Quality Improvement – Illinois needs a Quality Management System

Dec 8, 2012 by

Continuous Quality Improvement

Illinois needs a Quality Management System with a focus on Quality Enhancement that addresses outcomes important in the lives of individuals with intellectual and developmental disabilities (IDD).


Shift from a Bureau of Quality Management to a Bureau of Continuous Quality Improvement (BCQI).

The shift is not solely one of verbiage, but with the intent to empower the staff in the Bureau to work with new and existing providers by providing leadership, and technical assistance that promotes best practices for individuals with IDD.


The BCQI should set quality standards, as a coach and let BALC look at paperwork.


The Components of the new Quality Enhancement System with the Department of Human Services (DHS) Bureau of Quality Improvement (BCQI) would include:


  1.            I.    A Technical Assistance Component: The Bureau will have competent staff that are able to provide technical assistance to providers when they are on- site for a review or upon request from a provider. This technical assistance should be available in the areas of:
  • Rights Protection and Promotion
  • Natural Supports and Community Participation
  • Privacy and Confidentiality
  • Outcome Reviews
  • Policies and Procedures
  • Health Care and Self- Administration of Medication
  • Person Centered Supports


  1.         II.    Training Component: The Bureau will have staff with expertise or utilize outside consultants to provide information on a number of topics.  Each year the Bureau will focus on three main areas and provide information to people with disabilities, families, providers, and other DHS staff.

The focus of the targeted training will come from trend analysis data including but not limited to:

ü Critical and incident tracking date,

ü OIG data,

ü BALC survey data, and

ü Illinois Core Indicators data.

As an example, the first year of training could focus on:

  • Decreasing the use of physical and chemical restraints;
  • Choking, swallowing, and special diets;
  • Best practices in critical incident data collection


  1.       III.    Trend Analysis Component: Government collects substantial amounts of data.  That data should be used to improve quality.

The state should have a system of trend analysis in the review of:

  • Incident Reports
  • OIG Findings
  • BALC Data
  • Illinois Core Indicators Data

This data can be utilized to create system’s change at the local and state level. The Bureau could use the skills their staff acquired from the Council funded CQL training to move forward with a metric focus on outcomes and quality improvement.


  1.        IV.    Regulatory Reform: Shift the focus of regulations and compliance to BALC.  Take all of the state regulations related to health and safety from the BALC regulations, BQM regulations, the Medicaid waiver, and the provider contract, locate them in one document and allow BALC to do regulatory compliance.
  • Conduct cross walks of BALC and BQM regulations.
  • Eliminate duplication.
  • Shift the responsibility for health and safety to BALC.
  • Shift the focus of BQM to outcome measures that improve lives.
  • Define the matrix for BQM in outcome language.


  1.          V.    Build on Outcomes:  Currently within the BQM regulations there are about 6-8 outcome measures.  The new Quality Committee of DHS.DD should craft a document for Direction Casey’s review defining 6- 10 key outcomes that will drive a statewide quality management system.


Design a statewide system of recognition that rewards provider excellence with a certificate of excellence from the DHS Secretary and recognition on the DHS website.


The Bureau should also help providers to set up quality enhancements systems with their organizations by modeling best practice in the Bureau’s reviews.


  1.        VI.    Other Systems: The state of Massachusetts designed a quality assurance system in 2002.  The state of Massachusetts used the following indications of service quality and system performance:
  2. People are supported to have the best possible health.
  3. People are protected from harm.
  4. People live and work in safe environments.
  5. People understand and practice their human and civil rights.
  6. People’s rights are protected.
  7. People are supported to make their own decisions.
  8. People use integrated community resources and participate in everyday community activities.
  9. People are connected to and valued members of their community.
  10. People gain/maintain friendships and relationships.

10. People are supported to develop and achieve goals.

11. Individuals are supported to obtain work.

12. People receive services from qualified providers.


Illinois. In 2010 in Illinois, a subcommittee of the DHS/DD Quality Committee drafted quality indications to be the measurement of quality in Illinois.  Nothing was ever done with the work of the subcommittee. These quality indicators included:

  • The agency supports people to exercise their rights.
  • The agency implements person centered planning.
  • Individuals control decision making.
  • People are supported to make and sustain meaningful relationships with others.
  • People are safe from harm.
  • Providers have a system to review and analyze trend data.
  • The organization’s mission, values, and operations promote personal outcomes.
  • Home environments are comfortable and enjoyable.
  • The organization has a system for continuous quality enhancement.
  • The organization promotes self advocacy.


CMS. The CMS Quality Framework requires:

  • Design
  • Discovery
  • Remediation
  • Quality Improvement


Tennessee. The state of Tennessee has adopted ten principles for their Quality Management System.  Illinois should consider adopting these principles for the Bureau of Quality Improvement.   These principles include:

  1. Support person centered practices.
  2. Produce improvement in services.
  3. Be implemented consistently statewide.
  4. Include the least possible amount of duplication processes.
  5. Include an information system capable of collecting and performing reliable information – effective data collection system.
  6. Make user- friendly reports available.
  7. Highlight positive practices.
  8. Include a mechanism for remediation problems and do so quickly.
  9. Include effective sanctioning and recoupment options; where these are necessary.

10. Be supported or at least accepted by stakeholders.


Tennessee’s Steps to a Solution:

  1. Foundation: 10 domain areas with outcomes and indications to measure provider performance. These became the basic survey tools.
  2. Decide about data services to review:
  • Qualitative surveys
  • ISP monitoring
  • Incident and investigation reporting
  • BALC data
  • Lone Indications
  • OIG Data



  1. Create a mechanism for analyzing data related to provider performance.


Regional- State Quality Management Committee, state staff responsible for supporting providers in reviewing data and moving forward quality enhancement.


New York. The state department has decided in New York that they need:

  • Integrated QA information systems to pinpoint systemic areas that need to be addressed.
  • Quality and competencies of state employee workforce.
  • Changing mindset, moving from a place based to a service based system.
  • They have an unsustainable fiscal platform, an aging infrastructure, an antiquated rate methodology; and 90% of their funding is tied to facility based services.
  • Established a centralized incident management unit to follow up on incidents of abuse and neglect and conduct analysis of the data.
  • Restructure agency operations to be more focused on service delivery, whole being more responsive to people with disabilities and families.
  • Continuous quality improvement system- Quality outcome measures at an individuals, providers, and systems level.

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