1. GOOD AFTERNOON! We will be starting shortly.  Please orient yourself to Live Meeting including use of Q and A  Please mute your microphones and/or telephone  Please email Tegan Ruland at tegan.ruland@wisconsin.gov if you are having any difficulties tegan.ruland@wisconsin.gov

2. Performance Improvement in Public Health Learning Session #3: Public Health Quality Improvement 101

3. Welcome and Introductions  Brief description of today’s learning session  Brief introduction of those participating  Overview of Live Meeting process including muting, accessing handouts, and asking questions

4. By the end of this session you should be able to:  Have a basic understanding of quality improvement in PH - purpose and process  Understand “Big QI” vs. “small qi”  Describe some ways to start integrating QI into your agency  Access additional resources

5. WHAT IS QI AND WHY SHOULD WE CARE?

6. What is QI? It’s about Process  Is used to improve existing processes  Changing the way you do things to impact longer term outcomes  It is a process – a way of doing things The race for quality has no finish line. ~Unknown

7. What is QI? It’s about Data  Using data to identify opportunities for improvement and to make decisions  Data can help identify the root cause of your problem.  Data can help you focus on where to spend your time and effort for the greatest return

8. What is QI? It’s about Learning!

9. Working to Do the Right Things Right!

10. And We Already Do It, Everyday!

11. And at Work Too!

12. Why QI Now?  Fewer Resources + More Work + Constant Change = Stress  Everything we do has a cost and everything we don’t do but should also has a cost ~Jim Butler  Helps staff deal more effectively with change  Helps make change more effective

13. Why QI?  Accreditation  It’s just good practice! Who wouldn’t want to expand their horizons and create a better organization? LHD staff member (Michigan)

15. PLAN DO STUDY ACT - THE QUALITY IMPROVEMENT MODEL “Quality is not an act, it is a habit” ~Aristotle

16. Plan Plan changes aimed at improvement, matched to root causes Do Carry out changes; try first on small scale Study See if you get the desired results Act Make changes based on what you learned; spread success Quality Improvement Process: Plan-Do-Study-Act Plan DoStudy Act

17. Model for Improvement: Three Key Questions in PDSA 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in improvement?

18. Change vs.. Improvement It is essential to learn the difference between doing something in a different way, and doing it in a better way “Of all changes I’ve observed, about 5% were improvements, the rest, at best, were illusions of progress.” ~W. Edwards Deming

19. BIG QI AND LITTLE QI Moving from projects to integration

20. Levels of Integration of QI into Agency Culture MarMason Consulting * Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009

21. Levels of QI Integration MarMason Consulting Bill Riley and Russell Brewer

22. “BIG QI” vs. “small qi” Little qiBIG QI Often program or unit specificSystem focused One time projectsContinuous – part of strategic plan Limited staff involvementMany staff knowledgable and participating QI is an “extra”Culture of quality – QI is business as usual

23. Integration Recommendations MarMason Consulting  Implement QI as a comprehensive management philosophy rather than a project-by-project approach  Use the lessons/proven methods from others [police, etc.] to overcome barriers  Find creative ways to secure resources for QI  Build on existing PH tools and capabilities  Conduct a self-assessment for QI readiness in your agency Bill Riley and Russell Brewer

24. Tips and Strategies  Think big but start small  Look for winnable opportunities  Discuss the need for change – the disconnect between “the way we used to do it”, the way “we’ve always done it”, and the needs of today  Empower people to act – make them agents of change

25. Tips and Strategies  Articulate quality as part of the organizations core values  Incorporate quality improvement skills into job descriptions  Discuss professional and program improvement opportunities during regular performance reviews  Acknowledge failure and opportunities for growth  Celebrate small victories

26. QI RESOURCES: HOW YOU CAN LEARN MORE

27. References  Public Health Memory Jogger  Embracing Quality in Local Public Health: Michigan’s Quality Improvement Guidebook  The Public Health Quality Improvement Handbook

28. WIQI Webinars  Available in the Institute for Wisconsin’s Health website  Root Cause Analysis – 5 Whys and Fishbone (posted soon)  Determining Root Causes and Prioritizing Issues with the Affinity Diagram and Inter-relationship Diagraph  Focusing on Key Problems and Prioritizing Using Pareto Charts and Nominal Group Technique

29. NACCHO Webinars  NACCHO, with many partners, has developed several webinars on  Process  Tools  QI in Action See Resources Guide for details.

30. Questions?

31. QI IN THE FIELD An Example from Oneida County

32. Baby Steps  Just jump in and get started  First QI projects not picture perfect  Learn as you go  Get comfortable with the language  Pick a couple tools and stick with them until your comfortable  Keep learning (add onto your QI knowledge)  Have a team of people who know QI (QI team)

33. TRH Transient Rooming House annual inspections NIATx Change project form 1. Change Project TitleTRH Transient Rooming House annual inspections 2. What AIM will the Change Project address? % of completed annual inspections measured from July1, 2010 to June 30, 2011 (fiscal year). Aim for 95% completion. In 2010 50% of inspections were completed as of 4-1-11. 3. LOCATION Oneida County 4. Start Date and expected completion date 10-1-10 to 6-30-11 5. Level of Care 6. What Client Population are you trying to help? TRH licensees 7. Executive Sponsor Linda Conlon 8. Change Leader Teri Schwab 9. Change Team Members Todd Troskey, Jody McKinney 10. How will you collect data to measure the impact of change? Health Space 11. What is the expected Financial Impact of this change project?

