Download - PERFORMANCE MANAGEMENT AND BUILDING QI INTO YOUR AGENCY CULTURE MCPP Healthcare Consulting
PERFORMANCE MANAGEMENT AND BUILDING QI INTO YOUR AGENCY CULTURE
MCPP Healthcare Consulting
Marni Mason BSN, MBA
More than 30 years in private healthcare and public health as clinician, manager and consultant Primary & specialty care clinic nurse and nursing
director (15 years) Consultant in healthcare performance measurement
and improvement (18 years) Public health performance management – since 2000 Surveyor for NCQA (11 years) and Senior Examiner
for state Baldrige Quality Award Consultant for PHAB Standards Development (2008-
2009)
MCPP Healthcare Consulting
Learning Objectives
In today’s session the participants will develop a better understanding of: Components of Performance Management Methods and Tools for Building QI Culture Preparing for Accreditation
MCPP Healthcare Consulting
Performance Management
QI Plans & Councils
Business Process Analysis
Public Health Indicators
Standards for Public Health
Performance
AssessmentImproving PH processes
QI Methods & Tools
MCPP Healthcare Consulting
Performance Management
MCPP Healthcare Consulting
Application of P-D-S-A
MCPP Healthcare Consulting
Performance Standards 1st Quadrant
Establish Performance Standards NACCHO – Operational Definition and Standards National Public Health Performance Standards
(CDC) Public Health Accreditation Board Standards
Local, State and Tribal Health Departments Establish and Define Outcomes and
Indicators Process and Intermediate Outcomes Health Status Indicators
MCPP Healthcare Consulting
Performance Measurement2nd Quadrant
MCPP Healthcare Consulting
Performance Measurement Definitions
MCPP Healthcare Consulting
Quality Improvement Process 3rd Quadrant Use data to identify opportunities for
improvement and to make decisions Quality Improvement Methods:
Improvement Collaboratives Adapting or Adopting Model Practices Establishing QI Councils, Plans, and Teams Logic Models, RCI, Business Process
Analysis QI Tools; Data Analysis and Root Cause
Principles of Quality Management
1. Know your stakeholders and what they need
2. Focus on processes3. Use data for making decisions4. Understand variation in processes5. Use teamwork to improve work6. Make quality improvement continuous7. Demonstrate leadership commitment
MCPP Healthcare Consulting
Plan• Objective• Questions and predictions• Plan to carry out the cycle (who, what, where, when)• Plan for data collection
Do• Carry out the plan• Document problems and unexpected observations• Begin analysis of the data
WORK PLAN
Study•Complete the data analysis•Compare data to predictions•Summarize lessons
DATA REPORT
Act• What changes are to be made?• Next cycle?
DOCUMENTATION OF CHANGE - MINUTES
REVISE LOGIC MODELLOGIC MODELREVISE LOGIC MODEL
MCPP Healthcare Consulting
Learning and Improvement Cycle
Tools to Link Work and Outcomes Logic Models and detailed high level flow
charts Identify customer-supplier relationships Client flow, information flow, materials flow,
decision making flow Data and Analysis tools PH Memory Jogger
MCPP Healthcare Consulting
MCPP Healthcare Consulting
Adopt or Adapt Model Practices
Use data to identify need for improvement Identify exemplary practices in:
Other local and state health departments, CDC and other national organizations,
www.naccho.org/topics/modelpractices Other industries
Describe your process (Logic Model or Flow Chart)
Study the exemplary practice process Adopt or adapt as appropriate
Reporting Progress4th Quadrant
Reporting of Performance (Local and State Standards and Program Evaluation)
Reporting of Indicators and Outcomes Health Indicators Program Evaluation Data
Requires regular tracking, analysis and review to tell you if you are achieving your agency goals
Provides the basis for deciding on QI efforts and the baseline information for measuring the impact of quality improvement activities
MCPP Healthcare Consulting
Stages of Organizational Performance
Infrastructure Process Coordination Results
Leadership & Decision making
Boards of Health Policies &
Procedures Enforcement/
Investigation Protocols
Financial management
Information & reporting
Set of Core Indicators
Program performance goals/ objectives
Assessment processes
CD investigation case write-ups
EH enforcement action and case files
Education sessions
Work of community groups and coalitions
Communication mechanisms
Public and private work on access to services
Hand-offs between local health and state programs
Program evaluation results
Key indicator outcomes (CD/EH/PP)
Financial performance
MCPP Healthcare Consulting
Program Maturity
Does Size of Department Matter? Good News! Smaller LHDs can demonstrate
standards at same level as large LHDs “Money (and staff) matter, but they aren’t
all that matters” (Joan Brewster) In Washington, 40% of the higher
performers in the 2008 review cycle were smaller LHDs (less than 2 million annual budget). A couple of higher performers were LHDs with annual budgets of approximately $600,000
MCPP Healthcare Consulting
Correlation of Budget & FTEs Relationship of budget and FTEs to overall
performance in the Standards is nearing random (little or no correlation)
Five non-urban LHJs with budgets of $2 million or less had > 60% demonstrated
There is variability not connected to budget or size, other drivers of high performance are local priority-setting; leadership; local funding; staff skill, training and experience; and documentation and data systems
MCPP Healthcare Consulting
Correlation of Budget to Performance
Slight correlation and relationship between annual budget and overall performance in the Standards
MCPP Healthcare Consulting
20
Correlation of Per Capita Budget
No correlation or relationship of per capita budget to overall performance in the Standards
MCPP Healthcare Consulting
Building QI into Your Culture
MCPP Healthcare Consulting
Definition of Quality Improvement* “A management process and set of
disciplines that are coordinated to ensure that the organization consistently meets and exceeds customer requirements.”
