Every Program, Every Agency: A CQI Solution to Meet the Needs of All Organizations Hannah Hirschland, LMSW, Managing Director of Analytics & Evaluation Kelsey Louie, MSW, MBA, CEO GMHC 6/17/16

What is Continuous Quality Improvement? A management philosophy or approach for identifying ways to improve efficiency and effectiveness of services A continuous process ultimately improving service delivery Focuses on program-level (NOT the time to talk about individual’s performance) Well-executed quality improvement projects can lead to drastic improvements in service delivery, client outcomes, client and staff satisfaction

Purpose: Overall Role of CQI Sometimes organizations don’t meet the goals they set for themselves Ensure that the highest quality of care is provided to our clients Ensure highest quality of service is provided to customers who are users of that service Foster a work culture that values self-reflection, evaluation, learning and creativity Opportunity to have an open, honest, productive discussion that leads to creative solutions using institutional expertise Identify barriers, then implement and test solutions for better service delivery

Main Purposes of CQI Prepare for audits Monitor progress toward agency-wide goals Address “biggest problems”

Key Components of CQI Involvement of staff Process/systems approach Continual improvement Data-driven approach to decision making

Who is involved in a CQI process? CQI teams should include representation from all levels of the staff members within each program and in other relevant departments Senior Leadership – support data-driven learning culture Manager – identify problem and guide process Direct Service/Line Staff – participate in brainstorming session and implementation of action items Evaluator – supports manager, facilitates root cause analysis, provides outside perspective

What are the steps of CQI? Problem identification & data collection Brainstorming possible root causes of the problem Work Plan Development Execution of solutions and continued data collection Monitoring and evaluation Make changes, as needed, and repeat

When do you use CQI? Reserve CQI for addressing biggest problems. Prioritize based on things like: 'Keeping the lights on’ Agency mission Program mission Funder directives and other external stakeholder demands Use Program Dashboards as a guide

Institutionalizing Change Permanent solutions: implement and maintain real system changes Monitor Performance

Tools for Root Cause Analysis and CQI Fishbone Diagram Affinity Diagram PDSA Work Plans 7 Why’s

Fishbone/Ishikawa Diagram

Mental Health Dashboard 2016 6/14/2016 1/1/2017   FY Target FY Start Date FY End Date Jan-16 Feb-16 Mar-16 Target Actual Program or Department Operations Treatment/Clinical Docs Completeness (per audit) 100% 1/1/2016 12/31/2016 94% 92% Eligibility Docs Current and Acceptable (per audit) 93% 98% Funder Trainings 6 1 2 Program or Department Service Delivery # of active clients in the program 130 118 128 131 # of cases with no activity of more than 30 days 5 avg days from outreach to 1st intake appt scheduled 8 16 avg days from intake appt completed to Initial Tx session 15 14 26 % no show of on-going scheduled appointments 10% 18% 27% 24% Contract Deliverables Care Coordination - Primary Care Provider 51 23 19 39 Group Counseling - MH 332 168 119 164 166 203 Individual Counseling - MH 263 132 207 221 257 Treatment Adherence Counseling - Individual 60 31 29 42 30 34 Reassessment 24 10 Service Plan Development 20 7 12 # of Program Contract Reports Submitted on Time Contract or Budget Management # of Variance Meetings Budget Spent $ 191,790.00 $ 38,860.50 $ 38,254.18 $ 39,783.00 $ 38,023.00 $ 38,408.00 Spending Rate Variance +/-1% 2% -2% -1% Triad Management Data Driven Administrative Supervision (#) Skills Building Supervision Hours 120 22 # of CQI Meetings descriptive D # of open CQI projects with a workplan # of Triad Meetings Human Resources # of Management Positions Vacant # of Line Staff Positions Vacant # of Staff on Progressive Discipline # of Terminations # of Resignations with <30 Days Notice

Example – Mental Health Services Root Cause Analysis Policies Procedures Staff Customers Environment Equipment

Example – Mental Health Services CQI Work Plan Obj # Objective Task # (A,B,C) Task Name Step # (1,2,3) Steps Responsible Parties Start Date Deadline Time Frame (days) Days to Deadline Status   A

How CQI fits into management paradigm Administrative Data-driven Supervision: Staff-level assessment (broad) of service delivery Continuous Quality Improvement: Program/department-level assessment of service delivery, testing and implementation of quality improvement activities Skills Building: Staff-level assessment (focused), clinical skills building and training

Questions??? Thank you!