQM Program

• CQM programs coordinate activities aimed at improving patient care

and patient satisfaction to drive health outcomes improvement

• CQM activities should be continuous and fit within and support the

framework of grant administrative functions

• Components of a CQM program
• 1. Infrastructure
• 2. Performance measurement
• 3. Quality improvement

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Grant Administration

• Grant administration refers to the activities associated with administering

a RWHAP grant or cooperative agreement

• The intent of grant administration is not to improve health outcomes.

Therefore, they are not CQM activities Grant Administration ≠ Clinical Quality Management

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Examples – Grant Admin vs. CQM

• Grant Administration
• Creating a performance

measurement system to collect minimum data required by the RWHAP legislation and HAB

• Creating care systems and service

standards

• Management of mandated

reporting

• Provider training geared toward

compliance

• Clinical Quality Management
• Creating a sophisticated

performance measurement system to collect service data tied to HIV health outcomes

• Tests of change to improve care,

systems, or standards

• Management of peer learning and

collaboration programs

• Provider training geared toward

improving HIV health outcomes (evidence-based/evidence- informed)

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Quality Assurance vs Quality Improvement

Quality assurance:

• Refers to a broad spectrum of activities aimed at ensuring compliance with

minimum quality standards

• Include the retrospective process of measuring compliance with standards
• Part of the larger administrative function of a recipient’s program or
• rganization and informs the CQM program

Quality Assurance ≠ Quality Improvement

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Examples – QA vs. QI

• Quality Assurance
• Measuring compliance with

standards / Contract monitoring / Chart reviews

• Focused on individual “bad apples”
• Responsibility of a few to carryout
• Quality Improvement
• Continuously improving

performance beyond minimum service standards

• Focuses on health systems and

processes

• Responsibility of all

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Performance Measurement Data

The things you are already required to collect

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Traditional Performance Measurement

• HAB Performance Measures
• Identifying core performance measures that are most critical to the care and

treatment of people living with HIV

• Combining performance measures to address people of all ages living with HIV
• Promoting relevant performance measures used in other federal programs
• Archiving performance measures that are no longer consistent with U.S.

Department of Health and Human Services guidelines or applicable to the general population

https://hab.hrsa.gov/clinical-quality-management/performance-measure-portfolio

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RWHAP Reporting Requirements

• Ryan White Services Report
• Network primary recipient requirements
• ADAP Services Report
• Dental Services Report

https://hab.hrsa.gov/program-grants-management/data-reporting-requirements-and-technical-assistance

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Strategies for Enhanced Data Management

• Data element and measures inventories
• Use this to manage waste through duplicated reporting requirements (or slight

differences)

• Test for completeness and performance
• Identify priorities for data cleaning and data collection process improvement
• Drill down clinical measures included in required reporting using

demographic and clinical data

• Identify priorities for “story-telling” and QI

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Data Element and Measures Inventories

• Simple lists of all data elements and performance measures you need to

collect

• Include level of detail (e.g., is transgender T or is it MTF and FTM?

What is the cut off for VS?)

• Put it in excel so you can sort and filter
• Double check for duplicates and NEGOTIATE!
• Update data collection to include the MOST granular level wherever you

land

This is a Data Dictionary!

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Data Element Completeness

• Garbage in, Garbage out…
• Where are there holes in the data?
• Use excel to identify cross-sectional holes
• What holes can be “padded”?
• What holes can you live with and what ones do you need to fill to tell

your story?

• Work with patient and staff groups to identify ways to increase data

completeness from both sides of the desk

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Testing Performance Measures

• Run all required performance measures and

populate the results in a table like for the data element inventory

• Ideally, populate a calculator or other tool that

can be modified to answer questions you have about your data

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Experience Data

• Don’t forget our Quadruple Aim!
• Improving patient outcomes
• Improving patient experience
• Decreasing costs
• Joy in work (improving staff experience)
• Experience data complements outcome

and cost data and is important to the community you serve

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Patient Experience

• A measure of your patients’ morale
• Red flags and important areas of investigation
• Trends over time
• Influences retention in care, health seeking behavior, patient attitudes toward staff
• Can be responsible for poor retention in addition to patient population expansion

(word of mouth travels fast)

• Identifies areas of potential concern to community

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Staff Experience

• A measure of staff morale
• Red flags and important areas of investigation
• Trends over time
• Influences the care provided and the environment where patients are treated
• Can be responsible for downward spirals

in addition to forward motion

• Identifies areas of patient care, care

environment and staff supports that require improvement

• TRAUMA can affect your staff, too

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Leveraging Data for Health Equity

Using the data you already collect for noble purposes

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Step 1: Performance Measurement

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You’re Already Doing It!

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Health Disparity Calculator – Data Entry

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Health Disparity Calculator - Analysis

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Step 2: Root Cause Analysis

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5 Whys Analysis

• The root cause is “the evil at the bottom” that sets in motion

the entire cause-and-effect chain causing the problem(s)

• Some root cause analysis approaches are geared more

toward identifying true root causes than others; some are more general problem-solving techniques, while others simply offer support for the core activity of root cause analysis

• By becoming acquainted with the root cause analysis

toolbox, you’ll be able to apply the appropriate technique

• r tool to address a specific problem

http://asq.org/learn-about-quality/root-cause-analysis/overview/overview.html

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Cause and Effect Diagrams

http://www.ihi.org/resources/Pages/Tools/CauseandEffectDiagram.aspx

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Root Cause Analysis is Important!

