Using the QI Roadmap to create a culture of Quality Improvement Public Health in the Rockies 2015 Heather Weir & Rebekah Marshall

Acknowledgments National Association of City and County Health Officials Pooja Verma Public Health Foundation Jack Moran

QI Roadmap 1. NO KNOWLEDGE OF QI 2. NOT INVOLVED IN QI ACTIVITIES EXIT 6 EXITS 4-5 6. QI CULTURE 4. SOME FORMAL QI ACTIVITIES 5. FORMAL AGENCY-WIDE QI 3. INFORMAL OR AD HOC QI ACTIVITIES EXIT 3 EXITS 1-2 1. NO KNOWLEDGE OF QI 2. NOT INVOLVED IN QI ACTIVITIES

QI Roadmap Strategies for Transition Characteristics Marketing QI to leaders Leadership & staff training Share stories of success Incentives for engaging in QI Intentionally manage change “Deselect” resistant leaders Characteristics Lack awareness/understanding of QI Overwhelmed with other issues Satisfaction with status quo Don’t value/link QI to PH practice EXIT 1 NO KNOWLEDGE OF QI EXIT 1

QI Roadmap Strategies for Transition Characteristics Mentorship Integrate QI in agency planning ‘Firefighters’ to problem solvers Task-focus to QI project focus Membership in ASQ Market QI thru successes Characteristics Begin to embrace/understand QI Problems are ignored/buried Staff are viewed “hired hands” Data are not available or not used EXIT 2 Not Involved With QI Activities

QI Roadmap Characteristics Strategies for Transition Data not routinely used Discrete QI efforts “Pseudo-QI” QI not part of organization’s strategy Few lessons learned and sharing Anxiety of Doing it wrong or Finding problems Strategies for Transition Share stories organization-wide Build learning communities Performance management Demystify QI Celebrate all improvements Address resistance to change EXIT 3 INFORMAL OR AD HOC QI ACTIVITIES

QI Roadmap Strategies for Transition Characteristics QI division or function Sharing QI results externally Results-sharing is the norm More working across silos Data use/access increases Talk of systematic Performance Management Draft a comprehensive QI plan Join ASQ Report results to local governance Characteristics 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 EXIT 4 FORMAL QI ACTIVITIES IMPLEMENTED IN SPECIFIC AREAS ONLY

QI Roadmap Characteristics Strategies for Transition 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 EXIT 5 FORMAL AGENCY-WIDE QI

QI Roadmap Sustainability Characteristics QI CULTURE 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 EXIT 6 QI CULTURE

Foundational Characteristics People: Selecting employees who are well-suited to learn and teach QI techniques Collaborative AND learning culture Data analysis skills AND problem solving skills Engaged and knowledgeable leadership Flexibility in decision-making (at all levels) Supervisors coach to improve processes (rather than fire fighting)

Foundational Characteristics Process: QI integrated into strategic plan Theoretical vs. practical balance (50,000 ft and 5 ft view) Customer focus QI should be integrated into funder requirements (expected as program work, not “extra”)

Report out on one of your top transition strategies Group Activity Select what phase you think your organization is in Move to your phase in the room Select one person to write on the white paper As a group discuss: Why you think you are in this phase? (5 minutes) What is keeping you from moving to the next phase? (10 minutes) What transition strategies might work to move to the next phase? (10 minutes) Report out on one of your top transition strategies

Examples Using the Roadmap Denver Public Health Annual QI Survey used to inform Departmental strategic plan Goal 10: Continuous Quality Improvement throughout the department Strategy: Develop a culture of quality improvement at Denver Public Health Quality Committee develops Action items Implementation strategies Metrics

Examples Using the Roadmap CDPHE Transition Strategies: QI Plan Training Participation in QI Projects Communication Aligning performance measures/dashboards Implement the customer satisfaction policy

QI Roadmap www.qiroadmap.org

Resources and Next Steps COQuIP – Social Networking site for CO LPHAs http://coquip.ning.com ECHO Learning Community: QI in Colorado www.PublicHealthPractice.org/training 3 Case-based Learning 2 Expert Presentation 1 Multiple Sessions via Video Case Relates to topic Example from work Challenges Peer input Agenda Expert :10-15 Case :10-15 Discussion :30 Jan Feb Mar Apr

Questions?

Contact Information Heather Weir Director, Office of Planning, Partnerships and Improvement Colorado Department of Public Health and Environment Heather.Weir@state.co.us 303.692.3034