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Slide1
GOOD AFTERNOON!We will be starting shortly.
Please orient yourself to Live Meeting including use of Q and A
Please mute your microphones and/or telephone
Please email Tegan Ruland at
tegan.ruland@wisconsin.gov
if you are having any difficultiesSlide2
Performance Improvement in Public Health Learning Session #3:
Public Health Quality Improvement 101Slide3
Welcome and IntroductionsBrief description of today’s learning sessionBrief introduction of those participatingOverview of Live Meeting process including muting, accessing handouts, and asking questionsSlide4
By the end of this session you should be able to:Have a basic understanding of quality improvement in PH - purpose and processUnderstand “Big QI” vs. “small qi” Describe some ways to start integrating QI into your agency
Access additional resourcesSlide5
What is QI and why should we care?Slide6
What is QI? It’s about ProcessIs used to improve existing processes Changing the way you do things to impact longer term outcomes
It is a
process –
a way of doing things
The race for quality has no finish line.
~UnknownSlide7
What is QI? It’s about DataUsing data to identify opportunities for improvement and to make decisionsData can help identify the root cause of your problem.
Data can help you focus on where to spend your time and effort for the greatest returnSlide8
What is QI? It’s about Learning!Slide9
Working to Do the Right Things Right!Slide10
And We Already Do It, Everyday!Slide11
And at Work Too!Slide12
Why QI Now?Fewer Resources + More Work + Constant Change = StressEverything we do has a cost and everything we don’t do but should also has a cost ~Jim Butler
Helps staff deal
more effectively with change
Helps make change more effectiveSlide13
Why QI?AccreditationIt’s just good practice!
Who wouldn’t want to expand their horizons and create a better organization?
LHD staff member (Michigan)Slide14Slide15
Plan Do Study Act - The Quality Improvement Model“Quality is not an act, it is a habit” ~AristotleSlide16
Plan Plan changes aimed at improvement, matched to root causes
Do Carry out changes; try first on small scale
Study See if you get the desired results
Act Make changes based on what you learned; spread success
Quality Improvement Process:
Plan-Do-Study-Act
Plan
Do
Study
ActSlide17
Model for Improvement: Three Key Questions in PDSAWhat are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?Slide18
Change vs.. ImprovementIt is essential to learn the difference between doing something in a different way, and doing it in a better way
“Of all changes I’ve observed, about 5% were improvements, the rest, at best, were illusions of progress.”
~W. Edwards DemingSlide19
Big QI and little QI Moving from projects to integrationSlide20
Levels of Integration of QI into Agency CultureMarMason Consulting
*
Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009Slide21
Levels of QI IntegrationMarMason Consulting
Bill Riley and Russell BrewerSlide22
“BIG QI” vs. “small qi”Little qiBIG QI
Often program or unit specific
System focused
One time projects
Continuous – part
of strategic plan
Limited
staff involvement
Many
staff
knowledgable
and participating
QI is an “extra”
Culture of quality – QI is business
as usualSlide23
Integration RecommendationsMarMason ConsultingImplement QI as a comprehensive management philosophy rather than a project-by-project approach
Use the lessons/proven methods from others [police, etc.] to overcome barriers
Find creative ways to secure resources for QI
Build on existing PH tools and capabilities
Conduct a self-assessment for QI readiness in your agency
Bill Riley and Russell BrewerSlide24
Tips and StrategiesThink big but start smallLook for winnable opportunitiesDiscuss the need for change – the disconnect between “the way we used to do it”, the way “we’ve always done it”, and the needs of today
Empower people to act – make them agents of changeSlide25
Tips and StrategiesArticulate quality as part of the organizations core valuesIncorporate quality improvement skills into job descriptionsDiscuss professional and program improvement opportunities during regular performance reviewsAcknowledge failure and opportunities for growthCelebrate small victoriesSlide26
QI Resources: How you can learn moreSlide27
References Public Health Memory JoggerEmbracing Quality in Local Public Health: Michigan’s Quality Improvement GuidebookThe Public Health Quality Improvement HandbookSlide28
WIQI WebinarsAvailable in the Institute for Wisconsin’s Health websiteRoot Cause Analysis – 5 Whys and Fishbone (posted soon)Determining Root Causes and Prioritizing Issues with the Affinity Diagram and Inter-relationship DiagraphFocusing on Key Problems and Prioritizing Using Pareto Charts and Nominal Group TechniqueSlide29
NACCHO WebinarsNACCHO, with many partners, has developed several webinars onProcessToolsQI in ActionSee Resources Guide for details.Slide30
Questions?Slide31
QI in the Field An Example from Oneida CountySlide32
Baby Steps Just jump in and get startedFirst QI projects not picture perfectLearn as you goGet comfortable with the languagePick a couple tools and stick with them until your comfortableKeep learning (add onto your QI knowledge)Have a team of people who know QI (QI team)Slide33
TRH Transient Rooming House annual inspections NIATx Change project form1. Change Project Title
TRH Transient Rooming House annual inspections
2. What AIM will the Change Project address?
% of completed annual inspections measured from July1, 2010 to June 30, 2011 (fiscal year).
Aim for 95% completion. In 2010 50% of inspections were completed as of 4-1-11.
3. LOCATION
Oneida County
4. Start Date and expected completion date
10-1-10 to 6-30-11
5. Level of Care
6. What Client Population are you trying to help?
TRH licensees
7. Executive Sponsor
Linda Conlon
8. Change Leader
Teri Schwab
9. Change Team Members
Todd Troskey, Jody McKinney
10. How will you collect data to measure the impact of change?
Health Space
11. What is the expected Financial Impact of this change project?Slide34
PDSA CyclesRapid Cycle #
Cycle Begin Date
Cycle End Date
Plan What is the idea/change to be tested
Do
What steps are you specifically making to test this idea/change?
