Beyond industry-wide changes like value-based care, the managed care final rule is causing organizations across the care continuum to increase their focus on quality management. However, implementing a quality management program requires significant change, and a lack of structure or attention to key components can create a lot of work with limited or no results.
Jay Bulot, Ph.D., has spent the last several years helping states implement quality management programs for Medicaid, aging, and disability agencies. In this blog, Dr. Bulot uses his firsthand experience to outline his top seven tips for developing an effective quality management program.
1. Create clearly defined, patient-centered goals.
In 2008, the Institute for Healthcare Improvement developed Triple Aim, which is a framework for improving health care systems by focusing on individuals to achieve that goal. Triple Aim was later adopted by the Centers for Medicare and Medicaid Services (CMS) to take a systems approach to improving health care across the U.S. The three components of the Triple Aim were:
- Improving patient care
- Improving population health
- Reducing costs
Triple Aim has been widely implemented across care settings, and it also applies to Long-Term Services and Supports (LTSS) programs because it prioritizes patient-centered care. Triple Aim also includes all the ancillary services a person might receive, including public health and social services.
Since it’s creation, Triple Aim transformed into Quadruple Aim, expanding to include a fourth component: the clinician experience, which is includes any individual providing services.
Creating an aim statement is the first step in focusing on the Triple and Quadruple Aim. An aim statement is defined as: A clear, explicit summary of what your team hopes to achieve over a specific amount of time, including the magnitude of change you will achieve.
An aim statement guides your work by establishing what success looks like. Research shows that teams who develop a good aim statement perform better.
2. Work with your team to establish agreed-upon objectives.
Once you’ve created an overarching AIM, you’ll want to establish your objectives. What is your quality management program about? As you develop those objectives, you’ll want to ensure they follow SMART criteria — that is, t Specific, Measurable, Attainable, Reasonable, and Time-bound. Stating a non-SMART objective such as “making life better” makes it difficult to determine if your program is succeeding, which in turn makes it difficult to communicate your success to your stakeholders.
3. Know what’s important to measure.
Knowing what information is important, what’s measurable, and what’s actionable is a critical component of developing goals and objectives. Common mistakes include unrealistic expectations about what can and cannot be achieved (large agencies are especially susceptible to this mistake).
It’s important to note that just because something can be measured does not necessarily mean you can improve it.
Work with your stakeholders to determine which measures matter most to your agency and the people you serve. Here are some good thought starters: Are these measures appropriate and important? Can they be collected in an affordable fashion? Are they easy to understand?
4. Choose the quality improvement model that’s right for your organization.
There are several quality framework models — including continuous quality improvement (CQI), total quality management (TQM), Six Sigma, Baldrige, and more. There is no single “right” model, but you should use some kind of framework to build structure in your system.
Anything is better than a passive/do-nothing model, which cycles between measure, report, and explain. This model, which follows the flow in the first graphic below, improvement initiatives only occur when some external entity (typically and funder or regulatory agency) forces a change.
Almost every model uses some components of the PDCA method — Plan, Do, Check, Act. The act of and striving to improve your programs begins with using your data and making changes to improve.
5. Be prepared for value-based purchasing.
For many agencies, this could be their first official quality program, because of the recent and ongoing shift toward value-based purchasing, which forces agencies to implement a quality management program. Value-based initiatives, along with the desire to provide better services, are causing providers to reassess their quality programs. Additionally, states, managed care organizations, insurers, and others are examining opportunities for value-based purchasing and alternative payment models. Medicare is running several pilots, and most Medicaid Managed Care contracts already have value-based purchasing and alternative payment model requirements.
6. Plan ahead to avoid common challenges and barriers.
Regardless of whether you’re a managed care provider, a payer, a care coordinator, or a provider, there are going to be challenges in implementing or improving your quality management program. You can mitigate program risks by focusing on the following:
- Getting executive buy-in
- Focusing on culture
- You can do this by ensuring your organization’s culture prioritizes quality, and outcomes, and data sharing.
- Continuously reviewing relevant data
- Using dashboards to promote data visibility and usability
- Revising your quality program as needed
- Ensuring you have adequate resources (in terms of both finances and personnel).
- Including all stakeholders early in the process
7. Don’t panic.
Health care providers are already used to the pressure to provide quality care. But quality programs are a relatively new area for human services professionals. Even though these processes are new, don’t panic when you start to look at your data and see new challenges and opportunities you weren’t aware of before. Much like driving a car, you rely on the gauges on your dashboard to let you know if you are going too fast, if there are problems, or if you are about ready to blow your engine. The same is true of program quality.
Your data is your dashboard — it tells you whether you are doing well, performing poorly, or if you should stay the course. An effective quality management program helps you use the data you already have to make program changes, redirect resources, and identify new opportunities for improvements to achieve the goals you identified.
A strong quality management program in any health care or social services program will ensure that you are providing or coordinating the best care possible for your clients or constituents. If you’re just getting started, or if you have a program in place that needs a refresh, review these seven tips to see what you might be missing. Start or restart your planning processes, review your data, make changes to improve performance, and repeat! Good luck!
Want to learn more? Watch Dr. Bulot’s recorded webinar on quality programs here: 7 Essentials of an Effective Quality Management Program