Quality Input, Quality Output: Developing Quality Management Plans and Managing QM Committees _______________________________ Nanette Brey Magnani, EdD NQC Quality Consultant NQC National TA Call, March 8, 2007, 3 – 4 pm EST

Purpose of Presentation Purpose and components of a written Quality Management Plan Uses and benefits of participatory processes Keys to set up/maintain a Quality Management Committee

Quality Management Plan Purpose Provides direction of what needs to be accomplished (goals) and how to implement (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

Key Components of an Annual QM Plan Quality Statement QI Infrastructure - Focus of today Performance Measurement – 5/10 session Annual Quality Goals – integrated into 7/12 use of data Stakeholder Development – integrated into series Consumer Involvement – 9/13 session Evaluation Workplan

BIG Questions: Who writes the QM Plan? Who needs to be involved? Several issues identified in responses from Part A and Part B programs: No QM Plan Difficulties with QM Plan Implementation Setting goals Developing standards of care, quality indicators and 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

Who writes the QM Plan? …depends on who has the authority and experience Grantee choices: QM Committee Quality Manager Combination of the above TA or subcontract

Possible Solutions Inexperience – ask for training (NQC Quality Academy, NQC TA Request…); 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 Title I and II programs (Title I Manual or ask NQC) Not a realistic plan; no buy-in - COMPLICATED

Why is it Complicated? The process for developing the written QM Plan (and the workplan) needs to involve the people who are expected to do the work to reflect realistically what can get done and when. Participatory planning processes can be more time consuming, but, in the end IMPLEMENTATION is generally smoother and the outcome is better!

Participatory Planning Processes or Managing Trade-offs! Guiding principles top-down, bottom-up strategy leads to more effective and sustained changes, i.e., “the top” needs to involve “the bottom” most effective decisions are made by teams/groups that represent diverse perspectives (horizontal and vertical representation)

Participatory Planning Processes (cont.) Stakeholders (grantee staff, providers, Council members, consumers) are more likely to take responsibility for the QM Plan and QI changes when they are involved in the decisions that affect them: Developing annual plan Development of/selection of standards of care, performance indicators, measures Goal setting Evaluation Workplan

Tips for Who is Involved, How and When? Make a list of stakeholders who need to be involved in various aspects of the work: developing, implementing, and monitoring the plan. For example: Providers, Clinical leadership Grantee staff Planning council members Others in community

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 on existing QM committee meetings Getting input (for stakeholders who can’t attend meetings due to time, distance, etc.) Prior to writing the QM Plan (e.g., at a CAB meeting, at QM committee meeting, at provider agency)

Tips for Who is Involved, How and When? Getting feedback on QM Plan draft by circulating the plan, then, revising and circulating again to achieve consensus (or close to it!) TRADE-OFF – set feedback deadlines to manage time! Systematize timing for QM Plan updates Annually Bi-annual updates

_______________________________ Quality Input, Quality Output: QM Infrastructure: Quality Management Committees _______________________________

Managing Effectiveness Key Factors: Charge to Quality Management Committee Membership/composition of the Quality Management Committee 3. Leadership of the Quality Management Committee

QM Committee: Motivation Finding the Right Mix

QM Committee Charge Formation Mission Key task groups Expectations of membership Frequency of meetings Length of service Nature of work and how much Timeline for getting work done Parameters of work Resources

QM Committee Leadership Functions of Committee Chair Balances participation of membership with accomplishments (‘runs an effective meeting’) Accesses resources Understands the needs of the grantee and the needs of the providers Aims at building consensus and collaborative relationships

QM Committee Leadership Roles from which Chairs are selected: Planning Council member Quality Manager Both (co-chairs) Day-to-day functions Assigns responsibility to staff member(s) Ensures minutes are taken and distributed to stakeholders Maintains communication among members Promotes collaborative relationships Supports membership in accomplishing work

QM Committee Membership Recruitment of membership knowledgeable, skillful, and experience (consistent with mission) invested in the outcome willingness to commit the time a good mix - diverse talents, representative of providers and consumers

Issues regarding QM Committees Too many sub committees, fractured work Members not able to attend every meeting Disinterested in QM Lack of QM knowledge Infrequent and inconsistent attendance Staff turnover Ineffective relationship between Committee Chair and Quality Manager

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 Title II, Title I and setting up an All Titles QM. Not understanding what the QM Committee needs to do and how to do it

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 found scheduling 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

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.

NQC QM Planning materials and resources RWCA All-Grantee Presentations, 8/06 and NQC Web Ex Presentations, 3/07 Presentations: - Strengthen Your Quality Infrastructure by Developing a Sound QM Plan - QM Planning – Missouri Dept. of Health and Senior Services Oakland EMA Broward County EMA (TODAY’s) Materials: Quality Management Plan Checklist Sample QM Plans: Missouri Title II, Oakland EMA – Title I

National Quality Center (NQC) NYSDOH AIDS Institute 90 Church Street—13th Floor New York, NY 10007-2919 888-NQC-QI-TA Info@NationalQualityCenter.org NationalQualityCenter.org