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Presentation on theme: "PERFORMANCE MANAGEMENT AND BUILDING QI INTO YOUR AGENCY CULTURE MCPP Healthcare Consulting."— Presentation transcript:


2 Marni Mason BSN, MBA  More than 30 years in private healthcare and public health as clinician, manager and consultant  Primary & specialty care clinic nurse and nursing director (15 years)  Consultant in healthcare performance measurement and improvement (18 years)  Public health performance management – since 2000  Surveyor for NCQA (11 years) and Senior Examiner for state Baldrige Quality Award  Consultant for PHAB Standards Development (2008- 2009) MCPP Healthcare Consulting

3 Learning Objectives  In today’s session the participants will develop a better understanding of:  Components of Performance Management  Methods and Tools for Building QI Culture  Preparing for Accreditation MCPP Healthcare Consulting

4 Performance Management QI Plans & Councils Business Process Analysis Public Health Indicators Standards for Public Health Performance Assessment Improving PH processes QI Methods & Tools MCPP Healthcare Consulting

5 Performance Management MCPP Healthcare Consulting

6 Application of P-D-S-A MCPP Healthcare Consulting

7 Performance Standards 1 st Quadrant  Establish Performance Standards  NACCHO – Operational Definition and Standards  National Public Health Performance Standards (CDC)  Public Health Accreditation Board Standards Local, State and Tribal Health Departments  Establish and Define Outcomes and Indicators  Process and Intermediate Outcomes  Health Status Indicators MCPP Healthcare Consulting

8 Performance Measurement 2 nd Quadrant MCPP Healthcare Consulting

9 Performance Measurement Definitions MCPP Healthcare Consulting

10 Quality Improvement Process 3 rd Quadrant  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

11 Principles of Quality Management 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 MCPP Healthcare Consulting

12 Plan Objective Questions and predictions Plan to carry out the cycle (who, what, where, when) Plan for data collection Do Carry out the plan Document problems and unexpected observations Begin analysis of the data WORK PLAN Study Complete the data analysis Compare data to predictions Summarize lessons DATA REPORT Act What changes are to be made? Next cycle? DOCUMENTATION OF CHANGE - MINUTES REVISE LOGIC MODEL LOGIC MODEL REVISE LOGIC MODEL MCPP Healthcare Consulting Learning and Improvement Cycle

13 Tools to Link Work and Outcomes  Logic Models and detailed high level flow charts  Identify customer-supplier relationships  Client flow, information flow, materials flow, decision making flow  Data and Analysis tools  PH Memory Jogger MCPP Healthcare Consulting

14 Adopt or Adapt Model Practices  Use data to identify need for improvement  Identify exemplary practices in:  Other local and state health departments,  CDC and other national organizations,  Other industries  Describe your process (Logic Model or Flow Chart)  Study the exemplary practice process  Adopt or adapt as appropriate

15 Reporting Progress 4 th Quadrant  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 MCPP Healthcare Consulting

16 Stages of Organizational Performance MCPP Healthcare Consulting

17 Does Size of Department Matter?  Good News! Smaller LHDs can demonstrate standards at same level as large LHDs  “Money (and staff) matter, but they aren’t all that matters” (Joan Brewster)  In Washington, 40% of the higher performers in the 2008 review cycle were smaller LHDs (less than 2 million annual budget). A couple of higher performers were LHDs with annual budgets of approximately $600,000 MCPP Healthcare Consulting

18 Correlation of Budget & FTEs  Relationship of budget and FTEs to overall performance in the Standards is nearing random (little or no correlation)  Five non-urban LHJs with budgets of $2 million or less had > 60% demonstrated  There is variability not connected to budget or size, other drivers of high performance are local priority-setting; leadership; local funding; staff skill, training and experience; and documentation and data systems MCPP Healthcare Consulting

19 Correlation of Budget to Performance Slight correlation and relationship between annual budget and overall performance in the Standards MCPP Healthcare Consulting

20 20 Correlation of Per Capita Budget No correlation or relationship of per capita budget to overall performance in the Standards MCPP Healthcare Consulting

21 Building QI into Your Culture MCPP Healthcare Consulting

22 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 MCPP Healthcare Consulting * Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009

23 Demonstrate Leadership Commitment  Build a QI culture  Connect the organization’s 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 MCPP Healthcare Consulting

24 Demonstrate Leadership Commitment  Clearly stated and enacted constancy of purpose— a 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 MCPP Healthcare Consulting

25 Demonstrate Leadership Commitment  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 MCPP Healthcare Consulting

26 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 MCPP Healthcare Consulting

27 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 MCPP Healthcare Consulting


