Docs Need SOCs - Chapter 4

Chapter 4
The Right Stuff: Quality Improvement Tools

Introduction

You need the right tools for the job. "The job," in this case, is the whole QI process we have been describing. Like any complex and technical job, having the right tools and knowing how to use them will be a determining factor in success.

The concept of "QI Tools" is extremely broad in scope. Some, you might take for granted. Examples are process tools to facilitate work group meetings and task completion, communication tools (office mail, e-mail, Intranet) to bind work groups together, and presentation graphics to convey complex ideas about data and redesigned processes. Nothing can be taken for granted.

Other QI tools include planning models, budget formats evaluation schemes, scheduling systems, model QI policies, checklists, forms for specific tasks, report formats for external requirements, specialized software.

Finding the right tools can be a chore. Sometimes you have to invent your own, custom-made for the particular QI task at hand. But often there are good tools and instruments already out there, in the public domain, which you can obtain and adapt to your particular need. It’s much more cost-effective to borrow the best and modify it than to spend valuable staff time reinventing the wheel. Patient satisfaction surveys and employee satisfaction surveys are good examples.

In the remainder of this chapter we offer a set of such QI tools. This set is neither systematic nor comprehensive. Rather, it’s a careful selection of some things we have actually seen work well or we know to be essential. We hope this will be a first step in a continuing process of "tool-sharing" among primary care centers by which we share our best finds and creations. With the WVPCA, we hope to develop a Web site with a systematic classification of tools to facilitate this sharing process.

Quality Improvement Tools
(Note: Tools available for the Internet are linked here. This page will be updated as more tools become available.)

Model Quality Improvement Policy
Provides a model for health centers to use in formulating their quality improvement policy. The model incorporates the BPHC and JCAHO requirements and addresses the QI Committee, recurring and special audits, credentialing, patient complaints, and mid-level practioner supervision.
QA Audit Planning Form (.pdf)
A form for use in planning and presenting a quality performance audit.
QA Audit Example
A completed Audit Planning Form examining performance with respect to follow-up on abnormal mammograms.
The BPHC Annual Plan Format
The BPHC format for the annual health care plan. can also be used for organizing and presenting departmental and personal performance objectives. This example addresses the problem of immunization rates.
Provider Performance Audit Form (.pdf)
A description of the procedure for conducting regular provider performance audits, including selection of records, feedback to providers, and reporting.
Provider Performance Audit Procedure
A description of the procedure for conducting regular provider performance audits, including selection of records, feedback to providers, and reporting.
Evaluation Guide for Health Center Leaders and Supervisors
A sample format for evaluating department heads, program directors, and other management in a health center. The guide reflects the need for quality improvement-related competencies in health center leadership.
The BPHC Clinical Outcome Measures
The list of Clinical Outcome Measures for each of the five lifecycles (perinatal, pediatric, adolescent, adult and geriatric). Audits are to be conducted and reported annually.
The HEDIS 3.0 Reporting and Testing Set Measures (http://www.ncqa.org)
Presents the measures to be reported on by managed care plans seeking NCQA accreditation or who are otherwise required to report on HEDIS measures. Presents those measures that are now being used to evaluate health plans and those that are being tested for possible inclusion. The HEDIS may apply to health centers in so far as they contract with managed care companies that are required to report on these measures.
The Quality Assurance Calendar (.pdf)
A sample grid for planning and tracking all of a health center’s performance audits.
Patient Satisfaction Survey 1 (.pdf) and
Patient Satisfaction Survey 2
Samples of patient satisfaction surveys. Note that the second survey is offered by the Partners in Health Network, which will scan completed survey forms into a computer database and provide quarterly reports for health centers for a fee of $250 per year.
Staff Opinion Survey
A sample survey for discovering strengths and weaknesses of a health center related to staff perceptions of their work environment. Meets JCAHO requirements.
Health History and Risk Assessment Data Collection Forms
Sample medical record forms to facilitate collecting clinical and psycho-social information on patients in each of the five life cycles. The forms collect information for several purposes: to identify preventive health needs of the particular patient; and to identify health problems or risks that may require more intensive case management (particularly important if the health center has some financial risk for the total cost of care.) the forms also are designed to facilitate compliance with the BPHC Clinical Outcome Measures and the JCAHO requirements for routine preventive health screening.
Principles of Graphical Excellence
From Tufte, Edward R. The Visual Display of Quantitative Information. p. 51, Chesire, CT: Graphics Press, 1983.
Integrated Service Agreement (.pdf)
The sample Integrated Service Agreement provides health centers, or health center netwrks, with a format for establishing formal relationships with some referral service providers to improve the integration of health services and assure access to needed services.
Preventive Health Schedules and Data Collection Forms
Three medical record forms for guiding compliance with Preventive Health Schedules for Children, Adolescents and Adults, and Patients over Age 65. Provides a grid that facilitates preventive health data collection and retrieval services. The actual content of the agreement depends on the service and the specific objectives of the health center. This format would meet PCER and JCAHO requirements for evidence of integration with services needed by patients, but not provided by the health center.
Clinic Referral Form (.pdf)
A sample three-part form for making and tracking specialist referrals or referrals for diagnostic tests or treatment procedures. This form was modified from the original model developed by the WVU Office of Health Services Research. it is relevant to referral management for managed care purposes and to BPHC and JCAHO tracking and case management requirements.

