7/15/2013 More than 30 years in private healthcare and public health - PDF document

7/15/2013 More than 30 years in private healthcare and public health as clinician,  manager and national consultant  Consultant PH performance standards and improvement since 2000 ; NACCHO CHA/CHIP project (2011-12), ASTHO QI Demonstration project (2012-13), NNPHI COPPHI QI Coach (Phase I & II) and for all 3 Multistate Learning Collaboratives (2005-2011), including more than 70 QI teams  National trainer and presenter for QI and Accreditation in more than 20 states and for ASTHO, NACCHO, NIHB, NNPHI, and RWJF  Contributed to the Michigan QI Handbook, the 2009 ASQ Public Health QI Handbook, and authored numerous JPHMP articles including Jan/Feb 2012 “Understanding and Controlling Variation in Public Health” .  Consultant for PHAB Standards Development and training of site reviewers (2008-2010)  Surveyor for National Committee for Quality Assurance-NCQA (15 years) and Senior Examiner for WA state Quality Award (Baldrige Criteria for Performance Excellence- late 1990s)  Owner and Managing Consultant of MarMason Consulting, LLC based in Seattle, WA Marni Mason, MarMason Consulting, LLC MarMason Consulting 2 1 2  In today’s session the participants will: ◦ Discuss application of Quality Improvement principles, methods and tools ◦ Strategies for building and sustaining a culture for quality improvement ◦ Discuss and review the components of effective QI Plans ◦ Determine strategies to develop a QI Plan that meets PHAB requirements for Domain 9 ◦ Conduct a Mock review of QI Plans Strategic Planning against PHAB Domain 9 requirements 3 MarMason Consulting MarMason Consulting 4 1

7/15/2013  Performance Quality Improvement Standards • Use data for decisions to ◦ Identify relevant improve policies, programs, standards outcomes ◦ Select indicators • Manage changes ◦ Set goals and targets • Create a learning ◦ Communicate organization Expectations Reporting of Progress  Performance Measures • Analyze and interpret data ◦ Refine indicators • Report results broadly ◦ Define measures • Develop a regular reporting ◦ Develop data systems cycle ◦ Collect data MarMason Consulting 5 MarMason Consulting 6  All work, including management, consists of  Results focus permeates strategies, processes, linked processes forming a system, even if the organizational culture and decisions system was not designed and is not understood.  Information, measures, goals, priorities and activities are relevant and aligned to health improvement and  Every system is perfectly aligned to achieve the strategic initiatives results it creates. Process determines  Information is transparent – easy to access, use and performa rmance. understand  The results of an aligned system far exceed a  Decisions and processes are driven by timely, accurate, system that fights against itself. and meaningful data  Practices are sustainable over time and organizational  Integrated management systems ensure that changes performance excellence happens by design, not  Performance management is transformative to the by chance. agency, its management and the policy-making process * A Performance Management Framework from the National Performance Management Advisory Commission 2010 7 MarMason Consulting MarMason Consulting 8 2

7/15/2013 KITSAP COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN FIVE-YEAR 30,000 FT STRATEGIC PLAN KITSAP COUNTY COMMUNITY HEALTH QUALITY STRATEGIC ASSESSMENT 20,000 FT IMPROVEMENT IMPLEMENTATION PLAN PLAN 10,000 FT PROGRAM WORK PLANS INDIVIDUAL PERFORMANCE PLANS SEA LEVEL MarMason Consulting MarMason Consulting 9 10  http://www.turningpointprogram.org/toolkit/  Establishing and implementing performance pdf/PM_Self_Assess_Tool.pdf management systems helps state agencies:  For each component, several questions serve • Align agency plans to reduce duplication and increase efficiency and effectiveness as indicators of your performance • Prioritize planning and improvement efforts management capacity. • Address accreditation requirements  These questions cover elements of your • Demonstrate the results of PH programs and capacity such as having the necessary services through performance measurement and resources, skills, accountability, and reporting communications to be effective in each component. 12 MarMason Consulting MarMason Consulting 11 3

7/15/2013  What is your A management process and set of experience with disciplines that are coordinated to ensure the four that the organization consistently meets components of and exceeds customer requirements. performance management at MCHD? QI Top management philosophy resulting in complete organizational involvement qi Conduct of improving a process at the micro system level Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009 MarMason Consulting MarMason Consulting 13 14  Agency-wide commitment to 1 Know your stakeholders and what they need assessing and continuously improving quality over time? 2 Focus on processes • Decisions based on data? 3 Use data for making decisions • Agency achieving goals?  Use data to decide on 4 Use teamwork to improve work improvement initiatives and 5 Make quality improvement continuous to know if the improvements are successful? 6 Demonstrate leadership commitment  Measurement of results and progress are outcome based? MarMason Consulting MarMason Consulting 16 4

7/15/2013 Identify stakeholders and their  Improve overall process, needs not just one part • Sector mapping (public, private, • 85% of poor quality is a community, academic/research) result of poor work • Community assessment processes, not of staff • Advisory council input (BOH, Tobacco doing a bad job Coalition, Wellness Collaborative, Food • Processes often “go wrong” Safety Council) • Survey data and focus groups at the point of the “handoff” Set goals based on stakeholder • Some of the most complex needs processes are the result of creating a “work around” MarMason Consulting MarMason Consulting Inputs Outputs Short Term Intermediate Long Term Logic models and work Outcomes Outcomes Outcomes Resources Activities flow charts Reduced Program Morbidity ◦ Customer-supplier Informed, Development Money Improved Targeted relationships Improved knowledge, Program Reduced beliefs, Behaviors ◦ Client flow, information Program Mortality attitudes Staff Planning flow Appropriate, Targeted Materials Improved Materials Development, Quality of Distribution Life MarMason Consulting MarMason Consulting Note: See PH Memory Joggers at GOAL/QPC or QI tools at ASQ 19 20 5

7/15/2013  Census  Use performance  Vital Records (births and deaths) assessment data to  Behavioral Risk Factor Surveillance System target improvement (BRFSS)  Student Health and Risk Prevention (SHARP)  Use data analysis tools Surveillance System – Youth Risk Behavior, to develop information Youth Tobacco Survey, Nebraska Risk and  Analyze data to identify Protective Factor Student Survey root cause  Hospital Discharge Data  Cancer Registry  Use data to monitor  County Health Rankings (University of performance outcomes Wisconsin & RWJ)  Resources: Data Workbook, Data Dashboard and State data reports and tools MarMason Consulting 22 W. Edwards Deming transformed quality control To Show Use Data Needed processes by applying his Simple percentage or Bar charts, pie charts Simple tallies by beliefs magnitude or summary statistics category (At least 30 comparisons cases) • Measuring outputs/outcomes Trend Line graphs Time-ordered at the end ignores root cause measurements (At least and ensuing poor results. 12 sets of data points) • Addressing root causes Distributions Histograms Forty or more through ongoing evaluation measurements and quality improvement Correlations Scatter diagrams Forty or more paired avoids problems and measurements improves quality. • Ongoing measurement with From Methods and Tools of Quality Improvement feedback loops helps Institute for Healthcare Improvement MarMason processes. 23 The Public Health Quality Improvement Handbook, p. 22 Consulting 6