Improving Planning Processes in Public Health

1. Improving Planning Processes in Public Health Marlene (Marni) Mason MarMason Consulting, LLC Minnesota MLC-3 Collaborative April 4, 2011

2. Today’s Agenda • Welcome and Revised Format (Kim) • Method to Improve Planning Processes and how it applies to building capacity in public health • Individual or Group discussion and report out (15 min.) • The Quality Trilogy; Quality Planning, Quality Control and Quality Improvement • Individual or Group discussion and report out (15 min.) • Q&A and Next Steps MarMason Consulting

3. Projects to Conduct Planning • Some projects to plan services to address new or emerging issues aren’t a good fit for “traditional” quality improvement methods and tools, such as Rapid Cycle Improvement (RCI) • Excellent for the Collaborative or Breakthrough Method from Institute of Healthcare Improvement (IHI) • Do benefit from AIM statements and from using the Plan-Do-Study-Act cycle MarMason Consulting

4. When is Quality Planning project appropriate? • Service/process has never existed before • Customer requirements are not known • Existing service/process performance is not capable of meeting customer requirements • Service/process is ad hoc; extremely variable; never been well defined or worked on before as a whole • Unstable environment – major market, technology, organizational change • No performance data exists or would take excessive time/expense to collect data MarMason Consulting

5. Quality Planning • J. Juran* described the three basic managerial processes to manage quality as interrelated: • Quality planning (QP) • Quality control (QC) and • Quality improvement (QI) • Purpose for QP is to provide the organization with the means to provide services that can meet client and stakeholder needs. • Quality control is needed to stabilize a process and to hold the gains made through QI efforts. *Juran on Planning for Quality, pg. 11 MarMason Consulting

6. QP compared with QI • How does quality planning differ from project-by-project quality improvement? • Juran uses example of an alligator infested swamp and the difference between removing alligators individually (QI) or draining the swamp to remove all the alligators at once (QP).* • Another description is the difference between improving an existing work activity, action or intervention and the method used to design a new program or activity. *Juran on Planning For Quality MarMason Consulting

7. Application in PH • PH already has expertise in parts of the quality planning process • MAPP, Sector Mapping, Partner Tool, Program Development, many others • Strengthen QP step of optimizing program to meet HD and stakeholder needs • Force Field Analysis, Meeting Effectiveness, Interrelationship Digraph, Failure Mode Analysis, many others • Strengthen step of optimizing the work processes to achieve desired results • Common QI tools-work flows, fishbone diagrams, PDSA cycles • Implement only after program and work processes have been optimized to deliver results MarMason Consulting

8. QP Roadmap* • In broad terms, QP consists of developing services and processes required to meet stakeholders’ needs. • Identify stakeholders and their needs • Develop an activity or program to address the needs (establish stakeholder related measures) • Optimize the program or service activities to meet health department needs • Develop a work process to conduct the services and interventions • Optimize the work process, prove that it delivers the results needed • Implement the program or service in the health department *Juran on Planning For Quality MarMason Consulting

9. Quality Planning Cycle • Take Action • Fully implement if expected outcomes achieved • Initiate QI if outcomes not achieved • Define Opportunity & Stakeholder Needs • Problem/Opportunity to Address • Identify clients/stakeholders and needs • Translate stakeholders needs • Establish performance measures based on needs • Monitor Impact/Results of Service • Measure Outputs and Outcomes • Compare actual results to expected results • Design & Pilot Service/Process • Develop activity to meet needs • Establish outcome measures • Implement service/process MarMason Consulting

10. Application of QP:Consultation for City Planners • Original concept: Hire a temporary, part-time health educator to provide consultation services to city planners to include built environment concepts into next round of plans. • QP tools used: customer interviews • Results: Customers didn’t need the services; program not implemented. MarMason Consulting

11. Application of QP:Healthy School Grants Program • Original concept: Offer mini-grants to school districts to choose from a menu of “best practice” policies and systems-level interventions • QP tools to be used: customer needs analysis, benchmarking, process controls, performance measures • Results: TBD MarMason Consulting

12. Discussion and Comments • Each group/individual take 10 minutes to discuss current program planning and how they might benefit from quality planning efforts • Report out from 2-3 groups • Comments and Questions MarMason Consulting

13. Adapted from Juran on Planning for Quality, Joseph Juran Optimize the design of the activities and services Identify clients and stakeholders (List of Stakeholders) Establish activity/service goals., objectives and performance measures Identify stakeholder needs (List of Needs in client language) Implement the service and measure outputs & outcomes Translate client needs (in our language) Compare actual outcomes to expected outcomes Establish performance measures based on needs Initiate QI, if not meeting expected outcomes or fully implement program, if meeting outcomes Develop activities and services to meet MarMason Consulting

14. Examples of Tools for Quality Planning • Sector Mapping to identify Key Stakeholders and their needs • Force Field Analysis to identify driving forces and restraining forces • Meeting Effectiveness Tool to improve the participation and contribution of community partners MarMason Consulting

