This year's winner of the NQC's Award for Leadership in Quality, Shaundelyn DeGraffenreidt, has been responsible for carrying out a wide range of quality-related activities and has helped transform the Fort Lauderdale/Broward County, Florida EMA's Clinical Quality Management Program into a nationally recognized model of excellence. Broward was the winner of NQC's 2012 Quality of Care Award for Performance Measurement. Shaundelyn has served as the EMA's Quality Assurance Coordinator for the last three years where she directs quality activities across a network of thirteen (13) funded providers who serve an estimated 7,100 Part A consumers annually. Her commitment to improving health outcomes in disenfranchised communities is rooted in her first position as an organizational effectiveness analyst for a large hospital system where she developed a deep understanding of the impact the quality improvement activities can have in clinical settings.
 

One of the major initiatives that Shaundelyn has led is the restructuring of the EMA's Quality Improvement (QI) Networks. The Networks are made up of funded Part A subgrantees representing all locally funded Part A service categories. There are five Networks:

• Outpatient/ambulatory medical care,
• Medical case management,
• Mental health/substance abuse,
• Oral health care, and
• A combined network covering centralized intake and eligibility determination, food bank, pharmacy, and legal services, housing (e.g., HOPWA), and Part B-funded transportation services.

Participants are mostly direct service providers (e.g., physicians, case managers) and their managers. This ensures that the work is very hands on and reflects the reality in the field. The Networks work together if they are addressing similar issues. Holding joint meetings allows participants to learn from each other and breaks down the boundaries between service categories. 
 

Before the restructuring, the Networks were run on a very formal basis. Each Network meeting tended to focus on a specific topic-there was no coherence from meeting to meeting and the Networks did not engage in long-term projects. Now, the Networks are more action oriented. Each network has an annual work plan that reflects the goals of the EMA's Comprehensive Plan, which is developed by the Planning Council, and the 3-year Quality Management Plan.
 

The restructuring of the Networks coincided with the launch of the in+care Campaign. To align their work with the Campaign, each of the Networks focused on retention and the Campaign's performance measures.Each month Networks analyze the Campaign measures through the use of client-level and service category specific reports.  These reports were used to identify barriers and challenges to retention in care.  
 

"Participating in the Campaign helped drive the process," says Shaundelyn. "It gave us something concrete to work toward. By focusing on retention for the length of the Campaign we were really able to go back and see if there had been improvement in this area."  For example, the EMA has improved the number of patients with a kept OAMC visit in the last 180 days from 70% in FY2011 to 80% in FY2012 and 82% in FY2013.
 

One of the major functions of the Networks is helping to address systems issues. They have played an important role in identifying the data necessary to measure performance, especially at the client level, and provided suggestions on how to streamline data collection and reporting processes. Since the Networks bring together providers from across the EMA they have also been valuable in identifying training needs. For example, the EMA conducted trainings on depression for clinicians and case managers when data indicated that a significant number of consumers suffer from depression and these consumers are more likely to drop out of care.