good afternoon! we will be starting shortly. please orient yourself to live meeting including use...
TRANSCRIPT
GOOD AFTERNOON!
We will be starting shortly. Please orient yourself to Live Meeting
including use of Q and A Please mute your microphones and/or
telephone Please email Tegan Ruland at
[email protected] if you are having any difficulties
Performance Improvement in Public Health Learning Session #3:
Public Health Quality Improvement 101
Welcome and Introductions
Brief description of today’s learning session
Brief introduction of those participating
Overview of Live Meeting process including muting, accessing handouts, and asking questions
By the end of this session you should be able to:
Have a basic understanding of quality improvement in PH - purpose and process
Understand “Big QI” vs. “small qi” Describe some ways to start integrating
QI into your agency Access additional resources
WHAT IS QI AND WHY SHOULD WE CARE?
What is QI? It’s about Process Is used to improve
existing processes Changing the way you
do things to impact longer term outcomes
It is a process – a way of doing things
The race for quality has no finish line.
~Unknown
What is QI? It’s about Data
Using data to identify opportunities for improvement and to make decisions
Data can help identify the root cause of your problem.
Data can help you focus on where to spend your time and effort for the greatest return
What is QI? It’s about Learning!
Working to Do the Right Things
Right!
And We Already Do It, Everyday!
And at Work Too!
Why QI Now?
Fewer Resources + More Work + Constant Change = Stress
Everything we do has a cost and everything we don’t do but should also has a cost ~Jim Butler
Helps staff deal more effectively with change
Helps make change more effective
Why QI?
Accreditation It’s just good
practice!
Who wouldn’t want to expand their horizons and create a better organization? LHD staff member (Michigan)
PLAN DO STUDY ACT - THE QUALITY IMPROVEMENT MODEL“Quality is not an act, it is a habit”
~Aristotle
Plan Plan changes aimed at improvement, matched to root causes
Do Carry out changes; try first on small scale
Study See if you get the desired results
Act Make changes based on what you learned; spread success
Quality Improvement Process:Plan-Do-Study-Act
Plan
DoStudy
Act
Model for Improvement: Three Key Questions in PDSA
1. What are we trying to accomplish?2. How will we know that a change is an
improvement?3. What changes can we make that will
result in improvement?
Change vs.. Improvement
It is essential to learn the difference between doing something in a different way, and doing it in a better way
“Of all changes I’ve observed, about 5% were improvements, the rest, at best, were illusions of progress.”
~W. Edwards Deming
BIG QI AND LITTLE QI
Moving from projects to integration
Levels of Integration of QI into Agency Culture
MarMason Consulting
*Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009
Levels of QI Integration
MarMason Consulting
0
25
50
75
100
Level 1- No interest or activities
Level 2-Awareness, interest and
one-time projects
Level 3- Multiple
teams and QI tools, but no
repetition or
saturation
Level 4- Speciic QI
model integrated
into agency management
structure with
continuous improvement
Bill Riley and Russell Brewer
“BIG QI” vs. “small qi”Little qi BIG QI
Often program or unit specific System focused
One time projects Continuous – part of strategic plan
Limited staff involvement Many staff knowledgable and participating
QI is an “extra” Culture of quality – QI is business as usual
Integration Recommendations
MarMason Consulting
Implement QI as a comprehensive management philosophy rather than a project-by-project approach
Use the lessons/proven methods from others [police, etc.] to overcome barriers
Find creative ways to secure resources for QI
Build on existing PH tools and capabilities
Conduct a self-assessment for QI readiness in your agency
Bill Riley and Russell Brewer
Tips and Strategies
Think big but start small Look for winnable
opportunities Discuss the need for
change – the disconnect between “the way we used to do it”, the way “we’ve always done it”, and the needs of today
Empower people to act – make them agents of change
Tips and Strategies
Articulate quality as part of the organizations core values
Incorporate quality improvement skills into job descriptions
Discuss professional and program improvement opportunities during regular performance reviews
Acknowledge failure and opportunities for growth
Celebrate small victories
QI RESOURCES: HOW YOU CAN LEARN MORE
References
Public Health Memory Jogger Embracing Quality in Local Public Health:
Michigan’s Quality Improvement Guidebook
The Public Health Quality Improvement Handbook
WIQI Webinars
Available in the Institute for Wisconsin’s Health website Root Cause Analysis – 5 Whys and Fishbone
(posted soon) Determining Root Causes and Prioritizing
Issues with the Affinity Diagram and Inter-relationship Diagraph
Focusing on Key Problems and Prioritizing Using Pareto Charts and Nominal Group Technique
NACCHO Webinars
NACCHO, with many partners, has developed several webinars on Process Tools QI in Action
See Resources Guide for details.
Questions?
QI IN THE FIELD
An Example from Oneida County
Baby Steps
Just jump in and get started First QI projects not picture perfect Learn as you go Get comfortable with the language Pick a couple tools and stick with them
until your comfortable Keep learning (add onto your QI
knowledge) Have a team of people who know QI (QI
team)
TRH Transient Rooming House annual inspections NIATx Change project form
1. Change Project Title TRH Transient Rooming House annual inspections
2. What AIM will the Change Project address?
% of completed annual inspections measured from July1, 2010 to June 30, 2011 (fiscal year).
Aim for 95% completion. In 2010 50% of inspections were completed as of 4-1-11.
