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1 Welcome to the Performance Driven Academy! We will begin the webinar shortly. Please take a moment to complete the 2 Minute Feedback Survey about the last webinar. If you are joining us for the first time, please make sure to complete the Intent to Participate Information and Baseline Survey. Links in the chat box! Questions? us at pda@ccsi.org

2 Performance Driven Bar graph Academy SESSION 5: CONTINUOUS QUALITY IMPROVEMENT PRACTICES

3 Brought to you by the Managed Care Technical Assistance Center SPEAKER: JOHN LEE, MBA DIRECTOR, CENTER FOR COLLABORATION IN COMMUNITY HEALTH COORDINATED CARE SERVICES, INC.

4 Reminders Please make sure everyone in your work group registers for one JUNE in-person session If you re joining us for the first time, complete the baseline survey (link in chat box) and review Webinars 1-4 on the MCTAC website Webinars are recorded and you should have received materials ahead of this webinar Use for any questions, comments, etc. Chat in questions/comments to all panelists at any time

5 What is the PDA?

6 Goal of the PDA Elements of a Performance Driven Organization Developed by CCSI s Center for Collaboration in Community Health

7 Actively Participating in the PDA Will Position you to know your cost, know your quality, and know your impact within the broader system of care Generate a workplan for integrating knowledge gained and transfer knowledge within you organization Provide tools and resources to support effective collaboration, measurement, financial analytics, and leadership values to support continuous growth and improved efficiencies Document your agency s growth and improvement through the evaluation Demonstrate your agency s commitment to performance driven principles through a certificate of completion

8 Where We ve Been Developing a culture that supports performance driven principles and prioritizes data-driven decision making Effective collaboration as a key to success and optimizing impact Best practices to support your human resources and heighten accountability for performance Defining effective measurement practices so that performance improvement can be built on valid and reliable data

9 4. Effective Measurement 6. Practice Development Semester 2: Finance and Leadership 5. Continuous Quality Improvement 7. In-person sessions

10 Continuous Quality Improvement Practices The Performance Driven Academy DAVID W. ECKERT, LMHC, NCC, CRC SENIOR CONSULTANT, CENTER FOR COLLABORATION IN COMMUNITY HEALTH COORDINATED CARE SERVICES, INC.

11 Background of Today s Speaker Licensed Mental Health Counselor, Nationally Certified, Certified in Rehabilitation Expertise in behavioral health clinical design, clinical documentation, open access, collaborative documentation, and Continuous Quality Improvement (CQI) CCSI Senior Consultant, Center for Collaboration in Community Health Supporting behavioral health providers and networks in Managed Care and Value-Based Payment readiness; improved outcomes

12 Joined by ANDREA MCINTYRE COMPLIANCE/QUALITY ASSURANCE OFFICER CHENANGO COUNTY MENTAL HYGIENE SERVICES Responsible for the direct oversight of the Compliance and Continuous Quality Improvement (CQI) efforts of the Chenango County Mental Hygiene Services. Chenango County operates outpatient mental health programs for adults and children, including satellite clinics in schools, as well as an outpatient substance abuse clinic. Chenango County has been active in Managed Care and Value Based Payment readiness efforts for over 2 years.

13 Today s Learning Objectives Try to cover a rich topic in under an hour Review essential Continuous Quality Improvement (CQI) practices Discuss the importance of consistent workflows, processes, and followthrough Provide an overview of CQI as applied at the agency and program levels Review some high profile measures that can serve as a focus of CQI efforts Offer agency-specific examples that show CQI in action Discuss the use of tools that support data collection and reporting Review how reports are being utilized to support effective CQI practice

14 What is Continuous Quality Improvement? CQI is the process by which organizations objectively, systematically, and continuously assess, assure, monitor, evaluate, and improve the quality of programs and services provided to their clients. This requires establishing program-specific goals, objectives and measures (performance indicators) and includes training staff in CQI methods and tools. CQI often utilizes on the Plan-Do-Study-Act approach

15 What is CQI, Really? A philosophy that focuses on improving the systems and processes of an organization Asks: How are we doing? How do we know? Can we do better? By using methodology that is: Specific Objective Data-Driven Cyclical

16 Why CQI? Helps any organization become better at improving the lives of those they serve, finding efficiencies, enhancing staff effort and well-being Foundation of a performance driven culture Facilitates alignment with State and Federal Policy goals Triple Aim Improve the quality of care Reduce costs Improve Population Health

17 Starting with Why Simon Sinek People need to first appreciate why improvement is needed to become engaged in the process This needs to align with their own values and why they do the work that they do Leadership is likely to have had more time to adjust to change and should understand that others need to be nurtured along Start with why and then move to how the agency plans to bring about change Then offer details on what will change by repeatedly communicating progress

18 PDSA Cycle Plan Act Do Study

19 Using PDSA to Improve Show Rates Across behavioral health systems and levels of care, improving attendance at scheduled appointments is a common goal How can we apply the use of the Plan-Do-Study-Act approach to be more consistent in achieving this goal? This is a win-win type of initiative Improves the quality of care Increases clinical consistency Improves financial performance

20 Other Common Measures Use of acute services- focus on reducing ER visits, hospitalizations, and re-hospitalizations Links between levels of care- successful transition and client engagement from inpatient to outpatient settings Access measures- time from initial call to first appointment Engagement measures- consistent attendance early in treatment Medication adherence- stimulants, antidepressants, antipsychotics, etc. Symptom & Functioning- PHQ-9, DLA-20, etc. Client Satisfaction Surveys

21 How to Begin Using PDSA? Who? Workgroup: Need buy-in! Individuals that may be impacted by PDSA cycle for their input Those with the data Leadership that has authority to make decisions on PDSA findings AND can ensure implementation of the DO What? PDSA cycle on ONE step at a time Ensures you are attributing change to the correct variable Timeline? Short Cycles (2 weeks) for rapid decision making This can be a challenge in the Behavioral Healthcare field

22 Plan: This is the Detail Part of the Cycle General Considerations What is the question this PDSA cycle is trying to answer? What is the goal? Specific to Show Rate Project Question: Are we taking the necessary steps to help our clients attend appointments consistently? Goal: Achieve targeted improvement in show rates for scheduled appointments.

23 CQI process: Review data did we answer the question? Determine impact (Brainstorm) Connect impact to System Goals (Logic Model) Create measure Identify Data Opportunities Select data collection method, balancing resource availability What s the Question? Identify outcome of focus Identify Data Availability

24 Plan: Details, Details, Details General Considerations Who will enact the PDSA cycle? What data points are needed? o Who will collect the data? o How will it be collected? o Who will be aggregating/analyzing? When to reconvene to look at data? Specific to Show Rate Project PDSA will be piloted in outpatient MH clinic Identify staff person responsible for generating reports Identify essential data sources and data points: o Electronic Medical Record o Appointment Types: Attended, Cancelled with Notice, Cancelled by Clinician, No-Show/No-Call o Reports by clinician, job type, and for MH clinic

25 Plan For: Data Collection and Reporting Tools utilized to extract and report data Electronic Medical Record System (EMR) Need to ensure that data points are identified and can be retrieved from the EMR Operationalize definitions so that the data represents what it is supposed to represent Excel Data is pulled in CSV files and then formatted in Excel Need to ensure consistency of processes Tableau Utilized for data visualization

26 Plan For: Data Validation Prior to reporting, make sure that data has been checked and rechecked for accuracy Verify that the data is correct; did you capture what you intended to capture? Be careful that accuracy isn t lost if through data entry or conversion processes Have 2 sets of eyes validating the data Check for blank fields Find and fix the source of any inaccuracies and validate again

27 Plan To: Establish Baselines & Targets Establishing Baseline: Choose a period of time that is long enough to address variability that can occur over time Decide the focus and breadth of the measurement Agency Program Job Type Clinician Client Create SMART goals/targets: Simple, Measurable, Achievable, Realistic, Time-Limited. Have baseline ready for review by CQI team CQI team can establish targets with input from stakeholders; What is a reasonable expectation for improvement?

28 Do: Go Forth and Do the Work! General Considerations Enact the PDSA cycle How will staff be notified about the workgroup and its aims? How will it be disseminated? Set Start and End Dates Specific to Show Rate Project Set target for Show Rates at 75% Introduced attendance improvement project to all staff Set up monthly CQI project Team meetings Generated Show Rate reports by clinician, job type, and for Clinic Created Attendance Agreement to clearly state expectations Utilized Administrative staff to ensure that client contact info is current Utilize Care Managers or Peer Specialists to assist clients with overcoming barriers to attendance Provide updates at Clinic meetings each month

29 Study: This is the Did it Work? Portion of the Cycle General Considerations What does the data show? Were the changes meaningful? Was there enough information to make a decision? What changes occurred as a result of the PDSA cycle? Barriers? Specific to Show Rate Project Results: o 72% for direct care clinicians o 68% for Crisis Stabilization Team o 67% for medical staff (MDs & NPPs) Many prescriptions filled by phone when clients missed appointments Significant variability between clinicians A relative small percentage of clients a high percentage of no-shows Awareness of problem and responses to address barriers increased

30 Study: This is the Did it Work? Portion of the Cycle

31 Study: This is the Did it Work? Portion of the Cycle

32 Workflows and Processes Traditional Access Client calls They are sent an Intake/Screen a packet Packet returned and reviewed Insurance checked Case assigned at Clinic Team meeting Client called back to schedule Intake Client registers before appointment Insurance verified Clinical assessment occurs Client admitted into treatment Open Access Client calls Client comes to clinic during Open Access hours Insurance is verified Intake/Screen information gathered Client registers Clinical Assessment occurs Client admitted into treatment

33 Average Time from Call to Admission Days to Access Days to Access Linear (Days to Access)

34 Specific Time from Call to Admission 100 Days to Access Days to Access Linear (Days to Access)

35 Act: What Are You Going to Do with This New Information? Here Are Some Options General Considerations Implement a policy/workflow change Expand the PDSA cycle to a larger group/department Disseminate the findings A new PDSA cycle with a different variable Stop doing an action/behavior Solicit additional input from other stakeholders Specific to Show Rate Project Reviewed clinician-specific data and targets with each clinician Clarified expectations for follow-up when clients miss appointments Clarified policy about clinicians cancelling appointments Included attendance expectations in Clinic brochure Recognized and learned from clinical staff that have high show rates Instituted Just-In-Time scheduling for prescribers

36 Are We There Yet?

37 Effective CQI Processes Require Tenacity Obstacles are what we see when we take our eyes off of our goals. -Vince Lombardi

38 Tool: CQI Workbook Excel workbook template for monitoring progress towards a target Workplan sections for each step of Plan, Do, Study, Act Specifics of the CQI process and who is responsible

39 Tool: CQI Workbook Brief screen to help evaluation the development of your quality improvement process

40 What Do I Do Next?

41 Take-aways: How Can I Get Started? Select an area of need or opportunity for improvement What are you currently measuring and do you have reports that can drive practice improvement? Beware of discussions that lead to more measurement without taking action on the data you already have. Identify the stakeholders involved in practice improvement Have some informal discussion with staff about why improvement in this area is important Produce baseline data to guide the discussion Just get started

42 Mark Your Calendars and Register Webinars (Wednesdays, 12-1pm): Practice Development and Management, 5/23/18 In-person events in late June (10am-2pm) Register individually, not by agency Albany- Tuesday, 6/19/18 Rochester- Monday, 6/18/18 NYC- Friday, 6/29/18 Semester 2: Dates coming soon

43 Upcoming Webinar of Interest Topic: Evaluation of Data Collection When: Friday, May 18 th Time: 12pm-1pm The Rochester Regional Health Behavioral Health Department provides an array of behavioral health services throughout the Rochester region, meeting the needs of individuals across the lifespan by offering acute, outpatient and community based behavioral health programming. The RRH BH department is working to develop a data infrastructure to support operational excellence and track key performance metrics within the organization. During this webinar, RRH will highlight one key performance metric and the process by which the organization implemented process improvement practices to improve outcomes and how data collection evolved from manual data entry integration into the larger data infrastructure practice. Presenters: Mandy Teeter, MBA, MSW, Director Operational Excellence & Adult Mental Health Liz Schreiber, MA, LMFT, Manager Operational Excellence Frankie Tangredi, Clinical Analyst Registration link in chat box!

44 Send us any questions or feedback Use the chat box or us at:

Welcome! We will begin the webinar shortly.

Welcome! We will begin the webinar shortly. If you are joining us for the first time, please make sure to complete the Intent to Participate Information and Baseline Survey. Questions? Email us at pda@ccsi.org