Study
What were the results? How do they compare with baseline measure?
Act
What is your next step? Adopt? Adapt? Abandon?
1
10-1-10
10-6-10
Look at overdue TRH inspection list from HS
Learn the process of making an overdue inspection list on HS
<50% of TRH inspections had been completed. Contact info, past inspections were missing or inaccurate in HS.
Adapt. Pull Paper files
2
10-7-10
10-31-10
Look at paper files to find:
Last inspection
Contact information
Call facility owners mark file as
Contacted date
Left message
Contact info not working
Too many files to keep track of efficiently
Abandon
Need a complete TRH facility list to make notations and record contacts
3
11-1-10
11-7-10
Print out TRH master list
Indicate on list:
Contacted date
Inspection date
Change of information
Contacting owners during regular business hours success rate about 15%, most numbers were not working or had to leave message
Adopt. Master list will be updatedSlide35
PDSA CyclesRapid Cycle #
Cycle Begin Date
Cycle End Date
Plan
Do
Study
Act
4
11-8-10
11-29-10
Send a letter and inspection request form to all TRH owners
Inspection request form
To update contact info
Let the owner realize inspections need to be done annually
About 50% of the facilities called, mailed or emailed the health dept. Mainly the response was from owners we had already contacted or inspected in the last year.
Adapt. Letter language was not strong enough to get a better response.
Collect and enter data that was received. Organize appts enter into office tracker and bulletin board
5A
12-1-10
12-31-10
Get organized
Appointment schedules, email contacts follow up with inspection request forms
Color code bulletin board for inspections.
Make a lodging group in email address book.
Make door hangars for no shows
Procedure to record appointments and enter contact information was established. 40% of facilities are recorded in email lodging group
Adopt. Asking for email addresses will be a priority in correspondence and during inspections. Scheduling appts for the same time next year.Slide36
PDSA CyclesRapid Cycle #
Cycle Begin Date
Cycle End Date
Plan What is the idea/change to be tested
Do
What steps are you specifically making to test this idea/change?
Study
What were the results? How do they compare with baseline measure?
Act
What is your next step? Adopt? Adapt? Abandon?
6
2-1-11
2-7-11
Color code and date master TRH list.
Record:
Scheduled inspection date
Call back date
Property manager
Email contact
Last inspection date, no contact, or last inspection date
Use HS as a guide for last inspection
Identified the contacts that had been made. Only 13 facilities out of 161 had no last inspection date or telephone/email contact information
Adopt.
Making contact notations on a master list lessens the scenario of calling owners multiple times.
Keep researching to try different numbers. Search the web and email requests for inspections.
7
2-7-11
3-1-11
Web research. Call or email to schedule an inspection.
Google search
Yellow book search
A few contacts were made. The web research worked better for the 5-30 lodging category. Able to find web information on 50% of facilities with no previous contact information.
Adopt…. Web research is very helpful if there are not too many facilities to look up. Revise request letter to have stronger language. License will not be renewed if an inspection is not scheduled and completed by 6-30-11.Slide37
PDSA CyclesRapid Cycle #
Cycle Begin Date
Cycle End Date
Plan What is the idea/change to be tested
Do
What steps are you specifically making to test this idea/change?
Study
What were the results? How do they compare with baseline measure?
Act
What is your next step? Adopt? Adapt? Abandon?
8
3-20-11
3-28-11
Send letter with stronger language and inspection request form.
Send to 13 facilities with no contact and no last inspection date.
Still in process
9
3-28-11
6-30-11
Develop system during inspection to update contact information and to schedule next annual inspection on the day of the inspection.
Have a check list for sanitarians to implement during inspection
Record new contact info
Schedule appt for next year
Write appt on business card
Record changes and appt a the office in HS and office tracker
Still in processSlide38
Learning Sessions Planned:5/9/2011: PH Performance Management 101
5/16/2011:
PH Quality Improvement 101
Today:
Wisconsin PH Improvement Initiative 101
5/23/2011(last session):
PH Accreditation 101Slide39
National Resources:CDC: http://www.cdc.gov/ostlts/NPHII/index.htmlNACCHO: http://www.naccho.org/topics/infrastructure/
ASTHO:
http://www.astho.org/Programs/Accreditation-and-Performance/
PHAB:
http://www.phaboard.org/
PHF:
http://www.phf.org/focusareas/pmqi/pages/default.aspx
NALBOH:
http://www.nalboh.org/Board_Governance.htm#
NIHB:
http://www.nihb.org/public_health/accreditation.phpSlide40
Primary Wisconsin Resources:CDC Infrastructure Grant: Mary Young, DPH Southern Regional Office mary.young@wisconsin.org
Prevention Block Grant: Jackie Bremer, DPH Northern Regional Office
Jacquelyn.Bremer@wisconsin.org
HW 2020 Capacity and Quality Focus Area: Lieske Giese, DPH Western Regional Office
elizabeth.giese@wisconsin.gov
WIQI: Nancy Young, IWHI
grayhorse@mac.comSlide41
Websites:IWHI http://www.instituteforwihealth.org/project-portal/DPHhttp://www.dhs.wisconsin.gov/localhealth/index.htmAccreditation site (soon to be available)
http://www.phawisconsin.com/Slide42
Tell us what you thought of today’s session:http://4.selectsurvey.net/dhs/TakeSurvey.aspx?SurveyID=96M2l721You will receive a link to the survey after the presentation as well.