Transcript Slide 1

Writing & Updating
Your
Quality Management Plan
April 9, 2009
Donna Yutzy, Consultant
National Quality Center
Co-Presenters: Margy Robinson,
Marisa McLaughlin, Claire Simeone
Agenda
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Welcome & Introduction
Overview of QM Plan Development
Portland Part A Presentation
Sonoma Part C/D Presentation
Questions & Discussion
Evaluation Poll
Learning Objectives
• Understand the importance and role of a QM
Plan to support ongoing QI activities
• Understand key elements of a useful written
QM Plan
• Know how to constructively review QM Plans
• Know where to access resources to help you
make your QM Plan a working and helpful,
guiding document
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National Quality Center (NQC)
Presentation Outline
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Key Terminology
HAB Expectations
Purpose of a QM Plan
Key Elements of a QM Plan
10 Tips for Success
Resources on QM Plans
National Quality Center (NQC)
Grantee-wide Vision
Strategic QM Plan (3-5 yrs)
QM Plan (annual)
Annual Goals
Workplan
Execution
Annual Evaluation
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National Quality Center (NQC)
Definitions of Terms
Quality Management Plan: A Quality
Management Plan is a written document that
outlines the program-wide HIV quality
program, including a clear indication of
responsibilities and accountability,
performance measurement strategies and
goals, and elaboration of processes for
ongoing evaluation and assessment of the
program.
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National Quality Center (NQC)
Definitions of Terms
Quality Management Program: The term
‘quality management program’ encompasses
all grantee-specific quality activities, including
the formal organizational quality infrastructure
(e.g., committee structures with stakeholders,
providers and consumer) and quality
improvement-related activities (performance
measurement, QI project and QI training
activities).
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National Quality Center (NQC)
Definitions of Terms
Strategic Plan: A Strategic Plan is a document
that describes the long-term (3-5 years)
objectives of the QM program with stretch
goals that are in line with the overall vision of
the organization.
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National Quality Center (NQC)
Definitions of Terms
Workplan: A Workplan or Implementation Plan
describes concrete steps in the
implementation of an annual QM plan with a
detailed description of responsibilities and
timetables and milestones. At times the
workplan is folded into the overall QM Plan.
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National Quality Center (NQC)
Grantee-wide Vision
Strategic QM Plan (3-5 yrs)
QM Plan (annual)
Annual Goals
Workplan
Execution
Annual Evaluation
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National Quality Center (NQC)
HAB QM Plan Expectations
“RWCA grantees are directed to establish clinical quality management
programs..” which include:

Development of a comprehensive clinical quality management infrastructure,
including routine QM Meetings with cross-functional representation

Description of QM Program in a quality plan, with a clear indication of
responsibilities and responsible parties

Inclusion and involvement of key stakeholders in your quality program
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Designated leaders for quality improvement and accountability
See a Side-by-side comparison at
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www.kff.org/hivaids/upload/7531-03.pdf
National Quality Center (NQC)
Quality Management Plan
Purpose
 Provides direction of what needs to be
accomplished (goals) and how it will be
accomplished (workplan)
 Clear indication of who is responsible
 Sets the framework for holding grantee and
providers accountable for its
accomplishments
 Basis for self-evaluation for next cycle of
improvement
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National Quality Center (NQC)
Elements of a Quality Management Plan
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Quality statement
Quality improvement infrastructure
Performance measurement
Annual quality goals
Participation of stakeholders
Evaluation
Workplan/Implementation Plan
National Quality Center (NQC)
Part 1: Quality Statement
What do we want to be?
• Brief purpose/mission statement describing
the end goal of the HIV quality program to
which all other activities are directed
• Assume an ideal world and ask yourselves,
"What do we want to be for our patients
and our community?“
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National Quality Center (NQC)
Part 1: Quality Statement
Tips:
• Be brief
• Be visionary
• Include internal and external expectations
• Make references to external legislative
requirements on quality management
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National Quality Center (NQC)
Part 1: Example
“The purpose of the Quality Management Program for
the xx Ryan White Program is to systematically monitor,
evaluate and continuously improve the quality and
appropriateness of HIV care and services provided to
all Ryan White patients through the combined efforts
of the CQI Program Designer, the Ryan White Program
Coordinator, medical staff, Regional CQI Committee,
and Ryan White consumers in concert with
PHS Guidelines for Care.”
