Trends in Quality Assurance Achieving Safety, Health and Valued Outcomes

Signs of Change in Performance Management No longer just better than the institution Rooted in outcomes Emphasis on enhancement Changing role of the state Changes in experiences of families and people with mental retardation Changes in accreditation approaches Outcomes Expectations Inclusion

More Signs of Change Movement away from prescriptive standards Emphasis on CQI Exploration of self-assessment Collaborative development of standards Inclusion of customer satisfaction Satisfaction Consensus CQI

Person-Centered Systems: Facilitate individual choice Support relationships and community membership Encourage natural supports Encourage health, well-being and safety Foster productivity and participation in meaningful work Maximize self-determination Support families Build staff and provider capacity

Public Quality Assurance Responsibilities Assuring that individuals are free from abuse, neglect, and exploitation; Protecting the rights of individuals and families; Assuring accountability in the use of public dollars; Assuring that individuals have access to necessary professional services; Evaluating the effectiveness if service and supports; Assessing the performance of service providers

Changing Quality Landscape Exposure of fault-lines in the system (e.g., HCFA and the press) Expansion of supports to individuals on the waiting list Emergence of self-determination Olmstead decision Struggles with MIS applications Direct support staff shortages

Critical Constraints Consolidation of providers Management of multiple systems “Generic” approaches to quality Increasing gray areas in public jurisdiction Pressure from HCFA Lack of collaboration with sister agencies

Emergence of Performance Indicators First appeared in behavioral and acute care Provide some “cues” for managing these complex systems Highlight impact of cost containment Illuminate what’s working Provide early warning signs For more information: www.hsri.org (Core Indicators Project)

Project Beginnings NASDDDS and HSRI collaboration Launched in 1997 Seven field test states + steering committee ~60 candidate performance indicators Development of data collection instruments

Current Participating States Arizona Connecticut Delaware Hawaii Illinois Iowa Indiana Kentucky Massachusetts Montana Nebraska North Carolina Oklahoma Pennsylvania Rhode Island Utah Vermont Washington West Virginia Wyoming

What will CIP accomplish? Nationally recognized set of performance and outcome indicators for developmental disabilities service systems Benchmarks of performance Trend data at the state level Broad dissemination to all stakeholders

What are the Core Indicators? Consumer Outcomes: Satisfaction, choice, employment, community inclusion, natural supports, family supports… System Performance: Service expenditures and utilization, access… Protection of Health and Safety: Injuries, crime victimization, mortality data… Provider Agency / Workforce Stability: Staff turnover…

Data Sources Consumer Survey Family Support Survey (plus new version for families with kids) Family/Guardian Survey Provider Survey (limited) DD System MIS

Consumer employment data Where people work: Duplicated counts Aggregate N = 3900 (11 states) 27.7% -- supported employment 21.7% -- group employment (enclave/crew) 40.4% -- facility-based employment 36.8% -- non-vocational day supports

Types of Employment Supports by State

Community Inclusion

Choice and Decision-Making

Consumer Outcomes Access Safety 81% of respondents reported that they almost always have a way to get where they want to go Safety 93% of respondents report feeling safe in their neighborhoods 96% report feeling safe at home

Health Outcomes

Health Outcomes

Health Outcomes

Family Survey Comparisons More positive responses on Family/Guardian Survey (this group was generally older and received more supports) Out-of-home families more satisfied with individual supports than those with family members living at home (84% vs. 64%) Much greater variation on satisfaction ratings for the in-home group (50% to 70%)

Staff Stability Day support providers report: Lower turnover Current staff have been employed longer Half as many vacant positions (both FT and PT) Both types of agencies report: Staff who left within the last year were employed on average about 19 months Part-time position vacancies are much higher than full-time position vacancies

For more information… Visit HSRI’s website: www.hsri.org/cip/core.html

Important Next Steps Get serious about uniform reporting of critical health and safety events Develop staff credentialing and expand training options Reassess roles of case managers Refine performance contracting Expand understanding of person-centered planning Place individual outcomes at the center of the system Enlist assistance of consumers and families Identify key areas of performance Link technology with need for information Look at the costs and benefits of existing approaches Make results available and accessible

Final Words “Beware the Continuous Improvement of Things Not Worth Improving” W. Edward Deming CAUTION