> NQC Update | DC EMA Collaborative Update  

"The DC Collaborative has been such a great experience," says Justin Britanik, quality management specialist for the HIV/AIDS Administration at the District of Columbia's Department of Health. "Those of us involved have learned so much through this journey."

The DC EMA Collaborative is still going strong, even though the NQC's role as facilitator ended in May 2012. The goal of the Collaborative was to foster cross-Part alignment, partnership, and collaboration among regional grantees and stakeholders serving the DC metropolitan area while advancing the quality improvement (QI) infrastructure across the entire EMA. Additionally, the DC Collaborative was designed to help create a common QI vision in the EMA, build the capacity of providers to carry out QI activities, support joint QI projects, reduce the data collection burden, and increase the involvement of consumers in these activities.

A major focus of the DC Collaborative was on capacity building. These efforts were guided by the Response Team, which was, and still is, made up of volunteers from health departments, subgrantees, and consumers across the EMA. Quarterly QI trainings were provided for frontline staff and consumers that included Quality 101, performance data collection and use, and the HRSA/HAB performance measures.

"We helped them see how their work fit into overall quality improvement activities," says Justin. "They learned about the performance measures and how what they were doing tied into the measures-everyone from clinicians, case managers, and even front desk staff plays a role in meeting the measures."

Another area of focus was data collection. At the start of the Collaborative the various jurisdictions and subgrantees in the EMA collected and reported data in many different ways. Through the Collaborative, members looked at ways to streamline the data collection and reporting process, as well as provided input on the selection on the performance measures to be tracked. Now, every jurisdiction and subgrantee in the EMA is using CAREWare.

"We can now compare data across providers," says Justin. "They can see how others are doing, compare outcomes, and the competition about outcomes is all in fun. Exploring outcomes opens the door for sharing best practices."

Consumers played an important role in the work of the DC Collaborative. They were involved at all levels, including the Response Team. During the DC Collaborative, consumers formed Advocates for Quality, a group of consumers supported by the DC Department of Health that trains consumers to become more involved in their own care and quality improvement-related activities.

Since the DC Collaborative officially ended, the Response Team has continued to meet. The primary focus of these activities is to plan for and provide ongoing training and team building opportunities. Quarterly, full-day trainings are offered and open to all-QI staff, case managers, data managers, program managers, and consumers - across the EMA. The quarterly trainings provide an opportunity to review progress on the Quality Management Plan and joint QI projects. An annual face-to-face QI Summit, in collaboration with NQC, is also held to continue the skills building that was so vital in the original Learning Sessions.

"Staff turnover at the subgrantee level is very high so there will always be people that need basic quality training. In addition, we have people who have gotten really savvy about quality. We need to provide training at a variety of levels," says Justin. "We also try to make it fun. At this point we have gone through every game in NQC's Game Guide and developed some games of our own."

The DC Department of Health plans to continue to support the work of the Response Team and the Advocates for Quality.

"It is something that we put a lot of effort into but we see the return in the participants and what they get out of the trainings," says Justin. "We are planting seeds for the future."

> Provider Corner | Open Door of Greater Elgin, Elgin, IL  

Institutional memory can be a valuable asset in quality improvement-related activities-knowing an organization's past can help to guide it into the future. Pat Lev has worked at Open Door of Greater Elgin for over 25 years. When she joined the organization as a case manager, there were two other employees. Now, there are 35.

Open Door's initial focus was providing testing for sexually transmitted diseases. In the early days of the AIDS epidemic, HIV counseling and testing was added. To address the needs of those that tested positive, Pat was was hired as a case manager in 1990. In 1993, services were once again expanded. This time it was to meet the needs of HIV-infected clients by providing access to HIV medical care. Since this time, Open Door has been a recipient of Ryan White HIV/AIDS Program Part A, B, and C funding. Clinics are based in Elgin and Aurora, Illinois.

In response to growing caseloads and growing staff, quality improvement was integrated into Open Door's activities and Pat began dividing her time between QI and case management in 2000.

"I bring a unique perspective. I am involved personally with clients through case management and am also focused on the data," says Pat. "It is not just about the numbers but the story that the data tell. It is about us and how we are doing."

Pat isn't the only person on staff focused on quality. Every staff member-from physicians, to case managers, to the receptionist-must conduct a QI project each year. Pat makes sure they have the tools they need by conducting annual trainings for all staff and quarterly trainings for new staff. Projects have focused on improving Pap rates, ensuring that care plans are completed, and improving viral suppression.

Consumers are also involved in quality activities. The chair of the consumer advisory board (who later became a peer navigator for Open Door Clinic) initiated an activity focused on retention in care. Consumers are given a participation card. They need to have clinicians (physician, case manager, therapist) sign off that they attended three appointments over the course of the year. They also had to check off their participation in the four social events for consumers and their families that are held each year. Those that attended all the activities are entered in a drawing. The 12 winners are treated to a festive dinner party.

Ongoing consumer involvement is especially important at this time in Open Door's development as in the clinic is in the process of applying for patient-centered medical home (PCMH) recognition. Open Door conducts consumer satisfaction surveys twice a year, with a participation rate of approximately 20 percent. The survey has been aligned to reflect PCMH requirements.

Pat has honed her quality improvement skills over the years at NQC trainings-she has achieved the NQC trifecta (Training-of-Trainers, Training of Coaching Basics, Training of Quality Leaders Programs). She also participated in regional activities conducted by NQC. NQC helped Pat develop Open Door's first written quality management plan.

Like the NQC, Pat is embracing technology to spread the message of quality improvement. She is exploring providing upcoming staff trainings online. This would make them available to staff at any time and archived versions would be available to new staff. Since staff training is an ongoing process, making some of the training offerings available electronically would allow Pat to focus on other aspects of the QI process.