Quality Management 101: Infrastructure Development

1
Quality Management 101 Infrastructure
Development

• Facilitator Nanette Brey Magnani, EdD
• HIVQUAL Consultant

2
Agenda

• Outcomes
• Define the NYS standards as components of a QM
  programs infrastructure.
• Understand and utilize the Organizational
  Assessment tool as a means for understanding the
  current status of a QM program.
• Identify components of a QM Plan by using a QM
  Plan Assessment tool and making recommendations.
  
• Define an HIV Quality Committee and steps for
  setting one up and identify issues in keeping it
  going.

3
Time Activity

• 900 Registration and working breakfast
• 930 Welcome and Introductions. Review agenda.
• 1000 Review of QI 101 workshop. (Team game)
• 1015 Overview of Infrastructure
• 1200 Working lunch.
• 1230 The Think Inside the Box Game.
• 100 Overview of QM Plans and Key Components
• (small group work)
• 230 Break
• 245 Quality Committees Setting Them Up and
  Keeping
• Them Going
• 330 Wrap up/feedback.
• 400 Adjourn.

4
Review from QI 101 Workshop

• Define quality improvement?
• What are two key differences between Quality
  Assurance and Quality Improvement?
• Name 3 key principles of Quality Improvement.
• What does PDSA mean?
• Name three guidelines to keep in mind when doing
  PDSAs?
• Name two reasons why you should do performance
  measurement.
• There are five categories of the NYS Quality
  Program Standards. How many can you list in 1
  minute?

5
HIV Quality of Care Program Standard

• A formal quality of care program that embraces
  quality improvement (QI) philosophy should be
  developed and implemented as part of the HIV
  service delivery program. An effective HIV
  quality improvement program includes the
  following components
• The infrastructure of the quality program should
  be fully described in the quality plan, with a
  clear indication of responsibilities and
  accountability, and elaboration of processes for
  ongoing evaluation and assessment.
• Staff should be actively involved in the HIV
  Quality Program and its QI activities.
  Participation in the quality program should be
  part of job expectations. Provisions should be
  made for ongoing education of staff about quality
  improvement.

6

• Performance measurement should include clearly
  defined indicators that address clinical, case
  management, and other services as prioritized by
  the program. A plan for follow-up of results
  should be outlined.
• QI activities should be based on performance data
  results. Specific QI projects should be
  undertaken which include action steps and a
  mechanism for integrating change into routine
  activities.
• Consumers should be included in quality-related
  activities

7
HIVQUAL Organizational Assessment Components

• Quality Structure
• Quality Planning
• Quality Performance Measurement
• Quality Improvement Activities
• Staff Involvement
• Evaluation of Quality Program
• Clinical Information Systems

8

• HIVQUAL Organizational Assessment
• Tool emphasizes sustainability of quality
  improvement programs
• G. Clinical Information Systems
• G.1. Does the HIV program have an information
  system in place to track patient care and measure
  quality?

9
Assessment Process

• Scoring instrument with criteria for score of 1 (
  low,rudimentary) to 5 ( high,advanced)
• Assessment allows exchange of information
• Areas of highest priority become apparent
• Resources can be identified and deployed
• Re-assessment tracks progress

10
Objective Understand and utilize the
Organizational Assessment tool as a means for
understanding the current status of a QM program.

• Instructions Roles will rotate.
• To begin, decide who will be a) the interviewer
  (person doing the assessment), b) the
  interviewee (the person being interviewed about
  his/her HIV Quality Program), and c) the
  observer.
• For the first round, the interviewer will ask the
  interviewee questions about Quality Structure and
  Quality Planning.
• For the second round, change roles a becomes
  b b becomes c and c becomes a.
  During the second round, the interviewer asks
  questions about Quality Performance Measurement
  and Quality Improvement Activities.

11

• For the third round, change roles again. During
  the final round, the interviewer asks questions
  about Staff Involvement, Evaluation, and Clinical
  Information System.
• Role of the Interviewer/ee You (a) are
  interviewing a representative (b_ from his/her
  Quality Program. As you ask each question, have
  the person read the explanation for each score
  and to suggest a score by giving examples to
  explain reasons. If you agree, then write in the
  score. If you dont then, discuss with b until
  you reach a consensus.
• Role of the Observer You are to observe the
  style of the interviewer and the interaction
  between the two. Note observations re
  interviewers ability to draw out the persons
  understanding of his/her program, style, etc.
  Before changing roles you will have an
  opportunity to give feedback to the interviewer.
• If you do not understand a question, ask the
  facilitator for further explanation.

