Transcript Strengthening Practice & Improving Results

Reviewing & Refining Our Practice:
Applying Disciplined Inquiry to Case Practice to Improve Results
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010
What is QSR?
• The Quality Service Review (QSR) provides ways of knowing
what’s working and not working at the practice points for
which children and families and why.
• QSR tests the PRACTICE MODEL used in actual cases.
• QSR connects results to local FRONTLINE CONDITIONS.
• QSR supports teaching & action learning processes that
clarify expectations, provide useful feedback, and affirm good
work.
• QSR stimulates actions taken to improve practice and
results at all levels of the organization.
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010
How Does QSR Work?
• Uses in-depth CASE REVIEWS to measure current status, recent
progress, and adequacy of current practices in getting results for
children and families being served in local sites. [Drill Downs]
• Uses the POWER FOR STORY to reveal what is happening and
working for families at the practice points. [Stories Teach]
• Uses aggregate quantitative PATTERNS of qualitative indicators
to reveal and describe the quality and consistency of local practice.
• Uses local focus group and key stakeholder interviews along
with case stories, data patterns, and local working conditions to
find and affirm what’s working now and to surface areas where
even better results might be achieved in the future.
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010
Core Functions in Child & Family Practice
Key Functions in a Our Practice Model
ELIGIBLE CHILD &
FAMILY => ENTRY
ENGAGING Family
Members/ Assemble
Family Team/ Begin
TEAMING 1
Processes
1
ADAPTING Services
Through On-going
Assessment and
Planning
7
TRACKING Progress,
6
Results, What’s Working;
Maintaining Situational
Awareness
SAFE CASE CLOSURE
OUTCOMES MET =>
EXIT
9
ASSESSING &
UNDERSTANDING the
Current Situation -Strengths, Needs,
Underlying Issues
2
8
COORDINATING,
INTEGRATING,
COLLABORATING
3
5
QSR Tests Basic
Practice
Functions
INTERVENING by Using
Treatment Strategies,
Supports, and Transitions
4
PLANNING Outcomes for
Safe Case Closure,
Change Strategies,
Actions, and Resources
RESOURCING Planned
Intervention Strategies,
Actions, and Supports
Leading Practice Development • © Human Systems & Outcomes, Inc., 2010
Possible Indicators in a QSR Protocol
Core Practice Functions
Optional Specialized
Practices
• Applicable for All Families •
• Limited, Situational Use •
•
1. Engagement
•
1. Cultural competence
•
2. Teamwork
•
2. Transitions & life adjustments
•
3. Assessment & understanding
•
3. Medication management
•
4. Long-term view / family outcomes
•
4. Crisis management
•
5. Planning a change process
•
OVERALL PRACTICE PERFORMANCE
–
A. Safety management
–
B. Permanency
•
6. Necessary resources
•
7. Intervention adequacy
•
8. Tracking & adjusting
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010
QSR Interpretative Guide for Practice Performance Indicator Ratings
Maintenance
Zone: 5-6
6 = OPTI MAL & ENDURING PERFORMANCE
. Consistent, effectiv e practicefor the
person in this area for thepast 6 monthsor since admission if less. The lev el of
performance is indicativ e ofexemplary practice and results
for the person.
Performance is effectiv e.
Efforts should be made to
maintain and build upon a
positiv e practice situation.
5 = GOOD ONGOING PERFORMANCE
. The practice function isw orking dependably for the person, under changing conditions ov er the
past 3 months.
Effectiv eness lev el isconsistent w ith long-term outcomes
for the person.
Refinement
Zone: 3-4
4 = FAIR PERFORMANCE
. Performance isminimally or temporarily sufficient to
meet short-term need or objectiv es
. Performance in this area of practice has
been no less thanminimally adequateat any time in thepast 30 day ,s but may
be short-term due to changing circum stances, requiring change soon.
Performance is minimal or
marginal and may be
changing. Further efforts
are necessary to refine the
practice situation.
Improvement
Zone: 1-2
Performance is inadequate.
Quick action should be
taken to improv e practice
now .
Acceptable
Range: 4-6
3 = MARGINALLY INADEQUATE PERFORMANCE
. Practice may beunderpow ered, inconsistent or not w ell-matched to need
. Performance isinsufficient at
times or in some aspects for the person to meet short-term needs or objectiv
. es
With refinement, this could becom e acceptable in the near future.
2 = POOR PERFORMANCE
. Practice isfragmented, inconsistent, lacking necessary intensity , or off-target
. Elements of practice may be noted, but it is
incomplete or not operativ e on a consistent or effective basis
.
1 = ADVERSE PERFORMANCE
. Practice may beabsent or not operativ .e
Performance may bemissing (not done). - OR - Practice strategies, if occurring
in this area, may be contra-indicated may
or be performed inappropriately or
harmfully.
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010
Unacceptable
Range: 1-3
Practice Pe rformance
Core Practice Functions
Engaging
50%
Te am ing
42%
As s e s s ing
50%
Planning
50%
Im ple m e nting
50%
Adjus ting
0%
Useful Reporting
For Monitoring
EXIT CRITERIA
58%
20%
40%
60%
80%
100%
Percent acceptable cases
Site: Alpha Baseline Review
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010
How Does QSR Stimulate Change?
• Promotes and applies the practice model to actual cases to
measure progress and results.
• Links results to frontline conditions at local practice points.
• Finds and affirms good practice in actual cases.
• Tracks progress toward meeting performance goals
• Provides immediate, safe, and useful feedback to practitioners.
• Uses grand-rounds sessions to teach from cases reviewed about
what’s working now and what to do next.
• Stimulates local supervisors and managers to take next steps
and enables effective use of technical assistance.
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010
QSR Activities in 2010
• January: QSR overview for key participants
• February: Design team process
• March: Protocol design & development
• April: Technical review and recommendations
• May: Protocol refinements, training preparation
• June: QSR reviewer training & pilot testing
• July: QSR refinements
• August: Second QSR training & site review
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010
Let’s Talk!
QSR/Practice Overview • © Human Systems & Outcomes, Inc., 2010