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Performance Driven Bar graph Academy SESSION 5: CONTINUOUS QUALITY IMPROVEMENT PRACTICES
Brought to you by the Managed Care Technical Assistance Center SPEAKER: JOHN LEE, MBA DIRECTOR, CENTER FOR COLLABORATION IN COMMUNITY HEALTH COORDINATED CARE SERVICES, INC.
Reminders ‣ Please make sure everyone in your work group registers for one JUNE in-person session ‣ If you’re joining us for the first time, complete the baseline survey (link in chat box) and review Webinars 1-4 on the MCTAC website ‣ Webinars are recorded and you should have received materials ahead of this webinar ‣ Use pda@ccsi.org email for any questions, comments, etc. ‣ Chat in questions/comments to all panelists at any time
What is the PDA?
Goal of the PDA Elements of a Performance Driven Organization Developed by CCSI’s Center for Collaboration in Community Health
Actively Participating in the PDA Will… ‣ Position you to know your cost, know your quality, and know your impact within the broader system of care ‣ Generate a workplan for integrating knowledge gained and transfer knowledge within you organization ‣ Provide tools and resources to support effective collaboration, measurement, financial analytics, and leadership values to support continuous growth and improved efficiencies ‣ Document your agency’s growth and improvement through the evaluation ‣ Demonstrate your agency’s commitment to performance driven principles through a certificate of completion
Where We’ve Been ‣ Developing a culture that supports performance driven principles and prioritizes data-driven decision making ‣ Effective collaboration as a key to success and optimizing impact ‣ Best practices to support your human resources and heighten accountability for performance ‣ Defining effective measurement practices so that performance improvement can be built on valid and reliable data
6. Practice Development 4. Effective Measurement Semester 2: Finance and Leadership 5. Continuous Quality Improvement 7. In-person sessions
Continuous Quality Improvement Practices The Performance Driven Academy DAVID W. ECKERT, LMHC, NCC, CRC SENIOR CONSULTANT, CENTER FOR COLLABORATION IN COMMUNITY HEALTH COORDINATED CARE SERVICES, INC.
Background of Today’s Speaker ‣ Licensed Mental Health Counselor, Nationally Certified, Certified in Rehabilitation • Expertise in behavioral health clinical design, clinical documentation, open access, collaborative documentation, and Continuous Quality Improvement (CQI) ‣ CCSI • Senior Consultant, Center for Collaboration in Community Health • Supporting behavioral health providers and networks in Managed Care and Value-Based Payment readiness; improved outcomes
Joined by… ANDREA MCINTYRE COMPLIANCE/QUALITY ASSURANCE OFFICER CHENANGO COUNTY MENTAL HYGIENE SERVICES Responsible for the direct oversight of the Compliance and Continuous Quality Improvement (CQI) efforts of the Chenango County Mental Hygiene Services. Chenango County operates outpatient mental health programs for adults and children, including satellite clinics in schools, as well as an outpatient substance abuse clinic. Chenango County has been active in Managed Care and Value Based Payment readiness efforts for over 2 years.