12
Quality Management PlanDefinition

• Quality Management Plan
• A Quality Management Plan is a written document
  that outlines the HIV Quality Program, including
  a clear indication of responsibilities and
  accountability, performance measures, goals, and
  an explanation of processes for ongoing
  evaluation and assessment of the Program. It
  generally includes annual improvement goals and
  an annual work plan inclusive of key program and
  improvement activities.

13
Quality Management Plan

• Quality Statement - brief purpose/mission
  statement describing an end goal.
• Accountability Description of accountability
  and reporting relationships and responsibilities
  (include a chart of your organizations diagram
  of accountability/reporting relationships)
• HIV Quality (Management) Committee
• QI Project Team
• Role of Consumers, i.e., CAB
• Participation of Stakeholders
• Plan for Communication
• Internal
• External

14
QM Plan continued.

• Performance Measurement System and Indicators
• Overall description of it works
• Clinical indicators
• Non-Clinical indicators
• Annual QM Plan Evaluation
• Evaluate effectiveness of infrastructure
• Evaluate QI Goals and Activities
• Evaluate the performance measures

15
Annual Quality Workplan

• Developed annually with changes in goals,
  projects and team members depending on the size
  of the HIV program. Most activities will be
  consistent from year to year such as annual
  planning meeting, data collection, and goal
  setting.
• It is an Activity Timeline (Who is responsible
  for What, When).
• Examples of Major Activities
• Setting Annual Quality Goals
• Performance Measurement
• Improvement Projects, Teams
• Staff Development
• Consumer Involvement
• Quality Program Evaluation

16
Key Components of a Quality Management Plan

• HIV QM Infrastructure
• Definition The QM infrastructure represents
  the organizational structure of the formal HIV
  Quality Program which includes the committee and
  team structures with stakeholders, providers and
  consumers, the performance measurement systems to
  collect clinical and non-clinical data, and the
  involvement of internal stakeholders that shape
  the HIV Quality Program.

17
Quality Management Infrastructure

• Quality Statement
• The end toward which all other program
  activities are directed.
• What are some key phrases that could be in a
  quality statement?

18
Example HIV QM Plan for Blake Smith Community
Health Center

• Quality Statement
• The HIV QM Program at Blake Smith Community
  Health Center is committed to the delivery of
  high quality care to our patients. The QM
  Program aims to continuously improve the quality
  of HVI care consistent with recognized national
  standards and current HIV research. The purpose
  of the QM program is to plan, implement, and
  evaluate performance improvements that affect the
  quality of care and services of the HIV program.

19
Description of QM Committee Structure and
Responsibilities

• HIV Quality Management Program Chart
• A chart can be very useful to depict visually
  the reporting and accountability relationships
  among the HIV Programs quality groups and
  between those groups and the quality groups of
  the larger organization and external
  organizations and advisory boards.
• What does the chart tell you?

20
Example 1. A
HRSA

IDU Executive Council
IDU Quality Management Committee

HIV Program Management Team
Medical Director
HIV Program MD, NP, SW, Nurses, CM, HCA, Clerks,
Research
Clinical Director
Consumer Advisory Board
HIV Quality Committee
Quality Improvement Project Team
Case Management Agencies
21
HIV Quality Committee

• An HIV Quality Committee oversees the QM progam.
  The plan usually addresses the following
• Committee Composition and Structure
• Leadership Who is ultimately responsible for
  quality initiatives?
• Membership Who will participate on the
  committee?
• Meeting structure When and how often will the
  committee meet? (at least 4-6 times/year specify
  time and location)

22

• Develop ground rules for meeting behavior, ie,
  start on time, etc.
• Documentation Decide on agenda format, minutes
  format and distribution
• Plan for consumer input and key stakeholders
• Communication Who needs to be kept informed of
  the findings/activities of the committee?
  Consumers, staff, another QM committee in the
  organization.

