Public Health Quality Improvement: Getting Started

Transcription

1 Public Health Quality Improvement: Getting Started Tanya Uden-Holman University of Iowa College of Public Health, Institute for Public Health Practice Julie Schilling Lee County Health Department

2 Objectives Provide an introduction to QI principles Learn how QI can help public health teams achieve results Provide an overview of QI methods Explore how to use the PDCA cycle

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5 Core Concepts Emphasis on processes and systems Measurable outcomes Reducing unwarranted variability Empowerment Continuous improvement Integration into an organization s culture

6 Characteristics of CQI Link to organization s strategic plan Training for personnel Mechanisms for selecting improvement opportunities Team formation Staff support for process analysis/redesign Policies that motivate and support staff participation

7 Elements for Success Developing the right culture for quality to flourish Attracting and retaining the right people to promote quality Devising and updating the right inhouse processes for QI Giving staff the right tools to do the job

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9 Goal Provide an awareness of quality improvement and how it can be used in public health to work smarter, not harder Intended Audience Board of Health, Board of Supervisors, Local Public Health Department Directors, County Leaders

10 Course Content CQI Myths Brief Overview of CQI Incorporating CQI into Organizational Culture Demonstrating How CQI works in Governmental Public

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14 Go to Course Catalog Search Text: CQI Search Type: All words

15 Public Health Quality Improvement Local Public Health Presented by: Julie Schilling, RNC, MA Administrator Lee County Health Department

16 NACCHO Accreditation Preparation and Quality Improvement Demonstration Site Project Participated in Round 2 for local public health agencies Supported by CDC and RWJ Foundation April 1, 2008 through November 30, 2008

17 Goal of Voluntary National Accreditation Improve and protect the health of the public by advancing the quality and performance of public health departments

18 NACCHO QI Project Conduct self-assessment using Operational Definition Prototype Metrics Assessment Tool Identify at least one measurable area for improvement Engage in QI process to address identified area

19 Why LCHD chose to participate Assess LCHD capacity to fulfill functions in Operational Definition Engage in QI activities to enhance capacity Provide feedback on application and development of standards Help prepare for accreditation

20 Self-Assessment Self-assessment team of agency management and selected staff Operational Definition Prototype Metrics Assessment Tool Calculate scores, analyze results, develop goals for improvement, and identify priority areas for QI process

21 Self-Assessment Team Administrator Program Directors cross section of agency, representing all service areas Two co-chairs of agency QI Team Staff nurse CCNC with agency for 18 years worked in several departments Project Coordinator: Michele Ross, LBSW

22 Self-Assessment Tool Operational Definition of a Functional Local Health Department (LHD) Metrics LHD Capacity Assessment Tool (Draft) Organized by 10 Essential Public Health Standards Performance Standards under each Essential Service Indicators under each Essential Service Illustrative Evidence for each indicator

23 Self-Assessment Process Instructions on Tool and Scoring Each team member reviewed tool and scored each area independently Team met together to discuss and compare scores agree on one final score for each area Submit final scores in on-line software Feedback on evaluation of metrics tool

24 Scoring Meet Standard: assure ES met, but do not have to provide all within your agency Scale: based on capacity to meet directly or through contracts. Comment section: non-contract partners. Score each indicator using the scale below: 0 No capacity 1 Minimal capacity (less than 25%) 2 Moderate capacity ( 25%-50%) 3 Significant capacity (51% - 75%) 4 Optimal (76%-100%)

25 Self-Assessment Results Computer generated color-coded report with scores calculated Analyze scores and results Identify two priority areas for improvement: Standard III-B: Data/information exchange on issues affecting population health Standard III-C: Provide health information to individuals for behavior change

26 Next Phase: QI Process Engage in QI process to address at least one of the identified priorities Select Focus Area: Maternal Child Health Program Select Core QI Team for developing, implementing, and evaluating QI process Use NACCHO approved QI Consultant to assist with development of QI plan and process Use Plan-Do-Study-Act (PDSA) cycle for QI process

27 Consultation and Training Two day workshop with Core QI Team and QI Consultant Consultant provided instruction on PDSA Consultant facilitated staff in setting AIMS statement, measures for improvement, and improvement plan Used QI tools: i.e. brainstorming, affinity & fishbone diagrams

