1. The Quality Management Plan The Quality Academy Tutorial 5

2. 2 Learning Objectives: You Will Learn About… Key terminology Crucial elements of a Quality Management Plan Quality statement Quality improvement infrastructure Performance measurement Annual quality goals Engagement of stakeholders Evaluation 10 rules for success Learning Objectives

3. 3 Quality Management Program The term ‘Quality Management Program’ encompasses all grantee-specific quality activities, including the formal organizational quality infrastructure (e.g., committee structures, roles for stakeholders, providers and consumers) and quality improvement related activities (performance measurement, quality improvement projects and quality training activities). Key Terms

4. 4 Quality Management Plan A quality management plan is a written document that outlines the grantee-wide HIV quality program, including a clear indication of responsibilities and accountability, performance measurement strategies and goals, and elaboration of processes for ongoing evaluation and assessment of the program. Key Terms

5. 5 Grant-wide Vision Strategic QM Plan (3-5 yrs) QM Plan (annual) Annual Goals Work planExecution Annual Evaluation Quality Management Plan Diagram

6. 6 Elements of a Quality Management Plan 1.Quality statement 2.Quality infrastructure 3.Performance measurement 4.Annual quality goals 5.Engagement of stakeholders 6.Evaluation QM Plan Elements

7. 7 Quality Statement: What Do We Want to Be? A brief mission statement describing the end goal of the HIV quality program to which all other activities are directed QM Plan Elements: Quality Statement

8. 8 Tips for the Quality Statement Be brief Be visionary Include internal and external expectations Make references to Ryan White legislative requirements on quality management QM Plan Elements: Quality Statement

9. 9 Infrastructure: How are We Organized? Leadership Accountability Quality committee(s) structure Resources QM Plan Elements: Quality Statement

10. 10 Tips for the Quality Infrastructure 3 to 5 pagesJob functions All stakeholdersList linkages QM Plan Elements: Quality Statement

11. 11 Performance Measurement: How Will We Assess Progress? Identify what’s important Develop ways to measure; Include process, outcome, and satisfaction measures QM Plan Elements: Performance Measurement

12. 12 Tips for Performance Measurement Develop quality indicators relevance measurability accuracy improvability Include a portfolio of process Who, When & How Reporting strategies QM Plan Elements: Performance Measurement

13. 13 Annual Quality Goals: What are the Priorities for the Quality Program? Quality goals are endpoints or conditions toward which a quality program will direct its efforts and resources. Three things to look at in designing goals: Frequency: How many patients/clients received and how many did not receive the standard of care/services? Impact: What is the effect on patient health if they do not receive this care/service? Feasibility: Can something be done about this problem with the resources available? QM Plan Elements: Annual Goals

14. 14 Tips for Annual Quality Goals No more than 5 measurable goals Use a broad range of goals Establish performance targets to achieve QM Plan Elements: Annual Goals

15. 15 How will staff, providers, consumers and others be involved in the QM program? Engage internal and external stakeholders Communicate information about quality improvement activities Provide opportunities for learning about quality Engagement of Stakeholders QM Plan Elements: Stakeholders

16. 16 Tips for Engagement of Stakeholders Outline internal and external stakeholder functions/responsibilities Include Providers Consumers Subgrantees other Ryan White CARE Act Titles List proposed training opportunities QM Plan Elements: Stakeholders

17. 17 Evaluation: How Will We Assess the Quality Management Program’s Performance? Infrastructure QM Plan Elements: Evaluation QI activitiesPerformance measures Did we improve HIV care and services? Do we require further adjustment? Were goals met? How effectively? Did work plan go as planned? Were established milestones hit? Were stakeholders informed? Was training provided? Are results in the expected range?

