Transcript Slide 1

NQC National TA Call:
Developing QM Infrastructure:
Examples and Solutions
from the Field
March 13, 2008, 3 – 4 pm EST
Nanette Brey Magnani, EdD, NQC Quality Consultant
Hollie Malamud-Price, MPH, Part D Program Coordinator, Michigan
Department of Community Health
Rosemary Donnelly, MSN, APRN, HIV Nurse Consultant, HIV Section,
Georgia Division of Public Health
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National Quality Center (NQC)
Agenda
• Purpose and components of a written Quality
Management Plan
• Purpose and tips for Quality Management
Committees
• Challenges and solutions related to QM Plans
and QM Committees
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National Quality Center (NQC)
Infrastructure enhances systematic implementation of
improvement activities
Infrastructure
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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)
Grantee-wide Vision
Strategic QM Plan (3-5 yrs)
QM Plan (annual)
Annual Goals
Workplan
Implementation
Annual Evaluation
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National Quality Center (NQC)
Key Components of an Annual QM Plan
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Quality Statement
Infrastructure
Performance Measurement – 5/8/08 TA Call
Annual Quality Goals – integrated into 7/10/08 TA Call
Stakeholder Development – integrated into series
Consumer Involvement – 9/10/08 TA Call
Evaluation
Workplan
National Quality Center (NQC)
Part 1: Quality Statement
What do we want to be?
• Describe 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)
Quality Statement Example
The Positive Health Care program provides
comprehensive HIV primary care and
prevention services to persons in Southern
Maine. Positive Health Care is committed to
the delivery of high quality care to our
patients. We strive to continuously improve
the quality of care consistent with recognized
national standards, current research, and
Ryan White Care Act guidelines.
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National Quality Center (NQC)
Part 2: Quality Improvement Infrastructure
How are we organized?
Leadership
 Who is responsible for the grantee-wide quality
improvement initiatives?
Accountability
 Who is responsible for making changes?
 How does it get reported?
 How are consumers involved? Other major
stakeholders?
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National Quality Center (NQC)
Part 2: Quality Improvement Infrastructure
Quality Committee Structure
 Membership
 Leadership
 Charge, plan, reporting
Resources
 Budget
 Staffing
 Time and assistance from MIS
 Volunteers
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National Quality Center (NQC)
Part 2: Quality Improvement Infrastructure
• List internal and external linkages
• Draw an organization diagram/chart to depict how
HIV Quality Program relates to other committees,
groups, departments in organization, sub contracting
agencies, other RW programs.
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National Quality Center (NQC)
Example: Georgia – QM Committees
QM Core Team
Sub committees
 Performance Measures
 Case Management
Coordination with Other Statewide QI/QA Activities
 across Ryan White Programs
 within DPH
 with ADAP
 Communication with Key Stakeholders
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National Quality Center (NQC)
MDCH – Ryan White Part D Quality Management System
Part D
MDCH Program Coordinator
Ryan White Cross Part
Quality Committee
Part D Executive Committee
Quality Mgmt Committee
Members & Representatives from
Funded Agencies
(Meets Quarterly)
Part D Sub-Contractor Quality Mgmt
Meetings/Trainings
DMC
Horizons
UHC
Quarterly Evaluation Mtg
Bi-Monthly Mgmt Team Mtgs
APM
PIDC
CHM
QI Group
Project Challenge
Monthly Team Meetings,
Includes QI
Immunology Clinic
Bi-Monthly Mgmt Team Mtgs
VNA
Care Services Monthly
Team Meetings
Wellness
Monthly Quality
Committee Meeting
Weekly Case Mgt Mtgs
DHWP
CARES
Quarterly Quality Mgt
Team Meetings
Monthly Mgmt Team Mtgs
Bi-Monthly Case Mgr Mtgs
Quarterly QM Committee Mtg
**All subcontracted agencies minimally participate in contractual Quality Improvement activities.
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National Quality Center (NQC)
Part 3: Performance Measurement
How will we assess progress?
• Identify and quantify the critical aspects of care and
services provided in your HIV program
• Develop indicators and measure progress
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National Quality Center (NQC)
Example: Michigan Part D
Quality indicators are chosen for review from
the following areas:
• Clinical/medical primary care
• Coordination of services
• Case management
• Outreach/peer support/advocacy
• Continuity of care
• Psycho social and mental health services
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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 a quality program directs its efforts and
resources
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National Quality Center (NQC)
Example: Michigan Part D Program
Function/Performance
Measure
Goals for 2008
Program
Responsible
Documentation of a pap
smear (statewide indicator)
75% of eligible female patients will have
documented test results and/or copies
from an outside provider.
# of women with annual Pap smears/#
of women with 1 medical visit in the 12
month period.
