1. Quality Improvement in the Real World: Lessons Learned from the Public Health Quality Improvement Exchange (PHQIX) Jamie Pina, Pamela Russo | June 11, 2014

2. 2 Today we will describe and discuss “lessons-learned” from PHQIX community members. Today’s Discussion

3. 3 Brief PHQIX update Review Lessons Learned review process Discuss themes from the review Today’s Agenda

4. 4 PHQIX is an online collaboration resource for public health practitioners interested in quality improvement and performance management What is PHQIX?

5. 5 140 searchable QI initiatives (and growing!) 1290 registered users Monthly e-newsletters Video Highlights Community Forum QI plans from 4 accredited HDs Brief Articles from QI Experts Resource Links to Partners What is PHQIX?

6. 6 PHQIX Homepage

7. 7 PHQIX Search

8. 8 Lessons Learned

9. 9

10. 10 Lessons Learned As a part of the “Results” section of a QI initiative, we ask submitters to share their “lessons learned.”

11. 11 PHQIX Submission Form: Lessons Learned, Observations, and Insights Describe other factors relevant to the conduct and interpretation of the QI findings. Examples of this information might include the following : Any insights regarding the findings of your QI Initiative, including a summary of key successes and difficulties in implementing the improvement Efforts to minimize and adjust for study limitations Differences between observed and expected outcomes Ethical aspects Any caution that should be applied when learning about the Initiative (limitations, confounding) How the Initiative addressed health equity or disparity Lessons Learned, Observations, and Insights Describe other factors relevant to the conduct and interpretation of the QI findings. Examples of this information might include the following : Any insights regarding the findings of your QI Initiative, including a summary of key successes and difficulties in implementing the improvement Efforts to minimize and adjust for study limitations Differences between observed and expected outcomes Ethical aspects Any caution that should be applied when learning about the Initiative (limitations, confounding) How the Initiative addressed health equity or disparity

12. 12 Our Process… We reviewed the 50 most recently published QI initiatives available on PHQIX A team of 5 staff members read the initiatives and discussed themes within the “Lessons Learned” sections Now we’ll present some of the themes to you!

13. 13 Lessons Learned Starting BIG, sizing down. Starting small, scaling UP “…the team agreed that its initial aim of 7% was relatively low.” Harford County Health Department Striving to Create a Welcoming Environment for Limited English Proficiency Clients

14. 14 Lessons Learned Buy-in with leadership and keeping them up- to-date is a key success factor “Collaboration needs to be modeled and valued by leadership.” Minnesota Department of Health Achieving Agency-Wide Tobacco Outreach Coordination

15. 15 Lessons Learned Administrative support facilitates QI Initiatives “This [admin] team member allowed other staff to focus on decision making and not get bogged down by planning and logistics.” The Nebraska Division of Public Health Increasing Enrollment into Chronic Disease Self-Management Programs.

16. 16 Lessons Learned Staff Turnover impacts QI “QI does not occur in an experimental bubble, and real-time adjustments need to be made for situations such as budget cuts and staff turnover” Maricopa County Department of Public Health “We Influence Change": Applying PDSA to Increase the Reach of WIC within the Maricopa County Department of Public Health

17. 17 Lessons Learned QI Impacts Workflow “Seek to understand completely the full process from the very beginning to the very end before making changes...” Tacoma-Pierce County Health Department Improving the Appropriate Collection of Revenue at a Local Health Department: The Medicaid Title XIX Match QI Project

18. 18 Lessons Learned QI Impacts Workflow “We needed to take the extra time up front to actually understand what everyone was doing in the process and how it impacted the person sitting next to them.” Tacoma-Pierce County Health Department Improving the Appropriate Collection of Revenue at a Local Health Department: The Medicaid Title XIX Match QI Project

19. 19 Lessons Learned Getting Honest Feedback about internal operations is difficult “Individuals involved in the review process did not want to offend the grant writer, so the feedback sometimes is not always as honest as it should be.” Bethlehem Health Bureau Utilizing QI to Improve the Acceptance Rate of Grant Proposals

20. 20 Lessons Learned Getting Honest Feedback about internal operations is difficult “…an intentionally optimistic approach, naming the elephant in the room, and conducting training in a positive light, the QI team and project coordinator were able to change the attitude of participating staff.” Tacoma-Pierce County Health Department Improving the Appropriate Collection of Revenue at a Local Health Department: The Medicaid Title XIX Match QI Project

21. 21 Lessons Learned Going through even one QI initiative boosts confidence and makes subsequent efforts easier “Staff are more confident in performing QI and have a better understanding of why QI is important.” Quote from Whatcom County Health Department Improving Whatcom County Health Department's WIC Scheduling Efficiencies Using Quality Improvement Techniques

22. Thank you Question or comments to Jamie Pina, PhD, MSPH jpina@rti.org