Quality Improvement A Journey

QA & QIAnd

Accreditation

A continuous process to review, critique, and implement measurable positive change in public health policies, programs or infrastructure.

What is Quality Improvement?

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It’s about process

It’s about data

It’s about learning

Quality Improvement

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A process is a series of steps or actions performed to achieve a specific purpose.

A process can describe the way things get done.

Your work involves many processes.

Quality Improvement Works on Existing Processes

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Process Improvement-Better inform the public about what services are provided by the local health department.

Problem Addressed – Increase the number of public health articles in the newspaper from 5 to 30 per year.

Results – Increased articles from 5 to 60

Berrien County LHD – MLC-2

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Data will tell you if you made a change or an improvement.

Data can help identify the “root” cause of the problem.

Data can help you focus on where to spend your time and effort for the greatest return.

Data can help you measure not just count.

DATA

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Process Improvement – Better provision of appropriate education to hepatitis C clients during visits to providers offices.

Problem Addressed – Inform providers of ways to provide effective education and counseling to clients diagnosed with Hepatitis C.

Results – Provider knowledge of management of Hepatitis C increased from 63.3% on pre-test to 89.3% post-test after training.

Kent County LHD – MLC-2

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Plan

DoStudy

Act

Plan

DoStudy

Act

Continuous Improvement/Learning

Process Improvement- Seeks to transform to a new more integrated and holistic organization model to assist and support in the development and preparation of staff for leadership positions

Problem Addressed- Assess and improve on communications issues that impeded internal leadership development

Results – Repeat survey results noted positive improvements in 7 specific categories addressing organizational development

Ottawa County LHD-MLC-2

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Is about process

Is about dataIs about learning

Remember Quality Improvement

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Quality Assurance and Quality Improvement both have the w Aren’t they just more of the same?

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THE

FIRST

BIG

HURDLE

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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

Meet s a Standard (Pass/Fail)

Quality Improvement

Proactive Works on Processes

or Systems Seeks to Improve

(culture shift) Led by Staff Continuous Proactively Selects a

Process to Improve To Exceed

Expectations

THEY ARE NOT THE SAME

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QUALITY ASSURANCE

A way to warrant that predefined standards are met. QA is the first step toward quality improvement.

QUALITY IMPROVEMENT

A continuous process to review, critique, and implement positive change in public health policies, programs or infrastructure.

DEFINITIONS

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Quality control; Privacy; Customer satisfaction; Employee satisfaction; Assessment/Accreditation

QA in a Broader Context

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An assessment/accreditation program is one that uses an identified set of standards or metrics to review the performance of state and/or local public health departments

Defining Assessment/Accreditation

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Statute or Rule (Standards) AKA Minimum Program Requirements

Indicators (Way to meet Standards)

Corrective Plan of Action (Way to meet Standards)

Michigan’s Local Public Health Accreditation Program

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QA is about defining measures and monitoring performance.

QI is about using performance measures to plan and test improvements in a program or process.

While different, both can improve quality

How do QA and QI relate to one another?

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Management usually leads accreditation & assessment efforts, staff usually make QI happen;

Work as a team to improve the program;

Management (QA) and Staff (QI) on the Same Path to Improvement

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Have a natural relationship

Accreditation defines measures and monitors performance and

QI uses the measures to plan and test improvements

Accreditation and Quality Improvement Together

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Moving from Monitoring

(QA) To

Improvement (QI).

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Plan

Do

Study

Act

QI

Processes Are All Variations of the Same

Basic Steps

Using QI Methods

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PDCA/PDSA is mature

Proven in many contexts;

Front line staff have significant input;

Many tools are available and inexpensive;

It Works!

But Why PDSA?

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Public Health often slow to adopt improvements

Cpt James Lancaster in 1601 proved Vitamin C prevented scurvy

British preventive policy on scurvy adopted 264 years later

Provides a set of proven, reliable, and repeatable steps that anyone or a team can use to make improvement

Why Quality Improvement?Why Now?

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Why So Much Time On This?

High Expectations for QI

Centerpiece for national accreditation

Transformational change

Systemic Change Culture of Quality Tell Public Health

Story Increase Funding Moves from outputs

to outcomes Moves from counting

to measuring

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We also said:

Your work involves many processes.

Most processes today are undocumented

We Said:QI Works on Existing Processes

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And everything we don’t do but should also has a cost.

You are too busy, too thinly staffed and can’t afford to make changes that don’t improve our work while at the same time continue to be good stewards of taxpayer monies.

Everything We Do has a Cost

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In one of my college courses, I remember studying the management involved in manufacturing widgets.  Through observation I believe the MPR's are good at counting widgets and making sure all the widgets are the same, however, the MPR's do not tell us if we are making the right widgets or if we are making them in the right way.  I see that the PDSA process and drilling down to a specific issue can tell us more about how widgets should be made and what they should look like. 

But It is not just Cost!

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Who wouldn’t want to expand their horizons and help to create a better organization?

There isn’t a single aspect of the work at any LHD that can’t be improved.

I learned that QI is essential for public health. We have limited resources and it is a great way to direct those resources to the places it is needed most and will have the most impact.

We now have staff eager to use the same tools and methods to evaluate performance and make improvements in other areas of our work.

MLC-2 Feedback-LHD Participants

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Quality

Costs

Less

“Quality is never an accident; it is always the result of high

intention, intelligent direction, and skillful execution. It

represents the wise choice of many alternatives.”

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Quality Improvement is

more than a method;

it is a mind-set – the

way we look at the

services we provide

and the services we

receive as customers

(clients)

Sky’s the LimitBuilding Knowledge Workers

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Any Questions?

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