1. Grace Gorenflo Jack Moran

3. Goal: To provide a foundation for COP-PHI awardees’ quality improvement efforts Learning Objectives: - Understand the distinction between quality improvement and other, related activities - Understand the phases of a Plan-Do- Check-Act cycle

4. “Quality improvement in public health is the use of a deliberate and defined improvement process, such as Plan-Do-Check-Act, which is focused on activities that are responsive to community needs and improving population health. “It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.” This definition was developed by the Accreditation Coalition Workgroup (Les Beitsch, Ron Bialek, Abby Cofsky, Liza Corso, Jack Moran, William Riley, and Pamela Russo) and approved by the Accreditation Coalition on June 2009.

5. Quality Assurance and Quality Improvement Evaluation and Quality Improvement

6. Quality Assurance Reactive Works on problems after they occur Regulatory usually by State or Federal Law Led by management Periodic look-back Responds to a mandate or crisis or fixed schedule Meets a standard (Pass/Fail) Quality Improvement Proactive Works on processes Seeks to improve (culture shift) Led by staff Continuous Proactively selects a process to improve Exceeds expectations

7. Evaluation  Assess a program at a moment in time  Static  Does not include identification of the source of a problem or potential solutions  Does not measure improvements  Program-focused  A step in the QI process Quality Improvement  Understand the process that is in place  Ongoing  Entails finding the root cause of a problem and interventions targeted to address it  Focused on making measurable improvements  Customer-focused  Includes evaluation

8. Plan – Do – Check – Act vs. Plan – Do – Study – Act

9. Plan Do Check/ Study Act

10. Identify and prioritize quality improvement opportunities www.adesblog.com/category/getting-things-done/

11. Identify / Prioritize Opportunities Example: Vital Statistics Customer average wait time more than 28 minutes

12. Develop an AIM Statement  WHAT are we striving to accomplish?  WHEN will this occur (what is the timeline)?  HOW MUCH ? What is the specific, numeric improvement we wish to achieve?  FOR WHOM ? Who is the target population?

13. AIM Statement Example: Reduce Vital Statistics customer wait time to 15 minutes

14. Describe the current process

15. Describe the Current Process for Vital Statistics: Limited number of cashiers to process transactions

16. Collect data on the current process

17. Vital Statistics Collect Data On: Number of cashiers and the wait time per customer

18. Identify all possible causes

19. Identify Possible Causes: No. of cashier windows open, Printer/network issues, Incomplete documentation etc.

20. Identify potential improvements www.talentt.com/productFile/1196704593.jpg

21. Identify Potential Improvements: Increase the number of cashier windows open(especially at rush hour)

22. Develop an improvement theory IF…THEN… scipp.ucsc.edu/theory/theoryhomepage.htm

23. Develop Improvement Theory: Create trigger system for supervisor to improve customer flow. Maintain wait time to 15mins.

24. Develop an action plan

25. Develop Action Plan: Pilot Program: One additional cashier added from Correspondence and additional cashier/s when wait time exceeds 15 minutes

26.  Implement the improvement  Collect and document the data  Document the problems, unexpected observations, lessons learned, and knowledge gained

27. Implement the Improvement: Implementation of Pilot Program for a week Collect and Document the data: Wait time reduced by 50%

28. Problems, Observations, Lessons Learned Pilot Program Implementation Day 1: Ran a snag – 4 staff out Day 2: Successfully implemented Pilot Program (5 cashier windows open)

29.  Analyze the results: was an improvement achieved?  Document lessons learned, knowledge gained, and any surprising results that emerged.

30. Reflect on the Analysis: Data obtained for wait time - 1 Week pilot program. Cashier Survey data Document Problems: Unavailability of Staff and Communication issues. Observation: Smooth running of pilot Lessons learned: Customer Wait time directly proportional to # of cashier window open

31.  Take action:  Adopt - standardize  Adapt – change and repeat  Abandon – start over  Once you’ve adopted – monitor and hold the gains!

32. Plan 1. Identify / Prioritize Opportunities: Customer average wait time more than 28 minutes 2. AIM: Reduce customer wait time to 15 minutes 3. Current Process: Limited number of cashiers to process transactions 4. Collect Data On: Number of cashiers and the wait time per customer 5. Identify Possible Causes: No. of cashier windows open, Printer/network issues, Incomplete documentation etc. 6. Identify Potential Improvements: Increase the number of cashier windows open(especially at rush hour) 7. Develop Improvement Theory: Create trigger system for supervisor to improve customer flow. Maintain wait time to 15mins. 8. Develop Action Plan: Pilot Program – One additional cashier added from Correspondence and additional cashier/s when wait time exceeds 15 minutes 1. Implement the Improvement: Implementation of Pilot Program for a week Do 2. Collect and Document the data: Wait time reduced by 50% 3. Problems, Observations, Lessons Learned Pilot Program Implementation Day 1: Ran a snag – 4 staff out Day 2: Successfully implemented Pilot Program (5 cashier windows open) Day 2-5: Pilot Successfully implemented Check/ Study 1. Reflect on the Analysis: Data obtained for wait time - 1 Week pilot program. Cashier Survey data Act: 2. Document Problems: Unavailability of Staff and Communication issues. Observation: Smooth running of pilot Lessons learned: Customer Wait time directly proportional to # of cashier window open Adopt Adapt Abandon Standardize Do Plan Blue Team: Vital Stats

33. PLAN DO CHECK ACT: Achieve Results? Decide to do QI Standardize No/Maybe - Adapt Yes - Adopt No - Abandon

34. Myth: QI is about weeding out the bad apples Truth: QI is about processes - series of steps or actions performed to achieve a specific purpose

35. Myth: If I don’t achieve my goal, I’ve failed Truth: When doing QI, there is no such thing as failure

36. Myth: All change = improvement Truth: All improvement = change

37.  http://www.naccho.org/topics/infrastruct ure/accreditation/upload/ABCs-of- PDCA.pdf  http://www.phf.org/resourcestools/Pages /The_ABCs_of_PDCA.aspx