Presentation Objectives and 
       Content
       Learning Objectives
       Upon completion of this event, participants should be able to:
       •   Distinguish Performance/Quality Improvement as a Separate Function 
           from Compliance.
       •   Develop and Implement a Performance Improvement Plan.
       Learning Content
       •   Defining Performance Improvement/Quality Improvement
       •   Performance Improvement/Quality Improvement models and tools (e.g., 
           PDSA Cycles, Scorecards, etc.)
       •   The Importance of Stakeholder (i.e., consumers, staff, community 
           stakeholders) Involvement in Creating “Culture of Quality”
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      What is Quality Improvement
      •  According to the U.S. Department of Health and Human Services (DHHS), Health 
         Resources and Services Administration (HRSA; 2011a) quality improvement “consists of 
         systematic and continuous actions that lead to measurable improvement in health care 
         services and the health status of targeted patient [or consumer] groups” (p. 1).
      •  This definition is clearly inclusive of mental health and IDD services.
      •  The Institute for Healthcare Improvement (IHI; 2016) defines the science of 
         improvement as “an applied science that emphasizes innovation, rapid-cycle testing in 
         the field, and spread in order to generate learning about what changes, in which 
         contexts, produce improvements.  It is characterized by the combination of expert 
         subject knowledge with improvement methods and tools.  It is multidisciplinary – 
         drawing on clinical science, systems theory, psychology, statistics, and other fields” 
         (para. 2).
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        What is Performance 
        Improvement
       As taken directly from the Health Resources and Services Administration (HRSA; 2011b):
       •   Performance measures are designed to measure systems of care and are derived from 
           clinical or practice guidelines.  Data that is defined into specific measurable elements 
           provides an organization with a meter to measure the quality of its care.
                         Performance Improvement is the act of improving an
               organization’s performance on various performance measures (Carr, 2019).
       •   Performance measurement is a process by which an organization monitors important 
           aspects of its programs, systems, and processes.  In this context, performance 
           measurement includes the operational processes used to collect data necessary for the 
           performance measures.
       •   Performance management is a forward-looking process used to set goals and regularly 
           check progress toward achieving those goals. In practice, an organization sets goals, 
           looks at the actual data for its performance measures, and acts on results to improve 
           the performance toward its goals.
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     Quality and Performance 
     Improvement
       •  Often the terms “Quality Improvement” (QI) and “Performance 
          Improvement” (PI) are use interchangeably.  We will use QI and PI 
          interchangeability as well.
       •  PI is:
           • Evaluation Focused
           • Client, Staff, and Community (i.e., stakeholder) Oriented
           • Organizationally Diagnostic
           • Focuses on Process and Outcome Improvement
           • Systemic in Nature
           • Data Driven/Utilizes Measurement
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      Quality and Performance 
      Improvement
       •  PI is NOT:
           • Compliance - the ongoing process of meeting or exceeding the legal, ethical, and 
             professional standards and regulations applicable to a particular healthcare organization 
             or provider (U.S. Dept. of Health and Human Services, OIG, 2018).
           • Utilization Review - a critical evaluation of health-care services provided to patients that 
             is made especially for the purpose of controlling costs and monitoring quality of care 
             (Merriam-Webster, 2019).
           • Utilization Management - The planning, organizing, directing, and controlling of the 
             healthcare product/service that balances cost-effectiveness, efficiency, and quality to 
             meet the overall goals of the LMHA. Use of systematic data-driven processes to influence 
             individual care and decision making to ensure an optimal level of service is provided 
             consistent with individual diagnosis and level of functioning within the financial 
             constraints of funding. Includes but is not limited to service authorization, prospective, 
             concurrent and retrospective reviews, discharge planning, and Utilization Care 
             Management (HHSC, 2014).
           • Quality Management – This term is frequently used in Texas Behavioral Health Centers 
             and often refers to a compliance department or program compliance.
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