29 QI Time Line at TPCHD MCPP Healthcare Consulting

30 QI Training & Tools  QI Principles, Methods and Tools  Just-in-time training for QI project teams, RCI method  Performance measures  QI Council training on QI concepts  QI concepts staff can use in daily work MCPP Healthcare Consulting

31 QI Infrastructure  Must have director and other senior management LEADING the initiative  Establish a steering committee or leadership group to direct and oversee agency efforts (e.g. QI Council)  Leadership and key staff on QI Council  QI Plan and regular evaluation of QI efforts  Assessment staff is an excellent resource  Start small; get people excited about a single project  Celebration of successes is important MCPP Healthcare Consulting

32 QI Plan and Evaluation  Annual QI plan  Lists major activities  Includes calendar  Identifies persons responsible & time lines  Annual evaluation of QI plan  Evaluates QI Council meetings  Analyzes performance measure data  Examines completion rate of QI plan activities MCPP Healthcare Consulting

33 Quarterly Reporting Form  Plan Item Name/No.  Indicator(s)  Baseline Data (if applicable)  Quarterly Data  Data Source  Methods Notes  Data Explanation/Other Comments MCPP Healthcare Consulting


35 QI Calendar (TPCHD example) III. 2009 Quality Improvement Council Calendar Staff ResponsibleCompletion DateQI Council Review Date Additional Review Dates A. Rapid Cycle Improvement Projects PurchasingMarcy KullandSep 21Sep 22 (final report)TBD (BOH) Solid waste code enforcement complaint resolution John Sherman Nov 23 Sep 22 (interim report) Nov 24 (final report) TBD (BOH) B. TPCHD Performance Measures See Section II BJul 31 Oct 31 Jan 31, 2010 Aug 25 Nov 24 Feb 23, 2010 Mar 3, 2010 (BOH) C. QI Projects at Request of Director TBD D. Program Evaluation Reports Menu labelingRick PorsoMay 25May 26 MCH home visitingDavid VanceOct 26Oct 27 E. Review of Health Indicators Three priority indicators (Review of performance measures in Table 2) Nigel Turner (Chlamydia) David Vance (LBW) Rick Porso (Adult Obesity) Jul 31* Oct 31 Jan 31, 2010 Aug 25 Nov 24 Feb 23, 2010 Mar 3, 2010 (BOH) MCPP Healthcare Consulting

36 Performance Measures  Twelve department-level measures  Modeled after Healthy People 2010 Leading Health Indicators... plus two more  Approx. 10-20 performance measures per business unit  Percent of solid waste complaints responded to within 20 days  Reduce the rate of positivity at Infertility Prevention Project (IPP) sites  Percentage of Positive Steps clients who engage in services for 30. days or more who have a 10% reduction on three youth violence risk factors MCPP Healthcare Consulting

37 TPCHD Performance Measures MeasureIndicatorResponsibility Improve immunization rates Increase the percentage of kindergarten enrollees that are up to date on their immunizations upon school entry from 86% to 92% by 2014. Nigel Turner Reduce tobacco useDecrease the percentage of adult smokers to 16% by 2014.Rick Porso Reduce overweight & obese populations Reduce the rate of increase for adult obesity to 0% by 2014.Rick Porso Increase healthy physical activity Increase the percent of youth who are physically active for at least 60 minutes per day from 16.8% to 18.5% by 2014. Rick Porso Reduce substance abuse Increase the number of adults receiving opiate treatment service by 23% by 2014, to 800 patients. David Vance Increase responsible sexual behavior Increase the percentage of sexual partners treated for sexually transmitted diseases by 10% by 2014. Nigel Turner Increase access to care Increase the number of children enrolled annually in health insurance programs by 42% by 2014. David Vance Decrease injury and violence Reduce youth violence risk factors among 75% of youth who participate in TPCHD youth violence prevention services for at least 30 days. David Vance Improve mental healthDecrease adult mental health problems in 20% of families provided TPCHD evidenced-based program services by 2014. David Vance Improve environmental quality Increase the percent of water systems that meet drinking water standards from 80% to 90% by 2014. Steve Marek Effectively respond to public health emergencies Respond within one hour in 100% of situations where TPCHD receives a notice of need for public health response to an incident within Pierce County. Joby Winans Decrease rates of key communicable diseases Increase the percent of ten key communicable diseases for which the trend in incidence rate is flat or decreasing from 38% to 50% by 2014. Nigel Turner MCPP Healthcare Consulting

38 QI Activities - TPCHD  Critical to make data/reporting meaningful to staff.  Performance measures:  More is not better  Resource level declines after the first data reporting period  Staff need lots of practice/training to develop good performance measures  RCI/QI projects:  Quality planning is more appropriate than QI for some projects with long-term outcomes MCPP Healthcare Consulting

