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Quality Improvement Overview


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    1. <?xml version="1.0"?><AllQuestions /> <?xml version="1.0"?><AllResponses /> <?xml version="1.0"?><Settings><answerBulletFormat>Numeric</answerBulletFormat><answerNowAutoInsert>No</answerNowAutoInsert><answerNowStyle>Explosion</answerNowStyle><answerNowText>Answer Now</answerNowText><chartColors>Use PowerPoint Color Scheme</chartColors><chartType>Horizontal</chartType><correctAnswerIndicator>Checkmark</correctAnswerIndicator><countdownAutoInsert>No</countdownAutoInsert><countdownSeconds>10</countdownSeconds><countdownSound>TicToc.wav</countdownSound><countdownStyle>Box</countdownStyle><gridAutoInsert>No</gridAutoInsert><gridFillStyle>Answered</gridFillStyle><gridFillColor>255,255,0</gridFillColor><gridOpacity>50%</gridOpacity><gridTextStyle>Keypad #</gridTextStyle><inputSource>Response Devices</inputSource><multipleResponseDivisor># of Responses</multipleResponseDivisor><participantsLeaderBoard>5</participantsLeaderBoard><percentageDecimalPlaces>0</percentageDecimalPlaces><responseCounterAutoInsert>No</responseCounterAutoInsert><responseCounterStyle>Oval</responseCounterStyle><responseCounterDisplayValue># of Votes Received</responseCounterDisplayValue><insertObjectUsingColor>Red</insertObjectUsingColor><showResults>Yes</showResults><teamColors>Use PowerPoint Color Scheme</teamColors><teamIdentificationType>None</teamIdentificationType><teamScoringType>Voting pads only</teamScoringType><teamScoringDecimalPlaces>1</teamScoringDecimalPlaces><teamIdentificationItem></teamIdentificationItem><teamsLeaderBoard>5</teamsLeaderBoard><teamName1></teamName1><teamName2></teamName2><teamName3></teamName3><teamName4></teamName4><teamName5></teamName5><teamName6></teamName6><teamName7></teamName7><teamName8></teamName8><teamName9></teamName9><teamName10></teamName10><showControlBar>All Slides</showControlBar><defaultCorrectPointValue>0</defaultCorrectPointValue><defaultIncorrectPointValue>0</defaultIncorrectPointValue><chartColor1>187,224,227</chartColor1><chartColor2>51,51,153</chartColor2><chartColor3>0,153,153</chartColor3><chartColor4>153,204,0</chartColor4><chartColor5>128,128,128</chartColor5><chartColor6>0,0,0</chartColor6><chartColor7>0,102,204</chartColor7><chartColor8>204,204,255</chartColor8><chartColor9>255,0,0</chartColor9><chartColor10>255,255,0</chartColor10><teamColor1>187,224,227</teamColor1><teamColor2>51,51,153</teamColor2><teamColor3>0,153,153</teamColor3><teamColor4>153,204,0</teamColor4><teamColor5>128,128,128</teamColor5><teamColor6>0,0,0</teamColor6><teamColor7>0,102,204</teamColor7><teamColor8>204,204,255</teamColor8><teamColor9>255,0,0</teamColor9><teamColor10>255,255,0</teamColor10><displayAnswerImagesDuringVote>Yes</displayAnswerImagesDuringVote><displayAnswerImagesWithResponses>Yes</displayAnswerImagesWithResponses><displayAnswerTextDuringVote>Yes</displayAnswerTextDuringVote><displayAnswerTextWithResponses>Yes</displayAnswerTextWithResponses><questionSlideID></questionSlideID><controlBarState>Expanded</controlBarState><isGridColorKnownColor>True</isGridColorKnownColor><gridColorName>Yellow</gridColorName></Settings> <?xml version="1.0"?><AllAnswers /> Quality Improvement Overview Pooja Verma, MPH Senior Program Analyst Accreditation & QI NACCHO

    2. Objectives • Define QI in public health • Identify common frameworks for QI • Explain the connections between QI and accreditation • Describe how to build a culture of QI • Identify QI resources

    3. What is quality improvement? The use of a deliberate and defined improvement process focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community. * • * Definition developed by the Accreditation Coalition Workgroup and approved by the Accreditation Coalition on June 2009

    4. Characteristics of continuous quality improvement? “If you can’t describe what you’re doing as a process, you don’t know what you’re doing.” “the performance of anyone is governed largely by the system that he works in…” “In God we trust, all others bring data.” "It is not necessary to change. Survival is not mandatory." (Counte & Meurer, 2001; Blumenthal & Kilo, 1998; Kahan & Goodstadt, 1999; Deming, 1994); Quotes by Deming

    5. Which QI framework should I use?

    6. IHI’s Model for Improvement & Plan-Do-Study-Act

    7. Commonalities Among QI Frameworks • Similar tools and techniques (e.g. process mapping, SPC) • Similar processes • Measurement and analysis • Common to use multiple frameworks

    8. Quality Management Models • Malcolm Baldrige Criteria for Performance Excellence • Balanced Scorecard Approach • ISO 9000 Certification

