Module 7: Capacity for Improving Quality

Multi-stakeholder Community Inventory Modules

Community quality collaboratives are community-based organizations of multiple stakeholders, including health care providers, purchasers (employers, employer coalitions, Medicaid and others), health plans, and consumer advocacy organizations, that are working together to transform health care at the local level. The Agency for Healthcare Research and Quality offers these organizations many tools to assist in their efforts.

Your Goals in This Inquiry

  • Identify existing quality improvement (QI) initiatives, status, and results including hospital, physicians, specific conditions, and populations.
  • Identify individuals, resources, and expertise that can be used to build a strategy to provide quality improvement training and support to providers in your community.
  • Identify groups that are not being reached, likely smaller practices or those in remote areas.
  • Brainstorm with the individuals contacted about how a coordinated and aligned QI strategy could be developed, identify what their organization could contribute to such an effort, and explore their interest and willingness to support the Community Quality Collaborative.

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Information You May Want to Gather

  • Analysis of the quality of care and health status in your community.
  • Market analyses of your community's health care and provider systems to determine largest and most influential providers, purchasers, health plans, health care organizations, public health agencies, health-related foundations.
  • Web pages of each of the existing local organizations' activities related to quality improvement.
  • Details on specific initiatives that warrant further inquiry.
  • State level health statistics to identify areas that need improvement.
  • Information on activities by quality improvement organizations (QIOs) and national programs such as the Centers for Disease Control and Prevention (CDC), Improving Performance in Practice (IPIP), Practice-Based Research Networks (PBRNs).

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Key Individuals to Contact

  • Health care system quality leaders, clinicians, physician groups, hospitals, IPAs who have implemented quality improvement programs.
  • Major health plan quality officers.
  • Purchasers including public and private employers, business coalitions who have an interest in improving health care quality.
  • Consumer advocacy groups.
  • QIO leadership.
  • Individuals who have attended Institute for Healthcare Improvement (IHI) or other quality improvement educational training.

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Other Individuals to Consider Contacting

  • Public reporting organizations.
  • Academic institutions.
  • State medical associations.
  • Hospital associations.
  • Regional Health Information Organizations (RHIOs)/Health Information Exchanges.
  • State, county, or local public health agencies.
  • Government regulators responsible for health care and quality.
  • Suppliers of services and products that improve quality.
  • Foundations with a quality and/or health care focus.
  • Medical malpractice insurance companies.
  • Physician practice management organizations.
  • Other organizations or programs related to quality improvement in health care (e.g., Improving Performance in Practice (IPIP), Practice Based Research Networks (PBRNs), Institute for Healthcare Improvement (IHI)).

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Suggested Questions

Communitywide Efforts to Build a QI Strategy

  • Has there been a coordinated, aligned, communitywide effort or discussions to improve quality of care across health systems and sites of care?
  • What was its focus?
  • Has it been successful?
  • What would make it more successful?
  • Who have been the key players?
  • Is there one area of care, e.g., diabetes, inpatient cardiac care, that might provide an initial focus for a coordinated community quality improvement strategy?
  • If applicable, how would you ensure that rural areas and small physician practices are included in QI activities?
  • Are there geographic issues, such as distances, market service areas, local jurisdictions, or other boundaries, that may pose challenges to implementing QI support?
  • Are there demographic issues such as age, income, or education levels that need to be considered?
  • Do you see any individual stakeholder as dominant in this market, for example, purchasers, providers, or health plans? If so, how might that impede or support the Community Quality Collaborative's goals in building a QI strategy?

Stakeholder-Specific Efforts to Build a QI Strategy

  • What is your organization's approach to QI?
  • What have you and others in your stakeholder group done to coordinate and align QI initiatives?
  • What is the focus of your QI efforts and how was the focus determined?
  • What QI initiatives are currently underway?
  • Do you have quantifiable goals for your initiatives and if so, what are they?
  • What are your qualitative goals of your initiatives?
  • What have been the results of your initiatives?
  • What are your lessons learned?
  • What are your goals and plans for the future?
  • Who are the key individuals in your organization's QI initiatives and what are their roles?
  • Who in your organization should be involved in the Community Quality Collaborative?

Future Community Quality Collaborative Efforts to Build a QI Strategy

  • What could your organization contribute to the Community Quality Collaborative?
  • How do and your organization envision being involved in the goals of the Community Quality Collaborative?
  • What opportunities do you see for building communitywide strategy to improve quality, such as linking disparate efforts, creating synergies across efforts, etc.?
  • Who else in the community would you recommend we contact for this inventory?
  • How would you build a QI strategy if it were your job?

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Compiling Results

Tracking your activities and results of your inventory in a table similar to the one below will be useful for reporting activities to the Leadership Team.

Strategy for Improving Quality — Activities and Results
Interviewee NamePosition, OrganizationSummaryConclusions/Next Steps
    
    
    
    
    
    
After data have been gathered from all sources in the focus area, the Focus Area Team Leader and members may analyze the results by reviewing the goals identified at the beginning of this section and by identifying and summarizing the following aspects of the inventory findings with each other and with other Focus Area Team leaders.
Strategy for Improving Quality — Analysis
Gaps 
Overlaps 
Opportunities for Alignment 
Challenges 
Lessons Learned 
Resources 
Leaders 

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Consensus Score Card

You may wish to develop a score for your Community Quality Collaborative's stage of development in each focus area to facilitate comparison of its stage of development across focus areas. You may discover differences in scores of individual key stakeholders for the same question. Identifying the degree of consensus among stakeholders will be useful in clarifying differing perceptions and goals and areas where consensus building may be useful for more effective collaboration.

If a quantitative approach doesn't fit in your situation, you may wish to use a more qualitative approach such as identifying areas of strengths and weaknesses or specific challenges and solutions.

  • Ask each team member to answer the following questions on a scale of 1-10 with 1 being the least developed and 10 being the most developed.
  • Average the scores of the team members, for each question, to get an average score per question.
  • Discuss any major differences between team members' scores to gain an understanding of each other's perspectives and knowledge.
  • Total the scores for all the questions and divide by the number of questions to get the score for this focus area.
  • Compare your Community Quality Collaborative's strength in this focus area to its strength in other focus areas in the overall Community Inventory Consensus Score Card when compiling and analyzing overall results from the tool.
Strategy for Improving Quality Consensus Score CardSCORE
(1-10)
1. Our community has resources that could be tapped to build a strategy to improve quality in our marketplace. 
2. There have been community wide initiatives to build a strategy to improve quality in our community. 
3. These collaboratives have been successful. 
4. Health care leaders in this community support collaboration to build a strategy to improve quality. 
5. The Community Quality Collaborative includes the right stakeholders to build a strategy to improve quality. 
6. The Community Quality Collaborative includes the right individuals to build a strategy for improving quality. 
7. The individuals at the table are willing and able to advocate on behalf of the Community Quality Collaborative QI goals in their respective organizations. 
8. Members of the Community Quality Collaborative share a common vision of how to build a strategy to improve quality. 
9. Individuals are willing to share relevant knowledge about QI openly. 
10. The organizations involved are willing to contribute expertise and capabilities regarding QI for the benefit of the community. 
11. The organizations are willing to provide resources, in-kind, financial or other, to build a strategy to improve quality. 
12. There are sufficient resources for this Community Quality Collaborative to be successful in its QI activities. 
13. The participants will devote adequate time and resources to the Community Quality Collaborative's QI goals. 
Total Score 

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Current as of March 2009
Internet Citation: Module 7: Capacity for Improving Quality: Multi-stakeholder Community Inventory Modules. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/cimodules/cimodules7.html