Developing a quality management system for behavioral health care: the Cambridge health alliance experience

The rapid pace of change in the health care system presents tremendous chal lenges for clinicians and managers charged with the delivery of mental heal th and substance abuse services. Declining reimbursement, new incentive str uctures, and increasing competition are placing unprecedented pressure on p roviders to deliver care efficiently. Regulatory scrutiny, consumer dissati sfaction, and a growing awareness of gaps between actual and ideal practice have led to intensifying pressure to improve quality. Yet system change ha s also presented new opportunities for managing cost and quality of care. C onsolidation of facilities and practices into integrated networks, developm ents in information systems technology, and the emergence of models to faci litate change have led to the rise of "quality management," a framework for assessing and improving clinical, operational, and financial performance w ithin a health care organization. This article reviews some of the precipit ating factors and theoretical structures underlying quality management and then, through a case study of one organization's experience, describes the implementation of a quality management program in a behavioral health care delivery system. The case study emphasizes how theoretical frameworks were operationalized and how organizational structure and process were shaped to address challenges well known in quality management, such as authority, ac countability, and follow-through. A multiphase model of quality management program development is formulated and used to provide context for this prog ram's development.