    9. Accreditation & QI

    10. Accreditation: A platform for QI • Reaccreditation every 5 years • Annual reports demonstrating improvements • Domain 9: Evaluate and continuously improve health department processes, programs, and interventions

    11. PHAB Domain 9: Performance Management & QI • Domain 9 includes two standards:

    12. PHAB Standard 9.1

    13. PHAB Standard 9.2

    14. Building a QI Culture

    15. Levels of Quality Improvement

    16. Foundational Elements for Building a Culture of QI • Leadership Commitment • Infrastructure for QI • Customer Focus • Teamwork and Collaboration • Employee Empowerment • Continuous Process Improvement

    17. Leadership Commitment • Understand principles of QI • Dedicate resources to QI • Hold staff accountable to QI • Allow for staff time • Ongoing communication and transparency • Set clear QI priorities that are aligned with strategic goals • Continually manage change

    18. Leadership Commitment: Change Management • 1. Unfreeze • Awareness • Readiness • Urgency • 2. Transition • Empower • Build capacity • Build infrastructure • 3. Refreeze • Institutionalize • Sustain

    19. Leadership Commitment: Change Management “Human” Side: • How are staff responding? • Is there resistance? • Address arising issues immediately • Create “safe” environment • Continually assess culture “Process” Side: • What systems/processes must be put in place? • How can the way we do business improve? • Develop policies and plans

    20. QI Infrastructure • Performance Management System • QI plan • QI Council

    21. Performance Management System • 9.1.1 A: Engage staff at all organizational levels in establishing or updating a performance management system • 9.1.2 A: Implement a performance management system • 9.1.3 A: Use a process to determine and report on achievement of goals, objectives, and measures set by the performance management system Source: Turning Point Performance Management Collaborative, 2003.

    22. QI Infrastructure: Performance Management System • Ensure data driven decision making • Do not rely on a “hunch” • Establish performance measures • Identify data sources and data needs • Data analysis skills is a must! “The plural of anecdote is not data.” ~ Anonymous

    23. Measure 9.2.1: Establish a QI program based on organizational policies and direction • QI Plan • I. Definitions of quality terms • QI • PDCA • ….. • II. Desired future state of quality • III. Key elements of QI governance • Structure • Membership • Roles/responsibilities • Staffing support • Resources

    24. Measure 9.2.1: Establish a QI program based on organizational policies and direction • QI Plan • IV. QI training • V. Project selection and alignment with strategic plan • VI. Goals, objectives, measures, and time-framed targets • i. Performance measures • ii. Person(s) responsible/timeframes • iii. Activities/projects • iv. Prioritization process

    25. Measure 9.2.1: Establish a QI program based on organizational policies and direction • QI Plan • VII. Monitoring and reporting • VIII. Ongoing communication • i. Storyboards • ii. Staff meeting updates • iii. Board of Health meeting minutes • iv. …….. • VI. Evaluate QI plan • i. Progress toward G&Os • ii. Lessons learned • iii. Revise/update

    26. Align QI Efforts with Agency Strategic Direction PHAB Measure 9.2.1 A:Establish a QI program based on agency policies and direction PHAB Measure 5.3.2 A: The strategic plan must link to the quality improvement plan and CHIP PHAB Measure 9.1.1 A: Engage staff at all levels in the performance management system

    27. Performance Management System • Goals, objectives, measures, targets, results • Measurement and analysis • Review actual-to-target performance • Report results • Identify improvements/update plans * Adapted from Kitsap County Health Department

    28. QI Infrastructure: QI Council • Membership: • Senior Management • Key staff • Horizontal representation Function: • Oversee all QI activities • Sponsor QI projects • Monitor performance • Review and revise QI plan

    29. Customer Focus • Assess customer needs (e.g. surveys, forms, focus groups) • Address gaps in customer expectations • 9.1.4 A: Implement a systematic process for assessing customer satisfaction with health department services

    30. Teamwork and Collaboration • Break silos • Form functional QI project teams • Share lessons learned

    31. Employee Empowerment • 9.1.5 A: Provide staff development opportunities around performance management • 9.2.1 A: QI plan should include types of training available and conducted • Grant authority • Involve staff in decision making • Cultivate QI champions • Provide training!

    32. Continuous Process Improvement • Identify root causes • Reduce variations and redundancies • Improve quality • Increase customer satisfaction • Several improvement models exist • 9.2.2 A: Implement QI activities

    33. NACCHO QI TA & Resources: www.naccho.org/QI • Roadmap to an Organizational Culture of QI (Revised version and website coming soon!!) • Example QI plans and templates • Stories of Measurable Improvement in Public Health Database • QI 101 “Ready-made” Training for Staff • ABCs of PDCA Guide • Example QI storyboards and case examples

    34. Additional QI Resources • Public Health Foundation: www.phf.org • NC Center for Quality: www.ncpublichealthquality.org • National Network of Public Health Institutes: www.nnphi.org • American Society for Quality: www.asq.org • Institute for Healthcare Improvement: www.ihi.org

    35. Thank You! Pooja Verma Accreditation & QI NACCHO (202) 507-4206 pverma@naccho.org www.naccho.org/QI