Presentation on theme: "Creating a Culture of Quality Improvement"— Presentation transcript:
1Creating a Culture of Quality Improvement Los Angeles County Department of Public HealthDivision of Quality ImprovementHello and welcome to An Introduction to Quality Improvement in Public Health, a course designed to provide you with a basic understanding of how quality is managed in a Public Health Department setting. Before we get started, please complete the pretest.-Next
2Goal #1: Develop an understanding of what Quality looks like in Public Health
3Quality in Public Health is… The degree to which policies, programs, services, and research for the population increase the desired health outcomes and conditions in which the population can be healthy -PHQF, 2008Before we can define quality improvement, we must first understand what is meant by the term “quality” when it comes to public health. Quality in Public Health is the degree to which policies, programs, services, and research for the population increase the desired health outcomes and conditions in which the population can be healthy.In other words, is the work that we are doing to improve the health of Los Angels county residents actually making a difference? Have we seen improvements in the health of the population that can be attributed to the work that we are doing here at DPH?For example…
4Quality at LACDPH Quality is the result of Worthy Work Well Done Worthy= We must have a clear direction (Strategic Plan)Work= Our work should have an intelligent direction based on evidence and best practices.Well Done= Our work should be carried out by a skilled and competent workforce and measured to track our performance.
5Goal 2: Develop a clear understanding of Quality Improvement and why it is necessary
6Quality ImprovementQuality Improvement (QI) is an integrative process that links knowledge, structures, processes and outcomes to enhance quality throughout an organization.-National Committee for Quality AssuranceQuality Improvement is an integrative process that links knowledge, structures, processes and outcomes to enhance quality throughout an organization.In other words….Quality Improvement is WORKING TO DO THE RIGHT THINGS RIGHT!
7Why QI?In a time of decreased funding and increased demand, QI can help answer key questions in public health:Are we using our resources (staff, money, time) in the best way?We often hear “work smarter, not harder”Are we getting the intended outcomes?
8Are we actually improving the health of the public in the most effective and efficient way possible? And if not, how can we do it better?
9QA & QI -They are not the same!!! Quality Assurance:Quality Improvement:Reactive; works on problems after they occurRegulatoryLed by managementOne point at a timeProactive – works on processes before problems occurSelf-determinedLed by staffContinuousExceeds expectationsSource: Public Health Foundation
103 Levels of Quality Improvement TopicOrganization-LevelProgram-LevelIndividual-LevelImprovementSystem FocusSpecific project focusDaily work level focusQuality Improvement PlanningTied to the Strategic PlanPerformance Measures tied to program-level Strategic PlanTied to yearly individual performanceEvaluation of QualityResponsiveness to a community needPerformance of a process over timePerformance of daily workProcessesCut across all programs and activitiesDelivery of a serviceDaily workQuality Improvement GoalsStrategic PlanIndividual Program level Strategic PlansIndividual Performance Evaluations
11Importance of Quality Improvement Quality Improvement positions an agency to achieve:Customer satisfactionEfficient use of resourcesMeasurable outcomesCommunity impact
12Connect staff with the benefits of Quality Goal #3Connect staff with the benefits of Quality
13Quality in Public Health Benefits Everyone Customers/ClientsEmployeesThe Organization
14Benefits of quality to clients Improved servicesImproved choicesExpectations met or exceededClient oriented employeesFriendlier atmosphereGive examples
15Benefits of quality to employees Pride in services deliveredJob satisfactionImproved communicationsStreamlined work processesHappier clientsStrong client relationshipsGive Examples
16Benefits of quality to the organization Improved/expanded servicesClient oriented employeesImproved client relationsImproved community relations = better political relationsLower costs/cost containedImproved fundingGive Examples
17Goal #4 Develop a clear structure and framework for quality management
19Determine Priorities and Goals What are the healthy behaviors and outcomes we want for people who live in LA County?What would these conditions look like if we could see them?Adapted from Mark Friedman’s “Results Accountability.” The questions on the left are the “big picture” questions that describe the general health goals we hope to achieve (Question 1) and specific conditions we plan to work on (Question 2). However, there will likely be more conditions to work on then we have time or resources to actually do. Here is where the need for strategic planning comes in...Currently, we have guidance from the LA County Strategic Plan and a newly released DPH Strategic Plan that helps us prioritize goals. In addition, Division Directors may require each program to create its own strategic plan.
