Continuous Quality ImprovementContinuous Quality Improvementandand

CCISCCCISC

Philosophy, Process and TechniquePhilosophy, Process and TechniqueOfOf

Systems ChangeSystems Change

Presented by: Presented by: Kenneth Minkoff, MDKenneth Minkoff, MD

andandChristie A. Cline, M.D., M.B.A., P.C.Christie A. Cline, M.D., M.B.A., P.C.

With Acknowledgement to:With Acknowledgement to:Lesa Yawn, PhD, JDLesa Yawn, PhD, JD

IInfo@ZiaLogic.orgnfo@ZiaLogic.org www.ZiaLogic.orgwww.ZiaLogic.org

ZiaLogicZiaLogic©2004©2004

TerminologyTerminology

CQI = Continuous Quality CQI = Continuous Quality ImprovementImprovement

TQM = Total Quality ManagementTQM = Total Quality Management QA = Quality AssuranceQA = Quality Assurance PDCA = Plan, Do, Check, ActPDCA = Plan, Do, Check, Act CCISC = Comprehensive, Continuous, CCISC = Comprehensive, Continuous,

Integrated Systems of Care Integrated Systems of Care

CQI/TQM PhilosophyCQI/TQM Philosophy

The customers and their needs shape The customers and their needs shape our organization and its work, not our organization and its work, not vice versa.vice versa.

Quality products and services result Quality products and services result from quality systems, processes and from quality systems, processes and methods.methods.

Quality is all-consuming focus of the Quality is all-consuming focus of the organization.organization.

CQI/TQM PhilosophyCQI/TQM Philosophy

An organization achieves quality by An organization achieves quality by mastering the methodology of mastering the methodology of improvement.improvement.

An organization pursuing quality An organization pursuing quality directs and focuses its energies.directs and focuses its energies.

There is a new paradigm of There is a new paradigm of leadership that requires managers to leadership that requires managers to reformulate what it means to lead.reformulate what it means to lead.

CQI/TQM CQI/TQM as a as a

Systems ProcessSystems Process

Ten PrinciplesTen Principles

For Leaders to FollowFor Leaders to Follow

Principle 1Principle 1

Define QualityDefine Quality vs “ vs “I know it when I know it when I see it”I see it”• Each quality outcome should have a Each quality outcome should have a

specific definitionspecific definition• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 2Principle 2

Customer Orientation Customer Orientation vs vs Internal Internal FocusFocus• Each quality indicator is determined by Each quality indicator is determined by

its relationship to improving outcomes its relationship to improving outcomes for the consumer.for the consumer.

• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 3Principle 3

Work Process Focus Work Process Focus vs vs End End Product FocusProduct Focus• Each quality outcome is designed to be Each quality outcome is designed to be

measured according to the extent to measured according to the extent to which work processes result in ongoing which work processes result in ongoing improvement over time.improvement over time.

• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 4Principle 4

Us Partnerships Us Partnerships vs vs We and TheyWe and They• Each quality outcome can be achieved Each quality outcome can be achieved

only through collaboration.only through collaboration.• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 5Principle 5

Proactive Proactive vs vs ReactiveReactive• Each quality outcome is achieved Each quality outcome is achieved

through planned and deliberate through planned and deliberate intervention over time, as opposed to intervention over time, as opposed to end product corrective action.end product corrective action.

• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 6Principle 6

100% Quality Attitude 100% Quality Attitude vs vs That’s That’s good enoughgood enough• Each quality outcome is attained by an Each quality outcome is attained by an

approach that works to achieve the best approach that works to achieve the best result for each consumer every time.result for each consumer every time.

• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 7Principle 7

Management by Facts Management by Facts vs vs Management by IntuitionManagement by Intuition• Each quality outcome is attained Each quality outcome is attained

through successive evaluation of data through successive evaluation of data and adjustment accordingly.and adjustment accordingly.

• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 8Principle 8

Engagement and Empowerment Engagement and Empowerment vs vs “Just follow the plan, man”“Just follow the plan, man”• Each quality outcome is implemented by Each quality outcome is implemented by

collective engagement in designing collective engagement in designing successful processes. Leadership successful processes. Leadership always strives to achieve proper balance always strives to achieve proper balance between control and empowerment.between control and empowerment.

• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 9Principle 9

Quality belongs to everyone Quality belongs to everyone vs vs “We have a quality department”“We have a quality department”• Each quality outcome is implemented Each quality outcome is implemented

through the interactive participation of through the interactive participation of all components of the system.all components of the system.

• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

Principle 10Principle 10

Continuous means continuous Continuous means continuous vs vs “we measure when its over”“we measure when its over”• Each quality outcome is implemented Each quality outcome is implemented

through the iterative processes of PDCA. through the iterative processes of PDCA. Quality outcomes are targets, always Quality outcomes are targets, always advancing as the system learns and advancing as the system learns and improves. improves.

