Nanette Brey Magnani and Susan Weigl NYS HIVQUAL Workshop: A Guide for Developing Your Quality Management Plans April17, 2008 Nanette Brey Magnani and Susan Weigl NYSDOH AIDS Institute breymagnan@aol.com,sweigl@yahoo.com

Learning Objectives Understand the importance and role of a QM Plan to support ongoing QI activities Understand key elements of a useful written QM Plan Create a draft of a QM Plan update your own QM Plan Know where to access resources to help you make your QM Plan a working and helpful, guiding document

Agenda 9:00 Welcome. Introductions Review agenda and materials. 9:15 Interactive Presentation: A Guide for Developing Your QM Plans. Individual/dyad exercise: After each component of a QM Plan is presented, participants review examples and highlight aspects of examples that are relevant to them. 11:00 Cut and paste highlighted parts into a draft QM Plan. 11:30 Large group sharing and next steps. 11:50 Feedback and evaluation. 12:00 Adjourn.

Infrastructure enhances systematic implementation of improvement activities

Quality Management Plan Purpose Provides direction of what needs to be accomplished (goals) and how it will be accomplished (action plan) and by whom Sets the framework for holding the HIV program and providers accountable for the quality of patient care Basis for self-evaluation for next cycle of improvement

Strategic QM Plan (3-5 yrs) Grantee-wide Vision Strategic QM Plan (3-5 yrs) QM Plan Annual Goals Action Plan Implementation Annual Evaluation

Format and Components of a QM Plan Section I: Description – Relatively unchanged from year to year Quality statement Infrastructure Performance measurement Annual quality goals Stakeholder participation and development Evaluation

QM Plan format and components contd. Section II: Annual QI Action Plan– Changes from year to year Presentation of data and results Annual Improvement Goals/Objectives QI Projects Activity Timeline

How is the QM Plan written? Decide on and systematize 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.)

(Title of Program) Quality Management Plan Section 1: Description of ____ HIV Quality Management Program

I.1. Quality Statement What do we want to be? Brief purpose/mission statement describing 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?”

I.2. Quality Improvement Infrastructure How are we organized? Leadership Who is responsible for the program-wide quality management initiatives? Accountability Who reports to whom re quality; what different committees/groups/meetings have a role in quality and how do they related to each other Quality Committee(s) Structure Members? Chairs? Roles? Frequency of meetings? Agendas? Communication Resources Resources for the QM program? Staffing?

HIV Quality Management Committee An HIV QM Committee oversees the quality management program. The plan usually addresses the following: Committee composition Frequency and schedule for meetings Plan for recording agendas, minutes, and other documentation Plan for consumer input

Description of QM Committee Responsibilities Selects an improvement process model such as HIVQUAL model and use of PDSAs Sets QI priorities Recommends new policies or changes in current policy to promote quality care Develops, monitors, and evaluates overall QM Program, QM Plan and Action Plan, and QI Projects. Provides in put on quality perspective in other planning activities (strategic planning, program development, grants)

QM Committee resp. contd Monitors performance measures on applicable PHS standards and on non-clinical standards related to access, linkages, services in support of clinical treatment, and/or other case management performance. Designs new processes, systems and procedures consistent with CQI principles and with the results of QI Projects. Develops a staff development plan to educate staff in quality principles and methods. Maintains internal and external accountability for quality management.

Quality Improvement Teams A QI Project Team is charged to make process improvement recommendations in the delivery of care to the HIV QM Committee. Responsibilities: Set improvement goals/objectives Plan, test and measure changes Provide progress reports to QM Committee Manage spread of more successful change strategies Evaluate effort

Quality Management Organizational Chart Organization diagram/chart depicts: Relationships: reporting, supervisory Internal and external linkages It helps to see it visually and oftentimes reveals more groups and individuals that have a role or need to be involved in some way. Also, helps to expand understanding of QM Program.

