Continuous Quality Improvement and CCISC Philosophy, Process and Technique Of Systems Change Presented by: Kenneth Minkoff, MD and Christie A. Cline, M.D., M.B.A., P.C. With Acknowledgement to: Lesa Yawn, PhD, JD ZiaLogic©2004

Terminology CQI = Continuous Quality Improvement CQI = Continuous Quality Improvement TQM = Total Quality Management TQM = Total Quality Management QA = Quality Assurance QA = Quality Assurance PDCA = Plan, Do, Check, Act PDCA = Plan, Do, Check, Act CCISC = Comprehensive, Continuous, Integrated Systems of Care CCISC = Comprehensive, Continuous, Integrated Systems of Care

CQI/TQM Philosophy The customers and their needs shape our organization and its work, not vice versa. The customers and their needs shape our organization and its work, not vice versa. Quality products and services result from quality systems, processes and methods. Quality products and services result from quality systems, processes and methods. Quality is all-consuming focus of the organization. Quality is all-consuming focus of the organization.

CQI/TQM Philosophy An organization achieves quality by mastering the methodology of improvement. An organization achieves quality by mastering the methodology of improvement. An organization pursuing quality directs and focuses its energies. An organization pursuing quality directs and focuses its energies. There is a new paradigm of leadership that requires managers to reformulate what it means to lead. There is a new paradigm of leadership that requires managers to reformulate what it means to lead.

CQI/TQM as a Systems Process Ten Principles For Leaders to Follow

Principle 1 Define Quality vs “I know it when I see it” Define Quality vs “I know it when I see it” Each quality outcome should have a specific definitionEach quality outcome should have a specific definition Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 2 Customer Orientation vs Internal Focus Customer Orientation vs Internal Focus Each quality indicator is determined by its relationship to improving outcomes for the consumer.Each quality indicator is determined by its relationship to improving outcomes for the consumer. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 3 Work Process Focus vs End Product Focus Work Process Focus vs End Product Focus Each quality outcome is designed to be measured according to the extent to which work processes result in ongoing improvement over time.Each quality outcome is designed to be measured according to the extent to which work processes result in ongoing improvement over time. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 4 Us Partnerships vs We and They Us Partnerships vs We and They Each quality outcome can be achieved only through collaboration.Each quality outcome can be achieved only through collaboration. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 5 Proactive vs Reactive Proactive vs Reactive Each quality outcome is achieved through planned and deliberate intervention over time, as opposed to end product corrective action.Each quality outcome is achieved through planned and deliberate intervention over time, as opposed to end product corrective action. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 6 100% Quality Attitude vs That’s good enough 100% Quality Attitude vs That’s good enough Each quality outcome is attained by an approach that works to achieve the best result for each consumer every time.Each quality outcome is attained by an approach that works to achieve the best result for each consumer every time. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 7 Management by Facts vs Management by Intuition Management by Facts vs Management by Intuition Each quality outcome is attained through successive evaluation of data and adjustment accordingly.Each quality outcome is attained through successive evaluation of data and adjustment accordingly. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 8 Engagement and Empowerment vs “Just follow the plan, man” Engagement and Empowerment vs “Just follow the plan, man” Each quality outcome is implemented by collective engagement in designing successful processes. Leadership always strives to achieve proper balance between control and empowerment.Each quality outcome is implemented by collective engagement in designing successful processes. Leadership always strives to achieve proper balance between control and empowerment. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 9 Quality belongs to everyone vs “We have a quality department” Quality belongs to everyone vs “We have a quality department” Each quality outcome is implemented through the interactive participation of all components of the system.Each quality outcome is implemented through the interactive participation of all components of the system. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

Principle 10 Continuous means continuous vs “we measure when its over” Continuous means continuous vs “we measure when its over” Each quality outcome is implemented through the iterative processes of PDCA. Quality outcomes are targets, always advancing as the system learns and improves.Each quality outcome is implemented through the iterative processes of PDCA. Quality outcomes are targets, always advancing as the system learns and improves. Working example: WELCOMINGWorking example: WELCOMING Working example: IDENTIFICATION OF THE POPULATIONWorking example: IDENTIFICATION OF THE POPULATION

CQI as Compared to QA CQI is a central tenet of management rather than a peripheral activity. CQI is a central tenet of management rather than a peripheral activity. CQI focuses on continuously improving rather than on reaching a plateau of quality. CQI focuses on continuously improving rather than on reaching a plateau of quality. CQI is a motivating force for improvement rather than a policeman of errors and faults. CQI is a motivating force for improvement rather than a policeman of errors and faults.

CQI as Compared to QA CQI focuses on the system meeting the needs of the consumer rather than individual performance as a foundation. CQI focuses on the system meeting the needs of the consumer rather than individual performance as a foundation. CQI cuts across organizational territories and departmental boundaries. CQI cuts across organizational territories and departmental boundaries.

Technique of CQI for CCISC Implementation

FOCUS F ind a process that needs improvement F ind a process that needs improvement O rganize a team knowledgeable about the process O rganize a team knowledgeable about the process C larify the knowledge about the process C larify the knowledge about the process U nderstand the causes of variations in the process U nderstand the causes of variations in the process S elect the improvement S elect the improvement

DO CHECKACT PLAN

PDCA Plan Plan Study a processStudy a process Collect and evaluate dataCollect and evaluate data Develop an ACTION PLANDevelop an ACTION PLAN Do Do Try out the planTry out the plan Check Check Evaluate the test runEvaluate the test run Act Act Adjust the plan and go back up to the top and try againAdjust the plan and go back up to the top and try again

CCISC ACTION PLAN Strategic, Dynamic and Interactive Strategic, Dynamic and Interactive System, Program, Clinical Practice, Clinician Development Interlinked System, Program, Clinical Practice, Clinician Development Interlinked Measurable Milestones Measurable Milestones Realistic Timeframes Realistic Timeframes Real People Accountable for Taking Real Action Real People Accountable for Taking Real Action

CCISC 12 Step Implementation Program A framework for CCISC implementation using CQI at the highest level of systems organization A framework for CCISC implementation using CQI at the highest level of systems organization Supported by the use of an organized toolkit that includes the CO-FIT 100™, COMPASS™, and CODECAT™ Supported by the use of an organized toolkit that includes the CO-FIT 100™, COMPASS™, and CODECAT™ Incorporates system, program, clinical practice, and clinician development aspects Incorporates system, program, clinical practice, and clinician development aspects Identifies and prioritizes quality indicators at each level of the system and organizes multiple CQI processes to achieve them Identifies and prioritizes quality indicators at each level of the system and organizes multiple CQI processes to achieve them Requires an organized leadership team to oversee the process defined by the CCISC Charter for the system Requires an organized leadership team to oversee the process defined by the CCISC Charter for the system

CCISC 12 Step Implementation Program 1. Organize leadership team with consumer/family input 2. Develop consensus charter and CQI plan (CO- FIT 100™) 3. Design project and create incentives with existing funding 4. Strategic prioritization for continuity using 4- quadrants 5. Define dual diagnosis capability as a program goal (COMPASS™) and implement over time using a CQI Action Plan 6. Develop initial steps toward “system” interaction through inter-program coordination

CCISC 12 Step Implementation Program (Continued ) 7. Develop and disseminate initial practice guidelines 8. Select practice priorities for CQI implementation (e.g., welcoming, access, and data collection) 9. Define clinicians’ initial scopes of practice 10. Identify a process to evaluate and improve clinician competencies over time (CODECAT™) 11. Develop training plan and train-the-trainer cadre 12. Plan to fill gaps in the comprehensive continuum