Quality management specialist

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I. Contents of quality management specialist

==================
The QMS is a contracted entity with DOH and reports directly to DOH Waiver Management
staff. The contractor for the services of the QMS is separate from that of the RRDC. The QMSs
are located in three (3) designated regions across New York State (refer to Section XIII QMS
Regions map).
The QMS promotes the Quality Management Program in the NHTD waiver program to ensure
the delivery of high quality services to the participants. The QMS is a liaison between DOH,
RRDCs, RRDSs, NEs, SCs and other waiver providers, and waiver participants regarding the
NHTD waiver. The QMS can not provide waiver services.
The QMS has the right to access all records regarding a participant's or a provider's activities
related to the waiver and has the right to meet with the participant at any time or place with
his/her permission. The QMS works closely with DOH Waiver Management staff to provide data
and input as needed regarding the administration of the NHTD waiver in their region.
Skills
The QMS must have:

Knowledgeable about the operation of 1915 (c) waivers and community-based services;

Professional experience working with people with disabilities and/or senior;

Experience in developing and implementing quality management programs;

Knowledgeable regarding issues concerning individuals with disabilities and seniors;

Experience supervising professional staff;

Experience in person/centered planning and team building;

Ability to review and analyze records;

Working knowledge of community-based resources for individuals with disabilities

and/or seniors;

Skill in analyzing reports or surveys to determine trends;

Skill in program development;

Working knowledge of benefits provided by Medicaid, Medicare and/or other third party
payers;

Excellent communication and presentation skills; and

Meet all additional qualifications outlined in the QMS contract.

Roles and Responsibilities of the QMS

QMS responsibilities include:
1. Incident Reporting

Oversee the SRI process, assuring compliance with the reporting process and the timely
completion and submission of all required documentation associated with the
investigatory process;

Notify DOH in all appropriate situations of alleged abuse or neglect, or when a

participant dies or at any time DOH involvement in the investigation process is
warranted;

Determine whether a SRI is closed or deemed open for further investigation, utilizing the
RRDS in consultation as needed;

Conduct follow-up contacts with the participant and/or legal guardian to assure
satisfaction with outcome of investigation; and

Track all pertinent information pertaining to SRIs for analysis to identify any regional
trends and emerging issues.

2. Quality Monitoring

Assist in the annual random retrospective review of a sample of Participant records as

part of the NYS Quality Management Program and to confirm adherence to proper
authorization procedures and satisfaction of federal review requirements;

Perform trend analysis identifying problematic areas, and develop activities that will
support positive outcomes;

Assure the completion of annual Participant Satisfaction Surveys of waiver participants

using the DOH designated form to assess participant satisfaction with the NHTD waiver
and to monitor quality assurance activities;

Arrange and facilitate annual Regional Forums to gather and discuss waiver related issues
in the QMS region;

Attend quarterly DOH meetings in Albany and at other times/places upon the request of
DOH; and

Attend Quality Advisory Board meetings to determine areas of intervention, training,

participant satisfaction and programmatic changes.

3. Review of Service Plans

Review all Service Plans over a specified dollar amount ($300 per/day) determined by
DOH and provide recommendations to the RRDCs; and

Assist RRDS in reviewing Service Plans upon request to assure information is accurate
and meets the health and welfare needs of the participant.

4. Development of Community Resources

Refer any potential provider(s)to the RRDS;

Provide trend analysis to DOH regarding provider capacity and capabilities in their
regions; and

Promote the quality and availability of services.

5. Information and Resource

Assist the RRDCs with outreach and dissemination of information to the community
when requested or as appropriate to his/her role; and

Refer all calls received from individuals, family members, advocates, professionals and
others requesting information regarding the NHTD waiver to the appropriate RRDS for
timely response.

6. Develop and Submit Reports to DOH

Review quarterly reports from RRDCs in the QMS region;

Review all reports submitted by provider agencies' Serious Incident Review Committee;
and

Submit quarterly and annual reports to DOH summarizing QMS activities which include:
findings from Participant Satisfaction Surveys, SRIs and Recordable Incidents, SP
reviews, regional trends and needs analysis, quality assurance activities and
improvements, cost savings, and progress made toward attaining the program objectives
articulated in the QMS contract; and

Make recommendations to DOH based on experience for improvements to NHTD waiver

policies and procedures.

7. Technical Assistance to other QMSs, RRDC, RRDS, Providers, and the DOH

Provide cross training and technical assistance and share areas of expertise with other
QMS's and the RRDC's in their region as requested;

Provide training to waiver provider agencies as requested by RRDS; and

Provide information and assistance to DOH as requested.

8. Other Roles and Responsibilities as Defined by DOH

Conduct evaluations upon request of DOH that reflect a possible system-wide concern.
Provide outcomes and recommendations to DOH.

==================

III. Quality management tools

1. Check sheet
The check sheet is a form (document) used to collect data
in real time at the location where the data is generated.
The data it captures can be quantitative or qualitative.
When the information is quantitative, the check sheet is
sometimes called a tally sheet.
The defining characteristic of a check sheet is that data
are recorded by making marks ("checks") on it. A typical
check sheet is divided into regions, and marks made in
different regions have different significance. Data are
read by observing the location and number of marks on
the sheet.
Check sheets typically employ a heading that answers the
Five Ws:

Who filled out the check sheet

What was collected (what each check represents,
an identifying batch or lot number)
Where the collection took place (facility, room,
apparatus)
When the collection took place (hour, shift, day of
the week)
Why the data were collected