18. 18 Tips for Evaluation Detail when and who is performing the evaluation Compare annual quality goals with year-end results Use findings to plan next year’s activities; learn and respond from past performance Routinely use organizational assessment tools QM Plan Elements: Evaluation

19. 19 Elements of a Quality Management Plan 1.Quality statement 2.Quality infrastructure 3.Performance measurement 4.Annual quality goals 5.Engagement of stakeholders 6.Evaluation QM Plan Elements

20. 20 Elements include: Quality statement Quality infrastructure QM Plan implementation Performance measurement Annual quality goals Engagement of stakeholders Evaluation Capacity Building Process to update QM Plan Communication Formatting TA Resource: Quality Management Plan Checklist Checklist for the review of an HIV- specific Quality Management Plan: http://www.ihi.org/IHI/Topics/HIVAIDS/ HIVDiseaseGeneral/Tools/HIVSpecificQM PlanReviewChecklist.htm QM Plan Elements

21. 21 The 10 QM Plan Rules 1.Do not reinvent the wheel, use established frameworks to get started 2.‘Steal Shamelessly, Share Senselessly’ 3.Size does not matter 4.80% planning, 20% writing (old software programming rule) 5.A few visionary annual goals are better than plenty of useful ones 10 QM Plan Rules

22. 22 The 10 QM Plan Rules (cont.) 6. Be inclusive, even it takes longer to get your final QM plan 7.If you have not touched your plan in the last 6 months, bring it to the next quality committee meeting 8.A perfect plan is never written 9.Plans are only as good as their implementation 10.Get started 10 QM Plan Rules

23. 23 Resources HRSA’s Quality Management TA Manual outlines a nine-step plan for implementing quality management programs. The manual provides concrete examples and outlines the expectations and legislative requirements of CARE Act grantees. The manual can be downloaded from: http://hab.hrsa.gov/tools/QM. The manual is now also available in Spanish: Supervisión de la Calidad: Manual de Asistencia Técnica, at: http://hab.hrsa.gov/tools/QMespanol/http://hab.hrsa.gov/tools/QM http://hab.hrsa.gov/tools/QMespanol/ For guidance in teaching small groups how to develop a quality improvement management plan, see the HIVQUAL Group Learning Guide "Quality Improvement Management Plan" exercise. You can download this publication at www.hivguidelines.org.www.hivguidelines.org For possible quality of care indicators: New York State DOH AIDS Institute (www.hivguidelines.org) Improving Care for People Living with HIV/AIDS Disease. Institute for Health Care Improvement, HRSA/HAB. HIV/AIDS Bureau Collaborative. Order via the HRSA Information Center (www.ask.hrsa.gov/detail.cfm?id=HAB00289) or call 888-ASK- HRSA.www.ask.hrsa.gov/detail.cfm?id=HAB00289 National Quality Measures Clearinghouse (www.qualitymeasures.ahrq.gov)www.qualitymeasures.ahrq.gov For examples and other general tips: The HIVQUAL Workbook, especially pp. 38-54. You can download this publication at www.hivguidelines.org.www.hivguidelines.org Resources

24. 24 Resources Measuring Clinical Performance: A Guide for HIV Health Care Providers. A publication of the AIDS Education Training Centers and the New York State Department of Health, AIDS Institute, 2002. The guide can be downloaded at : http://www.hivguidelines.org/public_html/center/quality-of- care/perform_guide/perform_guide.pdf. http://www.hivguidelines.org/public_html/center/quality-of- care/perform_guide/perform_guide.pdf CAREWare is a management information system that helps Ryan White CARE Act grantees and service providers collect, manage and report client-level data. It is available on the HRSA web site at http://hab.hrsa.gov/careware.http://hab.hrsa.gov/careware Agins, Bruce D., Gary R. Burke, William C. Ellis, Frances F. Rotunno, and Michael T. Young. A Statewide Program to Evaluate the Quality of Care Provided to Persons with HIV Infection, Journal on Quality Improvement, September 1995. Agresti, Alan An Introduction to Categorical Data Analysis, Wiley Series in Probability and Statistics. Applied Probability and Statistics, May 1996. Carey, R.G., and R.C. Lloyd. Measuring Quality Improvement in Healthcare. New York: Quality Resources, 1995. Resources

25. 25 Related Tutorials To learn more about establishing a quality infrastructure, study Tutorial 6 To learn more about where you can find quality resources, study Tutorial 5 Related Tutorials

26. 26 The Quality Academy For further information, contact: National Quality Center New York State Dept. of Health 90 Church Street, 13fl New York, NY 10007-2919 Work: 212.417.4730 Fax: 212.417.4684 Email: info@nationalqualitycenter.org info@nationalqualitycenter.org Or visit us online at www.NationalQualityCenter.orgwww.NationalQualityCenter.org In Closing