Grace GorenfloJack Moran

Goal:  To provide a foundation for COP-PHI awardees’ quality improvement efforts    

 Learning Objectives:- Understand the distinction between

quality improvement and other, related activities

- Understand the phases of a Plan-Do-Check-Act cycle

“Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. 

“It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.”

This definition was developed by the Accreditation Coalition Workgroup (Les Beitsch, Ron Bialek, Abby Cofsky, Liza Corso, Jack Moran, William Riley,

and Pamela Russo) and approved by the Accreditation Coalition on June 2009.

Quality Assurance and

Quality Improvement

Evaluation and

Quality Improvement

Quality Assurance

Reactive Works on problems

after they occur Regulatory usually by

State or Federal Law Led by management Periodic look-back Responds to a

mandate or crisis or fixed schedule

Meets a standard (Pass/Fail)

Quality Improvement

Proactive Works on processes Seeks to improve

(culture shift) Led by staff Continuous Proactively selects a

process to improve Exceeds expectations

Evaluation

Assess a program at a moment in time

Static Does not include

identification of the source of a problem or potential solutions

Does not measure improvements

Program-focused A step in the QI

process

Quality Improvement

Understand the process that is in place

Ongoing Entails finding the root

cause of a problem and interventions targeted to address it

Focused on making measurable improvements

Customer-focused Includes evaluation

Plan – Do – Check – Act vs.

Plan – Do – Study – Act

Act

DoCheck/Study

Plan

Identify and prioritize quality improvement opportunities

www.adesblog.com/category/getting-things-done/

Identify / Prioritize Opportunities Example:

Vital Statistics Customer average wait

time more than 28 minutes

Develop an AIM Statement

WHAT are we striving to accomplish? WHEN will this occur (what is the timeline)? HOW MUCH ? What is the specific, numeric

improvement we wish to achieve? FOR WHOM ? Who is the target population?

AIM Statement Example:

Reduce Vital Statistics customer

wait time to 15 minutes

Describe the current process

Describe the Current Process for Vital Statistics:

Limited number of cashiers

to process transactions

Collect data on the current process

Vital Statistics Collect Data On:

Number of cashiers and the wait

time per customer

Identify all possible causes

Identify Possible Causes:

No. of cashier windows open,

Printer/network issues,

Incomplete documentation etc.

Identify potential

improvements

www.talentt.com/productFile/1196704593.jpg

Identify Potential Improvements:

Increase the number of cashier

windows open(especially at rush hour)

Develop an improvemen

t theory

IF…THEN…

scipp.ucsc.edu/theory/theoryhomepage.htm

Develop Improvement Theory:

Create trigger system for supervisor to

improve customer flow.

Maintain wait time to 15mins.

Develop an action plan

Develop Action Plan: Pilot Program:

One additional cashier added from

Correspondence and additional cashier/s

when wait time exceeds 15 minutes

Implement the improvement

Collect and document the data

Document the problems, unexpected observations, lessons learned, and knowledge gained

Implement the Improvement:

Implementation of Pilot

Program for a week

Collect and Document the data:

Wait time reduced by 50%

Problems, Observations, Lessons LearnedPilot Program Implementation

Day 1: Ran a snag – 4 staff out

Day 2: Successfully implemented Pilot

Program (5 cashier windows open)

Analyze the results: was an improvement achieved?

Document lessons learned, knowledge gained, and any surprising results that emerged.

Reflect on the Analysis:

Data obtained for wait time - 1 Week pilot program.

Cashier Survey data

Document Problems: Unavailability of Staff and Communication issues.

Observation: Smooth running of pilotLessons learned: Customer Wait time directly

proportional to # of cashier window open

Take action: Adopt - standardize Adapt – change and repeat Abandon – start over

Once you’ve adopted – monitor and hold the gains!

Plan

1. Identify / Prioritize Opportunities:Customer average wait time

more than 28 minutes

2. AIM: Reduce customerwait time to 15 minutes

3. Current Process: Limited number of cashiers

to process transactions

4. Collect Data On: Number of cashiers and the wait time

per customer

5. Identify Possible Causes: No. of cashier windows open,

Printer/network issues, Incomplete documentation etc.

6. Identify Potential Improvements:Increase the number of cashier

windows open(especially at rush hour)

7. Develop Improvement Theory: Create trigger system for supervisor to

improve customer flow. Maintain wait time to 15mins.

8. Develop Action Plan: Pilot Program – One additional cashier added from

Correspondence and additional cashier/swhen wait time exceeds 15 minutes

1. Implement the Improvement:Implementation of Pilot

Program for a week

Do

2. Collect and Document the data:Wait time reduced by 50%

3. Problems, Observations, Lessons LearnedPilot Program ImplementationDay 1: Ran a snag – 4 staff out

Day 2: Successfully implemented Pilot Program (5 cashier windows open)

Day 2-5: Pilot Successfully implemented

Check/Study

1. Reflect on the Analysis:Data obtained for wait time - 1 Week

pilot program. Cashier Survey data

Act:

2. Document Problems: Unavailability of Staff and Communication issues.

Observation: Smooth running of pilotLessons learned: Customer Wait time

directly proportional to # of cashier window open

Adopt

Adapt

Abandon

Standardize

Do

Plan

Blue Team: Vital Stats

PLAN

DO

CHECK

ACT: Achieve Results

?

Decide to do QI

Standardize

No/Maybe - Adapt

Yes - Adopt

No - Abandon

Myth: QI is about weeding out the bad apples

Truth: QI is about processes - series of steps or actions performed to achieve a specific purpose

Myth: If I don’t achieve my goal, I’ve failed

Truth: When doing QI, there is no such thing as failure

Myth: All change = improvement

Truth: All improvement = change

http://www.naccho.org/topics/infrastructure/accreditation/upload/ABCs-of-PDCA.pdf

http://www.phf.org/resourcestools/Pages/The_ABCs_of_PDCA.aspx