Quality Improvement in a Large Local Health Department The San Diego Experience Tamara L.M. Bannan, MPH

Overview 2 Review of San Diego County Embarking on the Quality Improvement (QI) journey Sustaining QI in a large local health department

San Diego County 3.1 million people; ~4,200 sq. miles 2nd largest in California 5th largest in the U.S. 18 municipalities, with several other unincorporated cities 2010 Census (10% growth): white – 48%; blacks – 5% Hispanic – 32% (from 27%) Asians – 11% Pacific Islanders – 0.5% Nat. Am. – 0.9%

County Government 5 Board of Supervisors 5 Board of Supervisors Chief Admin Officer/General Management System Chief Admin Officer/General Management System 5 Business Groups 5 Business Groups Health and Human Services Agency Health and Human Services Agency Public Health Services Includes Emergency Medical Service DEH & Animal Services are separate departments

Accreditation Experience San Diego was a beta test site for national public health accreditation San Diego was a beta test site for national public health accreditation Underwent first 4 steps of accreditation Underwent first 4 steps of accreditation Identified areas to address before applying for actual accreditation Identified areas to address before applying for actual accreditation

San Diego’s QI Experience

Getting Started: Identifying the Project Conducted a Self- Assessment as part of the beta test Topics considered: Community Health Improvement Plan Interpretation Policy

Getting Started: Identifying the Team Important to include stakeholders in the change process Important to include stakeholders in the change process Public Health Nurse ManagersPublic Health Nurse Managers StatisticianStatistician Civil Rights CoordinatorCivil Rights Coordinator Orient the team to the QI process Orient the team to the QI process

The Project: Customer Interpretation Needs Reviewed our draft interpretation policy Reviewed our draft interpretation policy Analyzed the current process in each of 9 sites Analyzed the current process in each of 9 sites Determined to focus on establishing policy as 1 st step Determined to focus on establishing policy as 1 st step Next step was to increase staff awareness of the policy Next step was to increase staff awareness of the policy

Team engagement Each site was to draft a clinic flow chart of existing process Each PHN manager was asked to review policy and provide feedback Epidemiologist conducted survey and data analysis

Findings and Results

Lessons Learned Allow enough time for each phase of your project Cultivate strong relationships with each team member Try not to bias the process with a pre-identified solution

Incorporated into current FY goals Conduct ongoing QI training for staff Developing a team of staff to use the PDSA process and quality tools HHSA is conducting green and black belt training in Lean Six Sigma Sustaining QI in San Diego

Thank You