The Improvement Guide: A Practical Approach to Enhancing Organizational Performance

505.925. 7600 Fax 505.925-7601 www.envisionnm. org SBHC Quality Improvement at Envision New Mexico Envision New Mexico (ENM) is a pediatric quality improvement (QI) program that provides training, development and evaluation services to improve the quality of health services for children and youth throughout the state. As part of the Department of Pediatrics at UNM, ENM maintains an expert staff, utilizes up to date information technology, and draws upon the resources of the UNM Health Sciences Center to train and support SBHC providers in employing ‘best practices’ to ensure effective and efficient care health services. ENM is part of a larger movement of state‐based organizations working to improve the healthcare of children and families by teaching providers how to use quality improvement methods in their practices. Quality Improvement is defined here as a process to effect changes in provider practices that result in improvements in care. Research has dramatically improved SBHC providers’ understanding of how to improve health and decrease disease, and it is the job of quality improvement to translate this knowledge into practice. In other words, improving child health outcomes requires narrowing the gap between what providers know and what they do. Quality Improvement Methodology The QI process is based on established models for creating improvements in clinical practices and delivery systems developed by the Institute for Healthcare Improvement (IHI), the National Initiative for Children’s Healthcare Quality (NICHQ) and Dr. Scott Gee at Kaiser Permanente (Northern California). Conceptually, these developments are embodied in the Model for Improvement, a simple yet powerful tool for implementing improvement in health care quality. The “Plan‐ Do‐ Study‐ Act” (PDSA) process is an established tool that provides a structured process for providers and practices to plan, implement, and evaluate the impact of changes. The slogan for quality improvement is, simply, “all improvements involve changes but not all changes are improvements. ” ENM employs this model and method to teach providers in SBHCs to identify practice changes that will lead to improved patient care and help reduce health care costs. An essential element of QI is developing appropriate measures to determine progress towards improvement objectives and to test if the changes made represent the improvements desired. Four basic questions frame QI work: 1. What do we want to achieve? 2. What ideas can we develop to achieve our goal. 3. How will we know if the plan is working? 4. What modifications to the plan are needed? Specific measures of progress are identified and monitored. These measures allow each SBHC site to gauge its own progress towards objectives, allow ENM to assess the effectiveness of its QI on particular objectives, and contribute to an overall assessment of the impact of QI on the system of care. The specific initiatives, along with objectives and related measures, evolve to meet the needs of SBHC programs. Ongoing evaluation guides the course of QI and assesses the impact of quality improvement on the programs and providers involved. The measures employed are derived from ‘best practices’ literature. A common tool used by ENM staff is Motivational Interviewing (MI). MI is an evidence‐based set of skills for improving communication between providers and patients for the purpose of enhancing behavior change. Primary care and