Roadmap to QI

1. Roadmap to QI Ty Kane Sedgwick County Health Department KPHA Pre-Conference Session September 20, 2011 Today’s Objectives: • Briefly describe SCHD’s initiative to begin developing a culture of QI • Reviewing the elements of a Quality Improvement Plan • Define “quality culture assessment” (with a framework provided) • Review the organizational “QI Continuum”

2. “15 SLIDES IN 15 MINUTES”

3. Building a QI Culture at a Local Health Department NOV ‘08 MAR ‘09 NOV ‘09 MAR ‘10 AUG-DEC ‘11 JAN ‘11 FEB ‘11 Launch capacity building plan Launch QI plan and policy .5 FTE for APQI PHAB vetting session First Q-Team meeting 6-month leader training All staff QI meeting

4. Quality Improvement Plan What is a QI Plan? • A written description of how an agency will manage and evaluate QI efforts. Key Elements • Description • Definitions • Administration • Project Selection • Training • Tools • Communication • Responsibilities • Evaluation • Sustainability

5. QI Culture Assessment The Six Dimensions of a Department’s Quality Culture And Radar Chart Rating Scale NOTHING IN PLACE JUST GETTING STARTED MOVING IN THE RIGHT DIRECTION ADEQUATE – WE HAVE MADE GOOD PROGRESS OVER THE LAST YEAR VERY GOOD PERFORMANCE AND HAVE PLANS IN PLACE TO EXPAND THE QI PROGRAM THROUGHOUT THE ORGANIZATION WE HAVE INSTITUTIONALIZED QI Source: J Public Health management Practice, 2010, 16(1), 72-78

6. Roadmap to an Organizational Culture of QI Pooja Verma, NACCHO, APQI pverma@naccho.org Ty Kane, SCHD tkane@sedgwick.gov

7. Roadmap to an Organizational Culture of QI EXIT 6 EXITS 4-5 6. QI CULTURE 4. SOME FORMAL QI ACTIVITIES 5. FORMAL AGENCY-WIDE QI EXIT 3 3. INFORMAL OR AD HOC QI ACTIVITIES EXITS 1-2 1. NO KNOWLEDGE OF QI 2. NOT INVOLVED IN QI ACTIVITIES

8. Roadmap to an Organizational Culture of QI • Characteristics • Lack awareness/understanding of QI • Overwhelmed with other issues • Satisfaction with status quo • Don’t value/link QI to PH practice • Strategies for Transition • Marketing QI to leaders • Leadership & staff training • Share stories of success • Intentionally manage change EXIT 1 NO KNOWLEDGE OF QI EXIT 1

9. Roadmap to an Organizational Culture of QI • Characteristics • Begin to embrace/understand QI • Problems are ignored/buried • Staff are viewed “hired hands” • Data are not available or not used • Strategies for Transition • Mentorship • Integrate QI in agency planning • ‘Firefighters’ to problem solvers • Task-focus to QI project focus • Market QI thru successes EXIT 2 Not Involved With QI Activities

10. Roadmap to an Organizational Culture of QI • Characteristics • Data not routinely used • “Pseudo-QI” • QI not part of organization’s strategy • Few lessons learned and sharing • Afraid of finding problems • Strategies for Transition • Share stories organization-wide • Build learning communities • Performance management • Demystify QI • Celebrate all improvements • Address resistance to change EXIT 3 INFORMAL OR AD HOC QI ACTIVITIES

11. Roadmap to an Organizational Culture of QI • Characteristics • Greater reliance on data • Fewer ‘firefighter’ supervisors • People viewed as critical to success • QI is a part of the job • In-house QI TA available • Strategies for Transition • QI division or function • Sharing QI results externally • More working across silos • Increase reliance on data • Performance Management • Draft a comprehensive QI plan EXIT 4 FORMAL QI ACTIVITIES IMPLEMENTED IN SPECIFIC AREAS ONLY

12. Roadmap to an Organizational Culture of QI • Characteristics • More data-driven decisions • QI plan individualized to setting • Integration of measures into “system” • QI integrated in operational plans • QI becomes more visible • Standardization in processes • Learning/sharing culture • QI in position descriptions • Customer-focus • Demonstrate ROI • QI policies • Strategies for Transition • QI on all meeting agendas • Leadership that walks the talk • Supervisors are QI coaches EXIT 5 FORMAL AGENCY-WIDE QI

13. Roadmap to an Organizational Culture of QI • Characteristics • Distribution of results to staff, stakeholders and customers • QI champions throughout organization • Ongoing training and networking • Data and tools used daily • Customer is front and center • Integrate with strategic plan • Getting better all the time • Self-assessment • Problems are “gold” • Sustainability • Caution: Digression is easier than progression EXIT 6 QI CULTURE

14. The following characteristics were identified throughout every phase in the roadmap: • Selecting employees who are well-suited to learn and teach QI techniques • A Collaborative AND learning culture • QI should be integrated into strategic plan • Data analysis skills AND problem solving skills (tools) • Leadership (including governance) must be engaged and have knowledge • Theoretical vs. practical balance (50,000 ft and 5 ft view) • Flexibility in decision-making (at all levels) is seen as critical piece to success • Supervisors are expected to engage in QI and see their job not as about fighting fires but rather, improving processes • Customer focus • QI should be integrated into funder requirements (expected as program work, not “extra”)

15. Questions and Comments Ty Kane, MPH Community Health Analyst Sedgwick County Health Department tkane@sedgwick.gov office phone - (316) 660-7368