QI AS RESOLUTION TO A MAJOR LAWSUIT

Background: In 1991, in response to a lawsuit filed in 1974, the Texas Department of Mental Health and Mental Retardation (TXMHMR) became th e first major state agency in Texas to implement a systemwide effort t o implement quality improvement (QI) in its Quality System Oversight ( QSO) program. QSO: The QSO approach includes a uniform internal hospit al management structure focusing on teams and data-based decision maki ng; the development of uniform work processes for each of the issues c ited in the lawsuit; and a uniform set of procedures for determining c ompliance, including the establishment of numeric targets for which ea ch hospital is accountable. Case study: At one TXMHMR hospital, patien t records in a monthly random sample were below the performance target . Data showed that approximately 40% of the patients leave the hospita l (many for a com-munity mental health center) before a treatment plan (at 14 days) is developed. Based on a team's recommendations, a unifo rm assessment package is being developed for use by all TXMHMR hospita ls and community mental health centers. The next step: In 1994, again in response to external pressures to improve quality, TXMHMR used a si mplified version of the Malcolm Baldrige National Quality Award criter ia for organizational self-assessment, Two pilot sites have developed action plans for improving performance as indicated on the self-assess ments. Summary and conclusions: The QSO program, put into place as a r esult of a lawsuit, provides a structure and database for TXMHMR to ef ficiently and effectively manage the performance of all hospitals in t he system. All but one of the eight hospitals have exited, or are clos e to exiting, the lawsuit.