Uppercase QI = top management philosophy resulting in complete organizational involvement
Lowercase qi = conduct of improving a process at the microsystem level
MCPP Healthcare Consulting
* Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009
Demonstrate Leadership Commitment
Build a QI culture Connect the organization’s strategic plan to
performance improvement Know and use quality principles Encourage all staff to use quality
improvement in daily work Reward improvements Ensure adequate QI infrastructure for
quality assessment and improvement activities
MCPP Healthcare Consulting
Demonstrate Leadership Commitment
Clearly stated and enacted constancy of purpose—a deep understanding of the vision and mission
Regular review of key indicator data Decisions made on data rather than
hunches or opinions Long range view supports search for root
causes and permanent solutions rather than quick fixes
MCPP Healthcare Consulting
Demonstrate Leadership Commitment
Focus on systems rather than individuals Continued identification of improvement
opportunities Publicize successes Clear communication agency-wide
regarding the commitment to quality and the change processes necessary to implement improvement
MCPP Healthcare Consulting
QI Infrastructure
Governance (formal/informal) Oversight and accountability
Program structure Who will do what when, with what processes
for recommending or deciding Staff
Support for ongoing monitoring and analysis, for training and facilitating improvement activities
Data system Collect data and report in a user friendly way
MCPP Healthcare Consulting
Quality Improvement Plan
Goals and objectives Monitoring activities associated with
important aspects of programs/services Planned QI efforts (in process, new) and
timelines Evaluation of current QI efforts Annual evaluation of QI work plan and
program description, with proposed revisions
MCPP Healthcare Consulting
TACOMA-PIERCE COUNTY HEALTH DEPARTMENT QUALITY IMPROVEMENT (QI) INITIATIVE
QI Time Line at TPCHD
MCPP Healthcare Consulting
QI Training & Tools
QI Principles, Methods and Tools
Just-in-time training for QI project teams, RCI method
Performance measures
QI Council training on QI concepts
QI concepts staff can use in daily work
MCPP Healthcare Consulting
QI Infrastructure
Must have director and other senior management LEADING the initiative
Establish a steering committee or leadership group to direct and oversee agency efforts (e.g. QI Council)
Leadership and key staff on QI Council QI Plan and regular evaluation of QI efforts Assessment staff is an excellent resource Start small; get people excited about a single
project Celebration of successes is importantMCPP Healthcare Consulting
QI Plan and Evaluation
Annual QI plan Lists major activities Includes calendar Identifies persons
responsible & time lines
Annual evaluation of QI plan Evaluates QI Council
meetings Analyzes performance
measure data Examines completion
rate of QI plan activities
MCPP Healthcare Consulting
Quarterly Reporting Form
Plan Item Name/No. Indicator(s) Baseline Data (if applicable) Quarterly Data Data Source Methods Notes Data Explanation/Other Comments
MCPP Healthcare Consulting
MCPP Healthcare Consulting
QI Calendar (TPCHD example)
III. 2009 Quality Improvement Council Calendar
Staff Responsible Completion Date QI Council Review Date
Additional Review Dates
A. Rapid Cycle Improvement Projects
Purchasing Marcy Kulland Sep 21 Sep 22 (final report) TBD (BOH)
Solid waste code enforcement complaint resolution
John ShermanNov 23
Sep 22 (interim report)Nov 24 (final report)
TBD (BOH)
B. TPCHD Performance Measures
See Section II B Jul 31Oct 31
Jan 31, 2010
Aug 25Nov 24
Feb 23, 2010Mar 3, 2010 (BOH)
C. QI Projects at Request of Director
TBD TBD TBD TBD
D. Program Evaluation Reports
Menu labeling Rick Porso May 25 May 26
MCH home visiting David Vance Oct 26 Oct 27
E. Review of Health Indicators
Three priority indicators (Review of performance measures in Table 2)
Nigel Turner (Chlamydia)
David Vance (LBW)Rick Porso (Adult
Obesity)
Jul 31*Oct 31
Jan 31, 2010
Aug 25Nov 24
Feb 23, 2010Mar 3, 2010 (BOH)
MCPP Healthcare Consulting
Performance Measures
Twelve department-level measures Modeled after Healthy People 2010 Leading
Health Indicators . . . plus two more Approx. 10-20 performance measures per
business unit Percent of solid waste complaints responded to
within 20 days Reduce the rate of positivity at Infertility
Prevention Project (IPP) sites Percentage of Positive Steps clients who engage
in services for 30. days or more who have a 10% reduction on three youth violence risk factors
MCPP Healthcare Consulting
TPCHD Performance Measures
Measure Indicator ResponsibilityImprove immunization rates
Increase the percentage of kindergarten enrollees that are up to date on their immunizations upon school entry from 86% to 92% by 2014.
