THE WEBCAST WILL BEGIN SHORTLY If you need technical assistance - PowerPoint PPT Presentation

THE WEBCAST WILL BEGIN SHORTLY If you need technical assistance please email naccho@commpartners.com The primary means of listening to this webcast is via streaming audio through your computer speakers. If you are unable to access streaming audio through your computer, please dial (800) 817­8874 and enter passcode 8025542# . Quality Improvement and Accreditation Preparation: Quality Improvement 101

Speaker Introductions • Marlene (Marni) Mason, BSN, MBA, MCPP Healthcare Consulting • Stacy Baker, MSEd, Public Health Foundation Quality Improvement and Accreditation Preparation: Quality Improvement 101

Webcast Agenda • Marni Mason: Overview of Quality Improvement • Tacoma­Pierce County Health Department Quality Improvement (QI) Initiative – Rapid Cycle Improvement Example • Rapid Cycle Improvement: Genesee County, Michigan Example • Stacy Baker: Tools and Resources for Public Health • Questions and Answers • Evaluation Quality Improvement and Accreditation Preparation: Quality Improvement 101

POLL: Have you applied quality improvement methods in your public health work? Yes – in the last 6 months Yes – but it was more than 6 months ago No, not yet Not sure Quality Improvement and Accreditation Preparation: Quality Improvement 101

Overview of Quality Improvement Marni Mason, BSN, MBA, Healthcare Management Consultant, MCPP Healthcare Consulting Quality Improvement and Accreditation Preparation: Quality Improvement 101

Performance Management has many components How do they work together? P u Standards for b l i c H I e QI Plans & Public Health n a d l i t c h a t o Councils r s QI Methods & Tools Business e c Improving PH n Process a t n m processes e r m o Analysis f s r s e e P s s A Quality Improvement and Accreditation Preparation: Quality Improvement 101

Performance Management System There are four important components of performance management: � Performance Standards � Performance Measurement � Quality Improvement Process � Reporting of Progress Guidebook for Performance Measurement, Turning Point National Program Quality Improvement and Accreditation Preparation: Quality Improvement 101

Performance Standards • We have standards for capacity and process/outcomes, AND • We have standards for results through health status and health determinant indicators • Both types of standards for performance are important and are needed for successful performance management and improvement Quality Improvement and Accreditation Preparation: Quality Improvement 101

Performance Measurement • Monitoring of Performance through Local and State Standards • Monitoring of Indicators � Core Health Indicators � Program Evaluation Data • Requires regular analysis and review to tell you if you are achieving your agency goals and objectives • Provides the basis for deciding on QI efforts and the baseline information for measuring the impact of quality improvement activities Quality Improvement and Accreditation Preparation: Quality Improvement 101

Principles of Quality Improvement 1. Know your stakeholders and what they need 2. Focus on processes 3. Use data for making decisions 4. Understand variation in processes 5. Use teamwork to improve work 6. Make quality improvement continuous 7. Demonstrate leadership commitment Quality Improvement and Accreditation Preparation: Quality Improvement 101

Quality Improvement Process • Use data to identify opportunities for improvement and to make decisions • Choose an improvement method targeted at a specific opportunity for improvement: � Plan­Do­Study­Act cycle � Improvement Collaboratives � Adapting or adopting Model Practices � Establishing QI Councils, Plans, and Teams � Logic Models, Rapid Cycle Improvement (RCI), Business Process Analysis (BPA) Quality Improvement and Accreditation Preparation: Quality Improvement 101

The PDSA Cycle for Learning and Improvement Small scale test Act Plan Series of tests Wide­scale tests • What changes • Objective Implementation are to be made? • Questions and • Next cycle? predictions (why) • Plan to carry out the cycle (who, what, where, when) • Plan for data collection Study Do •Complete the analysis of •Carry out the plan the data •Document problems •Compare data to and unexpected predictions observations •Summarize what was •Begin analysis of the learned data Quality Improvement and Accreditation Preparation: Quality Improvement 101