3. LOCATION Oneida County
4. Start Date and expected completion date
10-1-10 to 6-30-11
5. Level of Care
6. What Client Population are you trying to help?
TRH licensees
7. Executive Sponsor Linda Conlon
8. Change Leader Teri Schwab
9. Change Team Members Todd Troskey, Jody McKinney
10. How will you collect data to measure the impact of change?
Health Space
11. What is the expected Financial Impact of this change project?
PDSA CyclesRapid Cycle #
Cycle Begin Date
Cycle End Date
Plan What is the idea/change to be tested
Do
What steps are you specifically making to test this idea/change?
Study
What were the results? How do they compare with baseline measure?
Act
What is your next step? Adopt? Adapt? Abandon?
1 10-1-10 10-6-10
Look at overdue TRH inspection list from HS
Learn the process of making an overdue inspection list on HS
<50% of TRH inspections had been completed. Contact info, past inspections were missing or inaccurate in HS.
Adapt. Pull Paper files
2 10-7-10 10-31-10
Look at paper files to find:
Last inspection
Contact information
Call facility owners mark file as
Contacted date
Left message
Contact info not working
Too many files to keep track of efficiently
Abandon
Need a complete TRH facility list to make notations and record contacts
3 11-1-10 11-7-10
Print out TRH master list Indicate on list:
Contacted date
Inspection date
Change of information
Contacting owners during regular business hours success rate about 15%, most numbers were not working or had to leave message
Adopt. Master list will be updated
PDSA CyclesRapid Cycle #
Cycle Begin Date
Cycle End Date
Plan Do Study Act
4 11-8-10
11-29-10
Send a letter and inspection request form to all TRH owners
Inspection request form
To update contact info
Let the owner realize inspections need to be done annually
About 50% of the facilities called, mailed or emailed the health dept. Mainly the response was from owners we had already contacted or inspected in the last year.
Adapt. Letter language was not strong enough to get a better response.
Collect and enter data that was received. Organize appts enter into office tracker and bulletin board
5A 12-1-10
12-31-10
Get organized
Appointment schedules, email contacts follow up with inspection request forms
Color code bulletin board for inspections.
Make a lodging group in email address book.
Make door hangars for no shows
Procedure to record appointments and enter contact information was established. 40% of facilities are recorded in email lodging group
Adopt. Asking for email addresses will be a priority in correspondence and during inspections. Scheduling appts for the same time next year.
PDSA CyclesRapid Cycle #
Cycle Begin Date
Cycle End Date
Plan What is the idea/change to be tested
Do
What steps are you specifically making to test this idea/change?
Study
What were the results? How do they compare with baseline measure?
Act
What is your next step? Adopt? Adapt? Abandon?
6 2-1-11 2-7-11 Color code and date master TRH list.
Record:
Scheduled inspection date
Call back date
Property manager
Email contact
Last inspection date, no contact, or last inspection date
Use HS as a guide for last inspection
Identified the contacts that had been made. Only 13 facilities out of 161 had no last inspection date or telephone/email contact information
Adopt.
Making contact notations on a master list lessens the scenario of calling owners multiple times.
Keep researching to try different numbers. Search the web and email requests for inspections.
7 2-7-11 3-1-11 Web research. Call or email to schedule an inspection.
Google search
Yellow book search
A few contacts were made. The web research worked better for the 5-30 lodging category. Able to find web information on 50% of facilities with no previous contact information.
Adopt…. Web research is very helpful if there are not too many facilities to look up. Revise request letter to have stronger language. License will not be renewed if an inspection is not scheduled and completed by 6-30-11.
PDSA Cycles
Rapid Cycle #
Cycle Begin Date
Cycle End Date
Plan What is the idea/change to be tested
Do
What steps are you specifically making to test this idea/change?
Study
What were the results? How do they compare with baseline measure?
Act
What is your next step? Adopt? Adapt? Abandon?
8 3-20-11
3-28-11
Send letter with stronger language and inspection request form.
Send to 13 facilities with no contact and no last inspection date.
Still in process
9 3-28-11
6-30-11
Develop system during inspection to update contact information and to schedule next annual inspection on the day of the inspection.
Have a check list for sanitarians to implement during inspection
Record new contact info
Schedule appt for next year
Write appt on business card
Record changes and appt a the office in HS and office tracker
Still in process
Learning Sessions Planned:
5/9/2011: PH Performance Management 101
5/16/2011: PH Quality Improvement 101
Today: Wisconsin PH Improvement Initiative 101
5/23/2011(last session): PH Accreditation 101
National Resources:
CDC: http://www.cdc.gov/ostlts/NPHII/index.html
NACCHO: http://www.naccho.org/topics/infrastructure/
ASTHO: http://www.astho.org/Programs/Accreditation-and-Performance/
PHAB: http://www.phaboard.org/
PHF: http://www.phf.org/focusareas/pmqi/pages/default.aspx
NALBOH: http://www.nalboh.org/Board_Governance.htm#
NIHB: http://www.nihb.org/public_health/accreditation.php
Primary Wisconsin Resources:
CDC Infrastructure Grant: Mary Young, DPH Southern Regional [email protected]
Prevention Block Grant: Jackie Bremer, DPH Northern Regional [email protected]
HW 2020 Capacity and Quality Focus Area: Lieske Giese, DPH Western Regional [email protected]
WIQI: Nancy Young, [email protected]
Websites:
IWHI http://www.instituteforwihealth.org/project-portal/
DPHhttp://www.dhs.wisconsin.gov/localhealth/index.htm Accreditation site (soon to be available) http://www.phawisconsin.com/
Tell us what you thought of today’s session:
http://4.selectsurvey.net/dhs/TakeSurvey.aspx?SurveyID=96M2l721
You will receive a link to the survey after the presentation as well.