continuous quality...
TRANSCRIPT
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Continuous Quality Improvement: An Institute’s Experience in Creating Quality
Improvement Projects
New Orleans, LA • May 22, 2012
Catherine ShoultsGianfranco Pezzino
Kansas Health Institute
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What To Expect From ThisPresentation
! An example of application of qualityimprovement principles
! A new way to look at grant process
! Pointers for integrating QI in routinepublic health practice
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In the Beginning…
Immunize
Kansas KidsCoalition
QualityImprovement
Efforts(MLC)
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Immunize Kansas Kids
Goal: Protect every Kansas child fromvaccine-preventable diseases
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Multistate Learning Collaborative
Goal: Improve public health services byimplementing quality improvement practices
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Immunizations Plus QualityImprovement
Immunize
Kansas KidsCoalition
QualityImprovement
Efforts(MLC)
IKK QI
Projects
+
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QI Project Goals! Goals:
" Improve immunization practices
" Disseminate Plan-Do-Study-Act cycleand QI Culture
! Public and private immunizationclinics targeted
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Project Details! Project grants range from $5,000-
10,000 " Funded by Kansas Health Foundation
! Up to 10 projects awarded! Project completed in 12 months
" All projects are currently active
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Eligible Organizations ! Must deliver immunization services OR! Must coordinate or support vaccination
activitiesProjects can be submitted jointly as a
partnership between providersor as an effort by a public health
preparedness region
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Use of Project Funds! Direct and personnel costs for:
" Improvements in vaccination activities• Change workflow to improve efficiency• Create reminder system for parents
" Marketing campaign targeted to specificat-risk populations• Increase parental awareness of vaccines• Explain vaccine importance/safety
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Marketing of Projects! Sent RFP to stakeholders
" KDHE Community Health Bureau" KS AAP and AFP
! Outreach efforts" Booths at conferences" Webinar" Website
! IKK Partners
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IKK Projects Must Do theFollowing
! Use PDSA cycle! Incorporate evidence-based
practices! Include measurable objectives! Include evaluation measures
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Institute for Healthcare ImprovementPlan-Do-Study-Act Cycle
! What are we trying to accomplish?
! How will we know that a change is animprovement?
! What changes can we make that willresult in improvements?
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Preliminary QI ProposalProcess
Request forProposals
Receiveand ReviewApplication
ApproveProposal
RejectProposal
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Current QI ProposalProcess
Request forProposals
ReceiveApplication
ApproveProposal
ProvideTechnical
Assistance
ApplicantMakes
Changes
ReviewProposal
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Project One! Application rewrite: Determined root
cause, integrated PDSA model! End product: Improve full coverage
of vaccines in preschools! Surprise: Fully integrated PDSA
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Project Two! Application rewrite: Major limiting of
scope, integration of QI and PDSA! End product: Try multiple reminder
and recall systems! Surprise: Major changes from initial
proposal to approved project
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Project Three! Application rewrite: Determine root
cause, proof texting is best solution! End product: Use texting to remind
parents to come in for vaccinations! Surprise: Research based
interventions lend themselves to QI
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Project Four! Application rewrite: Root cause
analysis! End product: Integrate immunization
nurse into WIC clinic! Surprise: Embraced root cause
analysis and created multiplepossible solutions
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Project Five! Application rewrite: No rewrite!! End product: Target policy
change??? ‘may vs. shall’! Surprise: Well-versed in QI so
wanted to do improvement instead ofsolution
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Wait, Isn’t That QI?
QualityImprovement
for KHI!
QualityImprovement at
the Project Level
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KHI PDSA – What We Have Learned
! Applicants don’t immediatelyunderstand QI projects
! Application process of normal grantdoes not suit QI projects
! Most work in proposal stage! Applicants need help with root cause
analysis! KHI internal processes can be slow
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KHI PDSA – Solutions
! Next QI projects will have twophases" May integrate projects into larger grant
! Midterm report gave feedback area" Need to shorten our internal approval
processes! Documented lessons learned
throughout the process" Used OneNote to track the process and
find bottlenecks
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One Of Our Best LessonsLearned Has Been…
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QI Is Infectious!
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Take Away Messages! Process of approving proposal was
great learning opportunity:" For the applicants
" For the reviewers
! New-to-QI folks learn quickly
! Old-to-QI folks try new approaches(and keep learning!)
! You may already be doing QI!
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Conclusions! Integrating QI into ongoing activities
is possible AND beneficial ! Be flexible
! Practice what you preach
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Information for policy makers. Health for Kansans.
Kansas Health Institute
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Photo Citations! Slide 4 and 5: KALHD emblem, http://www.kalhd.org/! Slide 4 and 5: KDHE emblem, http://www.kdheks.gov/! Slide 12: PDSA cycles,
http://health.state.tn.us/MCH/MedicalHome/improvement.shtml! Slide 16: 30 Mini colorful envelopes,
http://www.etsy.com/listing/53015608/30-mini-multi-colored-envelopes! Slide 21: PDSA cycles,
http://health.state.tn.us/MCH/MedicalHome/graphics/plan_do_study_act.png! Slide 24: Woman Sneezing,
http://www.guardian.co.uk/science/2008/dec/19/reproduction-neuroscience