Roadmap to QITy Kane

Sedgwick County Health Department

KPHA Pre-Conference SessionSeptember 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”

“15 SLIDES IN 15 MINUTES”

Building a QI Culture at a Local Health Department

NOV ‘08 MAR ‘09 NOV ‘09 MAR ‘10 AUG-DEC ‘11 JAN ‘11 FEB ‘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 buildingplan

Quality Improvement Plan

Key Elements1. Description2. Definitions3. Administration4. Project Selection5. Training6. Tools7. Communication8. Responsibilities9. Evaluation10. Sustainability

What is a QI Plan?•A written description of how an agency will manage and evaluate QI efforts.

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 CultureAnd Radar Chart Rating Scale

Roadmap to an Organizational Culture of QI

Pooja Verma, NACCHO, APQIpverma@naccho.org

Ty Kane, SCHDtkane@sedgwick.gov

Roadmap to an Organizational Culture of QI6. QI CULTURE4. SOME FORMAL

QI ACTIVITIES5. 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

Roadmap to an Organizational Culture of QICharacteristics•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 1NO KNOWLEDGE OF QI

EXIT 1

Roadmap to an Organizational Culture of QICharacteristics•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

Roadmap to an Organizational Culture of QICharacteristics•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

Roadmap to an Organizational Culture of QICharacteristics•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

Roadmap to an Organizational Culture of QICharacteristics•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

Roadmap to an Organizational Culture of QICharacteristics•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

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”)

Questions and Comments

Ty Kane, MPHCommunity Health AnalystSedgwick County Health Departmenttkane@sedgwick.govoffice phone - (316) 660-7368