23
QI Committee Structure (continued)

• QI Committee responsibilities may include
• Annual Planning
• Establishing priorities
• Setting goals
• Determining measures
• Developing a work plan/timeline
• Providing guidance to QI teams
• Facilitating innovation and change such as
  recommending new policies/changes to promote
  quality of care

24
QI Committee Structure (continued)

• Promoting a QI culture
• Allocating resources
• Educating staff in quality principles and methods
• Maintaining internal and external accountability
  for QM

25

• QI Project Team
• The QI Project Team is charged to make process
  improvement recommendations in the delivery of
  care the HIV Quality Committee
• Responsibilities
• Report to the Quality Committee
• Review indicator data and set improvement goal
• Collect additional data if needed
• Be able to apply different QI tools including
  problems solving models
• Examine underlying causes
• Develop a QI Project plan or PDSA plan
• Select process improvement solutions and test
  them
• Continuously try solutions until goal achieved
• Spread and sustain improvements
• Give oral presentations
• Develop and present storyboards on QI Project

26
Quality Management Plan Components (continued)

• Annual Goals
• QI Goals What are we measuring? What QI
  Projects are we conducting? What do we want to
  achieve?
• What are our priorities?
• Set goals based on current measurement data. May
  included improvement goals and maintenance goals.
• Clinical and non-clinical
• Management Goals
• Establish an effective HIV Quality Management
  Program.
• Establish a data collection and reporting system
  to support performance measurement.
• Improve quality of patient care as measured by
  attainment of improvement goals.
• Access resources to support the quality
  management program.
• Create a QI culture within the HIV program.

27
Quality Management Plan Components (continued)

• Performance Measurement and Data Collection Plan
• Who is responsible for data collection?
• What indicators? How frequently will data be
  collected and on which indicators? Annually?
  Quarterly? Monthly?
• Who gets the results?
• What are your sources of data such as clinical
  database, Medical record, patient satisfaction
  surveys, intake forms, case management/social
  work records, laboratory database.

28
Quality Management Plan Components (continued)

• Staff Involvement
• Communication How is information about quality
  activities and project results shared?
• Education How are staff trained and how are
  learning opportunities provided?
• E.g. quality manuals, formal training sessions,
  in-service sessions

29
Indicators Clinical and Non Clinical

• Clinical Indicators Examples
• ARV Therapy Management
• Adherence to ARV Therapy
• HIV monitoring
• Gynecology exams (Pap smear, Gon, Chlya)
• Lipid Screening
• PCP Prophy.
• Syphilis screening
• Mycobacterium Tuberculosis
• Screening (PPD)
• Hepatitis C (HCV) screening
• Dental care
• Substance Use
• Mental Health care
• Patient retention
• Wait time

30

• Non Clinical Indicators Examples
• Case Management
• Prevention

31

• Evaluation
• Effectiveness of Infrastructure Does the
  quality infrastructure require any changes to
  improve how quality improvement work gets done?
• Quality Goals and Activities To what degree
  were improvement goals met? Team members should
  be working on important endeavors and improvement
  results need to be sustained over time.
• Performance Measures Were the measures
  appropriate to assess the clinical and
  non-clinical HIV care.

32
Example of Recent Performance Data
33
Quality Management Plan Components (continued)

• Workplan Development
• Divide work plan into key categories or areas of
  work
• List key activities with person responsible
• Depict beginning and ending times for each
  activity
• Key areas for Workplan
• Program Planning - Performance Measurement
• Monitoring - Performance Improvement
• Evaluation -Access Resources
• Create a QI Culture

34
oal
35
Small Group Work

• Review a Quality Management Plan.
• Identify those components listed in the
  Assessment tool.
• Rate those components and recommend how you would
  improve it.

36
Quality Committee Getting it started

• Committee Composition and Structure
• Leadership Who is ultimately responsible for
  quality initiatives?
• Membership Who will participate on the
  committee?
• Meeting structure When and how often will the
  committee meet? (at least 4-6 times/year specify
  time and location)
• Develop ground rules for meeting behavior, ie,
  start on time, etc.
• Documentation Decide on agenda format, minutes
  format and distribution
• Plan for consumer input and key stakeholders
• Communication Who needs to be kept informed of
  the findings/activities of the committee?
  Consumers, staff, another QM committee in the
  organization.

37
and keeping it going.

• QI Committee responsibilities may include
• Annual Planning
• Establishing priorities
• Setting goals
• Determining measures
• Developing a work plan/timeline
• Providing guidance to QI teams
• Facilitating innovation and change such as
  recommending new policies/changes to promote
  quality of care
• Promoting a QI culture
• Allocating resources
• Educating staff in quality principles and methods
• Maintaining internal and external accountability
  for QM

38
Choice Small Group Work

• Develop an annual workplan for a Quality
  Committee or
• Analyze data, set goals, select QI priorities.