ron chapman, md, mph director and state health officer california department of public health
TRANSCRIPT
Quality Improvement, Performance Management,
and Accreditation
Ron Chapman, MD, MPHDirector and State Health Officer
California Department of Public Health
• Pipes where demand for services goes in one end and a service/product comes out the other end.
• History and a series of decisions makes the pipes long and tortuous.
• The pipes need to be straightened and shortened.
What is the System?
• People create systems:–“Each system is perfectly designed to
serve the purpose for what is was intended.”
• People are not the system.
• Need to analyze and improve the system.
Systems Run Our lives
Actively use performance data to improve the public’s health.
Strategic use of performance measures and standards to establish performance targets and goals.
Performance management practices can also be used to: prioritize and allocate resources; inform managers about needed adjustments or changes in
policy or program directions to meet goals; frame reports on the success meeting performance goals.
Performance Management
Quality improvement (QI) in public health is the use of a deliberate and defined process which is focused on activities that are responsive to community needs and improving population health.
QI is a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, and outcomes of services and processes which achieve equity and improve the health of the community.
“Defining Quality Improvement in Public Health.” Journal of Public Health Management and Practice, Jan/Feb 2010.
Quality Improvement
QI is a set of tools to help people understand, analyze, and transform systems.
Need to tear apart the house to see the pipes.
QI principles◦Systems and customer focus◦Evidence-based and data driven◦Shared decision making◦Multidisciplinary process (many eyes!)◦Continuous!
The Tools
Continuous Quality Improvement (CQI) AKA Plan-Do-Check-Act (PDCA) or Plan-Do-Study-Act (PDSA)
Baldrige Performance or Balanced Scorecard ISO 9000 Lean Six Sigma Total Quality Management Turning Point Performance Management
Framework Kaizen
Quality Improvement Methods
People will learn and use the tools to analyze and transform systems.
People will be empowered to use these tools and to make the systems changes.
The system will be changed to provide better and faster services for our customers.
Process will not be sacrificed for product.
QI Expectations
Not a replacement for:◦ Leadership skills◦ Functional teams (team building)◦ Governance
What Performance Management and QI Are Not
Problem: Contracts are not being executed timely (3,000 contracts in CDPH)
Baseline Data:◦ DGS routinely rejected 60 – 70 % of contracts
◦ Analyze all of the DGS Rejections for past year Unclear and/or Poor Scope of Work and Budget 75% Conflicting Exhibits – 25%
QI Example: Contracts
Discussed Issues with DGS
Contacted another Departments Contract Units
◦ How do they do business?
Understand problem
Major root causes identified◦ No Inventory of contracts
No data source of contract activities that could provide guidance
◦ CMU Managers were not available to staff and review contracts to send to DGS; time spent in meetings with program
◦ Lack of contract knowledge both internally and externally
◦ Performance measure requiring CMU review in 15 days placed focus on quantity, not quality
Reasons for the problem (Root Causes)
No Inventory of contracts Inventory Contracts and develop meaningful reports
CMU Managers were not available to staff and review contracts to send to DGS CMU Managers need to be available to provide guidance to
CMU staff
Lack of contract knowledge both internally and externally Training Program for CDPH Staff involved with Contracts
CMU Performance measure focused on quantity, not quality Focus on quality not quantity
Possible Solutions to the Problem
Monitored DGS rejection rate of contracts ◦ Measured % of contracts approved by DGS in
first submission
Monitored if contracts moved through process◦ CMU Manager available to provide Quality
Control
◦ Feedback to CMU staff more valuable and efficient
Plan to Measure
Better Use of Information Technology◦ Develop processes to ensure:
All contract information accurately entered into CAPS
Staff Training◦ Classes developed for program staff and CMU staff
Streamline Contracting Process◦ Increased use of DGS established templates
◦ Updating “Exhibit” language to remove conflicts
Implement solution & collect data for evaluation
Ongoing inventory and clean up of CAPS◦ Ability to generate contract status reports
CMU Managers and shift in responsibilities◦ Managers available to CMU & Program staff to provide guidance
Ongoing training for CMU and program staff◦ Series of classes covering contracts and procurements
Eliminated redundant review of approved contracts◦ Saved approximately 2-3 hours of contract processing time
Philosophical shift from “just send to DGS” to “do it right” ◦ Executive management support is key to promote shift in
attitude
Analyze data and develop conclusions
Of last 900 contracts only 4 were returned from DGS=99.5% approval rate.
FY 10-11 completed about 300 contracts. FY 11-12 completed over 900 contracts. Productivity tripled!
Some program contracts given delegated authority from DGS.
Customers have noted improved contracting process.
Results
Achieve Targeted Improvements in Health Outcomes
Strengthen CDPH as an Innovative, High Performing
Organization
Strengthen Statewide
Infrastructure to Improve Health
Secure and Deploy Resources
for Sustainable Impact
Strengthen Deeper Understanding of
Public Health
Strengthen/Streamline Resource
Acquisition, Management &
Deployment
Integrate Data Systems to Monitor &
Investigate Health Problems
Use Determinants of Health in Policy and
Decision Making
Use Cost-Benefit and Health Outcome Analyses
Retain and Recruit a Skilled, Diverse and Empowered
Workforce
Leverage Opportunities to Secure Revenue
Enhance State and Local Public Health
Services
Develop Communication
Strategies for Unified Messaging
Foster a Cohesive,
Values-Driven Culture
Develop and Use Results-Oriented
Public Health Interventions
Optimize CDPH Organizational
Structure & Processes
Enforce Laws and Regulations to
Ensure Safety and Protect Health
Publish Reports and Outcome Measures
Strengthen Statewide Public Health Workforce
Development
Use Performance Management
Systems to Monitor Outcomes
Maximize Technology to Support CDPH
Priorities
Expand and Strengthen Collaborations and Partnerships
Make Continuous Quality Improvement a Way of Life in the Department
Leverage Key Opportunities to Define and Shape the Future of
Public Health in a Changing Environment
California Department of Public Health Strategic Map:2012-2014
Vision: Healthy individuals and families in healthful communities
Mission: The California Department of Public Health is dedicated to optimizing the health and well-being of the people in California
Prepare for and Respond to Public
Health Threats
Improve Alignment of Resources with
Departmental Priorities
Achieve National
Public Health Accreditation
Draft04/24/12
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Achieve Health Equity Through Public Health ProgramsH
Established July 2012.
Deputy Director reporting to CDPH Director.
Staff integrated from across CDPH.
CQI training for executives & teams July-Sept.
CQI Academy to train all 3,800 employees.◦ Disseminate to local public health.
Office of Quality Performance and Accreditation (OQPA)
OQPA will:
Track strategic objectives.
Support leadership development.
Provide leadership and structure for successful accreditation.◦ Collaborate and coordinate with local public
health.
OQPA
The goal of the national public health accreditation program is to improve and protect the health of the public by advancing the quality and performance of state, local, territorial and tribal health departments.
Accreditation will drive public health departments to continuously improve the quality of the services they deliver to the community.
National Accreditation Program
Evaluate and continuously improve health department processes, programs, and interventions.
Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.
Measure: Engage staff at all organizational levels in establishing or updating a performance management system.
Domain 9