EVALUATION      Conclusions/Recommendations      

Previous Use of Evaluation
2) The Local Business Plan is consistent with State Plan requirements for managing a continuous quality improvement process
   b) A description of how the LMEs earlier configuration of counties/area program participated in evaluation processes for the last two years and actions taken as a result of the evaluations

Most programs cited a previous accreditation process (one program reported how much the documentation had weighed), Division review, or current CQI process and client rights committee activity. In ten of the plans, however, it was not clear what improvements or actions were taken as a result of these evaluations. Some plans restated various outcome measures from previous sections or restated information from the Quality Management section. For the most part, those who reported specific actions as a result of previous evaluations made improvements in organizational processes around quality management and systems operation issues. Pathways was notable in that one of its actions resulted in the identification of actions to reduce suicide risk.

Plan for Quality Improvement Process
   c) A plan for the development of quality improvement process is provided

Most plans provided a broad overview of quality improvement effort, committees involved, and broad functions that the process would focus on. Some plans went beyond and specifically identified how their current plan would be changed and improved. Mecklenburg, for example, had a very detailed 12-month QIP workplan and noted specifically that it would increase population-based quality improvement projects as well as focus on continuity of care issue.

Nearly all plans recognized the need for consumer/family involvement in this process. Plans most often cited various committees or the CFAC as entities that would receive information, but it was not always clear what they would do with the information or how their input would be incorporated to improvement efforts.

Use of Performance Indicators in Evaluation Reports
3) The local business plan meets State Plan requirements for evaluation system performance
a) The plan for develop of the quality improvement process adopts system performance indicators in internal evaluation reports that include:

The Division has done a good job in identifying four system indicators. How the plans decided to assess these indicators and what data they chose to gather varied dramatically. This is not necessarily negative, depending on what the purpose is. If the intent is that this be strictly an internal LME process then this variability can be tolerated. If, however, the Division intends to compare these system performance indicators across programs the variability will make comparison impossible.

Evaluation Conclusions/Recommendations: In general, there seemed to be a strong commitment on the part of the LME’s to quality improvement processes. But many plans made rather broad statements and the degree to which programs have the specific plans and expertise to implement these processes remains to be seen. A successful Quality Improvement Program will require more than multiple committees meeting and reviewing data. How these committees use the data, interact with each other, and more importantly, create a system that can actually change and improve how things are done will be a tremendous challenge. Most programs have not engaged in Quality Improvement Programs to the extent required for successful reform. The Division also has not had this experience. It will be very important for the Division, LMEs, and CFACs to work with external consultants to jointly develop best practice quality improvement models and to provide a mechanism for technical assistance to programs as they develop such processes. Significant portions of this section seemed to be redundant with the Quality Management section. The Division may want to consider combining the Quality Management and Quality Improvement sections of the LBP into an overarching Quality Section.