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National Quality Center (NQC)
Part 1: Quality Statement Example—How do
you rate this mission statement?
Use the Chat Room to rate the example
(include comments):
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5.
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Poor
Poor-Average
Average
Average-Excellent
Excellent
National Quality Center (NQC)
Part 2: Quality Improvement Infrastructure
How are we organized?
Leadership
Who is responsible for the program-wide quality management
initiatives?
Accountability
Who are the major stakeholders? What are their expectations for the
quality management program?
Quality committee(s) structure
Who serves on the internal and external quality committee(s)? Who
chairs the HIV quality committee(s)? When will the quality committee
meet to assess progress and plan future activities? How will QM
activities be communicated?
Resources
What are the resources for the QM program? Staffing?
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National Quality Center (NQC)
Part 2: Quality Improvement Infrastructure
Tips
• Not more than 3-5 pages (not every detail is
needed)
• Avoid naming individuals (just job functions)
• List internal and external stakeholders
• List linkages
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National Quality Center (NQC)
Part 2: Example
‘…The Program A’s leadership is highly dedicated
in the QM process and provides guided effort in
implementing the QM Program. The staff is vitally
interested in the assessment of the effectiveness
of the QM Program in order to make changes in
the program that will keep it on the cutting edge
of progress and effective, efficient, high quality
patient care. Reports from the staff will be
provided to the QI Committee...’
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National Quality Center (NQC)
Part 2: Quality Improvement Infrastructure Example:
How do you rate the accountability in the sample?
Use the Chat Room to rate the example
(include comments):
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2.
3.
4.
5.
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Poor
Poor-Average
Average
Average-Excellent
Excellent
National Quality Center (NQC)
Part 3: Performance Measurement
How will we assess progress?
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Identify what’s important (critical aspects of
care and services provided)
Develop ways to measure what’s important
Include process, outcome and satisfaction
measures
National Quality Center (NQC)
Part 3: Performance Measurement
Tips
• develop quality indicators, keeping in mind three
main criteria: Relevance, Measurability and
Improvability
• include the process for reviewing and updating the
indicators (who/when/how)
• include a portfolio of process, outcome and
satisfaction measures
• include strategies how to report and disseminate
results and findings
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National Quality Center (NQC)
Part 3: Example
“List of collected indicators:
• Management of Antiretroviral (ARV) Therapy
• Medical Visits
• Treatment Adherence
• Medical Case Management Care Plan Updated
• CD4 and Viral Load Measurement
• Mental Health Assessment
• Hepatitis C Screening
• PPD Screening
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National Quality Center (NQC)
Part 3: Example
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Substance Use Assessment
Pelvic Exam and Pap Smear
HIV Specialist Care
Lipid Screening
Pneumonia (PCP) Prophylaxis
STD screening
Quality of life
Referral needs, tracking of referrals and referral
outcomes
• Coordination of care..”
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National Quality Center (NQC)
Part 3: Performance Measurement Example: How
do you rate the completeness of indicators?
Use the Chat Room to rate the example
(include comments):
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2.
3.
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5.
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Poor
Poor-Average
Average
Average-Excellent
Excellent
National Quality Center (NQC)
Part 4: Annual Quality Goals
What are the priorities for the quality program?
• Quality goals are endpoints or conditions toward which
the quality program will direct its efforts and resources
• Develop annual goals; the following three criteria can be
helpful:
 Frequency: How many patients/clients received and how many
did not receive the standard of care/services?
 Impact: What is the effect on patient health if they do not
receive this care/services?
 Feasibility: Can something be done about this problem with the
resources available?
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National Quality Center (NQC)
Part 4: Annual Quality Goals
Tips
• pick only a few measurable and realistic goals
annually (not more than 5)
• use a broad range of goals
• establish thresholds at the beginning of the year
for each goal
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National Quality Center (NQC)
Part 4: Example
“Goal 1: Improve the program wide rate of MH
screenings of PLWHA in primary care settings:
• Collect baseline data based on established MH
indicator.
• Assess present findings to QI Committee.