Nigel Turner
Reduce tobacco use Decrease the percentage of adult smokers to 16% by 2014. Rick PorsoReduce overweight & obese populations
Reduce the rate of increase for adult obesity to 0% by 2014. Rick Porso
Increase healthy physical activity
Increase the percent of youth who are physically active for at least 60 minutes per day from 16.8% to 18.5% by 2014.
Rick Porso
Reduce substance abuse
Increase the number of adults receiving opiate treatment service by 23% by 2014, to 800 patients.
David Vance
Increase responsible sexual behavior
Increase the percentage of sexual partners treated for sexually transmitted diseases by 10% by 2014.
Nigel Turner
Increase access to care
Increase the number of children enrolled annually in health insurance programs by 42% by 2014.
David Vance
Decrease injury and violence
Reduce youth violence risk factors among 75% of youth who participate in TPCHD youth violence prevention services for at least 30 days.
David Vance
Improve mental health Decrease adult mental health problems in 20% of families provided TPCHD evidenced-based program services by 2014.
David Vance
Improve environmental quality
Increase the percent of water systems that meet drinking water standards from 80% to 90% by 2014.
Steve Marek
Effectively respond to public health emergencies
Respond within one hour in 100% of situations where TPCHD receives a notice of need for public health response to an incident within Pierce County.
Joby Winans
Decrease rates of key communicable diseases
Increase the percent of ten key communicable diseases for which the trend in incidence rate is flat or decreasing from 38% to 50% by 2014.
Nigel Turner
MCPP Healthcare Consulting
QI Activities - TPCHD
Critical to make data/reporting meaningful to staff.
Performance measures: More is not better Resource level declines after the first data
reporting period Staff need lots of practice/training to develop
good performance measures RCI/QI projects:
Quality planning is more appropriate than QI for some projects with long-term outcomes
MCPP Healthcare Consulting
First RCI Project
STD Reporting of Race/Ethnicity
1. Collected data to identify “root cause” of problem
2. Pilot tested an education intervention
Percent of STD Case Reports That Include Race Data (Among Pilot Providers)
74
55
0
10
20
30
40
50
60
70
80
Pre Post
Pe
rce
nt
MCPP Healthcare Consulting
Second RCI Project
Final On-Site Septic System Inspections
1. Collected data to identify “root causes” of problem
2. Re-prioritized work duties
3. Monitored work flow
Percent of Septic Systems That Received a Final Inspection
94
70
0102030405060708090
100
Pre Post
Pe
rce
nt
MCPP Healthcare Consulting
MCPP Healthcare Consulting
TPCHD Results of QI Initiative Most performance
measures at department- and business unit-level achieved their stated target
Improvements sustained for RCI/QI projects
Health indicator projects met 100% of annual performance measures
Funding & staffing for QI has increased
MCPP Healthcare Consulting
WASHINGTON STATE DEPARTMENT OF HEALTH QUALITY IMPROVEMENT (QI) INITIATIVE
PM System and QI Structure
Focused Quality Improvement Efforts
Focused Quality Improvement Efforts
Organizational Strategic PlanningOrganizational
Strategic Planning
Performance Management
and Accountability
Performance Management
and Accountability
Operational/Business Planning and Performance
Operational/Business Planning and Performance
Quality Steering Committee
Quality Steering Committee
Performance Management System QI Structure
PALS(Performance Accountability Liaisons)
PALS(Performance Accountability Liaisons)
Project Mgmt. Resource TeamProject Mgmt. Resource Team
Process Improvement Teams
Process Improvement Teams
Quality Improvement Organizational Structure
Quality Steering Committee
Quality Steering Committee
Primary responsibilities include: Reviewing and approving the agency QI plan
annually Encouraging and fostering a supportive QI
environment Championing QI activities, tools and techniques Selecting and supporting agency QI projects
MCPP Healthcare Consulting
Step #5:Take
appropriate action.
