QUALITY AS A WAY OF LIFE IN A NOTFORPROFIT

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QUALITY AS A WAY OF LIFE IN A NOT-FOR-PROFIT

• The incorporation of quality principles at
• Aunt Marthas Youth Service Center, Inc. and
  Health Care Network
• ASQ Illiana Section 1213
• Quality Conference 1/30/09

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Aunt Marthas Youth Service Center, Inc. Health
Care Network

• Founded in 1972 as a center that would be
  concerned with the needs of young people.
• Starting with a walk-in counseling center and
  shelter care for runaways, Aunt Martha's assessed
  the needs of youth and added programs to meet
  those needs.
• Over 120 programs in 54 locations
• Served 63.980 clients/patients in FY08

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Aunt Martha?

• A founding member recalled that when she was a
  teenager and was having trouble at home she could
  go to her aunt to air grievances and seek help.
• It was hoped that the name would suggest concern
  and caring and that young people would find at
  the agency an atmosphere like one finds at the
  home of a close relative.

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My basis for quality at a not for profit

• Each nonprofit organization needs to think
  through why
• we are here. What is our mission? What are our
  results?
• The most exciting thing to me working with
  nonprofit
• organizations is that we no longer talk of the
  need, but of
• the results. We have become performance focused.
  And
• its high time because results are the key to our
  survival. If
• we keep on talking needs and not results, I dont
  think we
• will survive the next ten years.
• Peter F. Drucker, The Five Most Important
  Questions You Will Ever Ask
• Your Nonprofit Organization.

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The Five Most Important Questions

• What is our mission?
• Who is our customer?
• What does the customer value?
• What have been our results?
• What is our plan?

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Aunt Marthas Mission

• A caring community resource for children,
• youth and families.

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• Quality is never an accident it is always the
• result of high intention, sincere effort,
• Intelligent direction and skillful execution. It
• represents the wise choice of many
• alternatives.
• William Foster

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Begin with a Plan

• The Performance Quality Improvement
• Plan at AMYSC is based on the works of
• Walter Shewhart (PDCA)
• W. Edwards Deming (Fourteen Points)
• Joseph Juran (Juran Trilogy)
• Quality Planning
• Quality Control
• Quality Improvement

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Plan Objectives

• Support the mission and goals.
• Develop processes to systematically plan, monitor
  performance, analyze current performance, and
  improve performance as needed and to sustain
  those improvements.
• Support compliance with JCAHO standards.
• Address internal and external customer needs and
  expectations.
• Improve the mechanisms by which employees are
  educated in PQI principles and processes.
• Collaborate with agency leaders to maintain an
  environment that encourages and empowers staff to
  identify and address issues through the PQI
  process.

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PQI Process The PDCA Cycle

• Plan - based on objectives, goals and measures.
  
• Do - implement the plan.
• Check (Study) monitor the results using
  measures (data).
• Act - by adjusting the processes based on the
  results of the measures.

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PQI process (continued)

• Examination of data Client/Patient files,
  direct observation, assessment tools, Incident
  reports, progress notes, risk management
  reports/root cause analysis, financial reports,
  satisfaction surveys, grievance reports,
  individual/stakeholder interviews, focus groups,
  peer reviews, etc.
• Identify the problem - Determine what problem(s)
  exists. If more than one problem is identified,
  there may be a need to prioritize the problems in
  order to remain focused. Problems are prioritized
  based on high risk, high volume and potential for
  repeat occurrences of the problem or serious
  financial impact.
• Develop a Performance and Quality Improvement
  Initiative - This can include the creation of new
  forms, processes, addition of staff,
  reorganization, etc. All new processes and
  services are designed to meet the needs and
  expectations of the clients. Create a plan of
  action to resolve the existing problem.
• Evaluate progress - Each group involved in the
  PQI initiative will be able to determine if new
  plans need to be created or if the current plan
  needs to be refined based on this evaluation
  phase.
• Monitor improvements - There should be a
  continuous review of the improvements to ensure
  that they are maintained. A Performance
  Improvement Summary of Activity form should be
  completed and a copy submitted to the PQI
  Administrator.