Waterbury Hospital Accountability Diagram Internal Communication WHICH QM Committee HIV Care Team Consumer Advisory Group Ryan White Program Director

Plan for Communication Internal communication (Monthly): The QI program’s progress is on the agenda of the monthly HIV care team and the department of medicine’s monthly meeting. Two consumers are part of the HIV care team. The QI coordinator reports to the HIV care Team on the monthly progress re implementation of the QI work plan, sharing of data on QI projects, and the formation of subcommittees, as needed, during this meeting. The Program director and the CAG representative are present during the HIV care Team meeting.

Hospital Accountability Diagram External Communication (annually) WHICH QI Committee Waterbury Hosp QM Committee -HRSA -RW Part A office Ryan White Program Director Waterbury Hosp Executive Management Team Dept of Medicine Director

I.3. Performance Measurement How will we assess progress? Identify what’s important (critical aspects of care and services provided) Develop ways to measure what’s important Include process, outcome and satisfaction measures

I.4. Setting Annual Quality Goals How are the annual goals determined? What group/staff? What data is used? What criteria? How often?

I.5. Stakeholder Participation and Development How will staff, providers, consumers and other stakeholders be involved in the QM program? Who are they and how can they be involved in the QM Program (internal to the QM Program and external to it) What information do they need and when Provide opportunities for learning about quality improvement

I.6: Evaluation How will we evaluate our overall performance as a program? Infrastructure QI activities Performance Measures Did the QM Committee meet and oversee the QM program effectively? Did QI Project Teams meet their goals? Were the right staff on the teams? To what extent were consumers involved in the QM Program? Was the action plan realistic and reflective of the work of the QM Committee, QI Project Teams, & QM Program? To what extent were QI goals achieved? Sustained? Do the same QI Projects need to be extended? Was there the right mix of staff members on the QI Project teams? Were stakeholders informed of and participate in quality activities? Was training provided? Were performance measures reflective of standards of care? Were your results in the expected range? Were results shared with stakeholders? To what extent can quality reports be generated to support the QM Committee’s decisions and program monitoring? You will remember that part of the quality management process is an annual evaluation, the results of which are fed into next year’s quality management plan. The quality management plan needs to state how this evaluation will be done, and how the information the evaluation provides will be used. The evaluation needs to look at three things: Infrastructure effectiveness, QI activities, and performance measures. Was the quality committee effective in improving HIV care and services? Does the quality infrastructure require further adjustment? Were annual quality goals for quality improvement activities met? How effectively did you meet your goals? Did the implementation of the annual work plan go as planned? Did you meet established milestones? Were stakeholders informed about ongoing quality activities? Were staff and providers trained on QI methodologies and tools? Were the measures appropriate to assess the clinical and non-clinical HIV care? Are the results in the expected range of performance? In simple terms: Did our infrastructure work? Did we do what we said we were going to do? Did we get the results we sought, and were we measuring the right things to understand this? QM Plan Elements: Evaluation

Section II: Annual QM Program and QI Action Plan How will we implement the QM Plan? 1. Presentation of data and results Annual Improvement Goals: program level and patient care level 3. QI Projects 4. Activity Timeline

II.1. Presentation of Data and Data Analysis Data and analysis from performance measurement data (patient care) HIVQUAL data EHR data Patient satisfaction surveys Data and analysis from QM Program evaluation Organizational quality assessment Feedback from staff, consumers, QI Project Teams Disparity data Epidemiological data

HIV Monitoring Core Indicator

Gynecology Exams Core Indicator

II.2. Setting Quality Improvement Goals: Program Level and Patient Care What are the priorities for your quality program? Quality goals are endpoints or conditions toward which your Quality Program will direct its efforts and resources. There are generally two levels of improvement goals: QM Program level Patient care level

QM Program Level Based on your analysis and results of your organizational quality assessment, decide what particular aspects of your QM program can be improved during the next year. Consider the following criteria: What are our resources? Staff? Time? What next steps can we take that is doable?