• Present an action plan to QI committee and
request input from leadership, providers,
consumers, and consortia representatives
• Hold MH trainings for providers
• Evaluation of the action plan...”
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National Quality Center (NQC)
Part 4: Annual Quality Goals Example: How do
you rate the outlined goal?
Use the Chat Room to rate the example
(include comments):
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2.
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4.
5.
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Poor
Poor-Average
Average
Average-Excellent
Excellent
National Quality Center (NQC)
Part 5: Participation of Stakeholders
How will staff, providers, consumer and other
stakeholders be involved in the QM
program?
• Engage internal and external stakeholders
• Communicate information about quality
improvement activities
• Provide opportunities for learning about quality
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National Quality Center (NQC)
Part 5: Participation of Stakeholders
Tips
• List internal and external stakeholders and their
functions/responsibilities
• Include
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•
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Clinical providers
Non-clinical providers
Consumers
Sub-grantees
Representatives from agency, such as hospital, network, etc.
List proposed training opportunities for staff and
providers
National Quality Center (NQC)
Part 6: Evaluation
How will we evaluate our overall performance as a program?
• Evaluate infrastructure effectiveness
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Was the quality committee effective in its efforts to improve the quality of
HIV care/services? Does the quality infrastructure require any changes to
improve how quality improvement work gets done?
• Evaluate QI activities
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Were annual quality goals for quality improvement activities met? How
effectively did you meet your goals?
 Did the implementation of the annual work plan go as planned? Did you
meet established milestones?
 Were stakeholders informed about ongoing quality activities? Were staff
and providers trained on QI methodologies and tools?
• Performance measures
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Were the measures appropriate to assess the clinical and non-clinical HIV
care? Are the results in the expected range of performance?
National Quality Center (NQC)
Part 6: Evaluation
Tips
• Detail when and who is performing the
evaluation
• Compare annual QI goals with year-end results
• Use findings to plan next year’s activities; learn
and respond from past performance
• Routinely use organizational assessment tools
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National Quality Center (NQC)
Part 6: Example
“Service providers, QI Committee members, consumers,
and staff will work collaboratively throughout the year
and conduct a year-end evaluation. An assessment tool
will be developed to determine the quality of HIV care
and services based on the performance data and the
overall success of the QM program based on the
annually established QI goals. Staff will review the
evaluation and recommend a plan for improvement.
Evaluation results and findings will be discussed at the
QI committee meeting in a timely manner to be useful in
the annual priority setting process and resource
allocation decisions…”
•
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National Quality Center (NQC)
Part 6: Evaluation Example: How do you rate
the completeness of the evaluation strategies?
Use the Chat Room to rate the example
(include comments):
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2.
3.
4.
5.
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Poor
Poor-Average
Average
Average-Excellent
Excellent
National Quality Center (NQC)
The 10 QM Plan Rules
Rule 1 - Size doesn’t matter; longer isn’t better.
Rule 2 - 80% planning, 20% writing (old software
programming rule).
Rule 3 - Don’t reinvent the wheel; look at other plans and
use the QM Plan Review Checklist to get started.
Rule 4 - Be inclusive, even it takes a little longer to get a
working plan. (Make it a plan of many “Parts”.)
Rule 5 - No plan is complete until it addresses consumer
input.
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National Quality Center (NQC)
The 10 QM Plan Rules: (cont.)
Rule 6 - The perfect is the enemy of the good. (A “perfect” plan
was probably written by a consultant and nobody else has a clue
what it says.)
Rule 7- Keep your goals focused. (A few visionary annual goals
are better than lots of useful ones.)
Rule 8 - Plans are only as good as their implementation.
Rule 9 - If you haven’t changed the plan throughout the
year, you probably haven’t looked at it.
Rule 10- If you haven’t looked at the plan in 6 months, bring
it to the next QC meeting.
