DEPARTMENT OF HEALTH & HUMAN SERVICES

BEHAVIORAL HEALTH DIVISION

Milwaukee County

HECTÓR COLÓN Director

PAULA LUCEY Division Administrator

Quality Assurance/Quality Improvement Plan Template

Agency Name:
Address:
Date:
QI Plan Contact Person and Position:
QI Contact Person Phone #:
QI Contact Person E-mail Address:
Agency Scope of Services Provided:
Attach the Following Items (If Not Identified as Part of Your QI Plan):	Agency Mission Statement, Vision, Scope Agency Goals QI Committee Minutes Example of Consumer Satisfaction Survey QI Goals for the Agency
Overview and Purpose of QI Committee:
QI Committee Comprised of: (indicate names and positions)
Does your Agency Utilize Data to Make QI Decisions? If So, How Do You Use the Data?
Meeting Schedule:
Does Your Agency Have any of the Following Subcommittees: -Incident Reporting -Client Rights -Complaint/Grievance -QA Review of Records/Peer Review -Any Additional Committees?	Incident Reporting: Client Rights: Complaint/Grievance: QA Review of Records/Peer Review: Any Additional Committees:
How Does Your Agency Include Stakeholder Participation Within the Committees? (Please Ensure you Include Consumer/Family Input)
How Does Your Agency Utilize the Subcommittee Reporting Information to Provide Better Services to you Consumers?
Staff Training
Describe How Your Agency Addresses Staff Training on Core Competencies and Service Descriptions?
Describe How Your Training Plan Includes and Orientation for New Staff Which Covers your Agency’s Policies and Procedures, Rules and Requirements, Agency Standards, etc?
Describe How Your Agency Determines Additional Training Needs for Staff?
Outcomes Measurement
Describe Your Agency’s Process to Ensure Outcomes are Collected and Used to Improve Lives of Consumers Who Receive Services From Your Agency.
Describe Your Agency’s Process for Completion of Consumer Satisfaction Surveys. Include the Method of Collecting; How Often the Info is Collected, Your System of Communicating Results, and Use of the Satisfaction Data.
Evidence Based Practice and Best Practice Models
Describe Your Agency’s Use of Evidenced Based Practices and Best Practice Models. Detail the Training Protocol of Staff in These Practices and Models.

Annual QI Projects-Information
Based upon the findings of your QI activities and your QI Plan, your agency should be able to identify QI projects to better the services received by your consumers. In addition to your own findings by your QI process, the Milwaukee County Community Services Branch may also request a QI Project based upon the results of monitoring of your agency.
Your QI Projects Should Include the Following Items:	Basis for Project Strategies for Improvement Action Taken Evaluation of Results Recommended Additional Actions
QI Projects or Questions should be submitted to:	Milwaukee County Community Services Branch Attn: 9201 W. Watertown Plank Road Milwaukee, Wisconsin 53226