Example: QI Goals for Improving Infrastructure Goal: To increase the effectiveness of the QM Program’s planning and monitoring system. Form a QM Committee QM Committee meets more frequently, at least quarterly Write an annual QM Plan Hold an annual planning session for the QM Committee to discuss results of the performance measurement data and set priorities for improvement

Develop your annual QI action plan Examples contd. Develop your annual QI action plan Establish a performance measurement system: select measures train staff in data collection and entry collect data report results

Example: Improving Patient Care Guidelines: When determining priorities try using the following criteria when making your selections: Frequency: How many clients received/did not receive the standard of care/services? Impact: What is the effect on patient health if they do not receive this care/services? Feasibility: Can something be done about this problem with the resources available?

Example: QI Goals for Patient Care To increase the annual rate of cervical cancer screening from 43% to 72% by the end of December, 2009. To increase patient retention from 73% to 85% by the end of July, 2009.

QM Program Annual Action Plan 3 Goals: QM Program – Infrastructure Performance Measurement System Quality Improvement Quality Management Program

Action Timeline

Goal: Effective implementation and monitoring of QM Program

Goal: Establish ongoing data collection and reporting to support performance measurement.

Goal: Improved quality of patient care as measured by specific performance indicators.

Resources QM Plan Tips Resources (web sites, materials)

Tips on Writing a QM Plan

Part 1: Quality Statement Tips: Be brief Be visionary Include internal and external expectations Make references to external legislative requirements on quality management

Part 2: Quality Improvement Infrastructure Tips Limit the length of this section (not every detail is needed) Avoid naming individuals (just job functions) List internal and external stakeholders List linkages

Part 3: Performance Measurement Tips In developing quality indicators, remember: relevance measurability accuracy improvability Include the process for reviewing and updating indicators (who/when/how) Include strategies to report and disseminate results and findings

Part 4: Annual Quality Goals Tips Pick only a few measurable and realistic goals annually (not more than 5) Use a broad range of goals Establish targets at the beginning of the year for each goal

Part 5: Participation of Stakeholders Tips List internal and external stakeholders and their functions/responsibilities Include Clinical providers Non-clinical providers Consumers Representatives from agency, such as hospital, network, etc. List proposed training opportunities for stakeholders

Part 6: Evaluation Tips Detail when and who is performing the evaluation Compare annual QI goals with year-end results Use findings to plan next year’s activities; learn and respond from past performance Routinely use organizational assessment tools

10 QM Plan Tips Do not reinvent the wheel, use established frameworks to get started ‘Steal Shamelessly, Share Senselessly’ Size does not matter! 80% planning, 20% writing A few visionary annual goals are better than plenty of useful ones Be inclusive, even it takes longer to get your final QM plan What concrete tips might help when writing a quality management plan? Here are 10 steadfast rules to help guide you. Sample plans are out there. Use the references at the end of this Tutorial to find them, and begin there. As with so many things in quality, make use of what others have done and be willing to share what you’ve accomplished, to help others. It doesn’t matter how long it is. Substance matters more. Think through what you want to do before you start to write. Don’t obsess over the writing, it’s the planning that matters. Use the plan-writing process to push your organization forward. 10 QM Plan Rules

10 QM Plan Tips (cont.) If you did not update the plan throughout the year, you probably did not look at it A ‘perfect’ plan is never written Plans are only as good as their implementation Get started! (Start a first draft. If you have one that hasn’t been updated, take it to your next QM Committee mtg) Involve the people who need to be involved. They will make the plan a living document, rather than something that’s just a hoop to be jumped through. Here’s a tip to make sure your plan stays real – if you’re not using it regularly, haul it out and talk about it. It should be a living guide. Don’t let the perfect be the enemy of the good. If it works for your organization, it’s fine. Plans are only as good as their implementation. To use a popular cliché, just do it! All the planning in the world is for not if you do not take action. 10 QM Plan Rules

Resources HIVQUAL Workbook NQC Quality Academy Online Tutorial on QM Plans (www.NationalQualityCenter.org) NQC QM Plan Review Checklist Example QM Plans from others HIVQUAL Group Learning Guide Measuring Clinical Performance: A Guide for HIV Health Care Providers HRSA’s Quality Management TA Manual (9-Step Model)

THANK YOU Many of these materials can be sent electronically so please contact Nanette or Susan to request them.