39 First RCI Project STD Reporting of Race/Ethnicity 1.Collected data to identify “root cause” of problem 2.Pilot tested an education intervention MCPP Healthcare Consulting

40 Second RCI Project Final On-Site Septic System Inspections 1.Collected data to identify “root causes” of problem 2.Re-prioritized work duties 3.Monitored work flow MCPP Healthcare Consulting


42 TPCHD Results of QI Initiative  Most performance measures at department- and business unit-level achieved their stated target  Improvements sustained for RCI/QI projects  Health indicator projects met 100% of annual performance measures  Funding & staffing for QI has increased MCPP Healthcare Consulting


44 PM System and QI Structure Focused Quality Improvement Efforts Focused Quality Improvement Efforts Organizational Strategic Planning Organizational Strategic Planning Performance Management and Accountability Performance Management and Accountability Operational/Business Planning and Performance Operational/Business Planning and Performance Quality Steering Committee Quality Steering Committee Performance Management SystemQI Structure PALS (Performance Accountability Liaisons) PALS (Performance Accountability Liaisons) Project Mgmt. Resource Team Project Mgmt. Resource Team Process Improvement Teams Process Improvement Teams

45 Quality Improvement Organizational Structure Quality Steering Committee Quality Steering Committee Primary responsibilities include: Reviewing and approving the agency QI plan annually Encouraging and fostering a supportive QI environment Championing QI activities, tools and techniques Selecting and supporting agency QI projects MCPP Healthcare Consulting

46 Step #5: Take appropriate action. Step #5: Take appropriate action. Step #6: Provide closure. Step #6: Provide closure. Step #4: Analyze data and generate solutions. Step #3: Examine the process. Step #3: Examine the process. Step #1: Clarify the purpose. Step #1: Clarify the purpose. Step #2: Select & build the team. Step #2: Select & build the team. The Quality Improvement Process MCPP Healthcare Consulting

47 Integration of QI into Agency Culture MCPP Healthcare Consulting

48 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 MCPP Healthcare Consulting

49 Levels of QI Integration MCPP Healthcare Consulting

50 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 MCPP Healthcare Consulting


52 Establish HD Workgroup  Assign coordinator for preparation project (12-18 months in advance)  Assign specific categories/standards to individuals (usually managers)  Develop detailed work plan that addresses each standard  Establish meeting schedule for workgroup  Report progress and barriers to leadership team MCPP Healthcare Consulting

53 Conduct Self-Assessment  Use accreditation standards and documentation guidelines to conduct objective review against the standards  Identify documentation that shows performance  Identify areas not meeting the standard as areas for improvement MCPP Healthcare Consulting

54 Tell Your Story….  Reviewers will not be familiar with your HD or even your state  Provide short summary or note that describes your processes for the topic being addressed  Be “laser focused” on the specific requirement of that measure  Provide only the documentation that is needed to demonstrate performance. More is not better! MCPP Healthcare Consulting

55 Organizing Your Documents  Collect and organize all documents for reviewers to review  Online document library with folders for each standard and measure  PHAB accreditation submittal system  State page number (or highlight with text box) where specific information addressing the measure is located if document more than 3 pages long  Can use same document for multiple measures—just indicate all measures that are relevant and page of document MCPP Healthcare Consulting

56 Electronic System MindManager How does MindManager help you prepare for your review?  Electronic mind mapping tool.  Visual diagram that looks like a tree with a main topic and as many sub-topics as you like exploding out in branches.  Ability to give context and relationships that are difficult to see in a linear document.  Consolidate multiple sources of information.  Establishes greater accountability by enabling team members to track assignments.  Reviewers love having everything in one location.

57 MindManager Overview A look at the big picture.

58 MindManager Overview “Read Me” Text

59 Documentation in Daily Work  Build documentation into regular processes:  Use summary formats for regular reporting  Minutes of working committees  Case write-ups, logs, and progress reports  Emphasize conclusions, actions and results MCPP Healthcare Consulting

60 We Can Make Significant Improvement  Significant improvement was shown in the following measures that were comparable:  4.2L Health care providers receive information, through newsletters and other methods, about managing reportable conditions. (from 74% to 92%)  4.5L A notifiable conditions tracking system documents the initial report, investigation, findings and subsequent reporting to state and federal agencies (from 82% to 100%)  4.8L (EH Only) A tracking system documents environmental health investigation/compliance activities … as required. (from 67% to 94%) MCPP Healthcare Consulting

61 Change vs. 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 MCPP Healthcare Consulting

62 What questions do you have? MCPP Healthcare Consulting


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