Presentation to 12 th Annual Patients’ Rights
Advocacy Training Conference
Sacramento October 8, 2004
Doug Mudgett, RN, AMHS
State Department of Mental Health, County Operations

• A little bit about myself and my background
• Why I am here today, my DMH “QI” role
• Why I believe in Quality Improvement
• Keeping the focus of everything we do as a “system” on the people receiving services, on the quality and relevance of what we provide, and on the belief in Recovery
• De-mystifying Quality Improvement, give you an overview, and sparking an interest in you

1.
Why are we all here today?
2.
What is QI?
3.
Past, present, future of QI in counties?
4.
What is your role in this?

• Why are you here today? What do you want to get out of this discussion?
• What do you know about Quality Improvement
(QI)?
• Have you participated, or been asked to participate, in your county?
• What does “Quality” mean to you?

A systematic, deliberate, and continuous process and effort to improve the services we provide to individuals.

• Systematic
The process is based on an organized and structured “problem-solving” approach
• Deliberate
In order for QI to be successful, there must be belief in it, effort must be given to promoting its sustainability, and it must permeate and connect everything the organization does
• Continuous
It is virtually a neverending process…basic mantra: “no matter how good we think we are doing, there is always room for improvement

• Origins in 1950’s, ’60’s, and ’70’s
• The “Gurus”: Deming, Juran, and Crosby
• Deming considered “godfather” of Total Quality
Management”, or TQM, which reshaped and transformed Japanese manufacturing industry
• Largely a statistical process control approach at decreasing “variance” in product quality
• Delighting and satisfying customer expectations
• Continuous Quality Improvement, an offshoot of
TQM, evolved significantly during the late 1980’s and early 1990’s and was applied to health care

• Originally a Quality Assurance activity
“Monitoring adherence to standards”
• QI vs. QA
What is the difference between QI and
QA, and what are their complementary and distinct roles?
• Take-home Point
QI and QA are not the same.

• Quality Improvement goes way beyond Quality
Assurance. Perhaps the defining difference lies in the fact that in addition to focusing on processes, correcting problems, analyzing data, and making decisions based on information, QI adds the focus on “Improvement”, distinct going beyond standards, and attitude-belief-passion in betterment is central.
• This has been a significant paradigm shift for health care in general, and County mental health services in particular.

• Customer/Consumer Focus
The unifying driving element
• Process Oriented
Belief that most quality issues and problems are the result of processes, not people.
• Data Driven
Uses data as an indispensable tool for guiding, evaluating, and validating “success”.
• All Levels of Organization
All levels must be encouraged and supported to participate.

Plan-Do-Check-Act or “Deming Wheel”
Focus on Consumer
Outcomes/Benefit
Within a Recovery
Model or Vision
Plan Do
Act
PDCA
Check

• The most immediate current drivers for Quality
Improvement in counties come from the Managed
Care Contract (MHP Contract) with the State
DMH, California Code of Regulations Title 9 requirements, and language in WIC regarding quality management programs, and the role of
External Quality Review (EQR) including
Performance Improvement Project (PIP) evaluation.
• DMH MediCal Oversight (“Compliance”) continues its evaluation responsibility based on
“QA”.

DMH &
CMS
EQRO
Board of Supes
MH Boards
& Commissions
•DMH Medi-
Cal Oversight
•DMH Medi-
Cal Policy
•DMH County
Operations
•CIMH-Contract
•CMS Medicaid
Waiver , and
CFR 438
• “APS”
External
Quality
Review
Organization
•Required by
New Medicaid
Regs resulting
From “BBA 97”
Vested interest
In “Value”, i.e. Quality of services to County’s residents for the County
Dollars spent
Oversight and
Guidance of
MH system
Quality with emphasis of
Consumer &
Family
Member
Involvement

Quality Improvement
Regulations
Fed-State
MHP
Contract
Industry
Movement
Consumer
Voice
Professional
Ethics

• Becoming familiar with QI
• Gauging your county’s interest in asking for your involvement
• Contributing a valuable specialized perspective
• Realizing the importance of, and advocating for fidelity to, keeping the focus on the consumer and their outcomes in a
Recovery framework.

Phase 1
“Acquiring”
Phase 2
“Implementing”
Phase 3
“Integrating”
Knowledge &
Skills
Acquisition
Involvement &
Practice
Reconciling
“Theory”
With
“Reality”

Consumers
Director
Consumers’
Benefit
QI Coordinator
IT / IS
“Data”
Providers
ADVOCATES