Embracing Quality in Local Public Health

Transcription

1 Embracing Quality in Local Public Health Michigan MLC Quality Improvement Showcase Recognizing our Accomplishments, Sustaining our Gains, and Planning for our Future! Summary Report Prepared by:

2 Michigan Multi-state Learning Collaborative Quality Improvement Showcase: Recognizing our Accomplishments, Sustaining our Gains, and Planning for our Future Brief Report Compiled by the Michigan Public Health Institute s Center for Healthy Communities, Office of Accreditation and Quality Improvement Introduction On March 24, 2011 Michigan held its final MLC-3 Showcase event, Embracing Quality in Local Public Health: Recognizing our Accomplishments, Sustaining our Gains, and Planning for our Future. Participants included members of QI teams from 13 local health departments, members of the Michigan MLC-3 Steering Committee, and other partners. Additionally, Jean Chabut, Chief Administrative Officer of the Public Health Administration, gave the welcome address, and Bobby Pestronk, Executive Director of the National Association of County and City Health Officials (NACCHO) and former Genesee County Michigan Health Officer, provided a luncheon keynote address. Over the course of the day-long event, attendees participated in three facilitated mind mapping sessions focusing on what Michigan has accomplished, how Michigan s gains can be sustained, and plans for future QI work. Through this process participants identified priority strategies and action steps that can be used to sustain the quality improvement (QI) work Michigan accomplished through the MLC, as well as continue to grow the use of QI throughout the state. Participants also celebrated the many accomplishments of the MLC in Michigan over the past five years, including the development and use of Embracing Quality in Local Public Health: MI s Quality Improvement Guidebook, the QI Learning Sessions and QI trainings that were designed and implemented, use of the mini-collaborative and mentor models to support health departments work, development of story board templates and step-by-step QI tool trainings, and increased capacity and expertise in QI and Accreditation at the State, local, and Institute levels. 2

3 Results of Facilitated Mind Mapping Sessions Showcase attendees were assigned to one of three groups to engage in a structured brainstorming process called mind mapping. Each of the three groups spent the morning creating their mind maps by generating ideas related to one of the day s themes recognizing accomplishments, sustaining gains, and planning for the future. At the close of the morning session, each group selected its top priorities using dot voting. Facilitators worked during the break between sessions to identify the top three votedon areas from each mind map and brought these three priority areas back to the groups, which spent the afternoon breakout sessions creating action steps around the identified priorities. Below, each mind map is presented followed by a summary of the groups proposed action steps. 3

4 Recognizing our Accomplishments Figure 1: Recognizing our Accomplishments Mind Map 4

5 The top three priority areas selected by the Recognizing our Accomplishments group included: 1. Communicating the Use and Value of Data A fundamental principle of QI is that it involves using data to identify problems and to track changes. Using data in this way is a challenging skill that must be effectively taught and regularly practiced. A significant accomplishment of the MLC was that it convinced participating public health practitioners that data have value and it demonstrated how data can be used effectively to solve public health problems. This shift in understanding must be expanded beyond MLC participants to educate practitioners and stakeholders at all levels regarding the importance of using data to drive improvements in public health processes such that the public health community broadly in the state sees data as a resource for informing action. Action can be taken at the local, state, and national levels to keep the use of data and QI in the forefront for health departments. Recommended action steps at the local level include: 1. Promote, encourage, and support attendance by local public health practitioners at QI and other data-related training opportunities to increase capacity. 2. Include QI and reviewing data as a topic on the agendas for local health department planning meetings. 3. Educate local governing entities on the importance of using data to make decisions and inform QI projects, and provide information on national public health priorities around QI. 4. Develop QI champions at local health departments to spread the use of QI and provide on-theground training on how to use data to identify problems and make improvements. Recommended action steps at the state level include: 1. Incorporate more standards related to QI and using data to make decisions into the current Michigan Accreditation process. 2. Convene annual QI training to share best practices with practitioners at the local and state levels to help increase QI capacity and build a culture of QI. Recommended action steps at the national level include: 1. Create a method for sharing national best practices related to public health QI activities. Recommended action steps specific to providing education on best practices in data collection and use include: 1. Create and disseminate SMART objectives that are public health specific that can be used to guide data collection in public health agencies. 5