28 Focus Area: MCH Need to increase public/private relationships with physicians and dentists in MCH service area to achieve effective care coordination and referral system Not receiving referrals Need to improve strategies for reaching and assisting families, and educating providers on MCH services

29 Plan-Do-Study-Act Cycle* Plan: Identify an opportunity and plan for improvement Do: Test the theory for improvement Study: Use data to study results of test Act: Standardize the improvement and establish future plans *Embracing Quality in Local Public Health: Michigan s QI Guidebook

30 Plan 1. Getting Started: Self-assessment 2. Assemble Team: Core QI Team 3. Examine Current Approach: Current state of affairs Discuss problem concerning identified focus areas in Standard III

31 Plan Brainstorming: discussed problem areas: Education to parents, providers Medical home rate provider education, coding, health literacy questions understandable Linking children to care increase EPSDT rates, referring children to care, decrease no-shows LCHD identify associated with DHS, service area

32 Plan After Brainstorming, draft AIM Statement: Educate the community on importance of health and well-being of children, adolescents and young adults, and how LCHD can link families to care.

33 Plan Affinity Diagram: o Arrange ideas into groups o Create header cards o Sort categories into those that are under LCHD s control and those that are not under LCHD s control

34 Plan Affinity Diagram Categories: 1. Resources 2. Priorities 3. Process 4. Marketing 5. Time

35 Plan Core QI Team sorted into what LCHD had control of and did not have control of: In Control: Marketing Process Priorities Out of Control: Time Resources

36 Plan Focus on in-control groups and did root cause analysis using a fishbone diagram: Priorities Marketing Process Educate Community

37 Plan Head of Fish: draft AIM Statement Fishbone branches: Marketing Priorities Process Core QI Team chose focus area: Marketing

38 Plan 4. Identify Potential Solutions: Based on root causes identified in step three, identify potential solutions. Identified 5 Marketing Opportunities (Improvement Theories): Website Target audience focus New identifier Internal communication Partnerships with medical and dental providers

39 Plan Core QI Team chose to focus on: Increase partnerships with providers as primary improvement theory for PDSA cycle. Decision based on: feasibility, cost, availability of baseline data, ease of data collection, clear outcomes, and NACCHO deadline.

40 Plan 5. Develop Improvement Theory What do you predict data will show? Outcomes? Discussed and agreed upon 4 key elements of final AIM Statement: What: increase partnerships, provide awareness of MCH services When: by October 31, 2008 How much: target at least one doctor s office in each county of MCH/Title V service area For whom: the providers

41 Plan Final AIM Statement: By October 31, 2008, LCHD will increase awareness of TitleV/MCH care coordination services by meeting with at least one provider s office in each county of the Title V/MCH service area.

42 Do 6. Test the Theory: Carry out the plan Core QI Team to implement Developed Action Register: What Who By When Assigned roles and responsibilities Core QI Team to meet regularly

43 Do Developed educational/marketing packets for providers Team members assigned to provide written materials for packet Approval by IDPH of marketing materials Identified 10 provider offices to target and assigned staff to make contacts Developed plan for dropping off packets and calling one week later to schedule presentation with provider Identified method for tracking data and monitoring progress or barriers

44 Do Goal for Performance: At least 60% of all targeted providers would accept and schedule in-person presentation by MCH staff person.

45 Check 7. Check the Results: use data to study results 7/10 (70%) agreed to in-person presentation Positive comments from providers 3 of 5 counties: at least one presentation scheduled/provided 2 of 5 counties: declined presentation but had reviewed booklet and stated understood service Core QI Team: booklet great help in organizing/explaining services; to use in future

46 Act 8. Standardize the Improvement or Develop New Theory: reflect and act upon what is learned Track referrals in next 3 months Followup with providers in two counties who declined presentation Implement marketing process with additional providers

47 Act 9. Establish Future Plans: sustain accomplishments; additional improvements; repeat PDSA cycle as needed Use PDSA cycle for another MCH improvement area Use in another agency program Incorporate into existing Agency QI Team and Process

48 Resources Embracing Quality in Local Public Health: Michigan s Quality Improvement Guidebook. The Public Health Memory Jogger II.