Management for quality: continuous quality improvement to increase access to outpatient mental health services

OBJECTIVE: A health maintenance organization (HMO) examined whether continuous quality improvement could be used to address the problem of long waiting times for outpatient mental health services from a closed panel of providers during peak periods of demand. METHODS: A task force at a staff model HMO in Burlington, Vermont, used continuous quality improvement methods to identify and solve specific service access problems in five categories: quality, protocol, and standards; systems and processes; management and administration; clinical practice management; and public relations and marketing. RESULTS: Over a two- year period, the task force identified 13 specific problems, for which solutions were implemented. For example, two new support positions were created to meet clinicians' needs. Triage categories were defined, and acceptable waiting times for appointments, along with goals for percent compliance, were established. A weekly training program in brief psychotherapy and an extensive group psychotherapy program were implemented. A network of community providers was formed to complement the HMO's fixed provider panel during periods of high demand. The average waiting time was reduced from 22 days to six days, and patients' satisfaction increased markedly. CONCLUSIONS: Use of continuous quality improvement can guide clinical leaders in their central role of reinstating clinical quality as the goal of management. The author suggests that continuous quality improvement with balanced clinical and administrative leadership is the means to forge the needed synthesis of quality and cost capable of improving mental health.