UHC, PIDC,
Horizon’s Project
Documentation of case
management care (service)
plans (statewide indicator)
90% of clients will have a care plan
documented and updated at least every
six months.
Horizons, APM,
CARES, VNA,
Wellness
Clients with identified needs
will have documentation of
referrals.
Increase from 51% to 75% the number
of Part D eligible client charts which
documented coordination of services
among 2 disciplines.
UHC
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National Quality Center (NQC)
Example: Georgia, Part B
• Percent of HIV-infected clients with AIDS who were
prescribed HAART. (Goal 90%)
• Percent of HIV-infected clients on HAART with HIV
viral loads < 75 copies/mL. (Goal 50%)
• Percent of ADAP applicants approved or denied for
ADAP enrollment within two weeks of the ADAP
receiving a complete application. (Goal 95%)
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National Quality Center (NQC)
Georgia example cont’d.
• Percent of ADAP enrollees recertified for ADAP
eligibility criteria at least annually. (Goal 95%)
• RW funded providers will implement cont. quality
improvement mechanisms within their own agency
including written QM Plans and a report of most
recent CQI activities and results.
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National Quality Center (NQC)
Part 5: Stakeholder Development
• Assess education needs of
stakeholders
• Provide training opportunities for staff,
providers and other stakeholders
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National Quality Center (NQC)
Example: Michigan Part D Strategy
Combining Provider Training with Quarterly Meetings
Combine provider training with quarterly
meetings
 participants are staff responsible for quality
improvement projects
 Agenda includes
• Program updates
• Discussion of performance measurements and goals
• Training topics: QI projects, PDSAs, measuring PDSAs,
QI tools (not all in one session)
• Peer exchange of what works
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National Quality Center (NQC)
Part 6: Consumer Involvement
How will consumers be involved in the QM
Program?
• Engage consumers through various mechanisms with
the intent of increasing their participation over time.
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Moderate Participation
Higher Participation
Surveys
Focus groups
Individual interviews
Consumer Advisory Boards
Representation on Quality Committees
Representation at Planning Meetings
National Quality Center (NQC)
Part 7: Evaluation
How will we evaluate our overall
performance as a program?
Evaluation efforts should include:
• Review of performance data
• Review of QI Projects conducted over the year
• Effectiveness of QM Plan
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National Quality Center (NQC)
Example: Georgia, Part B - Evaluation
Self-Assessment
• QM Program Assessment Tool (NQC)
• Checklist for Review of QM Plan (NQC) to review Plan
• Rating of Completeness of strategies
Site Visits
• Conducted annually
• Review of subgrantee QM plans and QI activities and
progress on case management standards and performance
indicators
DPH
• Findings reported annually
• Revised QM Plan for approval
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National Quality Center (NQC)
Part 8: Annual Workplan
How will we implement the QM Plan?
• The workplan should include:
 List of key activities
 Identification of who is responsible for completing
or overseeing the completion of activities
 When the activities are to be carried out and
completed during the year
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National Quality Center (NQC)
Example: Georgia, Part B – Annual QM Timeline
Ryan White
Program Part
B Final
Progress
Report Due
Implement
Revised QM
Plan and
Workplan
April
May
June
July
QM Core Team Mtg.
Review Progress & Update
Workplan
Finalize Previous FY QM
Progress Report
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August
Ryan
White
Program
Part B
Grant Due
Mid-Year
Progress
Report
Due
September
October
QM Core Team Mtg.
Review Progress & Update
Workplan
Draft Interim Progress Report
November
December
QM Core Team Mtg.
Review Progress &
Update Workplan
Plan for Next FY
Revise QM
Plan &
Workplan
January
February
Obtain
Internal
Approval
for Plan
March
QM Core Team Mtg.
Review Progress
Review/Approve Revised
QM Plan and Workplan
National Quality Center (NQC)
Issues Identified by Grantees
Quality Management Plans
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National Quality Center (NQC)
BIG Questions: Who writes the QM Plan?
Who needs to be involved?
• No QM Plan
• Difficulties with QM Plan Implementation
 Setting goals
 Developing standards of care, quality indicators and
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measures
Not setting priorities
Inexperience of members (“it can be frustrating”)
Not a realistic plan
No buy-in
Time consuming
Conflicting personalities and who is in charge
National Quality Center (NQC)
Possible Solutions
Inexperience – ask for training (NQC Quality Academy,
NQC TA Request, join HIVQUAL Project for Parts C &
D…); ask a peer grantee for assistance
Conflicting personalities – bring in someone not
involved, training can help (NQC)
Time consuming – don’t reinvent the wheel, check
NQC website for examples of other QM Plans
Not a realistic plan; no buy-in – Use a participatory
planning process
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National Quality Center (NQC)
Tips for Who is Involved, How and When?
