1. Buffalo Trace District Health Department
Quality Improvement
Buffalo Trace District Health Department
Angela Carman, DrPH
May 23, 2016

2. Agenda
Introductions
What is Quality Improvement
PDCA Model
Elevator Speech
Assignment/Q&A

3. What is Quality Assurance?
Focuses on the maintenance of a desired level of
quality in a service or product.
Relates to Monitoring & Compliance
Standards met? Deficiencies corrected?
QA is reactive!
What is Quality Improvement?
Focuses on the process of moving to the next level with the aim to improve the organization and its impact on the health of the community
Relates to Learning & Improving.
QI is proactive!

4. Tough Economic Times Require a Different Approach!
Why QI in Public Health?
QI Can:
Reduce costs and redundancy
Eliminate waste
Streamline processes
Enhance ability to meet service demand
Increase customer satisfaction
Improve outcomes
Tough Economic Times Require a Different Approach!

5. Three Key Questions What are we trying to accomplish?
What changes can we make that will result in improvement?
How will we know that we have made an improvement? (DATA)

6. PDCA/PDSA Process Plan Check/ Study Do Act Adopt Adapt Do Abandon Plan
Identify and
Prioritize Opportunities
7. Develop Improvement
Theory/Idea
1. Reflect on the Analysis
2. Develop AIM
Statement
8. Develop Action Plan
2. Document Problems,
Observation, and
Lessons learned
3. Describe the Current
Process Do
1. Implement the
Improvement
4. Collect Data on
Current Process
Act
2. Collect and Document
The data
Adopt
Standardize
5. Identify All Possible
Causes
Adapt Do
3. Document Problems,
Observations, and Lessons
Learned
6. Identify Potential
Improvements
Abandon
Plan
The ABC’s of PDCA, G. Gorenflo and J. Moran

7. Identify and Prioritize Opportunities
FCHD QI Plan
Details of the Practice Scenario

8. Aim Statement Identifying your aim 2. Develop AIM Statement
Current State
Future State:
What are the important aspects of the future state?
What is driving us to this future state?
What might be the consequences of not moving to the future state?
What might change?
What is the proposed timeline?
DRIVING FORCES:
What is the current state?
Why is this important?
What is it costing us time /
dollars / staff / etc?
What is the impact on our customer/clients?
What is the impact on our division/agency?
PATHWAY
CONSEQUENCES
BENEFITS

9. (Indicate the metric’s starting point – current state)
AIM or Opportunity Statement Template
An opportunity exists to improve the
(name process, or area to work on)
beginning with
(beginning boundary, starting point)
and ending with .
(ending boundary, finish point)
This effort should improve
(key characteristics of area the team is working on)
for the
customers, staff or those affected by the process under improvement)
This process is important to work on now because
(what will it improve and for whom?)
The Baseline measurement is defined as the following metric::
(Indicate the metric’s starting point – current state)

10. Describe the Process

11. Describe the Process
3. Describe the Current
Process
Flow Chart – A picture of the separate steps of a process in sequential order

12. Data Discussion What data do we need? What data do we have?
4. Collect Data on
Current Process
What data do we need?
What data do we have?
Do we know how to get it?

13. Identify all Possible Causes
Cause & Effect Diagrams – Construction
Write the issue as a problem statement on the right hand side of the page and draw a box around it with an arrow running to it.
This issue is now the effect
Effect

14. Cause & Effect Diagrams – Construction:
Generate ideas as to what are the main causes of the effect
Header
Header
Label these as the main
branch headers
Effect
Organizes group knowledge about causes of a problem and display the information graphically
Header
Header

15. Cause and Effect Diagrams – Construction:
For each main cause category brainstorm ideas as to what are the related sub-causes that might effect our issue
Header
Header
why
why
why
Use the 5 Why techniques when a cause is identified
Effect
why
Keep repeating the question until no other causes can be identified
Header
Header
List the sub-cause using
arrows

16. Fishbone (Cause & Effect) Diagrams:
6 Common categories of causes

17. Identify Potential Improvements
Solution and Effect Diagrams - Construction
Place the Solution and Effect Diagram opposite the Cause and Effect Diagram
Write the issue as a positive statement on the left hand side of the page and draw a box around it with an arrow running to it. 
This issue is now the effect
Positive
Effect

18. Solution and Effect Diagrams - Construction
6. Identify Potential
Improvements
Solution and Effect Diagrams - Construction
Generate ideas as to what are the main Solutions of the effect
Label these as the main branch headers
Solution
Solution
Effect
Solution
Solution

19. Solution and Effect Diagrams - Construction
6. Identify Potential
Improvements
Solution and Effect Diagrams - Construction
Solution
Solution
For each main Solution category brainstorm ideas as to what are the related sub-solutions that might effect our issue
Use the 5 How techniques when a solution is identified
Keep repeating the question until no other solutions can be identified
List the sub-solutions using arrows
Effect
Solution
Solution

20. Causes and Solutions Cause Solution Effect Effect Solution Solution
7. Develop Improvement
Theory/Idea
Cause
Solution
Why?
How?
Why?
How?
Why?
How?
How?
Why?
Effect
Why?
How?
Effect
Solution
Solution
Cause
Cause
C = Cause Category
S = Solution Category

21. Action Plan
8. Develop Action Plan

22. Gantt Charts A Gantt chart is a matrix diagram
The vertical axis lists all the tasks to be performed for a project
Each row contains a single task identification
The horizontal axis is headed by columns indicating estimated task duration in hours, days, weeks, months, etc.
, skill level needed to perform the task, and the name of the person assigned to the task, followed by one column for each period in the project's duration. 22

24. Use Of Gantt Charts Establish order of tasks: Sequential and Parallel
Identify resources requirements
Timing of resource needs
Identify the critical path
Monitor the project “On-Time” Schedule
Alerts where remedial action is required

25. Identify and Prioritize Opportunities
High Volume
High Risk
Problem Prone
Where do ideas come from for projects?

26. Elevator Speech An elevator pitch is a brief, persuasive speech.
Used to spark interest
Should last no longer than a short elevator ride.

27. Assignment Participate in the all-staff training
Use your elevator speech to promote
Quality Improvement in FCHD
Practice using Quality Improvement Concepts
Display your results

28. Storyboards Be concise Visual Appeal Make sure your purpose
and final outcome is
clear
Present plans for sustaining Improvement

29. Sustain the Improvement
Is the improvement dependent on a specific person?
Do we need back-up?
Do we need training?
Do we need a policy, procedure, new flow-chart?
How will we know if we are “backsliding”?
Failure Modes and Effects Analysis
- Evaluate the new process in flowchart form
- Identify all the places where the process could “fail”
- Identify “fail-safe” processes to keep failure from
happening (Policy, Procedure, Training, Accountability check)

30. Q & A