21Results Based Accountability POPULATION INDICATORS(measures of population-levelhealth outcomes)PERFORMANCE MEASURES(measures of programeffort and output)ANDDPH and the Chief Executive Office use Mark Friedman’s “Results Accountability” approach for selecting goals and measures to assess the services we provide to the residents and visitors of Los Angeles County. This approach includes a quick and easy way to gain consensus on long-term goals and the actions/business processes needed to achieve them over time.One of the benefits of this approach is that measures are separated into 2 categories:Population-level indicators (with shared accountability); answers the question “How is the population better off?”Program- and SPA-specific performance measures (program accountability); answers the question “How effective is the program?”DPH will continue to use these 2 sets of measures and apply other selected “Results Accountability” principles in its PI efforts.Four quadrant approach to program performance measuresData development agendaHeadline measuresPublic HealthMeasures
22Population Indicators Longer life spanIncreased quality of lifeIncreased health equityLess diseaseLess premature deathHealthier choicesSafer environmentHealthier homesPOPULATION-LEVELHEALTH OUTCOMES& BEHAVIORSHow do we measure “success” in improving health at the population level? The list on the left includes currently accepted categories of health behaviors and outcomes. From these categories, Indicators can be created/written. The Indicator is the underlined portion, and we have specified the direction we want the Indicator to move in. Yellow indicates actual health outcomes, whereas white indicates upstream determinants of health (i.e. behaviors, built environment)
23Population Indicators Percent of students who had at least one drink of alcohol in the past 30 daysRate of foodborne illness hospitalizations each year (per 100,000)Percentage of children covered by health insuranceDeath rate from colorectal cancerAll of these examples of indicators were taken from the current set of DPH Public Health Measures (except #4). The respective categories are:Healthy choice/behaviorLess diseaseLess premature death
24Performance Measures Policies Created People Informed Improved BehaviorsSurveillance PerformedInvestigations CompletedIncreased Access to ServicesClient satisfactionMEASURES OFPROGRAMEFFORT & OUTPUTHow do we measure our work?
25Performance MeasuresPercent of outbreaks (excluding scabies) investigated within standard timeframePercentage of children under 6 years who participate in fully operational population-based [immunization] registriesNumber of cities that adopted a policy that prohibits smoking in outdoor areasAll of these examples of indicators were taken from the current set of DPH Public Health Measures. The respective categories are:Investigations completedSurveillance completedPolicies created
30Who Manages Quality at DPH Everyone Plays a Role in Quality Management:Director of Public HealthDivision of Quality ImprovementStrategic Directions CouncilExecutive TeamPerformance Improvement TeamProgram DirectorsManagers/SupervisorsAll Staff
31In order to establish a lasting culture of Quality, you must: Have a clear direction of what quality should look like in your organizationUnderstand Quality
32Goal #5:Clearly communicate your Quality Improvement plan and efforts throughout the organization
33Step 1: Create a Quality Improvement Program Description Document Give an overview of Quality at the organizationDescribe the structure for managing quality throughout the organizationEstablish roles and responsibilities for all levels of staff in relationship to Quality Improvement efforts.List and describe the organization’s QI effortsEstablish QI goals for the organization
34Step 2: Train staffIntroduction to Quality Improvement for all employeesIncorporate QI into existing trainingsConduct orientation sessions to orient staff to the QI PlanProvide advanced QI training to prepare staff to conduct quality improvement projects
35Step 3: Provide Support Technical Assistance 1:1 Consultation Presentations at program-level meetings
36SummaryIn order to establish a culture of quality, you must first decide what quality in your organization will look like and communicate that vision to othersThe structure and process for quality improvement should be visible and easily understood by everyone in the organizationBuy-in and support at all levels is essential to successfully establishing a culture of Quality