Step #5:Take
appropriate action.
Step #6:Provide closure.
Step #6:Provide closure.
Step #4:Analyze data and generate
solutions.
Step #3:Examine the
process.
Step #3:Examine the
process.
Step #1:Clarify the purpose.
Step #1:Clarify the purpose.
Step #2:Select & build
the team.
Step #2:Select & build
the team.
The Quality Improvement Process
MCPP Healthcare Consulting
Integration of QI into Agency Culture
MCPP Healthcare Consulting
Multilevel Model of Integration* Spread can be defined as moving from
common practices to best practices Diffusion is the rate at which innovation
is adopted within an organization or industry
*Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009
MCPP Healthcare Consulting
Levels of QI Integration
0
25
50
75
100
Level 1- No interest or activities
Level 2-Awareness, interest and
one-time projects
Level 3- Multiple
teams and QI tools, but no
repetition or
saturation
Level 4- Speciic QI
model integrated
into agency management
structure with
continuous improvement
MCPP Healthcare Consulting
JPHMP Article Recommendations Implement QI as a comprehensive management
philosophy rather than a project-by-project approach
Top officials must set a vision for the agency and exhibit constant leadership, focus continuously on mission
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 agencyBill Riley and Russell Brewer
MCPP Healthcare Consulting
ACTIONS TO PREPARE FOR AN ACCREDITATION REVIEW
MCPP Healthcare Consulting
Establish HD Workgroup
Assign coordinator for preparation project (12-18 months in advance)
Assign specific categories/standards to individuals (usually managers)
Develop detailed work plan that addresses each standard
Establish meeting schedule for workgroup Report progress and barriers to leadership
team
MCPP Healthcare Consulting
Conduct Self-Assessment
Use accreditation standards and documentation guidelines to conduct objective review against the standards
Identify documentation that shows performance
Identify areas not meeting the standard as areas for improvement
MCPP Healthcare Consulting
Tell Your Story….
Reviewers will not be familiar with your HD or even your state
Provide short summary or note that describes your processes for the topic being addressed
Be “laser focused” on the specific requirement of that measure
Provide only the documentation that is needed to demonstrate performance. More is not better!
MCPP Healthcare Consulting
Organizing Your Documents
Collect and organize all documents for reviewers to review Online document library with folders for each
standard and measure PHAB accreditation submittal system
State page number (or highlight with text box) where specific information addressing the measure is located if document more than 3 pages long
Can use same document for multiple measures—just indicate all measures that are relevant and page of document
MCPP Healthcare Consulting
Electronic System MindManager
How does MindManager help you prepare for your review?
Electronic mind mapping tool. Visual diagram that looks like a tree with a main topic and
as many sub-topics as you like exploding out in branches. Ability to give context and relationships that are difficult to
see in a linear document. Consolidate multiple sources of information. Establishes greater accountability by enabling team
members to track assignments. Reviewers love having everything in one location.
MindManager Overview
A look at the big picture.
MindManager Overview
“Read Me” Text
Documentation in Daily Work Build documentation into regular
processes: Use summary formats for regular reporting Minutes of working committees Case write-ups, logs, and progress reports Emphasize conclusions, actions and results
MCPP Healthcare Consulting
We Can Make Significant Improvement Significant improvement was shown in the following
measures that were comparable: 4.2L Health care providers receive information,
through newsletters and other methods, about managing reportable conditions. (from 74% to 92%)
4.5L A notifiable conditions tracking system documents the initial report, investigation, findings and subsequent reporting to state and federal agencies (from 82% to 100%)
4.8L (EH Only) A tracking system documents environmental health investigation/compliance activities … as required. (from 67% to 94%)
MCPP Healthcare Consulting
Change vs. Improvement
W. Edwards Deming stated “Of all changes I’ve observed, about 5% were improvements, the rest, at best, were illusions of progress.” We must become masters of improvement We must learn how to improve rapidly We must learn to discern the difference
between improvement and illusions of progress
MCPP Healthcare Consulting
What questions do you have?
MCPP Healthcare Consulting