Abstract
Behavioral health organizations have been increasingly required to implement plans to monitor and improve service quality. This qualitative study explores challenges that quality assurance and improvement (QA/I) personnel experience in performing their job in those practice settings. Sixteen QA/I personnel from different agencies in St. Louis, Missouri, U.S.A., were interviewed face-to-face using a semi-structured instrument to capture challenges and a questionnaire to capture participant and agency characteristics. Data analysis followed a grounded theory approach. Challenges involved agency resources, agency buy-in, personnel training, competing demands, shifting standards, authority, and research capacity. Further research is needed to assess these challenges given expected outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alexander, J. A., Weiner, B. J., Shortell, S. M., & Baker, L. C. (2007). Does quality improvement implementation affect hospital quality of care? Hospital Topics, 85(2), 3–12.
Berwick, D. M. (1989). Continuous improvement as an ideal in health care. New England Journal of Medicine, 320(1), 53–56.
Council on Accreditation. (2008). Performance and quality improvement. Retrieved from: http://www.coastandards.org/standards.php?navView=private§ion_id=75.
Crosby, P. B. (1979). Quality is free: The art of making quality certain. New York: McGraw-Hill.
Deming, W. E. (1986). Out of the crisis. Cambridge, MA: MIT Center for Advanced Engineering.
Donabedian, A. (2003). An introduction to quality assurance in health care. Oxford: Oxford University Press.
Goonan, K. J., & Jordan, H. S. (1992). Is QA antiquated, or was it at the right place at the wrong time? Quality Review Bulletin, 18, 372–379.
Harry, M. J. (1988). The nature of six sigma quality. Schaumburg, IL: Motorola University Press.
Hermann, R. C. (2005). Improving mental health care: A guide to measurement based quality improvement. Arlington, VA: American Psychiatric Association Publishing.
Hruschka, D. J., Schwartz, D., St. John, D. P., Picone-Decaro, E., Jenkins, R. A., & Carey, J. W. (2004). Reliability in coding open-ended data: Lessons learned from HIV behavioral research. Field Methods, 16(3), 307–331.
Juran, J. M. (1992). Juran on quality by design: The new steps for planning quality into goods and services. New York, NY: The Free Press.
Kojania, K. G., & Grimshaw, J. M. (2005). Evidence-based quality improvement: The state of the science. Health Affairs, 24, 138–150.
Kuzel, A. J. (1999). Sampling in qualitative research. In B. F. Crabtree & W. L. Miller (Eds.), Doing qualitative research (pp. 33–45). Thousand Oaks, CA: Sage Publications, Inc.
Kuzel, A., & Like, R. C. (1991). Standards of trustworthiness for qualitative studies in primary care. In: P. G. Norton (Ed.), Primary care research: Traditional and innovative approaches (pp. 138–158). Newbury Park, CA: Sage Publications.
Lee, M. Y., McMillen, J. C., Zayas, L. E., & Books, S. J. (2011). The quality assurance and improvement workforce in social services: An exploratory examination. Administration in Social Work, 35(3), 243–257.
McMillen, J. C., Proctor, E. K., Megivern, D., Striley, C., Cabassa, L., Munson, M., et al. (2005). Quality of care in the social services: Research agenda and methods. Social Work Research, 29, 181–191.
McMillen, J. C., Zayas, L. E., Books, S. J., & Lee, M. Y. (2008). Quality assurance and improvement practice in mental health agencies: Roles, activities, targets and contributions. Administration and Policy in Mental Health and Mental Health Services Research, 35, 458–467.
Miller, W. L., & Crabtree, B. F. (1999). Depth interviewing. In B. F. Crabtree & L. W. Miller (Eds.), Doing qualitative research (pp. 89–107). Thousand Oaks, CA: Sage Publications, Inc.
Office of Manned Space Flight. (1966). Apollo reliability and quality assurance program. Washington, DC: NASA.
Palmer, R. H. (1991). Considerations in defining quality of health care. In: R. H. Palmer, A. Donabedian, & G. Povar (Eds.), Striving for quality in health care: An inquiry into policy and practice (pp. 3–58). Ann Arbor, MI: Health Administration Press.
Pande, P. S., Neuman, R. P., & Cavanagh, R. R. (2000). The six sigma way: How GE, Motorola, and other top companies are honing their performance. New York: McGraw-Hill.
Parker, L. E., de Pillis, E., Altschuler, A., Rubenstein, L. V., & Meredith, L. S. (2007). Balancing participation and expertise: A comparison of locally and centrally managed health care quality improvement within primary care practices. Qualitative Health Research, 17(9), 1268–1279.
Qualitative Solutions and Research [QSR]. (2006). NVivo (release 7.0), Qualitative data management software. Melbourne, Australia: QSR International.
Roberts, J. S., Coale, J. G., & Redman, R. R. (1987). A history of the joint commission on accreditation of hospitals. JAMA, 288, 936–940.
Sederer, L. I., & Dickey, B. (1996). Outcomes assessment in clinical practice. Baltimore, MD: Williams & Wilkins.
Sederer, L. I., & St Clair, L. (1990). Quality assurance and managed mental health care. Psychiatric Clinics of North America, 13, 89–97.
Shortell, S. M., Bennett, C. L., & Byck, G. R. (1998). Assessing the impact of continuous quality improvement on clinical practice: What it will take to accelerate progress. Milbank Quarterly, 76(4), 593–624.
Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedure and techniques. Newbury Park, CA: Sage Publications.
Thomas, C. M. (1965). Quality assurance of remotely maintained equipment in a nuclear fuels reprocessing plant. No publisher listed.
Walton, M. (1990). Deming management at work. New York: Plenum.
Wang, M. C., Hyun, J. K., Harrison, M. I., Shortell, S., & Fraser, I. (2000). Redesigning health systems for quality: Lessons from emerging practices. Journal on Quality and Patient Safety, 32, 599–611.
Zirps, F., & Cassafer, D. J. (1996). Quality improvement in the agency: What does it take? In P. Pecora, W. R. Seelig, F. Zirps, S. M. Davis (Eds.), Quality improvement and evaluation in child and family services: Managing into the next century (pp. 145–174). Washington, DC: Child Welfare League of America.
Acknowledgments
This work was supported by a grant from the National Institute of Mental Health (P30 MH068579).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zayas, L.E., McMillen, J.C., Lee, M.Y. et al. Challenges to Quality Assurance and Improvement Efforts in Behavioral Health Organizations: A Qualitative Assessment. Adm Policy Ment Health 40, 190–198 (2013). https://doi.org/10.1007/s10488-011-0393-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-011-0393-5