2. Control chart
Control charts, also known as Shewhart charts
(after Walter A. Shewhart) or process-behavior
charts, in statistical process control are tools used
to determine if a manufacturing or business
process is in a state of statistical control.
If analysis of the control chart indicates that the
process is currently under control (i.e., is stable,

with variation only coming from sources common

to the process), then no corrections or changes to
process control parameters are needed or desired.
In addition, data from the process can be used to
predict the future performance of the process. If
the chart indicates that the monitored process is
not in control, analysis of the chart can help
determine the sources of variation, as this will
result in degraded process performance.[1] A
process that is stable but operating outside of
desired (specification) limits (e.g., scrap rates
may be in statistical control but above desired
limits) needs to be improved through a deliberate
effort to understand the causes of current
performance and fundamentally improve the
process.
The control chart is one of the seven basic tools of
quality control.[3] Typically control charts are
used for time-series data, though they can be used
for data that have logical comparability (i.e. you
want to compare samples that were taken all at
the same time, or the performance of different
individuals), however the type of chart used to do
this requires consideration.

3. Pareto chart

A Pareto chart, named after Vilfredo Pareto, is a type

of chart that contains both bars and a line graph, where
individual values are represented in descending order
by bars, and the cumulative total is represented by the
line.
The left vertical axis is the frequency of occurrence,
but it can alternatively represent cost or another
important unit of measure. The right vertical axis is
the cumulative percentage of the total number of
occurrences, total cost, or total of the particular unit of
measure. Because the reasons are in decreasing order,
the cumulative function is a concave function. To take
the example above, in order to lower the amount of
late arrivals by 78%, it is sufficient to solve the first
three issues.
The purpose of the Pareto chart is to highlight the
most important among a (typically large) set of
factors. In quality control, it often represents the most
common sources of defects, the highest occurring type
of defect, or the most frequent reasons for customer
complaints, and so on. Wilkinson (2006) devised an
algorithm for producing statistically based acceptance
limits (similar to confidence intervals) for each bar in
the Pareto chart.

4. Scatter plot Method

A scatter plot, scatterplot, or scattergraph is a type of

mathematical diagram using Cartesian coordinates to
display values for two variables for a set of data.
The data is displayed as a collection of points, each
having the value of one variable determining the position
on the horizontal axis and the value of the other variable
determining the position on the vertical axis.[2] This kind
of plot is also called a scatter chart, scattergram, scatter
diagram,[3] or scatter graph.
A scatter plot is used when a variable exists that is under
the control of the experimenter. If a parameter exists that
is systematically incremented and/or decremented by the
other, it is called the control parameter or independent
variable and is customarily plotted along the horizontal
axis. The measured or dependent variable is customarily
plotted along the vertical axis. If no dependent variable
exists, either type of variable can be plotted on either axis
and a scatter plot will illustrate only the degree of
correlation (not causation) between two variables.
A scatter plot can suggest various kinds of correlations
between variables with a certain confidence interval. For
example, weight and height, weight would be on x axis
and height would be on the y axis. Correlations may be
positive (rising), negative (falling), or null (uncorrelated).
If the pattern of dots slopes from lower left to upper right,
it suggests a positive correlation between the variables
being studied. If the pattern of dots slopes from upper left
to lower right, it suggests a negative correlation. A line of
best fit (alternatively called 'trendline') can be drawn in
order to study the correlation between the variables. An
equation for the correlation between the variables can be
determined by established best-fit procedures. For a linear
correlation, the best-fit procedure is known as linear
regression and is guaranteed to generate a correct solution
in a finite time. No universal best-fit procedure is
guaranteed to generate a correct solution for arbitrary
relationships. A scatter plot is also very useful when we
wish to see how two comparable data sets agree with each

other. In this case, an identity line, i.e., a y=x line, or an

1:1 line, is often drawn as a reference. The more the two
data sets agree, the more the scatters tend to concentrate in
the vicinity of the identity line; if the two data sets are
numerically identical, the scatters fall on the identity line
exactly.

5.Ishikawa diagram
Ishikawa diagrams (also called fishbone diagrams,
herringbone diagrams, cause-and-effect diagrams, or
Fishikawa) are causal diagrams created by Kaoru
Ishikawa (1968) that show the causes of a specific event.
[1][2] Common uses of the Ishikawa diagram are product
design and quality defect prevention, to identify potential
factors causing an overall effect. Each cause or reason for
imperfection is a source of variation. Causes are usually
grouped into major categories to identify these sources of
variation. The categories typically include
People: Anyone involved with the process
Methods: How the process is performed and the
specific requirements for doing it, such as policies,
procedures, rules, regulations and laws
Machines: Any equipment, computers, tools, etc.
required to accomplish the job
Materials: Raw materials, parts, pens, paper, etc.
used to produce the final product
Measurements: Data generated from the process
that are used to evaluate its quality
Environment: The conditions, such as location,
time, temperature, and culture in which the process
operates

6. Histogram method

A histogram is a graphical representation of the

distribution of data. It is an estimate of the probability
distribution of a continuous variable (quantitative
variable) and was first introduced by Karl Pearson.[1] To
construct a histogram, the first step is to "bin" the range of
values -- that is, divide the entire range of values into a
series of small intervals -- and then count how many
values fall into each interval. A rectangle is drawn with
height proportional to the count and width equal to the bin
size, so that rectangles abut each other. A histogram may
also be normalized displaying relative frequencies. It then
shows the proportion of cases that fall into each of several
categories, with the sum of the heights equaling 1. The
bins are usually specified as consecutive, non-overlapping
intervals of a variable. The bins (intervals) must be
adjacent, and usually equal size.[2] The rectangles of a
histogram are drawn so that they touch each other to
indicate that the original variable is continuous.[3]

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