1. Sustaining Improvement & Maintaining the Spirit Grace Duffy Public Health Foundation quality improvement consultant ACTION Campaign Webinar July 9, 2008

2. Joey Valdez, NIATx NPO, 5/15/06. The NIATx model

3. Encouraging Improvement and Change  Why should we lead people away from the status quo? What strategic tradeoffs and risks are we willing to make? What strategic tradeoffs and risks are we willing to make? How can we balance creativity and productivity? How can we balance creativity and productivity? Where do we reduce the burden of measuring what matters? Where do we reduce the burden of measuring what matters? When can we engage in conversations and promote collaboration in our social networks? When can we engage in conversations and promote collaboration in our social networks? Whose needs do we address, anticipate, and prioritize? Whose needs do we address, anticipate, and prioritize?

4. Who are our customers? Sometimes we choose our customers. Most often, they choose us. Three ways customers establish expectations: 1. Value 2. Fitness for Use 3. Transcendent

5. An eye-opener for me… 2006 Orange County Health Department 2006 Orange County Health Department Public Health Foundation grant Public Health Foundation grant STD and HIV/AIDS process improvement STD and HIV/AIDS process improvement Customer identification, flowcharts, teams, and measurements Customer identification, flowcharts, teams, and measurements 2008 return to OCHD for Environmental Health improvement project 2008 return to OCHD for Environmental Health improvement project

6. How to Improve a Process: Define the objective. Define the objective. Document current knowledge. Document current knowledge. Use an improvement cycle. Use an improvement cycle. Plan Do Study Act

7. Improvement Across the Organization

8. Improvement across the whole system Ensby, 2003

9. Where is the highest impact for improvement and change? Participant input: Participant input: Time allotted: 5 minutes Time allotted: 5 minutes Share areas within your organization OR client/supplier environment where a little improvement can make a BIG difference. Share areas within your organization OR client/supplier environment where a little improvement can make a BIG difference.

10. Discussion Debrief Are these different than the improvements you have implemented in your own organization? Are these different than the improvements you have implemented in your own organization? How do you feel when you complete an improvement project? How do you feel when you complete an improvement project? What actions create the biggest positive impact for your clients? What actions create the biggest positive impact for your clients?

11. Improvement from the customer’s perspective Who is your customer? (External, internal) Who is your customer? (External, internal) WIIFM … who benefits from improvement and how much? WIIFM … who benefits from improvement and how much? Change is an opportunity, not a threat. Change is an opportunity, not a threat. Involve those who will live with the change. Involve those who will live with the change. NIATx web resources for sustainability and change. NIATx web resources for sustainability and change.

12. Customers and Suppliers

13. Seminole County Child Support Services ASQ Community Good Works grant ASQ Community Good Works grant Partnership with ASQ Orlando Florida, County and Corporate sponsor Partnership with ASQ Orlando Florida, County and Corporate sponsor Assist recently privatized Child Support vendors establish infrastructure for operations Assist recently privatized Child Support vendors establish infrastructure for operations Six Sigma project with University of Central Florida students and ASQ Six Sigma Black Belts Six Sigma project with University of Central Florida students and ASQ Six Sigma Black Belts 9-month design, training, pilot and implementation effort 9-month design, training, pilot and implementation effort Returned to Central Florida with Department of Children and Families major process redesign project in 2007-08 Returned to Central Florida with Department of Children and Families major process redesign project in 2007-08

14. Keep an eye on the ball: Focus on the end result Focus on the end result Keep it simple Keep it simple Know how you will benefit from what you are doing Know how you will benefit from what you are doing Communicate with EVERYONE!! Communicate with EVERYONE!! Use quantitative and qualitative measures to track progress Use quantitative and qualitative measures to track progress Brag about what you are doing Brag about what you are doing

15. What are we sustaining? What is your most pressing organizational need at this time? (Current state) What is your most pressing organizational need at this time? (Current state)

16. Where do you want to be? If you could instantly fix your organization’s current state, what would the future state look like? If you could instantly fix your organization’s current state, what would the future state look like?

17. How will we benefit from the change? How is it impacting your organization’s: How is it impacting your organization’s: People? People? Processes? Processes? Performance? Performance? Culture? Culture? Morale? Morale? Shareholders? Shareholders?

18. Sustaining Effective Change Two Key Questions 1. How does the process under study support the organization’s strategic mission? 2. Is the process under study necessary to meet the demands of our clients?

19. Are you on the journey already? Do you currently have a plan to move your organization to this desired future state?

20. What does your map look like? If you have a plan, what are the major obstacles to implementing the plan? If you do not have a plan, how soon do you need one?

21. Focus on Strategic Priorities: Vision: Vision is to an organization what purpose is to an individual. Strategy: The few high value things that are critical to success. Values: Will the culture support the strategy? AlignmentAlignment

22. Strategic Planning moves vertically and laterally within the organization. Sr. Mgt Front Line Function T E A M S Modern Strategic Planning Format

23. Keep the feeling and results alive Show short term results Show short term results Align improvements to organization goals Align improvements to organization goals Coordinate changes across multiple improvements Coordinate changes across multiple improvements Integrate the changes into daily activity Integrate the changes into daily activity Share ideas and initiate “spread” Share ideas and initiate “spread” Celebrate the results and the behaviors Celebrate the results and the behaviors

24. Participant Input: 5 minutes What short-term results are important to your organization? What short-term results are important to your organization? How do the short-term results get in the way of your long-term goals? How do the short-term results get in the way of your long-term goals? How do you balance any conflict? How do you balance any conflict?

25. Alignment “Vertically” Within the Organization

26. Measures help us sustain Report those measures that truly matter. Report those measures that truly matter. Promote open sharing of performance data across business lines. Promote open sharing of performance data across business lines. Encourage commitment to the measurements initiative. Encourage commitment to the measurements initiative. Provide clear linkages between reward systems and achieving strategic goals. Provide clear linkages between reward systems and achieving strategic goals. Accountability and follow-through are crucial. Accountability and follow-through are crucial.

27. Key tasks for successful measures Identify results to be achieved through a report card. Identify results to be achieved through a report card. Identify core business functions and processes of critical impact. Identify core business functions and processes of critical impact. Engage multidisciplinary leadership staff Engage multidisciplinary leadership staff Define success metrics, comparative performance measures, goals and targets. Define success metrics, comparative performance measures, goals and targets.

28. Critical “measures” success factors Senior-leadership-driven Senior-leadership-driven Senior leader commitment and involvement Senior leader commitment and involvement Clear and rational objectives Clear and rational objectives Focus on behaviors and processes, not numbers Focus on behaviors and processes, not numbers

29. Other critical success factors Long-term vision Long-term vision Merged into organizational culture Merged into organizational culture Flexible and adaptable Flexible and adaptable

30. How do you celebrate now? Who do you include in the celebration? What benefits do you see from celebrating?

31. Keep your head and heart on task… You are the value. Yours is the success. Thank you.