6 2. Build capacity within organizations to create processes that facilitate collecting data in a useable format. 3. Disseminate data in a manner that makes it useful as a tool to identify opportunities for improvement and as a tool to inform action. 2. Opportunity to Learn and Apply QI Another success of Michigan s MLC-3 experience was the opportunity to build QI capacity by providing local health departments with the training and support they needed to successfully complete a QI project. Michigan s mini-collaborative teams were able to complete a PDSA cycle because they received intensive training and ongoing support, which were designed to ensure that teams experienced the project as a learning opportunity. Trainings were designed based on the needs of adult learners and the recognition that having the opportunity to actively work with new ideas is a critical part of the learning process. As such, the trainings involved exercises, hands-on activities, discussion, and applied project work, in addition to brief lecture-style presentation of materials. Moreover, ongoing technical assistance and support was multi-modal and designed to be just-in-time. Teams had access to one another, to a mentor from another department who was experienced in QI, to a QI expert, and to the broader core project team. They were also provided with webinars on QI topics as needed. Finally, this project required teams to complete a QI project using PDSA methodology and report on their project regularly using QI language and the PDSA steps. Identifying what can be learned from the success of this model and finding opportunities to use components of this model in other projects is critical to capitalizing on the accomplishments of this grant. Recommended action steps include: 1. Search and apply for additional funding to support dedicated staff time for QI activities. 2. Allocate staff time for QI to remove the perceived burden of these activities. 3. Develop teams and projects that involve staff from multiple disciplines to bring in different areas of expertise. 4. Share the results of QI efforts with local public health peers in and beyond Michigan. 3. Building Relationships An important success of the MLC-3 project in Michigan was that it brought together staff within and across health departments as a learning community to work together on QI. Project teams were strongly encouraged to include staff with varied roles and from multiple programs. Additionally, the minicollaborative model and the use of mentors allowed teams to work with other local health departments, sharing experiences, ideas, and even resources. Working with staff from different programs and departments built relationships that facilitated project success. In order to successfully foster implementation of QI within and across local health departments, practitioners must have the opportunity to continue to build relationships that encourage sharing of expertise and best practices, and that help move public health from operating in silos toward greater collaboration and integration. 6

7 Recommended action steps include: 1. Engage in transparent and frequent communication about QI activities with colleagues both within and across health departments. 2. Disseminate success stories about implementing QI in local public health. 3. Create opportunities for joint projects between local health departments. 4. Establish a state-wide, web-based resource page that outlines local public health QI projects and their outcomes. 7

8 Sustaining Our Gains Figure 2: Sustaining Our Gains Mind Map 8

9 The top three priority areas addressed by the Sustaining our Gains group included: 1. Institutionalize a Culture of Quality in Public Health QI projects are more successful in a supportive environment that is characterized by a culture of quality. Support for QI can mean many things, including providing staff at all levels with QI training, incorporating QI into job descriptions, discussing QI projects on a regular basis, encouraging transparent sharing of information about both successes and areas for growth, and developing systems that allow staff to use data to inform their work. While this project helped local health departments get started on their QI journey, more work is needed to move health departments toward creating a culture of quality and embracing QI as a standard way of operating in public health. Recommended action steps include: 1. Create and/or promote trainings for public health practitioners in QI methodology, including undergraduate and graduate school courses, and training opportunities for practitioners. 2. Incorporate QI into the jobs of public health workers by: a. Including questions about QI experience during the interviewing process. b. Incorporating QI into position descriptions. c. Including QI training in new staff orientation activities. d. Creating requirements for ongoing QI training for local health department staff. 3. Address QI (both training/education opportunities and QI project work updates) during meetings at all levels, including: a. Staff meetings b. Planning meetings c. Meetings of local governing entities d. State-level meetings of local public health practitioners, such as meetings of the Michigan Association of Local Public Health and other similar groups. 4. Incorporate language into Strategic Plans that emphasizes the use of QI. 5. Provide templates of QI policies and plans that health departments can use as a model for the development of such policies and plans at the local level. 6. Recognize QI accomplishments frequently, both at the local and state levels, to create pride and encourage QI. 2. Building Leadership Commitment to QI Leadership support is crucial to the ongoing success of QI activities and the development of a culture of quality. Michigan s MLC-3 teams found that leadership buy-in and openly communicated support of QI activities was critical to the success of their projects and to the continued use of QI following the completion of their projects. However, gaining and maintaining leadership buy-in can be challenging, especially when budgets are strained and attention is divided across so many priorities. It can also be challenging for leaders, who have little QI or performance management experience, to identify strategies to express their commitment to QI. In order to sustain the gains of this project, it will be 9

10 critical to identify strategies to focus the attention of public health leaders on QI and to help leadership identify strategies to support the use and expansion of QI methods in public health. Recommended action steps include: 1. Implement an open door policy that enables staff at all levels to bring ideas for possible QI projects to leaders. 2. Create QI champions/leaders within local health departments through both education and by making it a part of certain staff s job descriptions. 3. Communicate and recognize QI successes, including within the health department, at meetings of local elected officials, and at the state level. 4. Educate local practitioners in QI methodologies through use of QI mentors and other speakers presenting on QI methodology. 5. Participate in QI activities beyond the health department, including the Michigan Accreditation Quality Improvement Supplement and the National Voluntary Accreditation program. 3. Education, Tools, and Support Proper education, available information, and ongoing support can help foster success in QI activities. Local health departments that participated in MLC-3 were provided with education, technical assistance, and support throughout their projects, in the absence of the grant, the public health community in Michigan will need to take steps to ensure that these types of resources are available for all local health departments in Michigan on an ongoing basis. In order to sustain the QI work done in Michigan, practitioners across the state will need access to ongoing education and tools, as well as support and technical assistance. Recommended action steps include: 1. Identify or create, and disseminate, training modules or a toolbox of QI information. 2. Provide a list of available QI mentors within the state. 3. Create and regularly utilize a listserv for QI that enables resource sharing and discussion between different local health departments. 4. Collaborate with academia to bring further expertise to local health departments QI efforts. 5. Develop a website or other forum where information about QI projects could be shared on an ongoing basis. 10