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National Quality Center (NQC)
Resources
• NQC QM Plan Checklist
http://nationalqualitycenter.org/index.cfm/5923/15139
• HIVQUAL Workbook
http://nationalqualitycenter.org/index.cfm/5923/13487
• Strategies for Implementing your Quality Improvement Activities (NEW)
http://nationalqualitycenter.org/index.cfm/5923/19547
• NQC Quality Academy: The Quality Management Plan
http://nationalqualitycenter.org/index.cfm/5923/15527
• Building Capacity of Statewide Quality Management Programs - NQC Guide for
Ryan White HIV/AIDS Program Part B Grantees (NEW)
http://nationalqualitycenter.org/index.cfm/5918/17798
• HIVQUAL Group Learning Guide
http://nationalqualitycenter.org/index.cfm/5923/13400
•
HIV/AIDS Bureau Quality Management Manual
http://nationalqualitycenter.org/index.cfm/5918/12591
• HAB Part A Manual http://nationalqualitycenter.org/index.cfm/5659
• Contact NQC for sample plans and QM materials from other grantees
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National Quality Center (NQC)
NQC QM Plan Checklist
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National Quality Center (NQC)
Developing the Portland TGA Part A Quality
Management Plan
Margy Robinson, MPH, HIV Care Services Manager
[email protected]
Marisa McLaughlin, MPH, HIV Care Services Analyst
[email protected]
Multnomah County Health Department (Part A)
Portland, Oregon
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National Quality Center (NQC)
2007 – 2008 Quality Management Plan
• 1st plan using NQC QM Plan Review
Checklist as a template
• 3 staff members to systematically list our
activities/indicators and fit into format
• 20 pages long, 29 including appendices
 Repetitive
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National Quality Center (NQC)
2007 – 2008 QM Plan Individual Touches
• Used Chronic Care Model Elements:
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Health System
Delivery System Design
Community
Decision Support
Client Information System
Self-Management Support
To organize the different types of service indicators/performance
measures
• Quality Service Indicators from each provider
• Included our own administrative indicators/performance measures,
as well as service ones
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National Quality Center (NQC)
2007 – 2008 QM Plan
• QM Plan shared with Oregon HIV Services
Quality Management Task Force, HIV
Planning Council, Project Officer, etc.
• Results mainly shared through Annual
Reports which are distributed to State,
Planning Council, services providers, and
other key stakeholders
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National Quality Center (NQC)
2009 – 2010 Quality Management Plan
• Edit, edit, edit
 13 pages now
 Same concept, more succinct
• Incorporates in 2009 – 2011 Comprehensive
Plan Goals and Objectives
• Includes target benchmarks for all service
outcome indicators
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National Quality Center (NQC)
Lessons Learned
• Getting all the different components down was the
biggest hurdle
 Getting it all in one location has increased utility
• Sharing different components with different stakeholders
at different levels
• Got rid of duplication
 e.g. combined participation, communication and stakeholders
• Having a client-level database helps
• Good preparation for overall HD quality efforts
 e.g. prep. for PH accreditation, etc.
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National Quality Center (NQC)
Developing Our
Quality Management Work Plan
Claire Simeone, FNP, CQI Coordinator
Center for HIV Prevention and Care
Sonoma County Department of Health Services (Part C/D)
Santa Rosa, CA
[email protected]
707-565-7372
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National Quality Center (NQC)
Getting Started
• Resources committed: time, personnel
• Used template from our HIVQUAL consultant
 Year one: what does this mean?
 Year two: making it ours – cut/pasted/adapted/deconstructed
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National Quality Center (NQC)
HIV Quality Program Workplan – 2009
Goal 1: Develop and Enhance CQI Program Structure
Goal 2: Create a QI culture within HIV Clinic
Goal 3: Establish ongoing data collection and reporting to support performance measurement.
Goal 4: Create and evaluate Formal CQI Projects:
Goal 5: Access resources to support quality program
Goal 1: Develop and Enhance CQI Program Structure
Who
Activities
Completed by
Ja
n
Review Continuous Quality
Improvement Plan and Program
biannually (2010)
CQIC
Develop an Annual Workplan
CQIC
x
Monitor implementation of plan
quarterly
CQIC
x
Fe
b
Ma
r
Ap
r
Ma
y
Jun
e
Jul
y
Au
g
Sep
t
Oc
t
No
v
De
c
x
x
x
x
Evaluate Quality Program
Infrastructure (team membership,
meeting frequency, relationship
w/Mgmt Team [MT])
CQIC
x
Resources (staff time and capacity
to participate on CQI teams)
MT
x
QI Culture
CQIC
x
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National Quality Center (NQC)
Goal 3: Establish ongoing data collection and reporting
systems to support performance measurement
Who
Activities
Completed by
Ja
n
Determine local indicators for
HIVQUAL process
Anna,
Claire, soc
svc
Determine 2009 HIVQUAL data
collection process
CQIC
Fe
b
Ma
r
Apri
l
Ma
y
x
x
Jun
e
Jul
y
Au
g
Sep
t
x
x
Oc
t
No
v
De
c
x
Collect HIVQUAL data
x
x
Analyze HIV QUAL data
Claire,
Brian
Report HIV QUAL data at CCC
Claire,
Brian
Review monthly data reports,
and identify desired
improvement areas.
