the quality conundrum achieving safety, health and valued outcomes
TRANSCRIPT
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The Quality Conundrum
Achieving Safety, Healthand Valued Outcomes
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How Did We Get Here?
Initial concentration on rudiments of custodial careEvolution of programmatic standards that reflected growth in our understanding of people’s needs and our own expertiseIncreased concern about the efficacy of our interventionsAttention to the outcomes of services and supports from the perspective of the customer
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Valued Outcomes
Individualization
Integration/Inclusion
Relationships/Social Connections
Health and Safety
Personal Growth
Choice and self-determination
Dignity
Consumer Satisfaction
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Signs of Change in Performance Management
No longer just better than the institutionRooted in outcomesEmphasis on enhancementChanging role of the stateChanges in experiences of families and people with mental retardation Changes in accreditation approaches
Outcomes
Expectations
Inclusion
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More Signs of Change
Movement away from prescriptive standards
Emphasis on CQI
Exploration of self-assessment
Collaborative development of standards
Inclusion of customer satisfaction
Satisfaction
CQI
Consensus
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The Two Faces of QA: One: Control
Function Characteristics Mechanisms Quality control: to assure minimum performance
Protection from harm
Clear indicators
Immediate response
Licensure Certification Incident
reporting & review
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The Two Faces of QA: Two: Enhancement
Function Characteristics Mechanisms
Quality enhancement: to encourage optimal performance
Related to personal outcomes
Identification of strengths and limits
Collaborative
Training
Technical assistance
Performance-based contracting
CQI
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Pri
nci
ple
s Facilitate individual choice
Support relationships and
community membership
Encourage natural supports
Ensure health, well-being
and safety
Foster productivity and
participation in meaningful
work
Maximize self-determination
Support families
Build staff and provider
capacity
Person Centered Systems or Support Should:
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Public Quality Assurance Responsibilities
Assuring that individuals are free from abuse, neglect, and exploitation;Protecting the rights of individuals and families;Assuring accountability in the use of public dollars;Assuring that individuals have access to necessary professional services;Evaluating the effectiveness if service and supports;Assessing the performance of service providers
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Changing Quality Landscape
Exposure of fault-lines in the system (e.g., HCFA and the press)
Expansion of supports to individuals on the waiting list
Emergence of self-determination
Olmstead decision
Struggles with MIS applications
Direct support staff shortages
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Myths and Cautions
Choice is the only thing that matters
Health and safety are synonymous with outcomes
Providers are ready for outcomes
There is a correlation between “best practice” and consumer satisfaction”
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Critical ConstraintsDrain of knowledgeable staff frompublic sector
Consolidation of providers
Management of multiple systems
“Generic” approaches to quality
Increasing gray areas in public jurisdiction
Pressure from HCFA
Lack of collaboration with sister agencies
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Important Next StepsPlace individual outcomes at the center of the system Enlist assistance of consumers and familiesIdentify key areas of performanceLink technology with need for informationLook at the costs and benefits of existing approaches
Make results available and accessibleGet serious about uniform reporting of critical health and safety events
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More Recommendations
Develop Staff credentialing and expand training options
Reassess roles and responsibilities of case managers
Refine performance contracting
Expand understanding of person-centered planning
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Emergence of Performance Indicators
First appeared in behavioral and acute careProvide some “cues” for managing these complex systemsHighlight impact of cost containmentIlluminate what’s workingProvide early warning signs
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Characteristics of Performance Indicators
Reflect major organizational or system goals.
Address issues that can be influenced by the organization or system
Have face validity
Point a direction
Reflect rates or major events
Related to associated standards
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Consumer Involvementin Assuring Quality
Choice among providers/ purchasing decisions
Designing and refining QA mechanisms
Grievance/appeals process
Consumer satisfaction surveys
Membership on policy-making board
Telecommunications networks
“Consumer Reports”
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Health and Safety ImperativesEnsure adequate number of service coordinatorsBuild individualized health and safety plansScreen and train employeesTrain individuals and familiesIncrease federal fundingDevelop hotlines and ombudspersons
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Continuous Quality Improvement
Leadership at the senior levelEngagement of multipleconstituenciesIdentification of emergingissues and prioritiesDevelopment of an benchmarksIdentification of change strategiesMeasurement of progress
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What Do You Do With the Information?
Include at your web site
Prepare annual reports to the legislature
Develop provider profiles
Use with sister agencies
Monitor managed care initiatives
Use in allocation decisions
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Final Words
“Beware the Continuous Improvement of Things Not Worth Improving”
W. Edward Deming