• Working example: WELCOMINGWorking example: WELCOMING• Working example: IDENTIFICATION OF Working example: IDENTIFICATION OF

THE POPULATIONTHE POPULATION

CQI as Compared to QACQI as Compared to QA

CQI is a central tenet of management CQI is a central tenet of management rather than a peripheral activity.rather than a peripheral activity.

CQI focuses on continuously CQI focuses on continuously improving rather than on reaching a improving rather than on reaching a plateau of quality.plateau of quality.

CQI is a motivating force for CQI is a motivating force for improvement rather than a improvement rather than a policeman of errors and faults.policeman of errors and faults.

CQI as Compared to QACQI as Compared to QA

CQI focuses on the system meeting CQI focuses on the system meeting the needs of the consumer rather the needs of the consumer rather than individual performance as a than individual performance as a foundation.foundation.

CQI cuts across organizational CQI cuts across organizational territories and departmental territories and departmental boundaries.boundaries.

Technique of CQITechnique of CQIfor for

CCISC ImplementationCCISC Implementation

FOCUSFOCUS

FFind a process that needs improvementind a process that needs improvement

OOrganize a team knowledgeable about rganize a team knowledgeable about the processthe process

CClarify the knowledge about the processlarify the knowledge about the process

UUnderstand the causes of variations in nderstand the causes of variations in the processthe process

SSelect the improvementelect the improvement

DO

ACT

PLAN

CHECK

PDCAPDCA PlanPlan

• Study a processStudy a process• Collect and evaluate dataCollect and evaluate data• Develop an Develop an ACTION PLANACTION PLAN

DoDo• Try out the planTry out the plan

CheckCheck• Evaluate the test runEvaluate the test run

ActAct• Adjust the plan and go back up to the top and Adjust the plan and go back up to the top and

try againtry again

CCISC ACTION PLANCCISC ACTION PLAN

Strategic, Dynamic and InteractiveStrategic, Dynamic and Interactive System, Program, Clinical Practice, System, Program, Clinical Practice,

Clinician Development InterlinkedClinician Development Interlinked Measurable MilestonesMeasurable Milestones Realistic TimeframesRealistic Timeframes Real People Accountable for Taking Real People Accountable for Taking

Real ActionReal Action

CCISC CCISC 12 Step Implementation Program12 Step Implementation Program

A framework for CCISC implementation using CQI A framework for CCISC implementation using CQI at the highest level of systems organizationat the highest level of systems organization

Supported by the use of an organized toolkit that Supported by the use of an organized toolkit that includes the CO-FIT 100™, COMPASS™, and includes the CO-FIT 100™, COMPASS™, and CODECAT™CODECAT™

Incorporates system, program, clinical practice, Incorporates system, program, clinical practice, and clinician development aspectsand clinician development aspects

Identifies and prioritizes quality indicators at each Identifies and prioritizes quality indicators at each level of the system and organizes multiple CQI level of the system and organizes multiple CQI processes to achieve themprocesses to achieve them

Requires an organized leadership team to Requires an organized leadership team to oversee the process defined by the CCISC Charter oversee the process defined by the CCISC Charter for the systemfor the system

CCISC 12 Step Implementation ProgramCCISC 12 Step Implementation Program

1.1. Organize leadership team with consumer/family Organize leadership team with consumer/family inputinput

2.2. Develop consensus charter and CQI plan (CO-Develop consensus charter and CQI plan (CO-FIT 100™)FIT 100™)

3.3. Design project and create incentives with Design project and create incentives with existing fundingexisting funding

4.4. Strategic prioritization for continuity using 4-Strategic prioritization for continuity using 4-quadrantsquadrants

5.5. Define dual diagnosis capability as a program Define dual diagnosis capability as a program goal (COMPASS™) and implement over time goal (COMPASS™) and implement over time using a CQI Action Planusing a CQI Action Plan

6.6. Develop initial steps toward “system” Develop initial steps toward “system” interaction through inter-program coordinationinteraction through inter-program coordination

CCISC 12 Step Implementation Program CCISC 12 Step Implementation Program

(Continued(Continued))

7.7. Develop and disseminate initial practice Develop and disseminate initial practice guidelinesguidelines

8.8. Select practice priorities for CQI implementation Select practice priorities for CQI implementation (e.g., welcoming, access, and data collection)(e.g., welcoming, access, and data collection)

9.9. Define clinicians’ initial scopes of practiceDefine clinicians’ initial scopes of practice10.10. Identify a process to evaluate and improve Identify a process to evaluate and improve

clinician competencies over time (CODECAT™)clinician competencies over time (CODECAT™)11.11. Develop training plan and train-the-trainer Develop training plan and train-the-trainer

cadrecadre12.12. Plan to fill gaps in the comprehensive Plan to fill gaps in the comprehensive

continuum continuum