Improving mental health outcomes: achieving equity through quality improvement

Objective. To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design. Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting. A psychological therapy service in Westminster, London, UK. Participants. People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. Intervention(s). Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. Main Outcome Measure(s). (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Results. Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), com-pared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low

Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting

Continuous Improvement in Education

In recent years, 'continuous improvement' has become a popular catchphrase in the field of education. However, while continuous improvement has become commonplace and well-documented in other industries, such as healthcare and manufacturing, little is known about how this work has manifested itself in education.This white paper attempts to map the landscape of this terrain by identifying and describing organizations engaged in continuous improvement, and by highlighting commonalities and differences among them. The findings classify three types of organizations engaged in continuous improvement: those focused on instructional improvement at the classroom level; those concentrating on system-wide improvement; and those addressing collective impact. Each type is described in turn and illustrated by an organizational case study. Through the analysis, six common themes that characterize all three types of organizations (e.g., leadership and strategy, communication and engagement, organizational infrastructure, methodology, data collection and analysis, and building capacity) are enumerated. This white paper makes four concluding observations. First, the three case studies provide evidence of organizations conducting continuous improvement work in the field of education, albeit at different levels and in different ways. Second, entry points to continuous improvement work are not mutually exclusive, but are nested and, hence, mutually informative and comparative. Third, continuous improvement is not synonymous with improving all organizational processes simultaneously; rather, research and learning cycles are iterative and gradual in nature. Fourth, despite being both iterative and gradual, it is imperative that improvement work is planned and undertaken in a rigorous, thoughtful, and transparent fashion

New Generation of Educators Initiative: Reform Focus at Comprehensive Grant Sites

This first analysis of the early NGEI work at comprehensive grant campuses shows that collectively campuses are working across points on the pipeline to address the need for teachers who are better prepared to effectively teach to the new standards. While the bulk of the NGEI reform efforts are targeted at teacher preparation program reform, we see NGEI campuses reaching as far back as high school to cultivate early interest in, and preparedness for, teaching in response to local conditions such as limited candidate pools.Within teacher preparation, the early NGEI work of campuses is primarily clustered around the reform of the teacher preparation program coursework and clinical work (reflecting the first and third Key Transformation Elements). Partnerships with districts are at various stages of development and, in several cases, are focused primarily at the school level. A few campuses are reforming the formative feedback process for candidates through their NGEI work (Element 4). Work with district partners on the identification of the key skills, knowledge, and dispositions of well-prepared new teachers (Element 2) and work on continuous improvement based on data on candidates and program completers (Element 5) are less prominent in the NGEI work to date.As campuses clear the hurdle of launching their reforms in the summer and fall and look toward the next phase of NGEI funding, the evaluation (WestEd/SRI) and the facilitation (ConnectEd) teams are poised to provide support to grantees on the Key Transformation Elements that are not yet fully developed across all comprehensive sites, that is:* Partnerships with K–12 district partners to align programming as much as possible.* Shared understandings with K–12 district partners about the key knowledge, skills, and dispositions of a well-prepared new teacher that are used to inform teacher preparation program elements.* Feedback to candidates on their mastery of prioritized skills during preparation.* Data on candidate progress toward mastery of identified knowledge and practices during their training and after program completion.Specifically, ConnectEd is available to assist with implementation coaching and support for comprehensive campus teams and can support the work with K–12 partners.In addition to providing ongoing formative evaluation work across the comprehensive grant sites, the WestEd/SRI team can provide technical support for grantees to assist with the development of high-quality data on candidate progress toward mastery of identified knowledge and practices during their training and after program completion. The data inventories that the evaluation team developed for each campus show that there are opportunities to: a) enhance the quality of existing data, b) improve access to those data, and c) develop new data sources targeted toward the measurement of prioritized skills and knowledge for formative feedback to candidates. In the coming months, the evaluation team will also be seeking opportunities to bridge the system-level work described above in Box 1 with campus efforts to strengthen systems for continuous improvement.

Strategies for Improving the Diversity of the Health Professions

Evaluates programs and strategies that were designed to increase the number of underrepresented African Americans, Native Americans, and Latinos in the health professions in California. Includes recommendations

Creating Careers, Improving Care: A Win-Win Economic Advancement Strategy for Certified Nursing Assistants in Long-Term Care

Examines strategies for developing training and education programs that will facilitate career advancement for nursing assistants. Explores the link between recruitment, retention, and advancement practices and the quality of care provided by caregivers

Understanding Entry-Level Health Care Employment in Chicago

Restructuring within the health care industry over the past ten years has sought to improve the quality and delivery of health care services while reducing employers' costs. However, coupled with the tight local and regional labor market, these organizational changes have introduced new challenges for employers trying to find workers who are adequately prepared to deliver quality health care services.Earlier this year, the Chicago Jobs Council received funding from the Richard H. Driehaus Foundation and BP Amoco to conduct research in the health care industry. This report summarizes the most recent industry and occupational data on Chicago's health care industry and provides a snapshot of the entry-level recruitment and retention needs of Chicago's health care employers, job training programs, and low-income job seekers. Based on our findings, the report also makes recommendations to employers, training providers, public agencies and workforce boards

Pre-K Counts in Pennsylvania for Youngsters' Early School Success: Authentic Outcomes for an Innovative Prevention and Promotion Initiative

Examines the research base for the efficacy of early childhood education. Evaluates Pennsylvania's Pre-K Counts programs, including participants' characteristics, impact and quality of programs and partnerships, lessons learned, and recommendations