Introduction to QA, QI and Performance Management A Mark Durand PIHOA Quality and Health Information Coordinator December, 2011

Are you satisfied?

PIHOA QA Initiative was Born with Resolution #43-6 in April, 2006

QA/QI- Program Development by Site Key: 0 = No activity yet = Preliminary plan = Some progress = Program components installed = Program running

QA & QI & PM Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals

Church of God Seventh Day Adventist Congregational Catholic Orthodox Presbyterian Lutheran Baptist Church of Christ

Continuous Quality Improvement Total Quality Management Church of God Seventh Day Adventist Congregational Catholic Presbyterian Lutheran Baptist Church of Christ Quality Assurance Quality Improvement Continuous Quality Improvement Total Quality Management Performance Management Lean Six Sigma Baldridge Criteria Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals T

QA & QI & PM Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals

QA QI QI Tools Define Quality Standards Monitor & Report Quality Correct Deficiencies QA Plan Do Study Act QI QI= CQI …. W Edwards Deming QI Tools

Learning and Improvement Cycle 4/6/2017 Learning and Improvement Cycle Act What changes are to be made? Next cycle? Documentation of recommendations: report or minutes Plan Objective Questions and predictions Plan to carry out the cycle (who, what, where, when) Plan for data collection Logic model Study Complete the data analysis Compare data to predictions Summarize lessons Data analysis / report Do Carry out the plan Document problems and unexpected observations Begin analysis of the data Track progress on work plan or Gantt MCPP Healthcare Consulting 12

5 Why’s Technique Problem (Effect) Why? Why? Why? Why? Why?

Fishbone Diagram People Methods Resources Lack of knowledge & skill in QI Culture Materials

Cause and Effect Diagram for Low Use of HIV Screening: Test Location Client Don’t see benefit Not convenient Don’t Want Test Not Private Fearful Poor HIV Testing Not Client Centered Not Respectful Not Offered Poor Experience Counseling Staff

QA QI QI Tools Define Quality Standards Measure, Monitor & Report Correct Deficiencies QA Plan Do Study Act QI QI-- W Edwards Deming CQI vs QI (“raising the bar”) QI Tools

Agency (Director) ---------------------- Units/Programs ----- (Supervisors) Staff -------------

Key Point! What is the job of a health worker? - Perform your duties to help your team to deliver services What is the job of your health units and programs? - Perform specific tasks or deliver specific services What is the job of your agency? - Support the work of its units and staff - Meet the needs of the population

Benchmark

Health Worker Unit / Program Agency Question to answer   Health Worker Unit / Program Agency Question to answer How well does a health worker do his/her duties? How well does a unit or program do its tasks or services? How well does agency meet: - community needs? - needs of units/staff? Benchmark Job Description (Yearly Individual Performance Plan) Unit Standard Operating Procedures (QA) Goals& Objectives(QI) Strategic Plan (Goals & Objectives)  Improvement Planning Yearly Individual Performance Plan - Corrective action plan (QA) - “P” in PDSA (QI) Performance Management Plan (using PDSA as needed) How to monitor Individual performance evaluation - QA Survey (scores) - PDSA (Set indicators- “P”; Measure results- “S”) Perf Management Plan Reports Incentives Recognize, Merit $, Promote, “Perks” - Recognize team, celebrate, $$ (to team or individuals) - Budget, grants, Promotion/demotion

Measure, Monitor & Report Strategic Goals Measure, Monitor & Report Correct Deficiencies PM Agency or jurisdiction level Examples: 1. Nursing shortage Low $ collections 2. Access to care NCD epidemic QI Job of individual units and programs is to perform specific tasks or deliver specific services Job of agency is to meet the needs of the population, and to support the work of individual programs and units. Tools

Key Point! What is the job of a health worker? - Perform your duties to help your team to deliver services What is the job of your health units and programs? - Perform specific tasks or deliver specific services What is the job of your agency? - Support the work of its units and staff - Meet the needs of the population

Are we satisfied? Current situation? Needs Assessment What to do? Goals, strategies & objectives Assure success Performance Improvement System

3 Levels of response: Example: Situation: Nursing shortage Level 1: “reactive” response Level 2: partial response Level 3: performance management Reg Activities: Advisory committee Interest group Ongoing tech assist and resources Clearinghouse for ideas