Rapid Cycle Improvement (RCI) Model for Improvement The idea behind RCI is to be very clear about W hat are we trying to accomplish? the focus of the improvement and to first try a How will we know that a change idea on a small scale to see how it change is an improvement? works, and then modify it and test it again until it demonstrates real improvement. Then, and only then, should the change be implemented. Act P lan S tudy Do Quality Improvement and Accreditation Preparation: Quality Improvement 101

Some Quality Improvement Tools • Choose the conceptual or numerical tool needed to analyze your data • Work Process Analysis • Fishbone Diagram and other tools for identifying root cause like the 5 Why’s • Pareto Diagrams to identify the “vital few” • Variation analysis; common cause and special cause Quality Improvement and Accreditation Preparation: Quality Improvement 101

More QI Tools Conceptual Tools Numerical Tools • Affinity Diagram • Check Sheet • Brainstorming • Bar Chart • Histogram • Process Flow Chart • Pareto Chart • Interrelational Diagraph • Control Chart • Matrix Diagram • Run Chart • Tree Diagram • Cause and Effect Diagram Great descriptions of tools in Goal/QPC’s Public Health Memory Jogger Quality Improvement and Accreditation Preparation: Quality Improvement 101

Putting the pieces together Identify the weak spots in public health practice. One Problem: Program evaluation is weak , so we do not routinely measure Performance program impact son health. Standards One Example: We have not systematically evaluated immunization efforts. th DTAP. We have Our immunization rates for 2 year olds appear low for the 4 seen increased pertussis. Can we improve the effectiveness of this service? Quality Change what is not working Improvement Efforts Response: Provide training and tools on evaluation and apply to specific services. Implement strong evaluation. Use the results to make services more effective. Example: Outreach to medical providers, parents and day care to address immunization. Better data collection. Increased outreach to parents. Health Indicators Monitor Results Track rates: Determine if strategies are working Example : Did the strategies work? Immunization rates up? Pertussis down? If not – why not? Was success achieved one place – and why? Quality Improvement and Accreditation Preparation: Quality Improvement 101

“Plan – Do – Study – Act” Example: Immunization 1. Plan 2. Do Completing the full DTAP Outreach to health providers, immunization series protects Do parents and day care can increase Plan children and others from pertussis attention and follow through. Goals and targets are set Study Act 4. Act 3. Study Materials are improved, Tracking system is made Rates are monitored to see if they easier to use. Return to Plan step, above, and set new increased. Surveys may be used to targets. gather data. What worked? What did not work? Quality Improvement and Accreditation Preparation: Quality Improvement 101

Tacoma­Pierce County Health Department Quality Improvement (QI) Initiative – Rapid Cycle Improvement Example Quality Improvement and Accreditation Preparation: Quality Improvement 101

TPCHD Sexually Transmitted Disease Reporting Project • Assessment identified that STD reports did not contain accurate race/ethnicity information • STD team wanted to customize their follow­up based on race/ethnicity • Identified this as an opportunity for improvement • Chose Rapid Cycle Improvement as method to create improvement Quality Improvement and Accreditation Preparation: Quality Improvement 101

Rapid Cycle Improvement Project • Form workgroup � Supervisor/manager � Front line staff � Assessment staff • Conduct just­in­time training • Complete a three­month RCI project � Multiple PDSA cycles • Mid­term and final reports to Quality Improvement Council Quality Improvement and Accreditation Preparation: Quality Improvement 101

STD Reporting of Race/Ethnicity Percent of STD Case Reports That Include 1. Collected data to Race Data (Among Pilot Providers) identify “root 80 cause” of problem 70 Percent 60 2. Pilot tested an 50 74 education 40 intervention 55 30 20 10 0 Pre Post Quality Improvement and Accreditation Preparation: Quality Improvement 101

Change versus 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 Quality Improvement and Accreditation Preparation: Quality Improvement 101

Another Rapid Cycle Improvement Example Genesee County, Michigan Quality Improvement and Accreditation Preparation: Quality Improvement 101