Quality Assurance:
Continuous Quality
Improvement
2010 Texas Behavioral Health Institute
Rhonda G. Patrick, MPA, LCSW
Blue Basin, Inc.
Course Objectives
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Participants will understand what quality assurance
means and it purpose.
Participants will understand how to develop and
implement a quality assurance program.
Participants will have knowledge quality assurance
practices.
Participants will learn how to utilize a quality assurance
program to make management and organizational
changes.
Quality Assurance Is….
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Meeting the customer needs
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Identify the customer and what they need
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Improve the process to fully meet this need.
Continuous Quality Improvement
•Continuous
quality improvement (CQI) is a concept in which the
focus is on a team approach to improvement.
•Rewards
•A
the group when things get better.
shift in focus from the end product or service to the process.
•CQI
evaluates the entire client care delivery system to identify
opportunities for improvement.
•It
asks “how can the system be changed to improve quality
organization wide?”
Continuous Quality Improvement
•CQI
requires people to look at their work in terms of
being part of a continuous process.
•CQI is a relentless effort to add value for the customer.
•The CQI process should be driven from the top, but
implemented from the bottom.
•Problem areas must be prioritized, critical processes
selected for improvement, and improvement goals set for
the project team.
•Problem solving and implementation is done by teams
which include staff at the working level.
Continuous Quality Improvement
I.
FOCUS on a particular issue:
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Find a process to improve
Organize to improve a process
Clarify what is known
Understand variation
Select a process improvement
Continuous Quality Improvement,
Cont….
II. Move through a process
improvement plan, PDCA
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Plan: create a timeline of resources,
activities, training and target dates. Develop
a data collection plan, the tools for
measuring outcomes, and thresholds for
determining when targets have been met.
Do: implement interventions and collect
data.
Continuous Quality Improvement,
Cont….
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Check: analyze results of data and evaluate
reasons for variation.
Act: on what is learned and determine next
steps. If the intervention is successful, work to
make it part of standard operating procedure.
If it is not successful, analyze sources of
failure, design new solutions and repeat the
PDCA cycle.
Principles of CQI
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Quality improvement is oriented towards meeting the needs and
expectations of the patients and the communities.
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Quality improvement focuses on systems and processes.
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Quality improvement uses data to analyze service delivery
processes.
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Quality improvement encourages a multi-disciplinary team
approach to problem solving and quality improvement.
Benefits of CQI
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Shared leadership and governance
Total quality management principles applied
throughout the organization
Empowered staff and organizations
Better patients (clients) outcomes
Staff morale improved
Customer satisfied
Quality improvement institutionalized
Accredited Facilities
CQI Model
CQI Approaches
Comprehensive Approach
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Quality improvement policies, procedures and processes are
implemented simultaneously, starting at the top and moving
down the organization.
Begin with a thorough review of standards and specifications.
Assessment of health care and support services through either
an existing management information system or a monitoring
system specifically designed to measure service quality.
Identification of priority areas for quality improvement.
Must have system wide commitment to addressing quality of
care and availability of necessary resources towards large scale
implementation.
CQI Approaches
The Problem-oriented Approach
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Emphasis on practical, small-scale quality related
activities that produce incremental quality
improvements.
Based on the assumption that a monitoring system and
a more systematic approach can be developed over
time, once problem solving has become part of the
organizational culture.
Allows an organization to modify and adopt the a
problem-solving strategy before wider implementation.
Developing a CQI Program
Defining and Operationalizing Organizational
Goals
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Mission of Organizations
 Goals
of Organization
 Operationalize
strategies.
goals through objectives and
Developing a CQI Program, Cont..
 Goals
should be based on the
organizations strategic plan for growth.
 Goals should encompass:
 Administrative
and Management
Operations
 Personnel
 Treatment or Services (program
evaluation)
 Fiscal
Strategic Plans
Strategic planning is a multi-step process that includes:
• A review of stakeholders and customers
• Conducting a needs assessment
• Definition of the program's:
Purpose and values
Mission, vision
Service delivery model
Goals and objectives, and strategies and tactics
Strategic Decision Points
Developing a CQI Program
Parameters for Model Development
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Must identify Standards
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Must develop Policies and Procedures
Developing a CQI Program
Parameters for Model Development
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Model needs to Include:
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Evaluation of Administrative Processes
 Strategic Planning
 Reporting
 Contracting
 Regulatory Compliance
 Fundraising
Evaluation of Personnel Processes
 Hiring Practice
 Documentation
 Benefit Utilization
 Staff Growth and Development
 Performance
Developing a CQI Program
Parameters for Model Development
 Evaluation of Program Effectiveness
 Formal
program evaluation of program design
 Performance Measures
 Customer satisfaction
 Regulatory compliance
 Utilization Review Process
Developing a CQI Program
Parameters for Model Development
 Evaluation
of Fiscal Practices
 Adherence
to GAAP
 Contractual requirements
 Billing Controls
 Revenues Development
 Budgeting
Developing a CQI Program
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Data Management
What to measure
How to measure
When to measure
How to use what is measured
Information Systems
Developing a CQI Program
Measurement Tools
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Develop your own
Ask your oversight agency for a copy of their tools
Self development tools, ask yourself:
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How would I measure this?
What would I need to look at to know?
What do my oversight agencies look at?
