Continuous Quality Improvement
and
CCISC
Philosophy, Process and Technique
Of
Systems Change
Presented by:
Kenneth Minkoff, MD
and
Christie A. Cline, M.D., M.B.A., P.C.
With Acknowledgement to:
Lesa Yawn, PhD, JD
Info@ZiaLogic.org
www.ZiaLogic.org
ZiaLogic©2004
Terminology





CQI = Continuous Quality
Improvement
TQM = Total Quality Management
QA = Quality Assurance
PDCA = Plan, Do, Check, Act
CCISC = Comprehensive,
Continuous, Integrated Systems of
Care
CQI/TQM Philosophy



The customers and their needs shape
our organization and its work, not
vice versa.
Quality products and services result
from quality systems, processes and
methods.
Quality is all-consuming focus of the
organization.
CQI/TQM Philosophy



An organization achieves quality by
mastering the methodology of
improvement.
An organization pursuing quality
directs and focuses its energies.
There is a new paradigm of
leadership that requires managers to
reformulate what it means to lead.
CQI/TQM
as a
Systems Process
Ten Principles
For Leaders to Follow
Principle 1

Define Quality vs “I know it when
I see it”
• Each quality outcome should have a
specific definition
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 2

Customer Orientation vs Internal
Focus
• Each quality indicator is determined by
its relationship to improving outcomes
for the consumer.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 3

Work Process Focus vs End
Product Focus
• Each quality outcome is designed to be
measured according to the extent to
which work processes result in ongoing
improvement over time.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 4

Us Partnerships vs We and They
• Each quality outcome can be achieved
only through collaboration.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 5

Proactive vs Reactive
• Each quality outcome is achieved
through planned and deliberate
intervention over time, as opposed to
end product corrective action.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 6

100% Quality Attitude vs That’s
good enough
• Each quality outcome is attained by an
approach that works to achieve the best
result for each consumer every time.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 7

Management by Facts vs
Management by Intuition
• Each quality outcome is attained
through successive evaluation of data
and adjustment accordingly.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 8

Engagement and Empowerment
vs “Just follow the plan, man”
• Each quality outcome is implemented by
collective engagement in designing
successful processes. Leadership
always strives to achieve proper balance
between control and empowerment.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 9

Quality belongs to everyone vs
“We have a quality department”
• Each quality outcome is implemented
through the interactive participation of
all components of the system.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
Principle 10

Continuous means continuous vs
“we measure when its over”
• Each quality outcome is implemented
through the iterative processes of PDCA.
Quality outcomes are targets, always
advancing as the system learns and
improves.
• Working example: WELCOMING
• Working example: IDENTIFICATION OF
THE POPULATION
CQI as Compared to QA



CQI is a central tenet of
management rather than a
peripheral activity.
CQI focuses on continuously
improving rather than on reaching a
plateau of quality.
CQI is a motivating force for
improvement rather than a
policeman of errors and faults.
CQI as Compared to QA


CQI focuses on the system meeting
the needs of the consumer rather
than individual performance as a
foundation.
CQI cuts across organizational
territories and departmental
boundaries.
Technique of CQI
for
CCISC Implementation
FOCUS
Find a process that needs improvement
 Organize a team knowledgeable about

the process
Clarify the knowledge about the process
 Understand the causes of variations in

the process

Select the improvement
PLAN
DO
ACT
CHECK
PDCA

Plan
• Study a process
• Collect and evaluate data
• Develop an ACTION PLAN

Do
• Try out the plan

Check
• Evaluate the test run

Act
• Adjust the plan and go back up to the top and
try again
CCISC ACTION PLAN





Strategic, Dynamic and Interactive
System, Program, Clinical Practice,
Clinician Development Interlinked
Measurable Milestones
Realistic Timeframes
Real People Accountable for Taking
Real Action
CCISC
12 Step Implementation Program





A framework for CCISC implementation using CQI
at the highest level of systems organization
Supported by the use of an organized toolkit that
includes the CO-FIT 100™, COMPASS™, and
CODECAT™
Incorporates system, program, clinical practice,
and clinician development aspects
Identifies and prioritizes quality indicators at each
level of the system and organizes multiple CQI
processes to achieve them
Requires an organized leadership team to
oversee the process defined by the CCISC
Charter for the system
CCISC 12 Step Implementation Program
1.
2.
3.
4.
5.
6.
Organize leadership team with consumer/family
input
Develop consensus charter and CQI plan (COFIT 100™)
Design project and create incentives with
existing funding
Strategic prioritization for continuity using 4quadrants
Define dual diagnosis capability as a program
goal (COMPASS™) and implement over time
using a CQI Action Plan
Develop initial steps toward “system”
interaction through inter-program coordination
CCISC 12 Step Implementation Program
(Continued)
7.
8.
9.
10.
11.
12.
Develop and disseminate initial practice
guidelines
Select practice priorities for CQI implementation
(e.g., welcoming, access, and data collection)
Define clinicians’ initial scopes of practice
Identify a process to evaluate and improve
clinician competencies over time (CODECAT™)
Develop training plan and train-the-trainer
cadre
Plan to fill gaps in the comprehensive
continuum