11 Planning for Our Future Figure 3: Planning for Our Future Mind Map 11

12 The group that focused on Planning for Our Future suggested the following action steps: 1. Build State Infrastructure to Support Quality Improvement in Public Health MLC-3 played a critical role in providing a structure for advancing QI work in Michigan, and in order to ensure Michigan continues to adapt as the world of public health shifts and changes, it will be necessary to have structures in place to fill the gap left by the MLC. However, Michigan faces significant resource challenges that will limit the state s ability to replicate the structures put in place through MLC. As such, low- or no-cost strategies will be required. Recommended action steps include: 1. Develop a home for QI in Michigan on the internet. 2. Develop a system for gathering and sharing promising practices. 3. Create a network of mentors. 4. Provide workshops on QI within local health departments. 5. Provide training on QI that is available to all local health departments. 6. Provide networking opportunities for local health departments that are using QI. 7. Advocate for and communicate with local health departments regarding nationally emerging efforts that represent the future of public health, such as national accreditation. 8. Establish local and state QI-focused Groups, or expand the focus of existing groups to include a QI focus. 2. Engage Leadership in the Movement to Embrace QI in Public Health Leadership engagement is key to the success of any QI effort, large or small. Engaging existing leadership and developing strategies for engaging new leaders as leadership transitions occur at the local, state, and national levels will be critical to ensuring that QI has a place in the future of public health. Recommended action steps include: 1. Develop a set of key messages for leadership around QI that effectively communicate that: a. QI is an asset to public health b. QI has resulted in quantifiable and qualitative improvements c. Leaders that have shown commitment to QI have been successful in achieving their goals 2. Tailor messages to the needs and concerns of specific audiences. 3. Identify strategies for delivering messages effectively. 4. Collect information on promising practices in engaging leadership. 3. Connect QI to the National Vision for the Future of Public Health QI is one component of a broader vision for the future of public health as reflected in the National Voluntary Accreditation Program. Aligning with the 10 essential services, using data to identify and 12

13 address health priorities as a public health system, and utilizing performance management and evaluation to make decisions and improve performance are relatively new concepts to many local public health practitioners, as was QI when MLC began. In order to ensure that the public health community in Michigan effectively plans for and adapts to these changes, Michigan s local health departments will require information, training, support, and opportunities to practice implementing new ideas. This is the kind of experience MLC-3 provided local health departments, and similar strategies will be required to prepare Michigan for broader changes in public health. Recommended action steps include: 1. Explore alignment between state and PHAB accreditation standards. 2. Identify incentives and benefits of using QI and performance management. 3. Ensure Michigan is represented on PHAB. 4. Develop strategies for educating Michigan s local health departments about PHAB as it evolves. 5. Engage all local health department staff in information sharing efforts, not only leadership. 6. Develop state and local workgroups to track national trends related to QI in public health. 7. Explore opportunities to realign local health department structures with the 10 Essential Services. 13

14 Future Plans The groups proposed action steps align with four major themes. First, public health staff will require ongoing opportunities for training and technical assistance in QI methodology in order to implement QI activities. Secondly, leadership support is crucial to the success of QI in health departments. Third, the opportunity to share best practices and learn from one another s QI project experiences would be valuable. Fourth, Michigan benefits from remaining involved in public health QI efforts as they unfold on the national level. There are activities currently occurring throughout the state that begin to address each of these themes, providing a starting point for partners across the public health system to build into their existing work the action steps recommended by MLC-3 local health departments, despite limited resources. Michigan plans to sustain and grow QI efforts by implementing priority strategies and action steps identified during the Showcase, beginning by: working through its CDC Infrastructure grant to provide QI trainings (at least annually) to local health departments; increasing participation in the Michigan Local Public Health Accreditation Program s (MLPHAP) Quality Improvement Supplement (QIS); making additional modifications to the MLPHAP to continue to help prepare local health departments for National Voluntary Accreditation; continuing to participate on various PHAB workgroups; and exploring the possibility of offering a QI course for graduate students in public health. Moreover, QI is now incorporated into the MLPHAP website through the addition of a QI Resources page. The page contains a variety of resources related the MLPHAP s QIS as well as various materials from QI training sessions conducted at Michigan s Premier Public Health Conference in 2009 and MLPHAP staff will continue to add resources to this page as they are developed. Additionally, Michigan will continue to seek additional funding opportunities in the area of QI that align with the priorities and action steps recommended in this document. In April 2011, Michigan was awarded funding from the Robert Wood Johnson Foundation to work on developing a second edition of Michigan s QI Guidebook, and the feedback provided here will inform the development of the second edition. In May 2011, Michigan Public Health Institute MLC-3 staff applied for funding through the recently released Public Health Services and Systems Research Call for Proposals for a project that would further test Michigan s mentor-led model for QI. As work around QI in public health moves forward in the state, MLC-3 stakeholders are encouraged to use the recommendations produced by this group to build on the successes of MLC-3 toward a future that embraces the use of QI throughout Michigan s public health system. 14