Today’s Learning Objectives ‣ Try to cover a rich topic in under an hour ‣ Review essential Continuous Quality Improvement (CQI) practices ‣ Discuss the importance of consistent workflows, processes, and follow- through ‣ Provide an overview of CQI as applied at the agency and program levels ‣ Review some high profile measures that can serve as a focus of CQI efforts ‣ Offer agency-specific examples that show CQI in action ‣ Discuss the use of tools that support data collection and reporting ‣ Review how reports are being utilized to support effective CQI practice
What is Continuous Quality Improvement? ‣ CQI is the process by which organizations objectively, systematically, and continuously assess, assure, monitor, evaluate, and improve the quality of programs and services provided to their clients. This requires establishing program-specific goals, objectives and measures (performance indicators) and includes training staff in CQI methods and tools. ‣ CQI often utilizes on the “Plan-Do-Study-Act” approach
What is CQI, Really ? A philosophy that focuses on improving the systems and processes of an organization ‣ Asks: • How are we doing? • How do we know? • Can we do better? ‣ By using methodology that is: • Specific • Objective • Data-Driven • Cyclical
Why CQI? ‣ Helps any organization become better at improving the lives of those they serve, finding efficiencies, enhancing staff effort and well-being ‣ Foundation of a performance driven culture ‣ Facilitates alignment with State and Federal Policy goals • Triple Aim ◦ Improve the quality of care ◦ Reduce costs ◦ Improve Population Health
“Starting with Why” ‣ Simon Sinek ‣ People need to first appreciate why improvement is needed to become engaged in the process ‣ This needs to align with their own values and why they do the work that they do ‣ Leadership is likely to have had more time to adjust to change and should understand that others need to be nurtured along ‣ Start with “why” and then move to “how” the agency plans to bring about change ‣ Then offer details on “what” will change by repeatedly communicating progress
PDSA Cycle Plan Act Do Study
Using PDSA to Improve Show Rates ‣ Across behavioral health systems and levels of care, improving attendance at scheduled appointments is a common goal ‣ How can we apply the use of the Plan-Do-Study-Act approach to be more consistent in achieving this goal? ‣ This is a “win-win” type of initiative • Improves the quality of care • Increases clinical consistency • Improves financial performance
Other Common Measures ‣ Use of acute services- focus on reducing ER visits, hospitalizations, and re-hospitalizations ‣ Links between levels of care- successful transition and client engagement from inpatient to outpatient settings ‣ Access measures- time from initial call to first appointment ‣ Engagement measures- consistent attendance early in treatment ‣ Medication adherence- stimulants, antidepressants, antipsychotics, etc. ‣ Symptom & Functioning- PHQ-9, DLA-20, etc. ‣ Client Satisfaction Surveys
How to Begin Using PDSA? ‣ Who? Workgroup: • Need buy-in! • Individuals that may be impacted by PDSA cycle for their input • Those with the data • Leadership that has authority to make decisions on PDSA findings AND can ensure implementation of the “DO” ‣ What? • PDSA cycle on ONE step at a time ◦ Ensures you are attributing change to the correct variable ‣ Timeline? • Short Cycles (2 weeks) for rapid decision making ◦ This can be a challenge in the Behavioral Healthcare field
Plan: This is the Detail Part of the Cycle Specific to Show Rate General Considerations Project • Question: Are we taking • What is the question this PDSA cycle is trying to the necessary steps to help answer? our clients attend appointments consistently? • What is the goal? • Goal: Achieve targeted improvement in show rates for scheduled appointments.
Determine impact (Brainstorm) CQI Connect process: impact to Review data System – did we Goals (Logic answer the Model) question? Create Identify Data measure Opportunities Select data collection method, Identify Data balancing Availability resource What’s the availability Question? Identify outcome of focus
Plan: Details, Details, Details… General Considerations Specific to Show Rate Project • Who will enact the PDSA cycle? • PDSA will be piloted in outpatient MH clinic • What data points are needed? • Identify staff person responsible for o Who will collect the data? generating reports o How will it be collected? • Identify essential data sources and o Who will be data points: aggregating/analyzing? o Electronic Medical Record • When to reconvene to look at o Appointment Types: Attended, data? Cancelled with Notice, Cancelled by Clinician, No-Show/No-Call o Reports by clinician, job type, and for MH clinic
Plan For: Data Collection and Reporting ‣ Tools utilized to extract and report data • Electronic Medical Record System (EMR) ◦ Need to ensure that data points are identified and can be retrieved from the EMR ◦ Operationalize definitions so that the data represents what it is supposed to represent • Excel ◦ Data is pulled in CSV files and then formatted in Excel ◦ Need to ensure consistency of processes • Tableau ◦ Utilized for data visualization
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