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Visualize the 5 step process
Monitor the Improvements
Evaluate Progress
Develop and implement a PQI initiative
An ONGOING process
Examine the data
Identify the opportunity
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• Quality is a race without a
• finish line.
• David Kerns former Xerox president

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5 perspectives of quality

• Judgmental
• Product-based
• User-based
• Value-based
• Manufacturing-based

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What is Performance and Quality Improvement?

• Performance and Quality Improvement (PQI) is
• any action taken to increase value to the
• customer or other stakeholder by improving
• effectiveness and efficiency of processes and
• activities throughout the organization.

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The three fundamental principles of PQI

• A focus on customers and stake holders
• Participation and teamwork by everyone in the
  organization
• A process focus supported by continuous
  improvement and learning.

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Core Values of PQI

• The customer comes first.
• All work is part of a process.
• Quality improvement never ends.
• Prevention is achieved through planning.
• Quality happens through people.

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• Quality is everybodys responsibility
• W. Edwards Deming

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Three basic questions to answer in any
improvement initiative

• What are we trying to accomplish?
• How will we know the change is actually an
  improvement?
• What changes must we make to achieve the targeted
  improvement?

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Seven Quality Tools

• Pareto diagrams,
• Cause-and-effect diagrams,
• Histograms,
• Control charts,
• Scatter diagrams,
• Flowcharts, and
• Run charts.

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• Quality is the result of a carefully constructed
• cultural environment. It has to be the fabric of
  
• the organization, not a part of the fabric.
• Phillip Crosby

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Types of PQI projects

• Number of restraints in 24 hour care facilities
• Utilization review
• Medicaid documentation compliance
• Client/patient satisfaction
• Employee satisfaction
• Root Cause analysis
• Facilitate quality meetings

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More projects

• Quality control checks
• Program/department evaluations
• Risk review analysis
• Data trending
• Accreditation compliance monitoring
• Incident report tracking
• Program/department consultation
• Training

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Case study

• The behavioral management plan in 24 hour care
  facilities, includes the use of physical
  restraints for youth who are a danger to self or
  others.
• A committee of the Board of Directors felt that
  the use this intervention was on the increase.

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Project data

• Conducted a four year analysis of restraint data
  (2004-2007).
• 14 facilities/programs.
• Census capacity of 119.
• Updated reports on 1/28/09, to include 2008 data.

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Project data (continued)
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Histogram 1 - Clients served per year
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Histogram 2 - Restraints per year
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Histogram 3 - Incident reports per year
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Histogram 4 Comparison analysis
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Histogram 5
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Histogram 6
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Statistical analysis of the data

• Conducted a Chi-square test analysis to prove the
  following hypothesis
• The number of restraints are increasing based on
  the increased numbers of clients and incident
  reports, and not because it is becoming the
  preferred intervention.

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June 2008 results

• Chi-square 1.379
• degrees of freedom 3
• p-value 0.71046455
• Yates' chi-square 1.063
• Yates' p-value 0.78601269
• Df P 0.05 P 0.01 P 0.001
• 3 7.82 11.35 16.27

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January 2009 results

• Chi-square 31.687
• degrees of freedom 4
• p-value 0.00000355
• Yates' chi-square 28.877
• Yates' p-value 0.00000828
• Df P 0.05 P 0.01 P 0.001
• 4 9.49 13.28 18.47

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Interpretation of analysis

• The hypothesis of the June data was accepted.
  The percentages were proportionately equal.
• The hypothesis of the January data was rejected.
  There is an opportunity for improvement.

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Satisfaction survey analysis
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Comparing satisfaction by gender
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Out of the mouth of babes

• Good, better, best
• Never let it rest
• Until the good becomes the better
• And the better becomes the best.
• Elementary school rhyme