1. Roadmap to QI Ty Kane Sedgwick County Health Department KPHA Pre-Conference Session September 20, 2011 Today’s Objectives: Briefly describe SCHD’s initiative to begin developing a culture of QI Reviewing the elements of a Quality Improvement Plan Define “quality culture assessment” (with a framework provided) Review the organizational “QI Continuum”

2. “15 SLIDES IN 15 MINUTES”

3. Building a QI Culture at a Local Health Department NOV ‘08MAR ‘09NOV ‘09MAR ‘10 AUG-DEC ‘11 JAN ‘11FEB ‘11.5 FTE for APQI PHAB vetting session First Q-Team meeting 6-month leader training All staff QI meeting Launch QI plan and policy Launch capacity building plan

4. Quality Improvement Plan Key Elements 1.Description 2.Definitions 3.Administration 4.Project Selection 5.Training 6.Tools 7.Communication 8.Responsibilities 9.Evaluation 10.Sustainability What is a QI Plan? A written description of how an agency will manage and evaluate QI efforts.

5. QI Culture Assessment 1.NOTHING IN PLACE 2.JUST GETTING STARTED 3.MOVING IN THE RIGHT DIRECTION 4.ADEQUATE – WE HAVE MADE GOOD PROGRESS OVER THE LAST YEAR 5.VERY GOOD PERFORMANCE AND HAVE PLANS IN PLACE TO EXPAND THE QI PROGRAM THROUGHOUT THE ORGANIZATION 6.WE HAVE INSTITUTIONALIZED QI Source: J Public Health management Practice, 2010, 16(1), 72-78 The Six Dimensions of a Department’s Quality Culture And Radar Chart Rating Scale

6. Roadmap to an Organizational Culture of QI Pooja Verma, NACCHO, APQI pverma@naccho.org Ty Kane, SCHD tkane@sedgwick.gov

7. Roadmap to an Organizational Culture of QI 6. QI CULTURE 4. SOME FORMAL QI ACTIVITIES 5. FORMAL AGENCY- WIDE QI 1. NO KNOWLEDGE OF QI 2. NOT INVOLVED IN QI ACTIVITIES EXITS 1-2 EXITS 4-5 3. INFORMAL OR AD HOC QI ACTIVITIES EXIT 3 EXIT 6

8. Roadmap to an Organizational Culture of QI Characteristics Lack awareness/understanding of QI Overwhelmed with other issues Satisfaction with status quo Don’t value/link QI to PH practice Strategies for Transition Marketing QI to leaders Leadership & staff training Share stories of success Intentionally manage change EXIT 1 NO KNOWLEDGE OF QI EXIT 1

9. Roadmap to an Organizational Culture of QI Characteristics Begin to embrace/understand QI Problems are ignored/buried Staff are viewed “hired hands” Data are not available or not used Strategies for Transition Mentorship Integrate QI in agency planning ‘Firefighters’ to problem solvers Task-focus to QI project focus Market QI thru successes NOT INVOLVED WITH QI ACTIVITIES EXIT 2

10. Roadmap to an Organizational Culture of QI Characteristics Data not routinely used “Pseudo-QI” QI not part of organization’s strategy Few lessons learned and sharing Afraid of finding problems Strategies for Transition Share stories organization-wide Build learning communities Performance management Demystify QI Celebrate all improvements Address resistance to change INFORMAL OR AD HOC QI ACTIVITIES EXIT 3

11. Roadmap to an Organizational Culture of QI Characteristics Greater reliance on data Fewer ‘firefighter’ supervisors People viewed as critical to success QI is a part of the job In-house QI TA available Strategies for Transition QI division or function Sharing QI results externally More working across silos Increase reliance on data Performance Management Draft a comprehensive QI plan FORMAL QI ACTIVITIES IMPLEMENTED IN SPECIFIC AREAS ONLY EXIT 4

12. Roadmap to an Organizational Culture of QI Characteristics More data-driven decisions QI plan individualized to setting Integration of measures into “system” QI integrated in operational plans QI becomes more visible Standardization in processes Learning/sharing culture QI in position descriptions Customer-focus Demonstrate ROI QI policies Strategies for Transition QI on all meeting agendas Leadership that walks the talk Supervisors are QI coaches FORMAL AGENCY-WIDE QI EXIT 5

13. Roadmap to an Organizational Culture of QI Characteristics Distribution of results to staff, stakeholders and customers QI champions throughout organization Ongoing training and networking Data and tools used daily Customer is front and center Integrate with strategic plan Getting better all the time Self-assessment Problems are “gold” Sustainability Caution: Digression is easier than progression QI CULTURE EXIT 6

14. The following characteristics were identified throughout every phase in the roadmap: Selecting employees who are well-suited to learn and teach QI techniques A Collaborative AND learning culture QI should be integrated into strategic plan Data analysis skills AND problem solving skills (tools) Leadership (including governance) must be engaged and have knowledge Theoretical vs. practical balance (50,000 ft and 5 ft view) Flexibility in decision-making (at all levels) is seen as critical piece to success Supervisors are expected to engage in QI and see their job not as about fighting fires but rather, improving processes Customer focus QI should be integrated into funder requirements (expected as program work, not “extra”)

15. Questions and Comments Ty Kane, MPH Community Health Analyst Sedgwick County Health Department tkane@sedgwick.gov office phone - (316) 660-7368