Quality Measures 2005

General comments

Please be reminded that each section of the Quality Measures was designed to be a stand alone measure. When using the Quality Measures to improve service quality it will be important to consider them together as a collective. For example, the Shared Values, Basic Assurances^® and Personal Outcome Measures^® all have indicators that relate to people’s rights. When designing organizational systems be sure to consider all the sections.

Any assessment of service quality starts with an examination of our values and using the Quality Measures is no different. Start your exploration with the Quality Measures by lining up the Shared Values with your organizational values. Don’t just look at what is written – also look at organizational behaviours that are driven by organizational values.

Shared Values

Organizational values drive organizational behaviour. They influence management decisions, organizational priorities, and the character of the workforce. Just as individual behaviours are driven by our internal belief system or values, our collective values guide our organizational behaviour and shape our organizational culture. An organization represents a collection or community of people who come together to accomplish the “work” of the organization. The collective action of formal and informal leaders embeds values within the culture of the organization. Values then become important criteria in making organizational decisions. Most organizational decisions related to budget, human resource or regulatory matters are ultimately decisions about values - what people and organizations believe are important.

The new values for the Quality Measures 2005^® focus attention on:

People
Community
Organization

What should we do?

Values and beliefs about people shape expectations. Our values, beliefs and expectations about people determine the way we provide services, supports and resources. Conducting individual and focus group meetings with people reveal the basic importance of dignity and worth, legal and human rights, and self-determination and choice. Services and supports that incorporate these values support the attainment of personal outcomes and individual quality of life.

Use the Factors, Indicators and Probes to guide you in your quality improvement efforts for each of the measures. We use the term Factor to refer to the main topic areas under each section for a measures. Each factor has a number of Indicators used to set specific expectations for that factor. Within each indicator are Probes that assist organizations or systems to evaluate their progress in meeting the indicator. Think of the Probes as questions to be answered in the affirmative. If you can’t answer yes to a probe, examine what is preventing a particular indicator from being present - is there a values conflict? Remember you want to say yes to the indicator; the probes provide us with guidance about how to ensure that an indicator is present.

Use the Procedures for Information Gathering contained in the Shared Values manual at the end of each factor.

More on Shared Values

Basic Assurances^®

Basic Assurances^® are essential, fundamental, uniform and non-negotiable requirements for all service and support providers. Basic Assurances^® demonstrate successful operations in the areas of health, safety and human security. Although we can expect differing levels of quality among organizations, meeting Basic Assurances^® is a prerequisite for being in business in our field. Those organizations unable to meet the requirements of health, safety and human security are not permitted to operate as public or private entities.

Demonstrations of Basic Assurances^®mean that we individualize our thinking. We ask, “What are the important health, safety and human security issues for this person?”

What should we do?

Develop a method to track the presence of Basic Assurances^® both at the systems and practice level. This tracking should occur both on a person-by-person basis (the Personal Outcomes are often used to do this) and at the organizational level.

Use the Procedures for Information Gathering contained in the Basic Assurances^® manual at the end of each factor.

More on Basic Assurances^®

Personal Outcome Measures^®

With the introduction of the Personal Outcome Measures^® CQL Canada moved the quality focus from complying with organizational processes to learning about and supporting individual choice and preferences. Choice and self-determination are the foundation for personal quality of life. When people receive services and supports, they expect real outcomes based on those choices. Personal Outcome Measures^® focus on the choices people have in their lives. CQL Canada emphasizes emergence and new opportunities for tomorrow that occur for all people. This means that for all of us there is a possibility of choices and opportunities that did not exist yesterday and cannot be predicted for tomorrow.

Some organizations, however, set up barriers to emergence by allowing people only limited choices. They deny, rather than create, the opportunities and alternatives that enable people to learn, grow and explore new outcomes. In contrast, social capital, natural support networks and close friends promote emergence and new possibilities for tomorrow.

Personal Outcome Measures^® enable organizations to design, measure, and improve personal quality of life. People define outcomes for themselves. The outcomes are non-prescriptive; they have no norms. Each person is a sample of one. We all define friendship, health or respect uniquely. Thus, the meaning and definition of personal outcome items will vary from person to person. As a result, an organization can only design and provide the needed supports after it figures out how the person defines personal priority outcomes. Since the definition of the outcomes will vary from person to person, supports and services must be individualized. The supports that facilitate a particular outcome for one person may not do so for another. Supports chosen by one person may be a burden for someone else. The Personal Outcome Measures^® have served as a powerful tool for evaluating the quality of life for people and the degree to which organizations individualize supports to facilitate those measures.

