continuous quality...

Continuous Quality Improvement: An Institute’s Experience in Creating Quality

Improvement Projects

New Orleans, LA • May 22, 2012

Catherine ShoultsGianfranco Pezzino

Kansas Health Institute

What To Expect From ThisPresentation

! An example of application of qualityimprovement principles

! A new way to look at grant process

! Pointers for integrating QI in routinepublic health practice

In the Beginning…

Immunize

Kansas KidsCoalition

QualityImprovement

Efforts(MLC)

Immunize Kansas Kids

Goal: Protect every Kansas child fromvaccine-preventable diseases

Multistate Learning Collaborative

Goal: Improve public health services byimplementing quality improvement practices

Immunizations Plus QualityImprovement

Immunize

Kansas KidsCoalition

QualityImprovement

Efforts(MLC)

IKK QI

Projects

+

QI Project Goals! Goals:

" Improve immunization practices

" Disseminate Plan-Do-Study-Act cycleand QI Culture

! Public and private immunizationclinics targeted

Project Details! Project grants range from $5,000-

10,000 " Funded by Kansas Health Foundation

! Up to 10 projects awarded! Project completed in 12 months

" All projects are currently active

Eligible Organizations ! Must deliver immunization services OR! Must coordinate or support vaccination

activitiesProjects can be submitted jointly as a

partnership between providersor as an effort by a public health

preparedness region

Use of Project Funds! Direct and personnel costs for:

" Improvements in vaccination activities• Change workflow to improve efficiency• Create reminder system for parents

" Marketing campaign targeted to specificat-risk populations• Increase parental awareness of vaccines• Explain vaccine importance/safety

Marketing of Projects! Sent RFP to stakeholders

" KDHE Community Health Bureau" KS AAP and AFP

! Outreach efforts" Booths at conferences" Webinar" Website

! IKK Partners

IKK Projects Must Do theFollowing

! Use PDSA cycle! Incorporate evidence-based

practices! Include measurable objectives! Include evaluation measures

Institute for Healthcare ImprovementPlan-Do-Study-Act Cycle

! What are we trying to accomplish?

! How will we know that a change is animprovement?

! What changes can we make that willresult in improvements?

Preliminary QI ProposalProcess

Request forProposals

Receiveand ReviewApplication

ApproveProposal

RejectProposal

Current QI ProposalProcess

Request forProposals

ReceiveApplication

ApproveProposal

ProvideTechnical

Assistance

ApplicantMakes

Changes

ReviewProposal

Project One! Application rewrite: Determined root

cause, integrated PDSA model! End product: Improve full coverage

of vaccines in preschools! Surprise: Fully integrated PDSA

Project Two! Application rewrite: Major limiting of

scope, integration of QI and PDSA! End product: Try multiple reminder

and recall systems! Surprise: Major changes from initial

proposal to approved project

Project Three! Application rewrite: Determine root

cause, proof texting is best solution! End product: Use texting to remind

parents to come in for vaccinations! Surprise: Research based

interventions lend themselves to QI

Project Four! Application rewrite: Root cause

analysis! End product: Integrate immunization

nurse into WIC clinic! Surprise: Embraced root cause

analysis and created multiplepossible solutions

Project Five! Application rewrite: No rewrite!! End product: Target policy

change??? ‘may vs. shall’! Surprise: Well-versed in QI so

wanted to do improvement instead ofsolution

Wait, Isn’t That QI?

QualityImprovement

for KHI!

QualityImprovement at

the Project Level

KHI PDSA – What We Have Learned

! Applicants don’t immediatelyunderstand QI projects

! Application process of normal grantdoes not suit QI projects

! Most work in proposal stage! Applicants need help with root cause

analysis! KHI internal processes can be slow

KHI PDSA – Solutions

! Next QI projects will have twophases" May integrate projects into larger grant

! Midterm report gave feedback area" Need to shorten our internal approval

processes! Documented lessons learned

throughout the process" Used OneNote to track the process and

find bottlenecks

One Of Our Best LessonsLearned Has Been…

QI Is Infectious!

Take Away Messages! Process of approving proposal was

great learning opportunity:" For the applicants

" For the reviewers

! New-to-QI folks learn quickly

! Old-to-QI folks try new approaches(and keep learning!)

! You may already be doing QI!

Conclusions! Integrating QI into ongoing activities

is possible AND beneficial ! Be flexible

! Practice what you preach

Information for policy makers. Health for Kansans.

Kansas Health Institute

Photo Citations! Slide 4 and 5: KALHD emblem, http://www.kalhd.org/! Slide 4 and 5: KDHE emblem, http://www.kdheks.gov/! Slide 12: PDSA cycles,

http://health.state.tn.us/MCH/MedicalHome/improvement.shtml! Slide 16: 30 Mini colorful envelopes,

http://www.etsy.com/listing/53015608/30-mini-multi-colored-envelopes! Slide 21: PDSA cycles,

http://health.state.tn.us/MCH/MedicalHome/graphics/plan_do_study_act.png! Slide 24: Woman Sneezing,

http://www.guardian.co.uk/science/2008/dec/19/reproduction-neuroscience