No abstract

The literature on total quality management or continuous quality improvement in the behavioral health care field is just beginning to emerge. Although most of the evidence on its effectiveness remains anecdotal, it seems clear that it can work in behavioral health care organizations with strong leadership support and a long‐term commitment.

A state-operated residential facility has for the past five years been using performance feedback as the primary method for improving direct care staff interactions with clients. The major problem with this approach is determining when staff performance is significantly above or below average. Statistical process control charts are being used to determine whether variations in staff performance are the result of common or special causes. Analysis of staff performance for one year suggests that variation in staff performance may be due to special causes, such as the characteristics of the clients served and the type of service that is provided to these clients. Services were adapted to the characteristics of these clients, which improved staff performance and reduced variation.

There is periodic support in the mental health literature for increased training opportunities in the area of management and leadership. The purpose of this study was to verify the need for such training as perceived by state directors of mental health and mental retardation/developmental disabilities programs and to explore related issues. The results confirmed a perception of need and provided insights into ways that such training might be successfully provided to states.