Systems & Clinical Quality Improvement
Research, analysis, and field-level inquiry
Access opens the door. Clinical effectiveness determines whether people receive the help they came for.
Behavioral-health systems have invested substantial effort in expanding access, improving continuity, monitoring service delivery, and measuring outcomes. But getting people into care was never the whole task.
Once someone enters treatment, the outcome depends in part on what happens clinically: whether the clinician can understand the problem, establish a workable therapeutic alliance, determine what requires therapeutic attention, recognize when care is not helping, and revise direction responsibly.
Clinical effectiveness is therefore not only a matter of individual professional development. It is a quality responsibility.
The Clinical Layer of Quality
Organizations shape clinical practice through the conditions they create around it:
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how clinicians are prepared and developed;
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what supervision examines;
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how difficult and stalled cases are understood;
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whether outcome information leads to clinical inquiry;
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how training is reinforced in practice;
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what clinicians are expected to know and be able to do;
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whether the organization supports thoughtful clinical work.
These conditions affect what happens after a client enters care. They influence whether services become effective treatment and whether the outcomes quality systems seek can actually be achieved.
The Clinical Effectiveness Institute works with organizations and behavioral-health systems to strengthen this clinical layer of quality.
Where the work begins
The Clinical Effectiveness Institute begins, just as good psychotherapy should, by understanding the problem. An organization may identify concerns involving engagement, retention, repeated crises, stalled treatment, uneven outcomes, supervision, workforce development, or the transfer of training into clinical practice. But the stated concern does not necessarily tell us what is producing it.
The first task is to understand how the problem operates within the organization, what maintains it, and where change is actually needed. The answer may involve training. It may also involve supervision, case-review practices, leadership expectations, workflow, implementation support, or the way clinical quality is understood across the organization.
The aim is to determine what is limiting clinical effectiveness in this organization and develop a response suited to the problem.
Areas of collaboration
Clinical-effectiveness review: Examining how an organization currently defines, supports, and develops effective clinical practice; identifying existing strengths, gaps, and priorities; and determining where focused improvement work may be most useful.
Workforce development: Helping organizations move from isolated continuing-education events toward sustained clinical development supported through training, application, supervision, consultation, feedback, and reinforcement.
Supervisor development: Strengthening supervisors’ ability to examine clinical thinking, support formulation, recognize when care has stalled, and help clinicians determine what the therapeutic work requires.
Focused quality-improvement initiatives: Working with a program, clinical team, service line, or behavioral-health system on a defined clinical-quality concern through inquiry, implementation, observation, and revision.
Organizational consultation: Helping leaders connect clinical practice, supervision, workforce development, and quality improvement rather than treating them as separate organizational functions.
Institutional education and training: Developing education around identified organizational needs, including clinical formulation, therapeutic alliance, regulation, somatic information, clinical reasoning, and the recognition of treatment that is no longer producing meaningful movement.
How The Clinical Effectiveness Institute Works
CEI approaches organizational problems through the same disciplined process required in strong clinical work:
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Understand the concern as it is currently being experienced.
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Examine how the problem operates in practice.
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Develop a working formulation.
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Identify the level at which change is needed.
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Design a focused response.
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Observe what happens.
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Revise the approach based on what is learned.
This process allows training, supervision, consultation, and organizational change to be used in response to an understood problem rather than offered as interchangeable solutions.
Who this work is for
CEI works with organizations and leaders responsible for the quality of behavioral-health care, including:
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behavioral-health provider organizations;
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community mental-health agencies;
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Certified Community Behavioral Health Clinics;
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county and regional behavioral-health systems;
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managed-care organizations;
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substance-use treatment organizations;
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clinical directors;
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quality-improvement leaders;
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workforce-development leaders;
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supervisors and program leadership.
Experience behind the work
Sarah Ozol Shore’s work in quality and performance improvement began in community behavioral health in 2003, when she participated in the implementation of an agency-wide and county-wide quality-improvement initiative and later assumed responsibility for sustaining the work within her organization.
Her subsequent quality-improvement experience extended across the Montgomery County behavioral-health system, Princeton House Behavioral Health, Children’s Hospital of Philadelphia, and Temple University Hospital.
The Clinical Effectiveness Institute brings that systems experience together with more than two decades of clinical practice, clinical education, and inquiry into what effective psychotherapy requires.
An institutional responsibility
Quality cannot be defined only by what a system currently measures. Organizations responsible for behavioral-health services are also responsible for asking whether those services are helping the people who receive them. Improving access matters. Measuring outcomes matters. Ensuring that required services occur is important.
But responsibility does not end when a client walks through the door. It extends into the
clinical work itself.
Begin a conversation
CEI welcomes conversations with organizations examining the effectiveness of their clinical services, the development of their workforce, the function of supervision, or the place of clinical practice within quality improvement.