Illinois Multistate Learning Collaborative 3

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Illinois Multistate Learning Collaborative - 3

• Tuesday, March 3, 2009

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Tuesdays Agenda

• Components of Performance Management
• Building QI into Your Culture
• Using Data to Target Improvements
• Finalize RCI AIM Statements
• QI Team Work Plan Development

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Learning Objectives-Tuesday

• Participants will be able to describe some steps
  for building QI into their culture.
• Participant teams will have a final draft of RCI
  Steps 1 - 3 AIM Statement
• Participant teams will have a rough draft of
  their project work plan

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Performance Management and Building QI into Your
Culture

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Performance Management
Standards for Public Health
Public Health Indicators
QI Plans Councils
QI Methods Tools
Business Process Analysis
Performance Assessment
Improving PH processes
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Performance Management
Source Turning Point Performance Management
Collaborative, 2003.
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Performance Standards

• Establish Performance Standards
• Local and State Health Departments
• Establish and Define Outcomes and Indicators
• Process and Intermediate Outcomes
• Health Status Indicators

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Performance Measurement Definitions

• Performance measurement is the regular
  collection and reporting of data to track work
  produced and results achieved
• Performance measure is the specific quantitative
  representation of capacity, process, or outcome
  deemed relevant to the assessment of performance
• Performance measurement is NOT punishment

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Performance Measurement

• Monitoring of Performance
• Results of review of performance against local
  and state Standards
• Program evaluation results
• Monitoring of Indicators and Outcomes
• Process and intermediate outcomes
• Health status indicators

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Quality Improvement Process

• Use data to identify opportunities for
  improvement and to make decisions
• Quality Improvement Methods
• Improvement Collaboratives
• Adapting or Adopting Model Practices
• Establishing QI Councils, Plans, and Teams
• Logic Models, RCI, Business Process Analysis
• QI Tools Data Analysis and Root Cause

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Reporting Progress

• Reporting of Performance (Local and State
  Standards and Program Evaluation)
• Reporting of Indicators and Outcomes
• Health Indicators
• Program Evaluation Data
• Requires regular tracking, analysis and review to
  tell you if you are achieving your agency goals
• Provides the basis for deciding on QI efforts and
  the baseline information for measuring the impact
  of quality improvement activities

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The Quality Improvement Cycle Plan Do
Study Act
Standards and measures clarify expectations Scienc
e-based literature shows effective practices
Interventions are tried based on best available
evidence
Changes are made to improve performance based on
evaluation
Evaluation data shows if the intervention is
working. Is the indicator changing?
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Plan Do Study ActExample Immunization
1. Plan
2. Do
Completing the full DTAP immunization series
protects children and others from pertussis Goals
and targets are set
Outreach to health providers, parents and day
care can increase attention and follow through.
3. Study
Rates are monitored to see if they increased.
Surveys may be used to gather data. What worked?
What did not work?
4. Act
Materials are improved, Tracking system is made
easier to use. Return to Plan step, above, and
set new targets.
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Building QI into Your Culture

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Definition of Quality Improvement

• A management process and set of disciplines that
  are coordinated to ensure that the organization
  consistently meets and exceeds customer
  requirements.
• Uppercase QI top management philosophy
  resulting in complete organizational involvement
• Lowercase qi conduct of improving a process at
  the microsystem level
• Bill Riley and Russell Brewer, Review and
  Analysis of QI Techniques in Police Departments,
  JPHMP Mar/April 2009

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Demonstrate Leadership Commitment

• Build a QI culture
• Connect the organizations strategic plan to
  performance improvement
• Know and use quality principles
• Encourage all staff to use quality improvement in
  daily work
• Reward improvements
• Ensure adequate QI infrastructure for quality
  assessment and improvement activities

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Demonstrate Leadership Commitment QI Culture

• Clearly stated and enacted constancy of purposea
  deep understanding of the vision and mission
• Regular review of key indicator data
• Decisions made on data rather than hunches or
  opinions
• Long range view supports search for root causes
  and permanent solutions rather than quick fixes

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Demonstrate Leadership Commitment QI Culture

• Focus on systems rather than individuals
• Continued identification of improvement
  opportunities
• Publicize successes
• Clear communication agency-wide regarding the
  commitment to quality and the change processes
  necessary to implement improvement

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QI Infrastructure

• Governance (formal/informal)
• Oversight and accountability
• Program structure
• Who will do what when, with what processes for
  recommending or deciding
• Staff
• Support for ongoing monitoring and analysis, for
  training and facilitating improvement activities
• Data system
• Collect data and report in a user friendly way

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Quality Improvement Plan

• Goals and objectives
• Monitoring activities associated with important
  aspects of programs/services
• Planned QI efforts (in process, new) and
  timelines
• Evaluation of current QI efforts
• Annual evaluation of QI work plan and program
  description, with proposed revisions

