Logic and Methodical Work: Implementing

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Logic and Methodical Work Implementing
Sustaining a Comprehensive PQI Process

• Herman R. Barber, PhD, Special Projects
  Coordinator, Office of Planning, Policy, and
  Program Support, Child and Family Services
  Agency, Washington, D.C.
• Linda S. Butler, PhD, LCSW, Director of Research
  Special Projects, Spurwink Services, Portland,
  ME
• Al Durgin, LCSW, Director of CQI, Spurwink
  Services, Portland, ME

• And the end of all our exploring will be to
  arrive where we started and know the place for
  the first time. - T.S. Eliot

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Determine how to improve organizational capacity
and performance through improving each employees
knowledge and buy-in to the performance and
quality improvement program.
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The Vision
An agency-wide Performance and Quality
Improvement (PQI) program contributes to prudent
use of resources, efficient and effective service
delivery, and achievement of strategic and
program goals and mission.
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The Reality

• An agency can dabble in some PQI tasks because it
  is an accreditation requirement
• or
• An agency can embrace PQI as a best practice
  principle for managing in our ever changing world.

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Setting the Stage PA-PQI 1.02

• The agency endorses
• a. a culture that promotes excellence
• and continual improvement and
• b. implementation of an agency-wide
• PQI framework.

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At Spurwink this has meant

• Formal Structure
• Fanfare
• Models Supports
• Defining Roles
• Establishing Function

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• If the expectation is that the PQI unit will do
  PQI for the company, the benefits of PQI will not
  be realized.

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Formal Structure

• At Spurwink weve created two units which are
  largely responsible for the agencys PQI
  initiative.
• CQI Department
• Outcome Measures Research Department

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Fanfare

• PQI should be embraced by the agencys governing
  board, and
• Announced to the agencys staff

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Models Supports

• Personal Site Visits
• Begin by redefining current practices as part of
  a PQI process

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Where Do I Begin?
Parallel Processes

• Family team meetings
• Concurrent planning
• Therapeutic process
• Casework
• Parenting
• Cost/benefit analysis

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Models Supports

• Markets culture of Quality Improvement
• Customer Service
• Contagion Effect

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Defining Roles

• Cleary define role for all staff members
• Set standard of expectations
• The goals are
• Quality improvement
• Risk reduction
• Efficiency
• Effectiveness

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Establishing Function

• Goal setting
• Prevention over inspection
• Pro-action over reaction
• An informed response when necessary
• Data is valuable!
• Time is valuable!
• Collaboration functions exponentially

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Vagueness
PIP Outcome 1. Item 2A The agency will implement
a risk assessment at all key decision making
points within the life of the case.
Clarity is a key component to employee buy-in.
How clear is your terminology ?
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AGREEMENTS
Improvement Plans
Evaluations Assessments
Benefits to children and families Benefits to
agency Benefits to workers
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Analyzing and Reporting

• SPROLES
• Acute events including restraints
• Staff turnover
• Census monitoring
• Speed data
• Length of stay
• Medicaid/ISP compliance
• Documentation
• Analysis of on-call logs

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Occams razor

• Sometimes the simplest explanation is the right
  one

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Staff Training and Support

• Comprehensive orientation curriculum including
  section taught by CQI staff
• PQI focused site trainings
• Training on ISP development, ERS use and
  maintenance
• Peer review process
• Consultation
• As needed refresher and remedial training

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Quality Expectationsincorporated into key
documents including

• budgets
• policy procedure manuals
• new staff training material
• communications to staff, consumers, volunteers
  other stakeholders
• service provider contracts

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Challenges

• Buy in from senior managers
• Buy in from line staff
• Decentralized agency structure
• Finding all the things that we already measure
• Extracting data from our ERS
• Changing targets brought about by changing
  policies in state government

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Thinking about PQI means thinking critically

• Understanding the opinions of others
• Fair-mindedness in appraising reason
• Honesty in facing ones own biases, prejudices,
  stereotypes, egocentric ethnocentric tendencies
  
• Prudence in suspending, making, altering
  judgments
• Willingness to reconsider revise views
• Clarity in stating questions or concerns

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Something for Everyone!

• Those close to retirement
• Supervisors
• Program managers
• Administrators
• Directors
• Support Staff
• Contractors
• Board Members
• Direct care workers