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 difficulties

Performance Improvement in Public Health Learning Session #3:

Public Health Quality Improvement 101

Welcome and Introductions

Brief description of today’s learning session

Brief introduction of those participating

Overview of Live Meeting process including muting, accessing handouts, and asking questions

By the end of this session you should be able to:

Have a basic understanding of quality improvement in PH - purpose and process

Understand “Big QI” vs. “small qi” Describe some ways to start integrating

QI into your agency Access additional resources

WHAT IS QI AND WHY SHOULD WE CARE?

What is QI? It’s about Process Is 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.

~Unknown

What is QI? It’s about Data

Using data to identify opportunities for improvement and to make decisions

Data 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 return

What is QI? It’s about Learning!

Working to Do the Right Things

Right!

And We Already Do It, Everyday!

And at Work Too!

Why QI Now?

Fewer Resources + More Work + Constant Change = Stress

Everything 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 effective

Why QI?

Accreditation It’s just good

practice!

Who wouldn’t want to expand their horizons and create a better organization? LHD staff member (Michigan)

PLAN DO STUDY ACT - THE QUALITY IMPROVEMENT MODEL“Quality is not an act, it is a habit”

~Aristotle

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

DoStudy

Act

Model for Improvement: Three Key Questions in PDSA

1. What are we trying to accomplish?2. How will we know that a change is an

improvement?3. What changes can we make that will

result in improvement?

Change vs.. Improvement

It 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 Deming

BIG QI AND LITTLE QI

Moving from projects to integration

Levels of Integration of QI into Agency Culture

MarMason Consulting

*Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009

Levels of QI Integration

MarMason Consulting

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

Bill Riley and Russell Brewer

“BIG QI” vs. “small qi”Little qi BIG 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 usual

Integration Recommendations

MarMason Consulting

Implement 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 Brewer

Tips and Strategies

Think big but start small Look for winnable

opportunities Discuss 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 change

Tips and Strategies

Articulate quality as part of the organizations core values

Incorporate quality improvement skills into job descriptions

Discuss professional and program improvement opportunities during regular performance reviews

Acknowledge failure and opportunities for growth

Celebrate small victories

QI RESOURCES: HOW YOU CAN LEARN MORE

References

Public Health Memory Jogger Embracing Quality in Local Public Health:

Michigan’s Quality Improvement Guidebook

The Public Health Quality Improvement Handbook

WIQI Webinars

Available in the Institute for Wisconsin’s Health website Root Cause Analysis – 5 Whys and Fishbone

(posted soon) Determining Root Causes and Prioritizing

Issues with the Affinity Diagram and Inter-relationship Diagraph

Focusing on Key Problems and Prioritizing Using Pareto Charts and Nominal Group Technique

NACCHO Webinars

NACCHO, with many partners, has developed several webinars on Process Tools QI in Action

See Resources Guide for details.

Questions?

QI IN THE FIELD

An Example from Oneida County

Baby Steps

Just jump in and get started First QI projects not picture perfect Learn as you go Get comfortable with the language Pick a couple tools and stick with them

until your comfortable Keep learning (add onto your QI

knowledge) Have a team of people who know QI (QI

team)

TRH Transient Rooming House annual inspections NIATx Change project form

1. 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?

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 updated

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.

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.

PDSA Cycles

Rapid 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 process

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 101

National Resources:

CDC: http://www.cdc.gov/ostlts/NPHII/index.html

NACCHO: 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.php

Primary Wisconsin Resources:

CDC Infrastructure Grant: Mary Young, DPH Southern Regional Officemary.young@wisconsin.org

Prevention Block Grant: Jackie Bremer, DPH Northern Regional OfficeJacquelyn.Bremer@wisconsin.org

HW 2020 Capacity and Quality Focus Area: Lieske Giese, DPH Western Regional Officeelizabeth.giese@wisconsin.gov

WIQI: Nancy Young, IWHIgrayhorse@mac.com

Websites:

IWHI http://www.instituteforwihealth.org/project-portal/

DPHhttp://www.dhs.wisconsin.gov/localhealth/index.htm Accreditation site (soon to be available) http://www.phawisconsin.com/

Tell us what you thought of today’s session:

http://4.selectsurvey.net/dhs/TakeSurvey.aspx?SurveyID=96M2l721

You will receive a link to the survey after the presentation as well.