Implementing QI Projects Title I HIV Quality Management Program Case Management Providers Meeting May 26, 2005 Presented by Lynda A. O’Hanlon Title I HIV QI Consultant

What is “Quality Improvement”? Patients and our customers are the first priority Patients and our customers are the first priority Emphasis on systems of care, instead of individual providers Emphasis on systems of care, instead of individual providers Routine and periodic measurement of performance Routine and periodic measurement of performance QI goals are based upon performance data QI goals are based upon performance data Improvements are made by implementing specific quality projects Improvements are made by implementing specific quality projects Improvement projects include participation by those persons involved in the delivery of service Improvement projects include participation by those persons involved in the delivery of service

QUALITY IMPROVEMENT Model: Project Level Step 1: Collect and Analyze Baseline Data Step 1: Collect and Analyze Baseline Data Step 2: QI Team Selection Step 2: QI Team Selection Step 3: Develop a Project Team Work Plan Step 3: Develop a Project Team Work Plan Step 4 Project Team Investigates the Process Step 4 Project Team Investigates the Process Step 5. Project Team Plans and Tests Change(s) Step 5. Project Team Plans and Tests Change(s) Step 6: Project Team Evaluates Result(s) with Key Stakeholders Step 6: Project Team Evaluates Result(s) with Key Stakeholders Step 7: Systematize Change Step 7: Systematize Change

Step 1: Collect and Analyze Baseline Data Review existing performance measurement data Review existing performance measurement data Identify specific indicators to be measured Identify specific indicators to be measured Establish methodology, define population sample and design data collection tool Establish methodology, define population sample and design data collection tool Share results with quality committee Share results with quality committee Case Management Program Case Management Program Data collected by NYCHRO based on established indicators Data collected by NYCHRO based on established indicators Results shared with case management providers Results shared with case management providers Areas for improvement identified Areas for improvement identified 2004 – Coordination of Services 2004 – Coordination of Services 2005 – Quality Improvement Collaboratives 2005 – Quality Improvement Collaboratives

Step 2: QI Team Selection Multi-disciplinary and intra-departmental. Multi-disciplinary and intra-departmental. Persons affected by process change should be team members Persons affected by process change should be team members Provide on-going assistance and support Provide on-going assistance and support Ask them to work on complex meaningful problems, e.g., Coordination of care Ask them to work on complex meaningful problems, e.g., Coordination of care Ongoing projects should be shared with all staff during the process. Ongoing projects should be shared with all staff during the process. Involve customers/clients when possible Involve customers/clients when possible

Step 3: Develop a Project Team Work Plan Identify team members Identify team members Establish team roles and “Rules of the Road” Establish team roles and “Rules of the Road” Develop project team work plan with assignments and expected dates of task completion – “QI Project Plan” tool Develop project team work plan with assignments and expected dates of task completion – “QI Project Plan” tool Complete improvement project memo Complete improvement project memo Clearly state the team’s goal, distribute to team members and to the QI Committee Clearly state the team’s goal, distribute to team members and to the QI Committee

Step 4: Project Team Investigates the Process Review data and reassess project goals Review data and reassess project goals Investigate the process being reviewed Investigate the process being reviewed Chart the process flow within team Chart the process flow within team Identify and prioritize root causes Identify and prioritize root causes

Step 5: Project Team Plans and Tests Change(s) Select solutions for pilot testing Select solutions for pilot testing Plan and implement pilot tests Plan and implement pilot tests Measure and assess impact of pilot tests Measure and assess impact of pilot tests Implement further pilot tests if indicated Implement further pilot tests if indicated

Plan/Do/ Study/ Act ! Plan a change Plan a change Try it on a small scale Try it on a small scale Observe the results Observe the results Refine the change as necessary Refine the change as necessary

Example for PDSA Cycle Use of flowsheet will improve care to known standards Improved Decision Support AP SD A P S D AP SD D S P A DATA D S P A Cycle 1A: Develop tracking tool to communicate with medical providers Cycle 1B: Test with eight clients and two medical providers Cycle 1C: Refine the tool based on feedback Cycle 1D: Test revised tool with additional clients and providers Cycle 1E: Implement and monitor the standards

Step 6: Project Team Evaluates Result(s) with Key Stakeholders Review and document pilot test results Review and document pilot test results Present pilot results to key stakeholders and “Decision Makers” Present pilot results to key stakeholders and “Decision Makers” Gather feedback and generate buy-in Gather feedback and generate buy-in Evaluate pilot results and revise plan as indicated Evaluate pilot results and revise plan as indicated

Step 7: Systematize Change Integrate improvements into daily work Integrate improvements into daily work Policy & procedure revisions, staff training, ongoing communication, etc. Policy & procedure revisions, staff training, ongoing communication, etc. Re-collect data to assess improvement Re-collect data to assess improvement Assess effectiveness against original project work plan Assess effectiveness against original project work plan Benchmark against other programs Benchmark against other programs Spread improvements into wider system, if indicated Spread improvements into wider system, if indicated Celebrate Success!! Spread the word !! Communicate results to customers. Celebrate Success!! Spread the word !! Communicate results to customers.

Critical Ingredients for Success Leadership Leadership Establish organizational commitment Establish organizational commitment Support staff and activities Support staff and activities Set priorities and goals Set priorities and goals Resource Commitment Resource Commitment Create infrastructure Create infrastructure Provide staff development and training Provide staff development and training Improvement is about Learning Improvement is about Learning Use quantitative information Use quantitative information Learn from experienced sites and programs Learn from experienced sites and programs Share findings with staff Share findings with staff

Assistance from Title I HIV Quality Management Program Individualized On-site Consultation Quality Learning Network Workshops and Presentations Capacity-building for Quality Improvement Peer Learning Opportunities