Direct Effects of Quality Improvement in Public Health Ali Reed Compliance Analyst Irmine Reitl Communicable and Infectious Disease Program Manager September 15, 2011 Think Health. Act Now! . CITY OF MILWAUKEE HEALTH DEPARTMENT . www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission.

QI in Public Health? QI vs. QA- what is the difference? Public Health tendency towards Quality Assurance, reaction to problems or challenges No history of organized QI process in the Milwaukee Health Department

So Why Now? Accreditation Initiative at the MHD QI as good practice Need early start, large health department QI as good practice Grant Funding to help support initiative STD Clinic experiencing high “turnaway” rates at clinics, opportunity to initiate a QI process to examine issue

First Steps: Form a Committee Develop QI committee Ensure equal representation Designate a facilitator Notify senior management for support Schedule kick off meeting Funding Opportunities Grant from the State of Wisconsin

Potential Challenges of QI in a LPHD Management Supportive? Challenge of “change” in public setting Lack of knowledge, what is Quality Improvement? Pressure for a rapid cycle Resources Fiscal Staffing Time

MHD Experience

MHD STD Clinic Overview Free standing STD clinic serving approximately 7500/year 60%male, 40% female, 18-49 years of age “Nurse run” clinic; medical protocols CDS (7) conduct field investigations and participate in clinic operations

First Meeting February 2011 at STD Clinic Train QI Committee on Plan-Do-Check-Act Train QI Committee on Accreditation and how QI fits in MHD unique experience, “test run” on QI process Understand the power of the group, emphasis on thinking “outside the box” Discuss logistics for future meetings Photo by David LaHaye

QI Committee Meetings GOALS: Make meetings fun Consistency: meetings at 8:00 am on Tuesdays Feed the Team! Meet on site, make convenient for staff Photo by David LaHaye

Create an AIM statement To improve the overall quality of client service and clinic efficiency at the STD/HIV Clinic at the City of Milwaukee Health Department Photo by David LaHaye

Create a Project Plan Brainstorm: what is happening at clinics that can improve efficiency and reduce the client turn away rate? Identify top 5 priorities Define “Turnaway” for data purposes Identify “low hanging fruit” Create flow charts, understand process Plan a CHANGE: hire a Medical Assistant to do triage work

Example: Addition of a Medical Assistant Current process had Nurses and CDS staff running triage. This took away valuable time to spend with clients, therefore increasing MHD turnaway rates Group planned to hire and train a MA for triage function with carryover grant money from previous year. MA would also serve in other capacities, for example referring clients to appropriate clinics or giving immunizations to clients if needed. Question of Sustainability: if clinic could prove a MA would reduce turnaway rates and increase efficiency, hope for budget office to support position with tax levy dollars in future.

MHD Initiatives Improve PHN and CDS capacity: Triage run by MA position Fill vacant nurse positions Improve Overall Efficiency: File room organized and alphabetized Workflow charts created for all areas of STD Clinic: Nursing, Registration, Communicable Disease Specialists, Medical Assistant, and LAB Improve Technology: Use of STD-MIS as main data source Only required data into WEDDS Ease of reporting

Motivation Meet continuously Celebrate successes with entire program Commissioner visits staff meetings Discuss changes, did they work?

MHD Results: QI in STD Measures of Success in MHD QI process: # of clients turned away from services: In March of 2011 the clinic turned away 200 clients. In July of 2011 the clinic turned away 30 clients. # of clients seen by nursing staff: In April 2011 the nurses saw 345 clients. In June of 2011 the nurses saw 552 clients # of clients see by CDS staff in the field: In March 2011 the CDS staff saw 92 clients in the field, by July of 2011 they saw 144 clients in the field.

MHD Results: QI in STD Success in a Public Health Setting? Yes! Lesson Learned at MHD: Small improvements, one at a time can happen using a QI process. Provides power to staff to make changes that really work!

Next Steps QI as part of MHD culture, it won’t be easy! Integration into daily activities Future projects Accreditation

Questions?

Ali Reed Compliance Analyst afreed@milwaukee.gov September 15, 2011 Think Health. Act Now! . CITY OF MILWAUKEE HEALTH DEPARTMENT . www.milwaukee.gov/Health © Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission.