Improving Outcomes Improving Outcomes through through Quality and Performance Quality and Performance ImprovementImprovement

Susan Brandau

NYS Office of Alcoholism and Substance Abuse Services

SusanBrandau@oasas.state.ny.us

Presentation ObjectivesPresentation Objectives

Define Quality and Performance Improvement (QPI) and Key Principles

Define OASAS QPI Approach and Planned Activities

Interdivisional Quality and Practice Interdivisional Quality and Practice Improvement WorkplanImprovement Workplan

Acting Commissioner’s Charge:The Interdivisional Workgroup on Quality and

Practice Improvement should develop concrete, attainable short and long term recommendations to incorporate PI approaches at two levels: within OASAS & throughout the provider system (including counties).

QPI LOGOQPI LOGO

What Is Performance What Is Performance

Improvement?Improvement? Performance improvement is

defined as a series of administrative and programmatic processes designed for the achievement of organizational and individual results. The goal of PI is to provide high quality, measurable and sustainable prevention and treatment services for all OASAS customers.  

Other Key DefinitionsOther Key Definitions

Quality is defined as the degree to which the administration and delivery of chemical dependence and gambling services increases the likelihood of desired outcomes and are consistent with current professional knowledge. 

[Adapted from IOM definition]

Other Key DefinitionsOther Key Definitions

Evidence-based practices are those clinical and administrative practices that have been proven to consistently produce specific, intended results.

Turning Knowledge Into Practice, The Technical Assistance Collaborative, Inc., Boston (2003)

Key QPI Principles and MethodsKey QPI Principles and Methods: Staff Involvement and Teamwork

Organizational performance improvement is the responsibility of all staff; all are expected to participate and contribute to the desired outcomes of the organization. The expected teamwork involves training of staff in various performance improvement techniques.

Key QPI Principles and MethodsKey QPI Principles and Methods: Develop a Learning Culture

The development of a continuous learning culture is both the desired outcome of and results in continuous performance improvement.

Key QPI Principles and MethodsKey QPI Principles and Methods:

Leadership

All staff persons in positions of leadership are responsible to support performance improvement processes, and ensure that all staff are trained, participate, and contribute to the achievement of the agency’s strategic goals.

Key QPI Principles and MethodsKey QPI Principles and Methods:

Data and Analysis

Performance Improvement is based on the systematic collection and analysis of data using accepted performance improvement tools. It is through data collection and analysis that gaps between desired and actual performance are identified giving rise to performance improvement opportunities.

Key QPI Principles and MethodsKey QPI Principles and Methods: Customer Satisfaction

Customer satisfaction is key to QPI. Customers can be both internal and external to the organization. For OASAS initiatives, customers could include our patients, staff, control agencies, provider agencies and coalitions, referral sources, or any individual or entity that receives or “consumes” services provided by the agency.

Key QPI Principles and MethodsKey QPI Principles and Methods:

Measurable Outcomes

Continuous improvement is measured in terms of clearly stated, measurable, or countable outcomes, consistent with an organizations’ mission, strategic direction and goals.

QPI Components at OASASQPI Components at OASAS

Organizational Structure Inter-Divisional QPI Workgroup Performance and Practice Improvement Unit The Practice Research Collaborative Bureau of Prevention Bureau of Treatment Workforce Development ATC’s Field Offices Bureau of Enforcement MIS Support

QPI Improvement InitiativesQPI Improvement Initiativesat OASASat OASAS

Funding Support Best & Promising Practices Fund NIDA State Enhancement Grant Prevention SIG-E

External Partners NE Addiction Technology Transfer Center New York’s Clinical Trials Networks NIATx Northeast Center for the Application of Prevention Technology

(CAPT) ASAP SAMHSA – CSAT, CSAP

Current Studies/Improvement Current Studies/Improvement ActivitiesActivities

Statewide Roll-out of Modified Mini Screen (MMS) Development of a Quality Improvement Tool-Kit Pilot Studies of EBPs-Contingency Management, Behavioral Couples

Therapy, Modified Therapeutic Community Best & Promising Practices Studies Peer Review PIC Newsletter, Local Services Bulletins, CAPrI Prevention Activity and Results Info System (PARIS) NIATx, STAR Patient Feedback Managed Addiction Tx Services Communities that Care

Workplan GoalsWorkplan Goals

OASAS (Short-term) To enhance the agency-wide knowledge of QPI

approaches & established evidence-based practices (EBPs)

OASAS (Long-term) To incorporate data-driven, evidence-based

decision making into OASAS functions

Workplan GoalsWorkplan Goals

Providers (Short-term) To finalize a QPI improvement methodology

& to implement selected EBPs within selected provider settings in conjunction with other units.

Providers (Long-term) To establish a self-sustaining cycle of QPI

improvement within all OASAS providers that includes a capacity to evaluate the effectiveness of these efforts.

Planned Workgroup Activities: Planned Workgroup Activities: OASAS (Short-term)OASAS (Short-term)

Reorganize QPI Workgroup to include reps from each Division and establish an infrastructure that coordinates all QPI activities within OASAS.

Develop and disseminate marketing/informational materials to inform OASAS staff about the value and intent of the effort.

Develop an inventory of EBPs to be implemented by OASAS and providers.

Conduct briefings for Executive Staff and bureau/unit level briefings on QPI.

Planned Workgroup Activities: Planned Workgroup Activities: OASAS (Long-term)OASAS (Long-term)

Divisions conduct reviews of role relative to QPI; develop division level QPI plan.

QPI Workgroup reviews OASAS regulations, policies to identify barriers/supports for QPI implementation (e.g. defining the QI regulation).

QPI Workgroup coordinates selection of Best/Promising Practices dedicated fund projects.

QPI Workgroup develops/issues Practice Improvement newsletter, LSBs and other QPI information to OASAS staff and the field.

Planned Workgroup Activities: Planned Workgroup Activities: Providers (Short-term)Providers (Short-term)

Meet with provider groups/coalitions to describe effort.

Establish OASAS/Provider Joint QPI Task Force and provider communication linkages

Define statewide QPI priorities based upon assessed needs.

Identify QPI methods /EBPs for each major service Develop EBP inventory and process for

dissemination; enlist support of federal agencies. Identify structures to promote QPI/EBPs on an

ongoing basis

Planned Workgroup Activities: Planned Workgroup Activities: Providers (Long-term)Providers (Long-term)

Implement selected EBPs. Incorporate QPI/EBPs in provider work scopes,

CRISP and other OASAS review systems. Develop systems for monitoring and reporting on

provider QPI/EBP progress. Continue to assess and refine existing practices;

replicate in new locations/programs. Continue identifying EBPs and QPI areas based

on OASAS priorities and provider needs.

Related Strategic Plan GoalsRelated Strategic Plan Goals

Strategy 1.6 Increase the use of evidence-based practices and performance improvement strategies by OASAS, counties, and providers.

• Enhance the agency-wide knowledge of QPI approaches and EBPs.

• Implement evidence-based practices in selected provider settings. • Produce a “tool-kit” of evidence-based practices and

quality/performance improvement materials. • Analyze results of the first round of the Best and Promising

Practices Project studies; initiate second round • Oversee an Independent Peer Review Process that uses a process

improvement approach• Develop regional learning collaboratives on specific topical areas

Learning Collaboratives Learning Collaboratives

Identify topical areas based upon provider responses to LSP survey

Involve statewide provider association Recruit participants, interdisciplinary teams

with an expressed commitment to improve services within a temporary learning organization

Focus on one clinical or administrative improvement

Learning CollaborativesLearning Collaboratives

Identify content area “experts”-academic/research/peer providers

Participants learn from experts and their peers-includes change concepts, QI and practical “real-world” changes that worked at other sites

Participants use a change testing model to plan, implement and evaluate changes in rapid succession

Learning CollaborativesLearning Collaboratives

SSA utilizes Best and Promising Practices Fund to award via RFP small “mini-grants” to jump- start process

Teams set measurable targets and collect data to track performance

Participants regularly meet to learn methods, report out on experiences, change processes, results, discuss dissemination of innovations

Learning CollaborativesLearning Collaboratives

Between meeting activity: creation of list servs to exchange ideas, e-mail support, conference calls

SSA initially externally manages process, arranges logistics, and FOOD with the goal of cultivating local leadership and ownership to assume these responsibilities

Recommendations for Starting Recommendations for Starting Learning CollaborativesLearning Collaboratives

Choose the right subject: Relevance, Timeliness, Credibility, Flexibility, Bi-directionality

Define objectives Define roles/expectations Conduct team building exercises Emphasis is on mutual learning, not

teaching

START-UP ISSUES (cont’d)START-UP ISSUES (cont’d)

Motivate and incentivize teams-strive for inclusiveness!

Assist with the development of measurable and achievable targets

Provide TA re: data and change challenges Plan early for sustaining improvement Plan for dissemination and recruitment of

new participants

Strategies to Assist with Strategies to Assist with Implementation (Backer)Implementation (Backer)

Inter-personal Contact Planning and Conceptual Foresight- for

Implementation and Contingencies as they emerge

Outside Consultation on the Change Process User-oriented Transformation of Information Individual and Organizational Championship Potential User Involvement

1) Abstinence from Drug and Alcohol Use2) Employment/Education3) Criminal Justice/Juvenile Justice4) Family and Living Conditions5) Social Connectedness6) Access/Capacity7) Retention8) Client Perception of Care9) Cost Effectiveness10) Use of Evidence-based Practices

NATIONAL OUTCOME MEASURES NATIONAL OUTCOME MEASURES (NOMS) for Prevention & Tx Programs(NOMS) for Prevention & Tx Programs

QPI Cycle QPI Cycle

Provider/County Plans

QPI Interventions/EBPs

Revise OASAS/Local

Priorities

Measure Improvement