Decide on your approach to developing/updating
your QM Plan
 An annual planning meeting
 A series of shorter meetings that could include
piggybacking/using existing QM committee meetings
 Getting input (for stakeholders who can’t attend
meetings due to time, distance, etc.)
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National Quality Center (NQC)
Tips for Who is Involved, How and When?
Systematize timing for QM Plan updates
 Annually
 Bi-annual updates
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National Quality Center (NQC)
Quality Management Committees
Purpose
 Strategic planning
 Facilitating innovation and change
 Providing guidance
 Establishing a QI culture
 Allocating resources
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National Quality Center (NQC)
Tips for Effective QM Committees
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Start with a small group of critical individuals
Cross- functional representation
Include consumers
If applicable, include cross-Part reps
Clarify purpose/responsibilities of Committee
Train members on QI methodologies
Identify a Chairperson to moderate
Develop a meeting schedule
Set agenda and take minutes to document key
decisions
• Communicate Committee activities/decisions with staff,
providers, and other stakeholders
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National Quality Center (NQC)
Issues Identified by Grantees
Quality Management Committees
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National Quality Center (NQC)
Issues regarding QM Committees
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Too many sub committees, fractured work
Disinterested in QM
Lack of QM knowledge
Infrequent and inconsistent attendance
Staff turnover
Ineffective relationship between Committee
Chair and Quality Manager
National Quality Center (NQC)
Issues regarding QM Committees
• Membership turnover – how to get new people
up to speed. This places a greater burden on
fewer members to get the work done
• Membership is voluntary and secondary to
members’ fulltime jobs
• Competing demands between Parts A, B, and
setting up an All Parts QM Committee
• Not understanding what the QM Committee
needs to do and how to do it
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National Quality Center (NQC)
Making Your QM Committee a Success:
Ideas from Fellow Grantees
• Oakland meets quarterly instead of monthly to keep up
attendance
• San Juan changed the meeting times to coincide with
Planning Council meetings
• To keep members interested and develop their
knowledge and skills, San Juan and Oakland incorporate
training and guest speakers at meetings; others trained
members in how to develop indicators and measures
• Phoenix schedules meetings in advance so members
have meetings on their schedules; they want to increase
their meetings to quarterly; reviewing the QM plan
annually helps members see what was accomplished
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National Quality Center (NQC)
Making Your QM Committee a Success:
Ideas from Fellow Grantees
• Dallas requires their medical providers to have an active
role on its Performance Improvement Committee and
other service providers depending on the issue being
discussed
• Ohio found that once staff were trained in QM they were
interested in participating in the committee
• Norfolk saw interest in QM rise following an assessment
activity when providers said they were enthused about
doing QI Projects
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National Quality Center (NQC)
Resource: NQC Quality Management Plan
Checklist
Checklist for the
review of an HIV
specific Quality
Management Plan
www.NationalQualityCenter.org
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National Quality Center (NQC)
Resource: NQC QM Program Assessment
Tools (Part- Specific)
Standardized
Assessment Tools to
assess the key
elements of your QM
Program
www.NationalQualityCenter.org
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National Quality Center (NQC)
NQC QM Infrastructure Resources
NQC Quality Academy: www.nationalqualitycenter.org/QualityAcademy
• Tutorial 5: Quality Management Plan
• Tutorial 6: Quality Management Infrastructure
Previous NQC TA Calls: www.nationalqualitycenter.org
• April 12, 2007: Developing QM Infrastructure for Part C&D
• March 8, 2007: Developing QM Infrastructure for Part A&B
• June 5, 2006: QM Plans for Part C&D (with sample QM Plans)
• December 15. 2005: QM Plans for Part A&B (with sample QM
Plans)
2006 RWCA AGM Workshop:
• Strengthen Your Quality Infrastructure by Developing a Sound QM
Plan (Sample QM Plans: Missouri Part B, Oakland EMA)
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National Quality Center (NQC)
Today’s Grantee Presenters:
Hollie Malamud-Price, M.P.H.,RWTMA Part D Program
Coordinator
Michigan Department of Community Health, 3056 W. Grand Blvd., Suite 3-150
Detroit, MI 48202; (p) 313.456.4362; (f) 313.456.4427
E-mail: [email protected]
Rosemary Donnelly, MSN, APRN-BC, ACRN, PHSO Nurse
Consultant
HIV Section, Georgia Division of Public Health, 2 Peachtree Street, NW, Ste 12-264
Atlanta, GA 30303; (p) 404.463.0415; (f) 404.657.3119;
E-mail: [email protected]
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National Quality Center (NQC)
National Quality Center (NQC)
NYSDOH AIDS Institute
90 Church Street—13th Floor
New York, NY 10007-2919
888-NQC-QI-TA
[email protected]
NationalQualityCenter.org
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