34. PDSA Cycles Rapid Cycle # Cycle Begin Date Cycle End Date Plan What is the idea/change to be tested Do What steps are you specifically making to test this idea/change? Study What were the results? How do they compare with baseline measure? Act What is your next step? Adopt? Adapt? Abandon? 1 10-1-1010-6-10 Look at overdue TRH inspection list from HS Learn the process of making an overdue inspection list on HS <50% of TRH inspections had been completed. Contact info, past inspections were missing or inaccurate in HS. Adapt. Pull Paper files 2 10-7-1010-31- 10 Look at paper files to find:  Last inspection  Contact information Call facility owners mark file as  Contacted date  Left message  Contact info not working Too many files to keep track of efficiently Abandon Need a complete TRH facility list to make notations and record contacts 3 11-1-1011-7-10 Print out TRH master listIndicate on list:  Contacted date  Inspection date  Change of information Contacting owners during regular business hours success rate about 15%, most numbers were not working or had to leave message Adopt. Master list will be updated

35. PDSA Cycles Rapid Cycle # Cycle Begin Date Cycle End Date PlanDoStudyAct 411-8-1011-29-10Send a letter and inspection request form to all TRH owners Inspection request form  To update contact info  Let the owner realize inspections need to be done annually About 50% of the facilities called, mailed or emailed the health dept. Mainly the response was from owners we had already contacted or inspected in the last year. Adapt. Letter language was not strong enough to get a better response. Collect and enter data that was received. Organize appts enter into office tracker and bulletin board 5A12-1-1012-31-10Get organized  Appointment schedules, email contacts follow up with inspection request forms Color code bulletin board for inspections. Make a lodging group in email address book. Make door hangars for no shows Procedure to record appointments and enter contact information was established. 40% of facilities are recorded in email lodging group Adopt. Asking for email addresses will be a priority in correspondence and during inspections. Scheduling appts for the same time next year.

36. PDSA Cycles Rapid Cycle # Cycle Begin Date Cycle End Date Plan What is the idea/chang e to be tested Do What steps are you specifically making to test this idea/change? Study What were the results? How do they compare with baseline measure? Act What is your next step? Adopt? Adapt? Abandon? 62-1-112-7-11Color code and date master TRH list. Record:  Scheduled inspection date  Call back date  Property manager  Email contact  Last inspection date, no contact, or last inspection date  Use HS as a guide for last inspection Identified the contacts that had been made. Only 13 facilities out of 161 had no last inspection date or telephone/email contact information Adopt. Making contact notations on a master list lessens the scenario of calling owners multiple times. Keep researching to try different numbers. Search the web and email requests for inspections. 72-7-113-1-11Web research. Call or email to schedule an inspection.  Google search  Yellow book search A few contacts were made. The web research worked better for the 5-30 lodging category. Able to find web information on 50% of facilities with no previous contact information. Adopt…. Web research is very helpful if there are not too many facilities to look up. Revise request letter to have stronger language. License will not be renewed if an inspection is not scheduled and completed by 6-30-11.

37. PDSA Cycles Rapid Cycle # Cycle Begin Date Cycle End Date Plan What is the idea/change to be tested Do What steps are you specifically making to test this idea/change? Study What were the results? How do they compare with baseline measure? Act What is your next step? Adopt? Adapt? Abandon? 83-20- 11 3-28- 11 Send letter with stronger language and inspection request form. Send to 13 facilities with no contact and no last inspection date. Still in process 93-28- 11 6-30- 11 Develop system during inspection to update contact information and to schedule next annual inspection on the day of the inspection. Have a check list for sanitarians to implement during inspection Record new contact info Schedule appt for next year Write appt on business card Record changes and appt a the office in HS and office tracker Still in process

38. Learning Sessions Planned:  5/9/2011: PH Performance Management 101  5/16/2011: PH Quality Improvement 101  Today: Wisconsin PH Improvement Initiative 101  5/23/2011(last session): PH Accreditation 101

39. National Resources:  CDC: http://www.cdc.gov/ostlts/NPHII/index.htmlhttp://www.cdc.gov/ostlts/NPHII/index.html  NACCHO: http://www.naccho.org/topics/infrastructure/http://www.naccho.org/topics/infrastructure/  ASTHO: http://www.astho.org/Programs/Accreditation-and-Performance/http://www.astho.org/Programs/Accreditation-and-Performance/  PHAB: http://www.phaboard.org/http://www.phaboard.org/  PHF: http://www.phf.org/focusareas/pmqi/pages/default.aspxhttp://www.phf.org/focusareas/pmqi/pages/default.aspx  NALBOH: http://www.nalboh.org/Board_Governance.htm#http://www.nalboh.org/Board_Governance.htm#  NIHB: http://www.nihb.org/public_health/accreditation.phphttp://www.nihb.org/public_health/accreditation.php

40. Primary Wisconsin Resources:  CDC Infrastructure Grant: Mary Young, DPH Southern Regional Office mary.young@wisconsin.org  Prevention Block Grant: Jackie Bremer, DPH Northern Regional Office Jacquelyn.Bremer@wisconsin.org  HW 2020 Capacity and Quality Focus Area: Lieske Giese, DPH Western Regional Office elizabeth.giese@wisconsin.gov  WIQI: Nancy Young, IWHI grayhorse@mac.com

41. Websites:  IWHI http://www.instituteforwihealth.org/project- portal/http://www.instituteforwihealth.org/project- portal/  DPH http://www.dhs.wisconsin.gov/localhealth/index.htm  Accreditation site (soon to be available) http://www.phawisconsin.com/

42. Tell us what you thought of today’s session: http://4.selectsurvey.net/dhs/TakeSurvey.aspx?Surve yID=96M2l721 You will receive a link to the survey after the presentation as well.