Using State-Level Using State-Level Performance Data: Performance Data: an Update on the an Update on the National CIP National CIP Val Bradley and Sarah Taub Human Services Research Institute
Transcript
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Using State-Level Performance Data: an Update on the National
CIP Val Bradley and Sarah Taub Human Services Research
Institute
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How Did We Get Here? Initial concentration on rudiments of
custodial care Evolution of programmatic standards that reflected
growth in our understanding of peoples needs and our own expertise
Increased concern about the efficacy of our interventions Attention
to the outcomes of services and supports from the perspective of
the customer
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Signs of Change in Performance Management No longer just better
than the institution Rooted in outcomes Emphasis on enhancement
Changing role of the state Changes in experiences and expectations
of families and consumers Changes in accreditation approaches
Outcomes Expectations Inclusion
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More Signs of Change Movement away from prescriptive standards
Emphasis on CQI Collaborative development of standards Inclusion of
customer satisfaction Satisfaction CQI Consensus
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Changing Quality Landscape Exposure of fault-lines in the
system (e.g., HCFA and the press) Expansion of supports to
individuals on the waiting list Emergence of self-determination
Olmstead decision Struggles with MIS applications Direct support
staff shortages
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Emergence of Performance Indicators First appeared in
behavioral and acute care Provide some cues for managing these
complex systems Highlight impact of cost containment Illuminate
whats working Provide early warning signs
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Characteristics of Performance Indicators Reflect major
organizational or system goals. Address issues that can be
influenced by the organization or system Have face validity Point a
direction Reflect rates or major events Related to associated
standards
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Consumer Involvement in Assuring Quality Choice among
providers/ purchasing decisions Designing and refining QA
mechanisms Grievance/appeals process Consumer satisfaction surveys
Membership on policy-making board Consumer Reports
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Continuous Quality Improvement Leadership at the senior level
Engagement of multiple constituencies Development of benchmarks
Identification of change strategies Measurement of progress
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Project Beginnings NASDDDS and HSRI collaboration Launched in
1997 Seven field test states + steering committee ~60 candidate
performance indicators Development of data collection
instruments
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Current Participating States WA IN AZ UT NC IL IA OK VT WV KY
PA MA DE RI CT MT WY NE HI Orange County WA IN AZ UT NC IL IA OK VT
WV KY PA MA DE RI CT MT WY NE HI Orange County AL SD SC
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What will CIP accomplish? Nationally recognized set of
performance and outcome indicators for developmental disabilities
service systems Benchmarks of performance Trend data at the state
& national level Reliable data collection methods &
tools
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What are the Core Indicators? Consumer Outcomes: Satisfaction,
choice, employment Provider Agency/Workforce Stability: Staff
turnover System Performance Protection of Health and Safety
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Data Sources Consumer Survey Family Surveys Family Support
Survey (adult lives at home) Children/Family Survey (child lives at
home) Guardian/Family Survey (adult lives out-of-home) Provider
Survey DD System MIS (state-level)
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Selected Findings 1999 and 2000 Data
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Family Survey (2000)
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Family/Guardian Survey (2000)
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Children/Family Survey (2000) 84.7% of respondents choose the
agencies or providers that work with their family some or most of
the time 73.1% of families choose the support staff that work
directly with their family (some or most of the time) 87.3% of
respondents would like at least some control over the hiring and
management of their support workers, yet only 67.2% feel they have
some or more control over this hiring and management
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Community Inclusion
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Choice and Decision-Making
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Consumer employment data (1999) Where people work: Duplicated
counts Aggregate N = 3900 (11 states) 27.7% -- supported employment
21.7% -- group employment (enclave/crew) 40.4% -- facility-based
employment 36.8% -- non-vocational day supports
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Employment by state (1999)
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Health & Safety Outcomes Knowing how to file a grievance
Feeling safe in your neighborhood Having checkups with doctor and
dentist Being free from major/serious injuries Not taking
psychotropic medications if you dont need to Being safe from
crime
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Health Outcomes (2000)
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Consumer Outcomes (2000) Access 79% of respondents reported
that they almost always have a way to get where they want to go
Safety 94% of respondents report feeling safe in their
neighborhoods 96% report feeling safe at home
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Rate of direct support turnover Average length of time on the
job Vacancy rate Staff qualifications and competency considered but
postponed; considered a staff survey Staff Stability
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Staff Stability (1999) Day support providers report: Lower
turnover Current staff have been employed longer About half as many
vacant positions(both FT and PT) Both types of agencies report:
Staff who left within the last year were employed on average about
19 months Part-time position vacancies are much higher than full-
time position vacancies
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Staff Turnover (1999) Day Support Agencies 31.2% turnover
(n=294) Separated staff employed average of 19.4 months (n=242)
Current staff employed average of 40.3 months (n=290) Residential
Support Agencies 35.2% turnover (n=283) Separated staff employed
average of 19.5 months (n=259) Current staff employed average of
37.8 months (n=272)
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Staff Vacancies (1999) Day Support Agencies 5.9% of full-time
positions are vacant (n=222) 8.7% of part-time positions are vacant
(n=167) Residential Support Agencies 9.9% of full-time positions
are vacant (n=217) 18.9% of part-time positions are vacant
(n=199)
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Representation on Boards (1999) Across all providers reporting
(N = 302) 3.2% of board members are consumers 19.0% of board
members are family
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Board membership across states (1999) Consumer & Family
Representation on Boards
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For more information Visit HSRIs website:
www.hsri.org/cip/core.html
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What Do You Do With the Information? Include at your web site
Prepare annual reports Develop provider profiles Use with sister
agencies Use in allocation decisions Use to spot red flags
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Final Words Beware the Continuous Improvement of Things Not
Worth Improving W. Edward Deming