QA & QI And Accreditation

 A continuous process to review, critique, and implement measurable positive change in public health policies, programs or infrastructure. 2

 It’s about process  It’s about data  It’s about learning 3

 A process is a series of steps or actions performed to achieve a specific purpose.  A process can describe the way things get done.  Your work involves many processes. 4

 Process Improvement-Better inform the public about what services are provided by the local health department.  Problem Addressed – Increase the number of public health articles in the newspaper from 5 to 30 per year.  Results – Increased articles from 5 to 60 5

 Data will tell you if you made a change or an improvement.  Data can help identify the “root” cause of the problem.  Data can help you focus on where to spend your time and effort for the greatest return.  Data can help you measure not just count. 6

 Process Improvement – Better provision of appropriate education to hepatitis C clients during visits to providers offices.  Problem Addressed – Inform providers of ways to provide effective education and counseling to clients diagnosed with Hepatitis C.  Results – Provider knowledge of management of Hepatitis C increased from 63.3% on pre- test to 89.3% post-test after training. 7

Plan DoStudy Act Plan DoStudy Act

 Process Improvement- Seeks to transform to a new more integrated and holistic organization model to assist and support in the development and preparation of staff for leadership positions  Problem Addressed- Assess and improve on communications issues that impeded internal leadership development  Results – Repeat survey results noted positive improvements in 7 specific categories addressing organizational development 9

 Is about process  Is about data  Is about learning 10

 Quality Assurance and Quality Improvement both have the w Aren’t they just more of the same? 11

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Quality Assurance  Reactive  Works on Problems After they Occur  Regulatory Usually by State or Federal Law  Led by Management  Periodic Look-back  Responds to a Mandate or Crisis or Fixed Schedule  Meet s a Standard (Pass/Fail) Quality Improvement  Proactive  Works on Processes or Systems  Seeks to Improve (culture shift)  Led by Staff  Continuous  Proactively Selects a Process to Improve  To Exceed Expectations 13

QUALITY ASSURANCE  A way to warrant that predefined standards are met. QA is the first step toward quality improvement. QUALITY IMPROVEMENT  A continuous process to review, critique, and implement positive change in public health policies, programs or infrastructure. 14

 Quality control;  Privacy;  Customer satisfaction;  Employee satisfaction;  Assessment/Accreditation 15

 An assessment/accreditation program is one that uses an identified set of standards or metrics to review the performance of state and/or local public health departments 16

 Statute or Rule (Standards) AKA Minimum Program Requirements  Indicators (Way to meet Standards)  Corrective Plan of Action (Way to meet Standards) 17

 QA is about defining measures and monitoring performance.  QI is about using performance measures to plan and test improvements in a program or process.  While different, both can improve quality 18

 Management usually leads accreditation & assessment efforts, staff usually make QI happen;  Work as a team to improve the program; 19

 Have a natural relationship  Accreditation defines measures and monitors performance and  QI uses the measures to plan and test improvements 20

Moving from Monitoring (QA) To Improvement (QI ). 21

Plan DoStudy Act QI Processes Are All Variations of the Same Basic Steps 22

 PDCA/PDSA is mature  Proven in many contexts;  Front line staff have significant input;  Many tools are available and inexpensive;  It Works! 23

 Public Health often slow to adopt improvements  Cpt James Lancaster in 1601 proved Vitamin C prevented scurvy  British preventive policy on scurvy adopted 264 years later  Provides a set of proven, reliable, and repeatable steps that anyone or a team can use to make improvement 24

High Expectations for QI  Centerpiece for national accreditation  Transformational change  Systemic Change  Culture of Quality  Tell Public Health Story  Increase Funding  Moves from outputs to outcomes  Moves from counting to measuring 25

 We also said: Your work involves many processes. Most processes today are undocumented 26

 And everything we don’t do but should also has a cost.  You are too busy, too thinly staffed and can’t afford to make changes that don’t improve our work while at the same time continue to be good stewards of taxpayer monies. 27

 In one of my college courses, I remember studying the management involved in manufacturing widgets. Through observation I believe the MPR's are good at counting widgets and making sure all the widgets are the same, however, the MPR's do not tell us if we are making the right widgets or if we are making them in the right way. I see that the PDSA process and drilling down to a specific issue can tell us more about how widgets should be made and what they should look like. 28

 Who wouldn’t want to expand their horizons and help to create a better organization?  There isn’t a single aspect of the work at any LHD that can’t be improved.  I learned that QI is essential for public health. We have limited resources and it is a great way to direct those resources to the places it is needed most and will have the most impact.  We now have staff eager to use the same tools and methods to evaluate performance and make improvements in other areas of our work. 29

Quality Costs Less “Quality is never an accident; it is always the result of high intention, intelligent direction, and skillful execution. It represents the wise choice of many alternatives.” 30

Quality Improvement is more than a method; it is a mind-set – the way we look at the services we provide and the services we receive as customers (clients) Building Knowledge Workers 31

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