QUALITY IMPROVEMENT:FOOD PROTECTION & FACILITIES BRANCH

Larry Michael, NC Division of Public HealthFood Protection & Facilities Branch Head

Jim Hayes, NC Division of Public HealthPools, Tattoos, and State Institutions Program Head

Center for Public Health Quality• Focuses on building workforce QI capacity

• Develops, leads, and supports strategic QI initiatives for the DPH and local public health agencies

• Incorporates QI methods (e.g., Lean, MFI) that are commonly used by public health system partners

• Ultimately, aims to help all public health agencies have ability to continuously improve

Participants will be able to:• Use QI methods & tools in daily activities to improve the

effectiveness & efficiency of services

• Coach others within their organization/department to use QI methods & tools

• Develop a plan to incorporate QI methods & tools so that it becomes “the way we do business”

Program Objectives

“A continuous and ongoing effort and culture to best achieve measurable improvements

in the efficiency, effectiveness, quality, performance, and outcomes of services and systems with the goal of improving the health

of North Carolinians and our communities.”

NC DPH Management Team, 2009Adapted from Accreditation Coalition QI Subgroup Consensus Agreement

What is QI?

• Reduce costs and redundancy

• Eliminate waste

• Streamline processes

• Increase accountability

• Boost morale and teamwork

• Enhance ability to meet service demand

• Improve outcomes - Public Health Memory Jogger, 2007

Why QI?

Key Features of QI • Focus on systems, not individuals• Ideas/changes from customers & front line staff• Focus on small tests of change• Frequent, ongoing measurement and data-driven

decision making• QI is a never-ending process…it’s continuous• It should help staff, not hinder

Model for Improvement

QUALITY IMPROVEMENT PROJECT

Customer Satisfaction Survey• Conducted January 2013• Positive Comments:

• Staff effort• CIT & other training• Program evaluation• Authorization process and timeliness• Consultation• Response time to inquiries• Accessibility• Food Code

• What We Need to Work On• Consistency and Communication

Comments from the Survey

Consistency. Advice is vague

at times

We need MORE

PEOPLE!

Be more of the mindset to educate rather than just to

regulate.

A WORKING COMPUTER

DATABASE FOR FOOD AND LODGING

INSPECTIONS

TECHNOLOGY………!!!!!!!

To better improve consistency from one part of the state to

another when a regional makes a decision about an interpretation or something else, it should be

sent on the listserv so others can benefit

The Food Protection & Facilities Branch AIMS To:

• Improve consistency of interpretation and enforcement of the North Carolina Food Code by better communicating interpretations of the food safety standards to local Environmental Health Specialists by September 30, 2013.

Better Consistency Will…• Maintain program integrity• Build public trust• Protect public health• Reduce liability• Build credibility• Potentially improve use of regional specialists’ time

Quality Improvement Program• Establish Clearinghouse Committee to research and

answer questions about interpretation and enforcement of NC Food Code

• Use a standard template for communicating questions and answers

• Organize all documents about interpretation and enforcement of the NC Food Code in searchable online NC Food Code Annexes

• Evaluate for possible expansion to other programs

Position Statements• Clearly defines the topic• Law or Rule• Question/Issue• Discussion and Rationale• Response/Interpretation• References

North Carolina Food Code Annexes Website

• Makes all documents about interpretation and enforcement of the NC Food Code available online

• Documents are sorted by which subchapter(s) of the Code they pertain to

• Links to documents from FDA• Goal—To make it quick and easy to find answers to any

questions that have already been asked

What We Hope to Learn• Will formal position statements

improve consistency of information?

• Will online access to program documents allow answers to be found quickly?

• Will the NC Food Code Annexes be a popular and useful tool that could be applied to other programs?

• Will regional staff see fewer repeat questions if initial answers are more widely distributed?

Goals

80

159

43Question Mode

# Calls # Emails # Face

8 Consultants

Goal 1: Decrease # of Questions Received

Mar-13

Apr-13

May-13

Jun-13Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13Jan-14

Jan-14

Feb-14

Mar-14

Apr-14

0

50

100

150

200

250

300282

Questions Received

# of

Que

stion

s

Goal 1: Decrease Response Hours

Mar-13

Apr-13

Apr-13

May-13Jun-13

Jun-13Jul-1

3Jul-1

3

Aug-13

Sep-13

Sep-13

Oct-13

Nov-13

Nov-13

Dec-13Jan-14

Jan-14

Feb-14

Mar-14

Mar-14

Apr-14

0

20

40

60

80

100

120

102

Time to process questions#

of H

ours

8 Consultants282 Questions

Goal 2: Increase # of web hits

Mar-13

Apr-13

Apr-13

May-13

Jun-13Jun-13

Jul-13Jul-1

3

Aug-13

Sep-13

Sep-13

Oct-13

Nov-13

Nov-13

Dec-13Jan-14

Jan-14

Feb-14

Mar-14

Mar-14

Apr-14

0102030405060708090

100

Webhits to Annexes

Web

hits

Goal 3: Improve Communication

Jan-13 Jan-140

102030405060708090

100

Inadequate Communications

% LH

D EH

Sta

ff

Goal 4: Improve Consistency

Jan-13 Jan-140

10

20

30

40

50

60

70

80

90

100

"Lack of Consistency..."

% o

f LHD

EH

Staff

Goal 5: Improve Quality of Consultation

Feb-ru-ary-

March

Apr-10

May-10

Jun-10

Jul-10

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

0102030405060708090

100

Quality of Consultation Services rated as "Excellent or Good"

% of LHD EH Staff

Assessment – Value Stream Map Current State

Assessment – Improvement Ideas1. Web-based Food Code Annexes2. SOPs for responding to customer questions3. Question Submission form4. Position Statements5. Memo review6. Q&A database7. Clearinghouse Committee8. Roll out to stakeholders

PDSA to Test Changes

Question Submission Form

• PDSA cycle• Feedback applied• Planning another PDSA cycle

(technical challenges)

SOP - Clearinghouse Committee1. Review and make final decision for draft position statements

2. Maintain Q & A database after questions are answered

3. Q & A and Position Statements will indicate training needs

4. Review and maintain jurisdiction chart for the Web

5. Maintain awareness of trade secrets for firms

Position Statements

Classifying Memos

Revise…Review…Rescind

Classifying Memos

Q & A Database• 200+ questions received so far from LHDs EH staff• “frequently asked questions”• Sorting ability eliminates duplicate efforts• Resource on web for quick reference

Anticipated Benefits for ROI (Return on Investment)

• Reducing time in Q&A will increase face to face time• Improving consistency is a customer satisfier• “Real Time” web access reduces inequities across NC• Website promotes public awareness and trust• Creates transparency• Creates a standard for other states• Portable for other entity use (states, industries, public)• Compliant with FDA food standards 4, 6, & 7• Builds program integrity and credibility• Reduces liability

Next Steps• Develop customer request tracking log to promote transparency

• Reprioritize performance plans to support QI• Finalize flow chart routing, etc.• Evaluate web approach adaptability to other EH programs

• Develop web maintenance plan and protocol for updating information

• Conduct follow-up customer satisfaction survey

AHA!• We can see how it is all coming together• More productive being together vs silos• Understand how the different components of our project link together

• Question Submission Form will help us save time and be more efficient

• This identifies our program weaknesses• Realized the need for standardized processes• Outstanding issues not being high priority