Section I.
Quality Improvement
Chapter 1
Promoting Independence in the Community:
Introduction to Quality Improvement Strategies
Ronald W. Manderscheid, Ph.D.
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
The President’s New Freedom Commission on Mental Health (2003) has defined
independence and full community participation as essential goals of mental health
care. Achievement of these goals will require broad-based
transformation of mental health care systems in the United States. This transformation
will be effected through quality improvement strategies, as identified by the
Institute of Medicine (IOM) (2001) in its report, Crossing the Quality Chasm:
A New Health System for the 21st Century. A primary characteristic of these
transformed systems will be consumer and family
directed care.
Quality improvement strategies are positive, planned interventions designed
to modify the process of health care delivery and its outcomes. IOM (2001)
has identified four strategies that are essential for successful transformation:
implementation of evidence-based practices; better initial and continuing
training of health care providers; reform of financing mechanisms; and adoption
of improved information technology and performance measures.
In the past, quality improvement was thought to depend on the imposition of
negative sanctions by external agents. In contrast, modern quality improvement
strategies rely on direct benchmarking by health care providers themselves,
with extensive input from primary consumers and family members through surveys
and report cards. This change, effected in a period of fewer than 10 years,
is nothing short of revolutionary.
New developments continue to emerge in each of these areas. The IOM is currently
conducting a new study titled Adaptation of Crossing the Quality Chasm Framework
to Mental and Addictive Disorders. This study will provide a blueprint
for action in transforming behavioral health care in the United States. The
anticipated release date for the report from this study is fall 2005.
The Center for Mental Health Services (CMHS) continues to implement an Action
Plan to facilitate broad-based transformation of mental health care systems.
Daniels and Adams (2003) have shown how the transformational goals of the President’s
New Freedom Commission on Mental Health (2003) map directly to the IOM goals
and strategies. CMHS has major transformational initiatives under way around
each of the IOM strategies. The mental health consumer movement continues to
evolve apace. Currently, recovery and consumer control have emerged as major
themes and focuses for effort in the movement.
Finally, successful adoption of information technology itself is viewed as
a primary vehicle for effecting transformation. The effects can be seen at
the clinical, organizational, and institutional levels. CMHS is currently working
with the Software and Technology Vendors Association to develop and implement
a strategic plan for application of information technology in behavioral health
care.
Succeeding chapters provide additional detail around each of these developments.
References
Daniels, A. S., & Adams, N. (2003). From policy
to service: A quality vision for behavioral health. Pittsburgh, PA: American College of Mental Health Administration.
Institute of Medicine. (2001). Crossing the quality chasm:
A new health system for the 21st century. Washington, DC: National Academy Press.
President’s New Freedom Commission on Mental Health. (2003). Achieving
the promise: Transforming mental health care in America. Rockville, MD: U.S.
Department of Health and Human Services.
|
