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Factor Seven: Quality and Accountability

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“Quality is the result of a carefully constructed cultural environment. It has to be the fabricof the organization, not part of the fabric.”  Phil Crosby

 

Customer service is the foundation of any successful business.  The adage “the customer is always right” embodies a model that values feedback and uses it to improve services and products, so that customers will return.  Imagine applying this simple idea to programs that support individuals with behavioral health needs, addiction, intellectual or developmental disabilities and older adults.  In other words, what if the needs and outcomes for the person became the yardstick by which organizational effectiveness was measured?  What would happen if the person decided whether or not their needs and outcomes were met?  Person-centered organizations strive to measure what matters to people and how well the expected outcomes of the person are met in the most cost-efficient manner.  Thus, the organization is able to connect its efforts and processes with meaningful results and make decisions designed to continually improve the delivery of services and supports that facilitate outcomes.  In other words, the customer decides whether or not their expectations have been met, not the organization.

The following represent the essential “ingredients” of an effective, accountable quality management system:

  • Evaluation is designed to assess the impact of services and supports on the full range of outcomes desired by the person.  This integration looks at the whole person and their life, not a broadly defined goal such as “lives independently” or “medication compliance”.
  • Both qualitative and quantitative measures are used to assess services and supports for the individual and as aggregated data.  These include outcome measures, complaints, incidents and satisfaction data or “report cards”.
  • Individuals, their families and other stakeholders routinely evaluate the organization’s effectiveness in meeting its mission, vision and values. 
  • Results of evaluations are used, in partnership with individuals, families and stakeholders, to identify and implement changes in the organization’s policy and practice.
  • The organization is accountable for matters of abuse, neglect and exploitation and has processes in place to ensure appropriate attention is paid to these matters.
  • The public is informed through reports that clearly present information collected about aggregate outcomes, strategies to improve efficiencies, assurances for continuing improvement of service quality and the manner in which budget allocation decisions are made.
  • The lens of transparency is applied to all aspects of the organization’s activities.  While aggregate information about outcomes and accomplishments is shared freely, individual confidentiality is always maintained and respected.

“Quality is not an act, it is a habit.”   Aristotle

Resources:

American Society for Quality. ASQ is a global community of experts and leading authority on quality in all fields, organizations, and industries. http://asq.org/index.aspx

The CQL Resource Library has a variety of materials about quality

http://c-q-l.org/resources/category.aspx?cat=27&id=86&sec=

Evidence-Based Practices Implementation. This site was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) by the NASMHPD Research Institute, Inc. (NRI) Center for Mental Health Quality and Accountability  http://ebp.networkofcare.org/

LeadingAge. Quality First is the way in which LeadingAge and its members accept responsibility for assuring that the people they serve receive quality care and services. Quality First makes providers directly accountable for excellence.  http://www.leadingage.org/SubSection.aspx?id=1792

Quality Mall. A place where you can find lots of free information about person-centered supports for people with intellectual and developmental disabilities. http://www.qualitymall.org/main/

World Health Organization. This module is part of the WHO Mental Health Policy and Service guidance package, which provides practical information to assist countries to improve the mental health of their populations. www.who.int/mental_health/resources/en/Quality.pdf

Substance Abuse and Mental Health Services Administration: www.samhsa.gov/dataOutcomes/

Administration on Developmental Disabilities:  http://www.acf.hhs.gov/programs/add/

American Association of Intellectual and Developmental Disabilities:  http://www.aamr.org


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