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Public Health Performance Improvement: Understanding Your Workflow

Gain understanding of workflow improvement in public health through collaborative development methodologies. Learn how to redefine processes, identify inefficiencies, and implement changes for improvement.

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Public Health Performance Improvement: Understanding Your Workflow

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  1. Public Health Performance Improvement:Understanding Your Workflow Multi-State Learning Collaborative September 17, 2009

  2. Today’s Presenters • Claudia W. Brogan, MS Ed • Associate Director, Training • Deb Bara, M A • Associate Director, Programs

  3. The Institute & Improvement Part of our Mission Embedded in previous work Others are applying the methodology to quality improvement in public health

  4. Fundamental Questions for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Who will participate in the improvement process?

  5. Collaborative Requirements Development Methodology

  6. Business Process Analysis Collaborative Requirements Development Methodology • think • How do we do our work now? • Define goals and objectives • Model context of work • Identify business rules • Describe tasks and workflow • Identify common task sets

  7. Business Process Redesign Collaborative Requirements Development Methodology • rethink • How should we do our work? • Examine tasks and workflow • Identify inefficiencies • Identify efficiencies with repeatable processes • Refine business processes and business rules • Remodel context of work • Restructure tasks and workflow

  8. Requirements Definition Collaborative Requirements Development Methodology • describe • How can an information system support our work? • Define specific tasks to be performed for optimized business processes • Describe the implementation of business rules • Describe in words and graphics how an information system must be structured • Determine scope of next phase activities

  9. What is a Business Process? A set of activitiesand tasksthat logically group together to accomplish a goal or produce something of valuefor the benefit of the organization, stakeholder, or customer

  10. Sally’s Sandwich Shop

  11. Business Process Matrix • A table that helps keep track of all the business processes you are mapping • Includes, for each business process: • Goal • Objective • Business Rules • Trigger(s) • Task Set • Inputs • Outputs • (Measurable) Outcomes

  12. Business Process MatrixDefinitions Goal Objective Business Rules Trigger Task Set Inputs Outputs Outcomes The major goal in terms of benefits to population health that is supported by the business process. A concrete statement describing what the business process seeks to achieve, pointing to quantifiable measures of performance. A set of criteria that defines or constrains some aspect of the business process. Event, action, or state that initiates the first course of action in a business process. The set of required activities or steps that are carried out in a business process. Information received by the business process from sources outside of the process. Information transferred out of a business process. The result of performing a business process, which indicates the objective has or has not been met.

  13. Example: Order Fulfillment

  14. Sally’s Sandwich Shop + + Meal = Sandwich Side Drink

  15. Transactions Context Diagrams Entity Entity Who: Entities What: Transactions (exchanges) Why: Outcome

  16. Sandwichstation Greeting Sandwich order Order detail Bill Sandwich Payment Change Drinkstation Drink order Drink Side salad Side order Sidestation Sally’s: Order Fulfillment Customer Completed Order Order taker

  17. Task D Task E Task Series 2 Task F Task Flow Diagrams Task Series 1 Task Task A Task B Task C Decision Choice A Choice B Information Flow

  18. Sally’s Task Flow Order Fulfillment Sally’s Lunch Stop Public Customer Arrive Provide Order Detail Receive Food Provide Payment End Start Order Taker Sally’s Lunch Stop No Give Food Record Order Complete Transaction Provide Bill Amount Greeting Food Ready? Yes Prep. Station(s) Receive Order Prepare Food Deliver Food to Cashier

  19. Questions so far? Q A &

  20. Stakeholder Analysis:Influence / Interest Matrix HIGH Interest LOW Influence HIGH Interest HIGH Influence High STRATEGY: Provide information, status updates STRATEGY: High levels of communication and attention, goal alignment Interest LOW Interest LOW Influence LOW Interest HIGH Influence STRATEGY: Passive relationship management STRATEGY: Active engagement, targeted communication, goal alignment, leverage influence Low Low High Influence

  21. Business Process Redesign Steps Choose Measure Examine Redesign Test C M E R T

  22. Choosing a Process to Redesign Is it inconsistent? Antiquated? Inefficient or redundant? High volume? High risk?

  23. 2 x 2 Table High Impact Low Low High Difficulty

  24. Building a Home in Mahoning County

  25. Why Measures Are Critical What can we measure to quantify differences in performance between the old process and the redesigned process? Provides objective, quantifiable way to see if new, redesigned process is really better than the old one

  26. Public Health Application

  27. ExamineSymptoms of Inefficiency Duplication of effort Unnecessary tasks Long cycle times Processes unclear to staff Lots of activity for an unimportant task Quality checks too distant from the process

  28. Principles of Redesign •Eliminate unnecessary tasks •Streamline tasks•Group administrative tasks •Perform steps in parallel • Use multiple versions of the process •Minimize handoffs • Find and remove bottlenecks •Smooth work flow •Avoid cumbersome translations and interfaces • Use automation •Help all process participants feel ownership•Measure outcomes, not tasks or handoffs

  29. Pilot Testing Test before invest Start on small scale Gather feedback

  30. The PDSA Cycle - Objective - Questions & predictions (why) - Plan to carry out the cycle (who, what, where, when) - Plan for data collection - What changes are to be made? - Next cycle? - Complete the analysis of the data - Compare data to predictions - Summarize what was learned - Carry out the plan - Document problems and unexpected observations - Begin analysis of the data SOURCE: Institute for Healthcare Improvement, Improvement Guide, P 10 • Present: So many of you in the room are probably familiar with this diagram and may have used the

  31. The PDSA Cycle A A S A P A P P Changes that result in improvement S D S S D P D D DATA Hunches, theories, ideas SOURCE: Institute for Healthcare Improvement, Improvement Guide, P 10

  32. Questions and Discussion Q A &

  33. Thanks for attending! www.phii.org For more information about the Public Health Informatics Institute, visit us on the web at

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