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Tacoma-Pierce County Health Department Quality
Improvement (QI) Initiative
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Components for QI Culture

• Leadership/Vision
• Quality Improvement Training (just in time)
• QI Infrastructure
• Rapid Cycle Improvement Teams
• Regular Outcomes Data Reporting
• Celebrate Success and Expand

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QI Training

• QI theories concepts
• Data tools
• Examples
• Project idea
• Infrastructure
• RCI project topic

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QI Infrastructure

• Quality Improvement Council (QIC)
• Quality Improvement Plan
• QIC Calendar
• QI Plan Evaluation

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Quarterly Reporting Form

• Plan Item Name/No.
• Indicator(s)
• Baseline Data (if applicable)
• Quarterly Data
• Data Source
• Methods Notes
• Data Explanation/Other Comments

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(No Transcript)
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QI Time Line at TPCHD
WA DOH QI Training
1st RCI training
2nd RCI training
8/07
8/06
2/07
12/06
6/06
4/07
6/07
10/06
1st quarterly reports at QIC
2nd quarterly reporting cycle begins
1st quarterly reporting cycle begins
DOH Learning Collaborative
BOH update
1st RCI project starts
2nd RCI project starts
QI plan adopted at first QIC meeting
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Multilevel Model of Integration

• Spread can be defined as moving from common
  practices to best practices
• Diffusion is the rate at which innovation is
  adopted within an organization or industry
• Bill Riley and Russell Brewer, Review and
  Analysis of QI Techniques in Police Departments,
  JPHMP Mar/April 2009

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Levels of QI Integration
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JPHMP Article Recommendations

• Implement QI as a comprehensive management
  philosophy rather than a project-by-project
  approach
• Top officials must set a vision for the agency
  and exhibit constant leadership, focus
  continuously on mission
• 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

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What questions do you have?
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Using Data and Analysis to Target Improvements
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Targeting QI Improvements

• Remember criteria of high risk, high volume and
  problem-prone
• Analyze data to draw conclusions
• Use Pareto to identify vital few will get the
  greatest gain from QI efforts
• Evaluate relevance to population and choose
  highest relevance that is not achieving goal or
  target

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Use Data to Make Decisions

• The Four Dimensions of Variability

Shape
Center average, median or mode
Spread range or standard deviation
Sequence trend
From Methods and Tools of Quality Improvement
Institute for Healthcare Improvement
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Key Points for Analyzing Data

• The average by itself is not a good summary of
  data use a variety of numerical summaries
• Measures of center include
• Average/Mean the total data values divided by
  the total number of observations
• Median the middle value in the data set, half of
  the data value lie above, half lie below the
  median
• Mode the most frequently occurring values in the
  set of data
• Use histograms to look at overall variation
  patterns
• Use line graphs to look at patterns over time

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Identify the Vital Few

• Pareto Principle - In any group of things that
  contribute to a common effect, a relative few
  contributors (20) will account for the majority
  (80) of the effect
• These few contributors are called the vital few
  while the many other contributors are called the
  useful many
• The vital few hold the greatest potential gain
  from quality improvement efforts
• Pareto DiagramA fact based tool for priority
  setting in quality improvement efforts

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Application of Pareto Principle

• A few contributors
• Services
• Process steps
• Culture
• Items
• Reasons
• Theorized causes
• Indications
• Timeframes (hour/day)

• Account for majority of effects
• Problems
• Complaints
• Dissatisfaction
• Rework effort
• Cost of Quality
• Total time
• Errors
• Utilization

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Pareto Diagram Exercise

• How to construct a Pareto Diagram
• Turn to page 95 in the PH Memory Jogger.

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Answering the So What?

• Must use data to measure the outputs and outcomes
  of PH programs and activities
• Must establish and monitor quantifiable health
  status and health determinant indicators
• Feasible to link program outcomes and indicator
  results through rigorous use of data

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PH Program Logic Model
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Establishing Outcome Measures

• Data Description and Collection Form

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Use S-M-A-R-T Measures

• Specific
• Measurable
• Attributable
• Relevant
• Timebound

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Key Follow-Up Strategy

• The most important monitoring action you can take
  is the development of program-level reports that
  are made available to every staff person in the
  organization on a regular basis
• Supervisor and program manager reports that work
  with the same data elements
• These reports should be used on a regular basis
  to understand whether the program activities are
  performing as expected (cost, utilization,
  outcomes, etc.)

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Follow-Up Monitoring

• Every month key statistics should be kept to
  monitor how things are going, and to identify
  course corrections along the way

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Final Thoughts

• Two approaches to improvement to avoid systems
  without passion and passion without systems.
• Tom Peters, Thriving on Chaos

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What questions do you have?
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Teamwork on Next Steps

• Finalize AIM statement
• Develop implementation work plan
• Identify outcome measures
• Complete data description forms
• Plan for monitoring key outcomes
• Report progress at monthly web-based phone
  session