Columbia, South Carolina


TO:          All Organizational Components

FROM:    Office of Quality Improvement/Advocacy



By this directive the mission and function of the Office of Quality Improvement/Advocacy is established.


The mission of the Office of Quality Improvement/Advocacy is to advocate for the continuous improvement of the quality, appropriateness and continuity of services provided by the Department of Mental Health system for people eligible for its services services that build on the strengths of each person, provide them with an opportunity to improve their quality of life and attain a comfortable level of independence in the setting best suited to their needs.

The activities of this Office will focus on:

1. Client outcomes related to quality of life;

2. Family outcome related to effects of mental illness on the family;

3. Employee satisfaction and productivity;

4. Risk management and prevention of adverse outcomes;

5. Promulgation of clinical and program standards; and

6. Cost effectiveness of services.

The Office of Quality Improvement/Advocacy shall include but not be limited to the following functional components:

A. Program Assessment and Quality Improvement Section which uses quality related data and quality improvement processes to focus on the following areas:

1. Quality, continuity and appropriateness of individual care. programs, services and systems.

2. Patient outcome evaluation; patient management; patient treatment services; and patient ancillary services.

3. Patient therapeutic environment - Facility; Center; Community.

4. Professional staff qualifications; credentialing; clinical privileging; and professional development.

5. Management and support services - DMH; Facility; Center.

6. Service development potentials.

B. Data Analysis Section and Adverse Incident Management Section which provides detail on incidents and longitudinal outcome studies in the following areas:

1. Utilization review of appropriateness of services and resources.

2. Program and treatment effectiveness; outcome studies.

3. Analysis of monitoring data.

4. Quality care reviews.

C. Patient Advocacy Section which provides advocacy and intervention in the following areas:

1. Internal patient advocacy.

2. External patient advocacy.

3. Evaluating and responding to Public Safety reports that impact on patient care, rights or well-being.

4. Evaluating and responding to individual, family, community and interested others, complaints or criticisms.

The combined activities of this Office's functional components shall culminate in a focus on services that can be improved through reports and recommendations to the State Director for improvement initiatives.


The Office of Quality Improvement/Advocacy shall be headed by the Director who shall organize and administer a Department-wide Program as outlined herein.

All Facility, Center, and other Departmental organizational component heads are hereby given the responsibility of fully cooperating and assisting the mission of this Office of Quality Improvement/Advocacy. Reports and data indicators generated by this office shall be considered in performance ratings.

The establishment of this office in no way relieves the Facilities, Centers, or other Deparunental components of the responsibility of maintaining their own local Quality Improvement/Advocacy Program and appropriate accreditation activities.

Each Facility, Center, and component shall appoint appropriate persons (including Patient Advocacy and Adverse Incident Management) for liaison meetings and workshop activities at the Departmental level as directed by the Director of Quality Improvement/Advocacy

IV. This directive rescinds and supersedes Directive No. 695-86, "Establishment of the Division of Patient Care Standards, Advocacy, and Quality Assurance Monitoring."


                                                                                                Joseph J. Bevilacqua
                                                                                                            Joseph J. Bevilacqua, Ph.D
                                                                                                            Director of Mental Health

March 2, 1994