15. Sector Maps for Planning – Example of Public Sector Office of the Insurance Commissioner Governor / Legislature • School Boards • Public Schools (K-12) • Private Schools (K-12) • Health & Human Services • Center for Disease Control & Prev. • Center-Medicaid &Medicare Srvcs • Fed. Drug • Administration Employment Security Department • Department of Health • Community & Family Health • Women, Infants & Children • Licensing Boards Tribal Government Local Health Jurisdictions Health Care Authority Rural & Community Health Centers Dept. of Social & Human Services Local Government Public Library System Indian Health Service State Board of Health Bullets refer to examples of organizations and are not a comprehensive listing. MarMason Consulting

16. Example of Community-Based Sector • Service Organizations • Thousands of community-based agencies: specific partners will be identified in each community United Way Community Centers • Community Health Centers • Federally Qualified Health Centers • Migrant Health Centers Senior Centers • Youth Associations • YMCA / YWCA • Boys & Girls Club • Boy & Girl Scouts of America • Campfire Girls and Boys Faith-based Community Organizations Communities of Color Organizations • Community-based Daycare Sites • All ages • Birth to 3 childcare American Association of Retired Persons • Youth Sports Associations • Little League • Pop Warner • Soccer, etc Community Health Alliances Churches, Temples & Mosques Bullets refer to examples of organizations and is not a comprehensive listing. MarMason Consulting

17. Example of Target Populations MarMason Consulting

18. Force Field Analysis • Why use it? • To identify the forces and factors in place that support or work against the solution of an issue or problem so that the positives can be reinforced and/or the negatives eliminated or reduced. • What does sit do? • Presents the positives and negatives of a situation so that they can be compared • Forces people to think about all aspects of making a desired change a permanent one • Encourages honest reflection and that people to agree about the relative priority of factors on each side of the “balance sheet” PH Memory Jogger pg. 63 MarMason Consulting

19. How to Build a Force Field Analysis • Draw a large letter “T” on a flip chart • Above the top of the T write the issue or problem • To the far right of the top of the T, write a description of the ideal situation the team would like to achieve • Brainstorm the forces that are driving toward the ideal situation. • Forces may be internal or external and should be listed on the left side of the vertical line below the T. • Brainstorm the forces that are restraining movement toward the ideal situation. • Forces may be internal or external and should be listed on the right side of the vertical line below the T. MarMason Consulting

20. Fear of Public Speaking Ideal state: To speak confidently in any situation + Driving Forces Restraining Forces – MarMason Consulting

21. Optimizing the Chance of Success • Once the Force Field Analysis has been constructed: • Prioritize the driving forces that can be strengthened • Identify restraining forces that would allow the most movement toward the ideal state if they were removed • Achieve consensus through discussion or by using ranking methods like Multivoting or Nominal Group Process • Remember that it is often more helpful to remove barriers than to push the positive forces to create positive change MarMason Consulting

22. MarMason Consulting

23. Example- AIM for Meeting Effectiveness • What are We Trying to Accomplish? Increase the effectiveness of Community Health Improvement Plan (CHIP) coalition meetings and maximize stakeholder participation. We do this in order to increase member engagement and contribution to the implementation of the CHIP. MarMason Consulting

24. How Will We Know When We Get There? Measurements • Increase in meeting attendance (% of members that regularly attend) • Increase in effectiveness (% of members rating meetings as effective or valuable) • Increase in engagement (% of members rating their commitment as high) • Increase in participation (% of members that contribute resources to CHIP activities) MarMason Consulting

25. Evaluating Meeting Effectiveness MarMason Consulting

26. How Will We Know When We Get There? Measurements • Increase in meeting attendance (% of members that regularly attend) • Increase in effectiveness (% of members rating meetings as effective or valuable) • Increase in engagement (% of members rating their commitment as high) • Increase in participation (% of members that contribute resources to CHIP activities) MarMason Consulting

27. Effectiveness Ratings – Adams Co., IL MarMason Consulting

28. The Quality Trilogy (adapted from Juran) Take Action Define Opportunity & Stakeholder Needs Design & Pilot Service or Process Monitor Impact / Results of Service MarMason Consulting

29. Important Leadership Activities • Be intentional about determining whether the improvement effort in the agency is appropriate for QI or if it would be more successful with QP. • Train the team in QP methods and tools • Support the implementation of the team’s design and results • Recognize and celebrate QP team accomplishments MarMason Consulting

30. Discussion and Comments • Each group/individual take 10 minutes to discuss how the methods and tools for improving planning processes could be used in your agency • Report out from 2-3 groups • Comments and Questions MarMason Consulting

31. In Summary… • Using Quality Planning methods and tools can improve public health planning processes • Build on proven practices from other health departments • Be intentional about which methods and tools to use for improvement based on the topic and needs • Remember to plan for holding the gains and sustaining improvement (quality control) MarMason Consulting

32. What questions do you have? MarMason Consulting