The Phases of Continuous Quality Improvement

1. PLAN DO STUDY ACT The Phases of Continuous Quality Improvement Pam Sakamoto, Sr. Public Health Nurse, CCS Program Cynthia Coutee, Office Assistant III, TB Control Program May 1, 2012

2. Objectives • What is Continuous Quality Improvement (CQI) • Review of Plan Do Study Act (PDSA) Cycle • Flow Charting Exercise.

3. What is Continuous Quality Improvement? Continually improving our services to reach the most people in the most effective manner Quality a word used throughout our lives in our homes, in entertainment and in work.

4. Quality: A degree of excellence • Important to our customers (both internal and external) • Reducing costs and improving efficiency and effectiveness • Attracts and retains quality staff

5. Continued….. • Continuous Quality Improvement is a transformational change in organization culture. • The Plan, Do, Study, Act (PDSA) cycle is the basic tool to guide continuous quality improvement. • The cycle is executed by a team of the frontline staff with their collective experience and knowledge, to improve work related processes and outcomes.

6. CQI Prevents… Managers, supervisors and employees sometimes introduce solutions to the workflow process without knowledge of what is the real problem. So the solution doesn’t fix the problem.

7. What are the benefits of CQI? • Improved staff morale • Flexibility to meet service need changes • Ability to determine & track program integrity and effectiveness  • Allows creative/innovative solutions.

8. Who benefits from CQI? • Clients and customers • All levels of agency staff, volunteers, and students.

9. What can be accomplished by using CQI? • Improved quality of care • Improved health outcomes • Streamlined program and clinic operations • Enhanced sense of teamwork and ownership.

10. CQI Tool PDSA Wheel Plan Do Study Act

11. Plan-Do-Study-Act Wheel

12. Tools Within the Tool • Brainstorming-process of generating ideas, causes or solutions to address an issue. • Root cause analysis-a systematic approach used to get to the true “root” of a problem. • Prioritization-process of quickly and easily reducing all the options to a manageable number by either multivoting or nominal group technique.

13. Continued….. • Force field analysis is a structured process that helps a group identify, discuss, evaluate, and understand the various forces for (driving forces) and forces against (restraining forces) a proposed change. • Flow chart diagrams are graphic representation of a process in sequential order.

14. Flow Charting • What it Does: It promotes an understanding of a process pictorially, showing variations in a process its complexity, and it promotes standardization. • Why Should it be Used? To help staff or a CQI team gain a common understanding of the steps in a process; and it aides in training employees. • When should you use a flow chart? When steps in a process need to be clarified for the purpose of planning, and when members of a team do not know a process.

15. STANDARDIZED SYMBOLS Start or End Decision Point Step in Process Flow Line Stop

16. Steps to Creating a Flow Chart • 1. Identify process 2. Have the right players involved 3. Agree on amount of detail 4. Define where process starts and ends 5. Start with the big picture 6. Begin to draw flow chart 7. Brainstorm list of all event, activities and decisions on a flipchart 8. Arrange steps in the order they occur 9. Draw flow chart using appropriate symbols 10. Use arrows to show flow in process 11. Team must agree upon all steps 12. Once steps are listed and all agree; you can evaluate the process Exercise

17. Managers, supervisors and employees sometimes introduce solutions to the workflow process without knowledge of what is the real problem. So the solution doesn’t fix the problem. CQI Prevents…

18. Current Check Request Process Ministry Leader or appointee comes to Finance office and requests a check for an upcoming event. 1 1  Request is given to Treasurer; Treasurer okays for Financial Secretary to make check in requested amount. 2  Ministry Leader receives check make purchases and return receipts to Treasurer. 3  4 Treasurer reviews receipts (if available). If amount exceeds initial amount received, a reimbursement is issued in cash.  Reimbursement disbursed with. 5

19. Revised Check Request Ministry Leader submits dated request to Finance Office with event/program information 1  2 Request is given to Treasurer for review  3 Treasurer reviews amount of request and checks availability of funds.  No Does request exceed $200.00? 4 4a Treasurer reviews date of submission Go to step 5  Yes 4b Treasurer forwards request to Board of Trustee for Consideration allow 7 day response time)  No 5a Is request 1 month in advance of event? 5 Request is denied Ministry Leader notified.  Yes 5b Treasurer or Board approves requested amount  6 Check is issued with signed request form of approval and instruction for receipt handling

20. Questions

21. SOLANO PUBLIC HEALTH Mission Statement: • To optimize the health of the community through individual and population-based services which promote health and safety through prevention and treatment of disease and injury.