• Organizes and displays all causes and sub-causes that may influence a problem,
• utcome, or effect
• Helps push people to think beyond the obvious

causes, (money, time) to find some causes that they can fix/improve

• Helps organize potential solutions and make

clear who should be involved in solutions

• Encourages a balanced view
• Demonstrates complexity of

the problem

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Step 3: Prioritize

Random House Webster’s College Dictionary

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31 Potential Projects What is the potential impact? How many patients will it affect? Do you have the data? Do you have the support and resources? Is it reasonable achievable & feasible? Total Score

VLS Retention Perinatal trans. Dental Pap

Simple Priority Matrix

These can be scored via scale “10” is the most positive response “1” is the least positive response

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Benefit/Effort Matrix – Completed Table

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A B C D E F G H I J K L M N O P Q R S T 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Benefit Effort Pursue Consider Avoid, if Possible

Benefit/Effort Matrix – Plotted Matrix

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Step 4: PDSA Cycles

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Model for Improvement

https://careacttarget.org/cqii

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Act

Adapt? Adopt ? Abandon? Next cycle?

Plan

Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when)

Study

Complete the analysis of the data Compare data to predictions Summarize what was learned

Do

Carry out the plan (on a small scale) Document problems and unexpected

• bservations

Begin analysis

https://careacttarget.org/cqii

The PDSA Cycle

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Why Test?

• Increase your confidence that the change will result in improvement in

your organization

• Learn to adapt the change to conditions in the local environment
• Minimize resistance when you move to implementation

https://careacttarget.org/cqii

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CHANGE: New Follow-up Protocol for No-Shows AIM: Reduce Gaps in Care Over 3 Months

A P S D A P S D Cycle 1A: Revise evidence-informed template form and test with one of Jo’s clients on Tuesday Cycle 1B: Revise form based on learning and test again with Karl’s clients next Monday Cycle 1C: Present refined form to all case managers and document feedback Cycle 1D: Revise and test form with all clients for one week Cycle 1: Implement form throughout program

https://careacttarget.org/cqii

PDSA Cycle Example

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Tips for PDSA Cycles

• “What change could you test by next Tuesday?”
• Learn from others (‘Steal shamelessly, Share senselessly’)
• “Rule of 1”: 1 facility, 1 office, 1 provider, 1 patient
• Volunteers at first
• Useful, not perfect, data
• Customized measures for tests of change

are recommended

https://careacttarget.org/cqii

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Step 5: Training/Spreading Change

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Newsletters and Social Media

• Goals include letting the communities you serve know all you are doing

for them

• Use your data and the results of your QI activities
• Be action-oriented in requests
• Utilize a “campaign” mentality
• Go-in with community partners

who serve your clients in different settings

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Presentations

• Town hall meetings
• Create a local conference
• Invite other agencies
• Invite consumers
• Invite non-traditional partners

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Bring in New Team Members

• Think about the communities you serve
• Consumers, obviously
• Minority communities (i.e., LGBT)
• Other vulnerable populations
• Is your staff reflective of the communities you serve?
• Are there liaisons that can help you foster

relationships with segments of your service population who are hard to engage?

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end+disparities ECHO Collaborative

The 18-month collaborative aims to increase local quality improvement capacity and to increase viral suppression rates in four pre-selected populations based on CDC data. Participants help create a national community of learners from diverse program types, settings, and geographic locations. The initiative is managed by the Center for Quality Improvement & Innovation(CQII), funded by the HRSA Ryan White HIV/AIDS Program (RWHAP) and developed using the Project Extension for Community Health Outcomes (ECHO) model.

https://careacttarget.org/cqii/end-disparities-echo-collaborative

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Leveraging Data Beyond Quality Management

The magic of data can help you in innumerable ways

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Public Relations

• Leverage the information you have to tell compelling stories
• Cater information to specific audiences and their preferences
• Demographic information
• Longitudinal performance by group
• What are you doing to help these folks?
• How can the community get involved in

your work?

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Marketing and Advertising

• What makes your organization stand out?
• Against others in your area?
• In comparison with the whole country?
• Do you serve special populations well?
• How do you add value to

individual lives or to communities of people?

• Why come to your
• rganization vs another
• rganization nearby?

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Grant Writing

• Goes well beyond research!
• Use your data to RESPOND to RFA/FOA
• Use your data to APPROACH a funder
• Not unlike an informational interview
• PITCH PITCH PITCH!!
• Use your data to identify new community

partners to go in on a grant together

• Draw in collaborators!

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Know Your Purpose, Know Your Audience

• 1. Interestingness

– Relevant, Meaningful, New

• 2. Integrity

– Truth, Consistency, Honesty, Accuracy

• 3. Form

– Beauty, Structure, Appearance

• 4. Function

– Easiness, Usefulness, Usability, Fit

http://www.informationisbeautiful.net/2009/interesting-easy-beautiful-true/

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Question & Answer

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Michael Hager, MPH MA Hager Health, LLC

617-359-6074 MichaelHagerNYC@gmail.com