Level 1: Situation: Nursing shortage Needs assessment: Not done “reactive” response: Situation: Nursing shortage Needs assessment: Not done Goal: Not clear Objective: Not clear Strategy: 1. Train practical nurses whenever shortage becomes acute 2. Hire nurses off-island Reg Activities: Advisory committee Interest group Ongoing tech assist and resources Clearinghouse for ideas

Level 2: Situation: Nursing shortage Needs assessment: Done Partial response: Situation: Nursing shortage Needs assessment: Done Goal: A supply of high-quality, local nurses Objective: Not clear Strategy: 1. Recruit nurses to study off-island 2. Establish community college nursing pgm 2. Hire expat nurses

Level 3: Situation: Nursing shortage Needs assessment: Done Proactive response: Situation: Nursing shortage Needs assessment: Done Goal: An adequate supply of high-quality, local nurses Objective: 100% of ward nurses should have formal college nursing certificates or degrees by 2015 Strategy: Partnership between hospital and comm college - define target group of nurses - financing - employment policies - work-study scheduling, transport, classroom site Note that data is used- measurable objective Not complicated Needs

Are we satisfied? Current situation? Needs Assessment What to do? Goals, strategies & objectives Assure success Performance Improvement System

Community Health Assessment Community Health Improvement Plan Agency Strategic Plan Performance Improvement System (for 10 essential public health services) Assessment 􀂉 Monitor health status 􀂉 Investigate health problems 􀂉 Evaluate personal and population-based health services Policy Development 􀂉 To support individual and community health efforts 􀂉 Enforce laws and regulations that protect health. 􀂉 Research for solutions to health problems Assurance 􀂉 Link people to needed personal health services 􀂉 Assure a competent health care workforce 􀂉 Inform people about health issues 􀂉 Mobilize partnerships to solve health problems

Bureaus/Sections reponsible: Public Health Accreditation Board Standards and Measures   Bureaus/Sections reponsible: DOMAIN 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community Standard 1.1: Participate in or conduct a collaborative process resulting in a comprehensive community health assessment 1.1.1 S Participate in or conduct a state partnership that develops a comprehensive state community health assessment of the population of the state 1.1.2 S Complete a state level community health assessment 1.1.3 A Ensure that the community health assessment is accessible to agencies, organizations and the general public Standard 1.2: Collect and maintain reliable, comparable, and valid data that provide information on conditions of public health importance and on the health status of the population 1.2.1 A Maintain a surveillance system for receiving reports 24/7 in order to identify health problems, public health threats and environmental public health hazards 1.2.2 A Communicate with surveillance sites at least annually 1.2.3 A Collect additional primary and secondary data on population health status

PH Accreditation Orientation (web-based): http://www.cecentral.com/phab

CDC Performance Management Reporting Tool Type of measure (i.e., output or outcome measure) Format of measure (e.g., Yes/No, count, proportion, time-based, other) Measurement specifications (e.g., start/stop time, numerator/denominator, what is being counted) Baseline value and associated date(s) Target value and associated date(s)

Quiz: Is it QA-QI-PM?................ (or is it a “blind improvement attempt”?) Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals

“Blind improvement attempt” Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals Behavioral health unit offers substance abuse counseling training to DHS staff. “Blind improvement attempt”

Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals Staff in OPD put labels on supply shelves in clinic as part of corrective action plan from last survey. QA-QI-PM

“Blind improvement attempt” Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals Chief nurse arranges transportation to help night shift nurses get to work. “Blind improvement attempt”

QA-QI-PM (if impact is measured) Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals Nursing team develops plan to help decrease absenteeism rate on medical ward QA-QI-PM (if impact is measured)

“Blind improvement attempt” Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals Team from Public Health goes to Mortlocks to do screening and health promotion to address NCD epidemic “Blind improvement attempt”

QA-QI-PM (if follow-up measurment is done) Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals DHS works with legislature to pass increase in tobacco tax in hope of decreasing teen tobacco use 10% from current rate of 67% QA-QI-PM (if follow-up measurment is done)

Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals Nursing Supervisor requires all nursing unit supervisors to take on-line QI course, and follows-up until all supervisors on her list have completed QA-QI-PM

“Blind Improvement Attempt” Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals DHS hosts training workshop to train doctors, nurses and health assistants to apply new NCD treatment guidelines “Blind Improvement Attempt”

Define Standards or Goals Measure Monitor & Report Change what you do until you reach goals HRH Committee develops strategy for recruiting 60 new students into COM-FSM nursing program by 2013. QA-QI-PM

durand@pihoa.org A Mark Durand