Quality Evaluation Template: How to Develop a Utilization Focused Evaluation System Incorporating QI & QA Systems Presenter: Stanley Capela, Vice President for Quality Management & Corporate Compliance Officer HeartShare Human Services 12 MetroTech Center,29 th Floor Brooklyn, New York Key Participants: Donna Carroll, Senior Director Quality Assurance & Training and Ariana Brooks, Director of Evaluation, Planning & Research

Approach Case Study: How one organization incorporates QA & QI in a utilization focused approach to accomplish their goals.

HeartShare Human Services Developmental Disabilities Division Residential Programs (26 sites) Adult Day Programs (10 sites) Early Childhood Services (6 sites) Health and Mental Health Services (Article 16 & 28 Clinics) Medicaid Service Coordination (290 cases)

New York State Office of Persons with Developmental Disabilities (OPWDD) OPWDD Independent agency since 1978 Primary Funder of DD services Regulatory Body Provider of direct services (13 DDSO) Oversees all provider program development and activities

Department of Quality Management (DQM) The regulatory arm of OPWDD Subcontracted by NY State Health Department Responsibilities include: All provider recertification activity Ensure providers meet minimal compliance standards Complaint and special investigations Certification of all new provider program sites.

DQM Visits DQM is mandated to conduct a visit to every provider program site yearly. Two types of visits: Recertification = Full Service Review Annual = Limited Monitoring

The World of the SOD ISSUANCE Formal citations Response (POCA) Systematic plan Agency Responsibility to the POCA Implementation

Definition of Terms Quality Assurance Quality Improvement Performance Measurements Quality Management Compliance Change Benchmarks Value

Internal Review of Services and Protections Case Records Medical Records Human Rights Financials Incidents Staff Certifications Physical Plant Fire Safety Community Inclusion

Quality Assurance Our Standards Way beyond minimal compliance! Our Process Annual internal audit of every site Issuance of internal SOD Mandatory POCA Follow-up visit to confirm POCA implemented Monthly contact with program Additional site visits

HS Performance over 10 years Raw Numbers 203 citations citations citations citations citations citations citations citations citations citations 2010

Quality Improvement Process Quality Improvement Committee Use of Data =SOD Charts Set Goals =Target Problem Areas Case Example =Incidents

Performance Measurements Use of SOD’s as Performance Measurements Potential Pitfalls Interpreting the data Issues of subjectivity Staff resistance to change

SOD chart example (2010)

Creating Balanced Scorecards Internal vs. External Internal Initiatives Program Rating System Self Assessment Survey More on-site training External No Adverse Actions Reduce overall deficiencies annually No Deficiency Surveys

Quality Management 101 Real World Bottom line Funders Rule Good vs. Poor Management Corporate Culture Producing Results

Quality Management 102 Focus Funders set rules & monitor programs Key is how do you maximize value Focus: Quality Assurance, Quality Improvement & Performance Measures Can’t Solve Management Problems Key: Provide Direction & Identify Strengths & Weaknesses Corporate Culture Key: CEO & Senior Management Buy In Utilization Focused Team Approach Producing Results Key:First Meet Funding Standards - Minimum Second Meet Quality Standards - Maximum

Toolkit of Ideas Review funder standards & monitoring system Make sure everyone talks the same language Create Consensus – Idea Writing; Rapid Cycle What do you want to accomplish? What is the end result? Identify Measures Identify Systems Do it!