Tools for these areas, can be multiple, or one:
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Administrative
Personnel
Treatment
 Program Evaluation (pre-test/post-test)
 Compliance Checklists
Fiscal
Developing a CQI Program
Finding and Training Staff
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In-House Staff
 Look at your own staff, what strengths do they have, where
have they worked. Do they have aptitude.
Hire Credentials
 Certified QA Specialist
 CHCQM- Certified Healthcare Quality Manager
 LHCRM- Licensed Healthcare Risk Manager
Hire Experience
 CQI Experience
 Quality Management
Developing a CQI Program
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Training
 Certificate Programs
 Workshops
 On-line Instruction
 In-House Training
Consultants
 Use to help set-up programs and train, not as fulltime CQI coordinator
Implementing CQI
There are many ways to carry out a Continuous
Quality Improvement project. A generic approach
is described here which should suit most
situations. No projects are the same and so the
approach should be tailored to fit the job.
Implementing CQI
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Set up the Project
Team
Define the scope
Set the goals
Understand the
process
Flow Charts
Plan the project
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Determine Information
Needs
Chose the tools for the job
Identify the root causes
Develop solutions
Implement the solutions
Review the results
Standardize the Change
Implementing CQI
Set up the Project Team
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A team can draw on a wider range of experience and skills.
Chose team members to ensure the team is knowledgeable in
every aspect of the process being studied.
Major stakeholders and customers should be represented.
Lower level process teams should have people from the working
level.
Higher level process teams should include managers.
Team members must be knowledgeable in team building skills
and understand the tools and strategies that can be used for
problem solving.
Implementing CQI
Define the scope
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The Project Team should review the scope of the project.
Negotiate changes with the Steering Team.
Get input from the customer and end user to determine
problems and expectations.
The scope of the project should include:
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the statement of the problem
a definition of the boundaries
the magnitude of improvement goals
a target date for completion
resources available
Implementing CQI
Set the goals
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Determine what the customer and the end user want.
The goal should be to find out expectations and meet them.
Determine how the customer/end user:
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use the product or service
what problems they have with it
how it can be enhanced
The information should be analyzed.
The team should define the project goals.
The team should develop a very clear understanding of what is
expected from the project.
Implementing CQI
Understand the process
• Have a process description.
• The team should ask and answer key questions:
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What does the process do?
What are the stages of the process?
What are the starting and finishing points of the process?
What are the inputs and outputs from the process?
Who are the suppliers and the customers of the process?
Who uses the product and who pays for it?
Are there obvious problems with the process?
Implementing CQI
Flow Charts
Create a visual understanding of how the
process works.
Useful CQI Flow Charts:
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A Top Down Flow Chart
Deployment Matrix Chart
Implementing CQI
Plan the project
There is no 'right' way to tackle a project. There are
many ways and some will work better than others.
The basic plan of action will be to:
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identify root causes
develop solutions
implement the changes
review the results
Implementing CQI
Determine Information Needs
The team should review what information is needed to
analyze the problem.
For each goal the team should:
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determine what information is needed to understand how
well the process is working
what information is available and what is not available
and how to collect the information that is not presently
available
Implementing CQI
Chose the tools for the job
The tools include:
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Time Plots
Control Charts
Brainstorming
Consensus Building
Cause and Effect Diagrams
Structure Trees
Pareto Charts
Six Questions
Implementing CQI
Identify root causes
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Define the problem
Develop a list of possible causes
Generate ideas as to the root cause
Ask what and why questions until the team cannot
think of another question to ask.
Verify the conclusions with data
Why collect data
What data is needed to verify the conclusions
Take action to fix obvious root causes immediately
Implementing CQI
Develop solutions
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Define the characteristics of an ideal solution.
Identify the criteria that must be satisfied and the criteria that are
desirable but not absolutely necessary.
Constraints should be identified.
Each possible solution should be evaluated against the criteria
for selection.
When the team identifies constraints which in fact are not real
constraints, the team may find some flexibility if it pushes hard
enough to have constraints removed.
Feedback should be obtained from those that are most affected
by the changes.
Changes may be able to be implemented immediately, others
may need to presented to the Steering Team to obtain approval
before they can be implemented.
Implementing CQI
Implement the solutions
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To implement changes, the team should:
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Plan
Do
Check
Act
Define exactly what changes are to be made.
Generate a list of activities that need to be done.
Determine the sequence of steps that are required to implement the
changes.
A schedule of activities should be prepared and milestones defined.
Responsibilities for each of the action steps should be defined.
All who are affected by the changes are properly informed, briefed and
understand how the changes will take place.
Implement changes on a pilot basis.
Implementing CQI
Review the results
Monitor the effectiveness of the changes.
 Compare the results of the changes with the original
goals of the study.
Ask the following questions:
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Did the team achieve the expected benefits?
Where there any unexpected benefits or problems?
What can the team learn from these?
What can be done to fine tune the solution so that it can be
applied on a wider basis?
Implementing CQI
Standardize the Change
If the improvement project has been successful
with one process it should be refined and
applied to other processes which are similar.
One should not waste time setting up further
improvement teams to re-invent the wheel.
Implementing a CQI Program
Management Report
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Identifies area of strength
Identifies liabilities
Makes corrective action recommendation
Addresses corrective action taken
Effect of corrective action
Monthly reports will be fluid
Annual report to Executive Management and
Governing Board to be final product.