Quality Improvement in California’s County Mental Health Programs

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Quality Improvement in Californias County Mental
Health Programs

• Presentation to 12th Annual Patients Rights
  Advocacy Training Conference
• Sacramento October 8, 2004

Doug Mudgett, RN, AMHS State Department of Mental
Health, County Operations
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Introduction

• A little bit about myself and my background
• Why I am here today, my DMH QI role
• Why I believe in Quality Improvement
• Keeping the focus of everything we do
• as a system on the people receiving services,
  on the quality and relevance of what we provide,
  and on the belief in Recovery
• De-mystifying Quality Improvement, give you an
  overview, and sparking an interest in you

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Discussion Topics
1. Why are we all here today?
2. What is QI?
3. Past, present, future of QI in counties?
4. What is your role in this?
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Why are we all here today?

• Why are you here today? What do you want to get
  out of this discussion?
• What do you know about Quality Improvement (QI)?
• Have you participated, or been asked to
  participate, in your county?
• What does Quality mean to you?

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What is QI in general?

• A systematic, deliberate, and continuous process
  and effort to improve the services we provide to
  individuals.

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Breaking it down

• Systematic
• The process is based on an organized and
  structured problem-solving approach
• Deliberate
• In order for QI to be successful, there must be
  belief in it, effort must be given to promoting
  its sustainability, and it must permeate and
  connect everything the organization does
• Continuous
• It is virtually a never-ending processbasic
  mantra no matter how good we think we are
  doing, there is always room for improvement

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A Little History

• Origins in 1950s, 60s, and 70s
• The Gurus Deming, Juran, and Crosby
• Deming considered godfather of Total Quality
  Management, or TQM, which reshaped and
  transformed Japanese manufacturing industry
• Largely a statistical process control approach at
  decreasing variance in product quality
• Delighting and satisfying customer expectations
• Continuous Quality Improvement, an offshoot of
  TQM, evolved significantly during the late 1980s
  and early 1990s and was applied to health care

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Why History is Importantfor QI in County Mental
Health

• Originally a Quality Assurance activity
• Monitoring adherence to standards
• QI vs. QA
• What is the difference between QI and QA, and
  what are their complementary and distinct roles?
• Take-home Point
• QI and QA are not the same.

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QI vs. QA

• Quality Improvement goes way beyond Quality
  Assurance. Perhaps the defining difference lies
  in the fact that in addition to focusing on
  processes, correcting problems, analyzing data,
  and making decisions based on information, QI
  adds the focus on Improvement, distinct going
  beyond standards, and attitude-belief-passion in
  betterment is central.
• This has been a significant paradigm shift for
  health care in general, and County mental health
  services in particular.

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Continuous Quality Improvement

• Customer/Consumer Focus
• The unifying driving element
• Process Oriented
• Belief that most quality issues and problems
  are the result of processes, not people.
• Data Driven
• Uses data as an indispensable tool for guiding,
  evaluating, and validating success.
• All Levels of Organization
• All levels must be encouraged and supported to
  participate.

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PDCA CyclePlan-Do-Check-Act or Deming Wheel
Focus on Consumer Outcomes/Benefit Within a
Recovery Model or Vision
Plan
Do
PDCA
Act
Check
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Current Picture of QI in County Mental Health
Programs

• The most immediate current drivers for Quality
  Improvement in counties come from the Managed
  Care Contract (MHP Contract) with the State DMH,
  California Code of Regulations Title 9
  requirements, and language in WIC regarding
  quality management programs, and the role of
  External Quality Review (EQR) including
  Performance Improvement Project (PIP) evaluation.
• DMH Medi-Cal Oversight (Compliance) continues
  its evaluation responsibility based on QA.

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QI Oversight Consultative Players
Board of Supes
MH Boards Commissions
DMH CMS
EQRO

• DMH Medi-
• Cal Oversight
• DMH Medi-
• Cal Policy
• DMH County
• Operations
• CIMH-Contract
• CMS Medicaid
• Waiver , and
• CFR 438

• APS
• External
• Quality
• Review
• Organization
• Required by
• New Medicaid
• Regs resulting
• From BBA 97

Vested interest In Value, i.e. Quality of
services to Countys residents for the County
Dollars spent
Oversight and Guidance of MH system Quality with
emphasis of Consumer Family Member Involvement
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Broad Forces Impacting County QI
Quality Improvement
Regulations Fed-State
Consumer Voice
MHP Contract
Professional Ethics
Industry Movement
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What is your role in QI?

• Becoming familiar with QI
• Gauging your countys interest in asking for your
  involvement
• Contributing a valuable specialized perspective
• Realizing the importance of, and advocating for
  fidelity to, keeping the focus on the consumer
  and their outcomes in a Recovery framework.

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QI Learning Progress Diagram
Phase 1 Acquiring
Phase 2 Implementing
Phase 3 Integrating
Reconciling Theory With
Reality
Involvement Practice
Knowledge Skills Acquisition
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County QI Participants
Consumers
Providers
Director
Consumers Benefit
ADVOCATES
QI Coordinator
IT / IS Data
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Closing Questions, Discussion, and Comments