Contemporary Quality Management in Mental Health

Abstract

Contemporary approaches to quality management in mental health utilize methods derived from traditional quality assurance and industrial quality improvement. Quality assurance involves the use of measurable indi cators to monitor and evaluate care. Sentinel event indi cators refer to high risk events that require review each time they occur. Rate indicators refer to events that are reviewed in the context of trends and patterns. The process of choosing and developing indicators should involve identification of the indicator topic, the moni toring objectives, data collection mechanisms, and re sponsible staff. As well, indicator data must be evalu ated, actions taken, and communication of results must occur. Positive results, like positive diagnostic findings, point to a probability of the presence of a quality related issue. Quality improvement methods have led to a fur ther evolution of efforts to promote quality care. A ma jor goal of quality management is to utilize data to im prove clinical decisions. Reaching this important goal is difficult in mental health due to the uncertain rela tionship between interventions and outcomes of care. In the effort described, interventions were initiated to improve decisions relating to clinical risk management and resource utilization. Administrative restructuring enabled real-time review procedures and retrospective data analysis focused on decisions related to clinical instability and on permissive and restrictive clinical de cisions. Permissive decisions were defined as decisions to allow off-ward privileges for patients whose level of functioning scores suggested the need for greater re striction. Restrictive decisions involved extending hos pitalization of low risk patients. Inappropriate permis sive or restrictive decisions are undesirable from both risk management and quality-of-care perspectives. Re gression analysis suggested a steady downward trend of inappropriate off-ward privileges and low-risk hospi talizations during the 5-month period following the ini tiation of evaluation of such decisions. Thus practical and measurable improvements were achieved by utiliza tion of quality management principles to improve men tal health care.