What should we do?

Successful organizations recognize that organizational supports are the key to making the Personal Outcome Measures^® work. As a result, all organizational practices should be examined to ensure that they contribute to individual quality of life. Practices that interfere or place arbitrary restrictions on people should be eliminated. In situations where regulations place restrictive measures on people, work to understand the intent of the regulation, provide alternatives, and at the very least develop supports to ensure that the regulation does not impact individual quality of life.

Use individual outcome information to better understand each person’s priorities. Use this information to develop person centred plans and design services and supports based on each person’s priorities. Use the Personal Outcome Measures^® to evaluate the effectiveness of services and supports provided. Redesign services and supports as necessary.

Develop a database that contains the results of outcome information about people supported. Use both formal (structured interviews) and informal conversation to gather outcome information. Analyze trends gathered from the aggregate of the outcomes data to design or reconfigure how services and supports are delivered. Work toward attaining and maintaining a sample that includes 100 percent of the people supported. Ideally, to ensure that outcomes data is valid and reliable, an organization should have one or more certified interviewers. If it is not possible to have certified interviewers, staff who have received basic outcomes training can gather basic outcome information and examine trends.

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Responsive Services^®

Responsive Services^® are grounded in values and basic principles. They provide Basic Assurances^® and they contribute to Community Life^®, build social capital and facilitate personal outcomes. Responsive Services^® integrate the different quality indicators - Shared Values, Basic Assurances^®, personal outcome and community supports, and Community Life^®. Responsive Services^® direct the quality inquiry beyond questions of internal compliance and process conformity. These services perform the bridging function of connecting people with community support services that foster desired outcomes. Responsive Services^® address the question of how the organization provides Basic Assurances^®, builds social capital, contributes to Community Life^®, and facilitates personal outcomes for all citizens.

What should we do?

Integrate all of the quality measures to provide Basic Assurances^®, assist people to contribute to Community Life^® and facilitate personal outcomes for all people

Use the Procedures for Information Gathering contained in the Responsive Services^® manual at the end of each factor.

More on Responsive Services^®

Community Life^®

In emphasizing social capital and quality of life, the Community Life^® measures underline CQL Canada’s belief that we can only define quality in the context of community. We cannot focus solely on support or provider organizations, the informal network of friends and supporters, or the larger provincial or federal government. CQL Canada continues to integrate the person-based and place-based dimensions of quality. We emphasize the relationships between and among people - people with disabilities, their families and supporters, and their communities. We emphasize social capital and social networks that develop from the relationships with community. And finally, we continue to emphasize systems advocacy to promote change and responsiveness in community-based systems of service.

Person-based indicators – measures that describe characteristics of individuals or statistical aggregations of people within a given location.

Place-based indicators – measures that describe characteristics of a location without reference to people living in the location.

People ask, “What would make this community a healthier place?” The answer covers a wide range of Community Life^® indicators such as transportation, jobs, housing, health care or environment. These factors impact the quality of life for community members, including people with disabilities. These Community Life^® factors influence personal outcome planning and attainment. They affect the availability and quality of the supports that facilitate personal outcomes. Organizations supplement their own resources with those available through other community sources. Organizations can enhance outcomes for people by increasing community support capacity. This CQL Canada focus on community supports, social capital and network connections continues CQL Canada’s emphasis on systems advocacy.

In fulfilling its bridging role, the organization identifies the most relevant and important Community Life^® areas. These may include, but are not limited to:

Housing
Employment
Health Care
Transportation
Education and Learning
Social Capital

What should we do?

Collect and analyze data and information on key community indicators that impact all community members.

Data analysis includes information about people with disabilities, other community members and people from diverse socio-economic sectors.

Enter into partnerships with other community organizations to enhance Community Life^® for all citizens.

Define the organization's leadership role in promoting Community Life^®, including leadership roles and responsibilities for direct support professionals, people with disabilities and people with mental illness, their families, volunteers and members of the Board of Directors.

Facilitate opportunities for direct support professionals, people with disabilities, their families, volunteers and members of the Board of Directors to network, build social capital and increase Community Life^®.

Establish a clearly defined set of strategies for systems advocacy.

Establish a method for assessing success in systems advocacy.

Assist people to connect with other individuals and groups engaging in individual and systems advocacy related to enhancing Community Life^®.

More on Community Life^®