Buffalo Trace District Health Department Quality Improvement Buffalo Trace District Health Department Angela Carman, DrPH May 23, 2016

Agenda Introductions What is Quality Improvement PDCA Model Elevator Speech Assignment/Q&A

What is Quality Assurance? Focuses on the maintenance of a desired level of quality in a service or product. Relates to Monitoring & Compliance Standards met? Deficiencies corrected? QA is reactive! What is Quality Improvement? Focuses on the process of moving to the next level with the aim to improve the organization and its impact on the health of the community Relates to Learning & Improving. QI is proactive!

Tough Economic Times Require a Different Approach! Why QI in Public Health? QI Can: Reduce costs and redundancy Eliminate waste Streamline processes Enhance ability to meet service demand Increase customer satisfaction Improve outcomes Tough Economic Times Require a Different Approach!

Three Key Questions What are we trying to accomplish? What changes can we make that will result in improvement? How will we know that we have made an improvement? (DATA)

PDCA/PDSA Process Plan Check/ Study Do Act Adopt Adapt Do Abandon Plan Identify and Prioritize Opportunities 7. Develop Improvement Theory/Idea 1. Reflect on the Analysis 2. Develop AIM Statement 8. Develop Action Plan 2. Document Problems, Observation, and Lessons learned 3. Describe the Current Process Do 1. Implement the Improvement 4. Collect Data on Current Process Act 2. Collect and Document The data Adopt Standardize 5. Identify All Possible Causes Adapt Do 3. Document Problems, Observations, and Lessons Learned 6. Identify Potential Improvements Abandon Plan The ABC’s of PDCA, G. Gorenflo and J. Moran

Identify and Prioritize Opportunities FCHD QI Plan Details of the Practice Scenario

Aim Statement Identifying your aim 2. Develop AIM Statement Current State Future State: What are the important aspects of the future state? What is driving us to this future state? What might be the consequences of not moving to the future state? What might change? What is the proposed timeline? DRIVING FORCES: What is the current state? Why is this important? What is it costing us time / dollars / staff / etc? What is the impact on our customer/clients? What is the impact on our division/agency? PATHWAY CONSEQUENCES BENEFITS

(Indicate the metric’s starting point – current state) AIM or Opportunity Statement Template An opportunity exists to improve the (name process, or area to work on) beginning with (beginning boundary, starting point) and ending with . (ending boundary, finish point) This effort should improve (key characteristics of area the team is working on) for the customers, staff or those affected by the process under improvement) This process is important to work on now because (what will it improve and for whom?) The Baseline measurement is defined as the following metric:: (Indicate the metric’s starting point – current state)

Describe the Process

Describe the Process 3. Describe the Current Process Flow Chart – A picture of the separate steps of a process in sequential order

Data Discussion What data do we need? What data do we have? 4. Collect Data on Current Process What data do we need? What data do we have? Do we know how to get it?

Identify all Possible Causes Cause & Effect Diagrams – Construction Write the issue as a problem statement on the right hand side of the page and draw a box around it with an arrow running to it. This issue is now the effect Effect

Cause & Effect Diagrams – Construction: Generate ideas as to what are the main causes of the effect Header Header Label these as the main branch headers Effect Organizes group knowledge about causes of a problem and display the information graphically Header Header

Cause and Effect Diagrams – Construction: For each main cause category brainstorm ideas as to what are the related sub-causes that might effect our issue Header Header why why why Use the 5 Why techniques when a cause is identified Effect why Keep repeating the question until no other causes can be identified Header Header List the sub-cause using arrows

Fishbone (Cause & Effect) Diagrams: 6 Common categories of causes

Identify Potential Improvements Solution and Effect Diagrams - Construction Place the Solution and Effect Diagram opposite the Cause and Effect Diagram Write the issue as a positive statement on the left hand side of the page and draw a box around it with an arrow running to it.  This issue is now the effect Positive Effect

Solution and Effect Diagrams - Construction 6. Identify Potential Improvements Solution and Effect Diagrams - Construction Generate ideas as to what are the main Solutions of the effect Label these as the main branch headers Solution Solution Effect Solution Solution

Solution and Effect Diagrams - Construction 6. Identify Potential Improvements Solution and Effect Diagrams - Construction Solution Solution For each main Solution category brainstorm ideas as to what are the related sub-solutions that might effect our issue   Use the 5 How techniques when a solution is identified Keep repeating the question until no other solutions can be identified List the sub-solutions using arrows Effect Solution Solution

Causes and Solutions Cause Solution Effect Effect Solution Solution 7. Develop Improvement Theory/Idea Cause Solution Why? How? Why? How? Why? How? How? Why? Effect Why? How? Effect Solution Solution Cause Cause C = Cause Category S = Solution Category

Action Plan 8. Develop Action Plan

Gantt Charts A Gantt chart is a matrix diagram The vertical axis lists all the tasks to be performed for a project Each row contains a single task identification The horizontal axis is headed by columns indicating estimated task duration in hours, days, weeks, months, etc. , skill level needed to perform the task, and the name of the person assigned to the task, followed by one column for each period in the project's duration. 22

Use Of Gantt Charts Establish order of tasks: Sequential and Parallel Identify resources requirements Timing of resource needs Identify the critical path Monitor the project “On-Time” Schedule Alerts where remedial action is required

Identify and Prioritize Opportunities High Volume High Risk Problem Prone Where do ideas come from for projects?

Elevator Speech An elevator pitch is a brief, persuasive speech. Used to spark interest Should last no longer than a short elevator ride.

Assignment Participate in the all-staff training Use your elevator speech to promote Quality Improvement in FCHD Practice using Quality Improvement Concepts Display your results

Storyboards Be concise Visual Appeal Make sure your purpose and final outcome is clear Present plans for sustaining Improvement

Sustain the Improvement Is the improvement dependent on a specific person? Do we need back-up? Do we need training? Do we need a policy, procedure, new flow-chart? How will we know if we are “backsliding”? Failure Modes and Effects Analysis - Evaluate the new process in flowchart form - Identify all the places where the process could “fail” - Identify “fail-safe” processes to keep failure from happening (Policy, Procedure, Training, Accountability check)

Q & A