Other References and Tools

The Memory Jogger II: A Pocket Guide of Tools for Continuous Improvement and Effective Planning. Brassard and Ritter. Methuen, MA: Goal/QPC, 1994. Telephone: 1-800-643-4316. Web site: http://www.goalqpc.com.
How To Make Meetings Work. Doyle and Straus. New York: Jove Publications, 1982.
Clinician Skills for Managed Care. Doyle. Morgantown: WVU Offices of Rural Health, 1997. Telephone: (304) 293-6999.
The Team Handbook, Second Edition. Sholtes. Madison, WI: Oriel Inc., 1996. Telephone: 1-800-669-8326.
Excellent comprehensive step-by-step guide to the development and operation of teams engaged in quality improvement and process redesign.
Reengineering The Corporation and Beyond Reengineering: How The Process-Centered Organization Is Changing Our Work And Our Lives. Hammer. New York: HarperBusiness, 1993 and 1996.
The principles and practice of reengineering key processes really do have great relevance to creating effective and competitive health centers. These books provide inspiration and direction.
The Complete Idiot’s Guide to Project Management. Baker. New York: Alpha Books, 1998.

Making improvement in health care services usually comes down to projects, both small and large, carried out by teams. In fact, much of health center management can be understood as project development and management. Despite the insulting title, this book provides lots of helpful guidance on how to plan and implement projects that meet your objectives within the budget.

Computer Software for Quality Improvement

The NRHA has developed the following database programs to assist in meeting various quality objectives. These are available to health centers who want to build tracking processes around electronic tools. Contact Craig Robinson at the NRHA (304) 469-3348.

Abnormal PAP Smear Tracking and Recall. Database: Microsoft Access.
Diabetic Self-Care Clinic Tracking and Recall. Database: Microsoft Access.
Immunization Tracking and Recall. Database. Microsoft Access.
Database for Collecting and Analyzing Staff Survey Data. Database: Epi Info.
Database for Collecting and Analyzing Provider Performance Audits. Epi Info.

Also note that the Centers for Disease Control offer free software tools that are helpful for quality management, including Epi Info, an easy-to-use database/statistical program that can be used to develop surveys, audits, and report results. See the CDC Web site at http://www.cdc.gov/publications.htm.

Ambulatory Innovations of Indianapolis, Indiana (a subsidiary of Methodist Hospital of Indiana, Inc.), has developed a number of electronic and print aids to quality assurance and quality improvement. Telephone: 1-800-367-9180. This effort is led by Dale Benson, MD, the executive director of the Community Health Network (a CHC) of Methodist Hospital. they offer ambulatory clinical protocols and telephone triage protocols in print and in word processor formats. They also have created databases for collecting and reporting provider and patient satisfaction audit data.

Go to Chapter 5