Marie
x
x
x
x
x
x
x
x
x
x
x
x
Prioritize and allocate resources
for improvement projects using
Whiteboard
MT
x
x
x
x
x
x
x
x
x
x
x
x
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x
x
National Quality Center (NQC)
Report results for CQI
projects:
To MT
Project Team
Lead
pr
n
prn
prn
pr
n
prn
prn
prn
prn
prn
pr
n
prn
prn
To CQI Committee
MT member
or consultant
pr
n
prn
prn
pr
n
prn
prn
prn
prn
prn
pr
n
prn
prn
To Center staff –at CCC
Project Team
Lead
pr
n
prn
prn
pr
n
prn
prn
prn
prn
prn
pr
n
prn
prn
To Public Health
Leadership
Shari
To Funders
Shari
To Commission on AIDS in
Report from Public Health
Shari
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x
Part
C
x
EIP
Part
D
x
x
Part
A
x
x
x
National Quality Center (NQC)
Next steps
• Sought linkages in the community – HIVQUAL & local
community consortium - for
 Training opportunities for staff
 Peer consultation
 Stealing tools
 Opportunities for CQI work across our TGA
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National Quality Center (NQC)
Goal 2: Create a QI culture within HIV Clinic
Activities
Who
Completed by
Ja
n
Ongoing training for key
management staff to
principles of QI
1 – HIVQual Regional Mtgs
2.- QCS
3 – RCHC PIC
Claire,
Anna,
Shari,
Mallory,
Marie,
Brian
3
Conduct training on CQI for
all staff members
CQIC and
staff
x
Fe
b
x
Ma
r
Ap
r
Ma
y
Jun
e
Jul
y
1,
3
2
3
1
3
x
x
x
x
x
Au
g
x
Se
pt
Oct
No
v
De
c
1,
3
2
3
1
x
x
x
x
Add new trainings as they are
scheduled
4/28/08
CQI Updates - SB
5/12/08
AB/CS
HIVQUAL Prep -
6/09/08
all staff
HIVQUAL Action -
9/08/08
BG/CS
PDSA cycle –
10/27/08
back – CS
HIVQUAL Report
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National Quality Center (NQC)
What we needed to create:
• “the whiteboard” – a tool to organize and
prioritize our many projects. This rather large
grid details:
 Formal vs. streamlined project
 Project title
 Project scope
 Project lead
 Timeline
 Category
 Steps completed
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National Quality Center (NQC)
And create
• The “project improvement request form” – a
way for staff to submit their ideas for change
and improvement. It tracks:
 The idea
 The management team response
 The timeline
 The implementation
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National Quality Center (NQC)
In process
• Annual quality goals
 We are using HIVQUAL goals as well as “local
indicators” that we will look at annually
 We are looking at developing a “yearly report
card” for specific indicators in and out of the
clinical spectrum
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National Quality Center (NQC)
In process
• Stakeholders –
 Good progress with internal CQI teams
 Focusing on development of Community Advisory
Board
 More link to DHS QI programs – opportunity for
leadership?
 As HIV specialists, further develop relationship
with community clinics in the area of quality
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National Quality Center (NQC)
Lessons learned
•
•
•
•
Be patient
Be more patient
Take small bites
Develop tracking systems to keep things from
falling off the plate
• Commit to reviewing on time
• Ask – what does this mean for us?
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National Quality Center (NQC)
National Quality Center (NQC)
212-417-4730
NationalQualityCenter.org
[email protected]
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National Quality Center (NQC)