1. Where Results Begin

2. “We don’t have a health care delivery system in this country. We have an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited micro systems, each performing in ways that too often create suboptimal performance both for the overall health care infrastructure and for individual patients”. George Halvorson, Author of Health Care Reform Now!: A Prescription for Change. Our Problem To Solve

3. Where Results Begin The Formula Health Information Technology Continuous Quality Improvement Meaningful Use Structure and Process Incorporating Evidence-Based Standards of Care Providers Outcome

4. Where Results Begin

5. An ongoing effort to provide services that meet or exceed customer expectations through a structured, systematic process for creating organizational participation in planning and implementing quality improvements based on meaningful use of data that results in improved outcomes.

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7.  Providing ongoing feedback improves patient outcomes, health center operations and systems by encouraging continuous adjustments of programs, policies and activities.  Collecting information about how things are done and the results helps to understand how health center initiatives develop and disseminate lessons others can profit from.  Involving all members of the health system, people who haven’t had a voice gain the opportunity to better understand and contribute.  Finally, effective quality programs helps hold everyone accountable to health center expected outcomes and to the grant makers who provide funding.

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9. An organizational culture centered in Quality is a MUST. Involvement of People: Service Providers, Executive Management, Managers, Supervisors, Staff, Contractors, Board Members, Everyone!!!!!!

10. Where Results Begin  Who are the members?  What are the roles and responsibilities?  What is the meeting format? (who staffs, minute-taking, participation requirements, confidentiality, etc.)  Where does the Committee report?  When does the Committee meet?  How long do committee members serve?

11. Where Results Begin  Safe: Avoid injuries to patients from the care that is intended to help them.  Effective: Match care to science; avoid overuse of ineffective care and underuse of effective care.  Patient-Centered: Honor the individual and respect choice.  Timely: Reduce waiting for both patients and those who give care.  Efficient: Reduce waste.  Equitable: Close racial and ethnic gaps in health status. Source: Crossing the Quality Chasm: A New Health System for the 21 st Century. Institute of Medicine. 2001

12. Where Results Begin  What are we trying to accomplish?  What change can we make that will result in improvement?  How will we know a change is an improvement?

13. Where Results Begin  QM Program Description  QM Work Plan  Provider Credentialing and Privileging  Peer Review Process  Assessing Organizational Satisfaction (Employee, Provider and Patient)  Complaint Management  Incident Management  Infection Prevention and Control Management  Medical Record Standards  Medical Record Review Process  Confidentiality and Privacy of Personal Health Information  Use of Clinical Protocols

14. Where Results Begin Meeting Community Health Center HRSA QA/QI Program Requirements. The QA/QI program must: Include clinical services and management Maintain the confidentiality of patient records Include a Clinical Director whose focus of responsibility is to support the QA/QI program and the provision of high quality patient care. Include periodic assessment of the utilization and quality of services provided or proposed to be provided.

15. Where Results Begin Key Components: I. Overview II. Quality Program Structure III. Quality Improvement Methodology IV. Communication and Coordination V. Confidentiality and Privacy of Information VI. Program Review Process (Timeframes) VII. Health Care and Business Plan

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17.  Personnel  Data Management  Data Processing, Analysis and Reporting

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19. Analyze and Synthesize Findings Identify Program Performance Standards Interpret the Findings Make Judgments /Recommendations Share the Results

20. Where Results Begin  If you don’t know your destination … you won’t know which way you are heading.

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22.  Systematically identifying patterns in the information gathered and deciding how to organize, classify, interrelate, compare, and display it.

23. Where Results Begin Captivating –Focuses on things that are timely and meaningful. Credible – This is for real – Data- driven performance based on sound methodology and performance standards. Continuous – Displays results over time with summary of findings.

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27. DEMING’S Model: Plan: Analyze the process, determine what changes would most improve the process, and establish a plan for making the improvement; Do: Put your change into motion; Study: Check to see whether the change is working; Act: If the change is working, implement it on a larger scale. If the change is not working, refine it or reject it and begin the cycle again.

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29.  The solution(s) most likely to be successful should be implemented.  It is often preferable to do this on a small scale to see if the change(s) will work.  Make the data collection easy enough and the time frames short enough so that data collection can be repeated frequently to allow for trending of changes over time.  Allow enough time to improve performance.

30. Where Results Begin Study the data in order to determine: 1. What were the findings? 2. Did the improvement action(s) effect a change? 3. What were the positive and negative effects? 4. What are the potential causes contributing to these effects? 5. What could have been done better? 6. What would we change and do differently?

31. Where Results Begin  Act on what you learned.  Continue to make improvements in the process by going through the cycle again, starting at Plan.  Don’t forget a good outcome starts with a good process.

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33. Participation Reactions Learning Actions System and Environmental Change Health Outcomes

34. Where Results Begin  Improves outcomes for consumers  Improves consumer satisfaction  Improves workforce retention and satisfaction  Increases use of preventive interventions  Increases best practices/innovation  Foundation for performance based incentives  Reduces waste  Reduces rework  Reduces errors  Saves resources  Reduces liability  Improves processes for persons served/other stakeholders

35. Where Results Begin