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Performance Driven Academy

SESSION 5: CONTINUOUS QUALITY IMPROVEMENT PRACTICES

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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
• ne 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?

Elements of a Performance Driven Organization

Developed by CCSI’s Center for Collaboration in Community Health

Goal of the PDA

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

• 4. Effective

Measurement

• 5. Continuous

Quality Improvement

• 6. Practice

Development Semester 2: Finance and Leadership

• 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

• f 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 Do Study Act

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

General Considerations

• What is the question this

PDSA cycle is trying to answer?

• What is the goal?

Specific to Show Rate Project

• Question: Are we taking

the necessary steps to help

• ur clients attend

appointments consistently?

• Goal: Achieve targeted

improvement in show rates for scheduled appointments.

Determine impact (Brainstorm) Connect impact to System Goals (Logic Model) Identify Data

Opportunities

Identify Data Availability What’s the Question? Identify

• utcome of

focus Select data collection method, balancing resource availability Create measure CQI process: Review data – did we answer the question?

Plan: Details, Details, Details…

General Considerations

• Who will enact the PDSA cycle?
• What data points are needed?
• Who will collect the data?
• How will it be collected?
• Who will be

aggregating/analyzing?

• When to reconvene to look at

data?

Specific to Show Rate Project

• PDSA will be piloted in outpatient

MH clinic

• Identify staff person responsible for

generating reports

• Identify essential data sources and

data points:

• Electronic Medical Record
• Appointment Types: Attended,

Cancelled with Notice, Cancelled by Clinician, No-Show/No-Call

• 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

Plan For: Data Validation

• Prior to reporting, make sure that data has been checked and re-

checked for accuracy

• Verify that the data is correct; did you capture what you intended to

capture?

• Be careful that accuracy isn’t lost if through data entry or

conversion processes

• Have 2 sets of eyes validating the data
• Check for blank fields
• Find and fix the source of any inaccuracies and validate again

Plan To: Establish Baselines & Targets

• Establishing Baseline:
• Choose a period of time that is long enough to address variability that can occur over time
• Decide the focus and breadth of the measurement
• Agency
• Program
• Job Type
• Clinician
• Client
• Create SMART goals/targets: Simple, Measurable, Achievable, Realistic, Time-Limited.
• Have baseline ready for review by CQI team
• CQI team can establish targets with input from stakeholders; What is a reasonable expectation

for improvement?

Do: Go Forth and “Do” the Work!

General Considerations

• Enact the PDSA cycle
• How will staff be notified about

the workgroup and its aims?

• How will it be disseminated?
• Set Start and End Dates

Specific to Show Rate Project

• Set target for Show Rates at 75%
• Introduced attendance improvement project

to all staff

• Set up monthly CQI project Team meetings
• Generated Show Rate reports by clinician,

job type, and for Clinic

• Created ‘Attendance Agreement’ to clearly

state expectations

• Utilized Administrative staff to ensure that

client contact info is current

• Utilize Care Managers or Peer Specialists to

assist clients with overcoming barriers to attendance

• Provide updates at Clinic meetings each

month

Study: This is the “Did it Work?” Portion

• f the Cycle

General Considerations

• What does the data show?
• Were the changes meaningful?
• Was there enough information to

make a decision?

• What changes occurred as a

result of the PDSA cycle?

• Barriers?

Specific to Show Rate Project

• Results:
• 72% for direct care clinicians
• 68% for Crisis Stabilization Team
• 67% for medical staff (MDs & NPPs)
• Many prescriptions filled by phone

when clients missed appointments

• Significant variability between clinicians
• A relative small percentage of clients a

high percentage of no-shows

• Awareness of problem and responses

to address barriers increased

Study: This is the “Did it Work?” Portion of the Cycle

Study: This is the “Did it Work?” Portion of the Cycle

Workflows and Processes

• Traditional Access
• Client calls
• They are sent an Intake/Screen a

packet

• Packet returned and reviewed
• Insurance checked
• Case assigned at Clinic Team meeting
• Client called back to schedule Intake
• Client registers before appointment
• Insurance verified
• Clinical assessment occurs
• Client admitted into treatment
• Open Access
• Client calls
• Client comes to clinic during Open Access

hours

• Insurance is verified
• Intake/Screen information gathered
• Client registers
• Clinical Assessment occurs
• Client admitted into treatment

Average Time from Call to Admission

10 20 30 40 50 60 70 80 90 100

Days to Access

Days to Access Linear (Days to Access)

Specific Time from Call to Admission

10 20 30 40 50 60 70 80 90 100

Days to Access

Days to Access Linear (Days to Access)

Act: What Are You Going to Do with This New Information? Here Are Some Options…

General Considerations

• Implement a policy/workflow change
• Expand the PDSA cycle to a larger

group/department

• Disseminate the findings
• A new PDSA cycle with a different

variable

• Stop doing an action/behavior
• Solicit additional input from other

stakeholders Specific to Show Rate Project

• Reviewed clinician-specific data and

targets with each clinician

• Clarified expectations for follow-up

when clients miss appointments

• Clarified policy about clinicians

cancelling appointments

• Included attendance expectations in

Clinic brochure

• Recognized and learned from clinical

staff that have high show rates

• Instituted Just-In-Time scheduling for

prescribers

Are We There Yet?

Effective CQI Processes Require Tenacity

• “Obstacles are what we see when we take our eyes off of our goals.”
• Vince Lombardi

Tool: CQI Workbook

• Excel workbook template for

monitoring progress towards a target

• Workplan sections for each

step of Plan, Do, Study, Act

• Specifics of the CQI process

and who is responsible

Tool: CQI Workbook

• Brief screen to help evaluation the development of your quality improvement

process

What Do I Do Next?

Take-aways: How Can I Get Started?

• Select an area of need or opportunity for improvement
• What are you currently measuring and do you have reports that

can drive practice improvement?

• Beware of discussions that lead to more measurement without

taking action on the data you already have.

• Identify the stakeholders involved in practice improvement
• Have some informal discussion with staff about why improvement

in this area is important

• Produce baseline data to guide the discussion
• Just get started

Mark Your Calendars and Register

Webinars (Wednesdays, 12-1pm): Practice Development and Management, 5/23/18 In-person events in late June (10am-2pm) Register individually, not by agency Albany- Tuesday, 6/19/18 Rochester- Monday, 6/18/18 NYC- Friday, 6/29/18 Semester 2: Dates coming soon

Upcoming Webinar of Interest

Topic: Evaluation of Data Collection When: Friday, May 18th Time: 12pm-1pm

The Rochester Regional Health Behavioral Health Department provides an array of behavioral health services throughout the Rochester region, meeting the needs of individuals across the lifespan by offering acute, outpatient and community based behavioral health programming. The RRH BH department is working to develop a data infrastructure to support operational excellence and track key performance metrics within the organization. During this webinar, RRH will highlight one key performance metric and the process by which the organization implemented process improvement practices to improve outcomes and how data collection evolved from manual data entry integration into the larger data infrastructure practice. Presenters: Mandy Teeter, MBA, MSW, Director Operational Excellence & Adult Mental Health Liz Schreiber, MA, LMFT, Manager Operational Excellence Frankie Tangredi, Clinical Analyst

Registration link in chat box!

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email us at: pda@ccsi.org