1. Erin Barkema Iowa Department of Public Health Lisa Swanson Black Hawk County Health Department Community Health Profile

2. A Brief Overview Iowa Public Health System  Decentralized  District, County, and City Boards of Health  Iowa Dept. of Public Health (IDPH)  State Board of Health Modernizing Public Health in Iowa Redesign Modernization

3. A Brief Overview  Target Area Selection  Chosen by the Modernization Workgroup  Factors:  Upcoming Community Health Needs Assessment and Health Improvement Plan process  Data Warehouse Project  IDPH Data Warehouse Project Overview

4. Mini-Collaborative Participants State and Local Mini-Collaboratives  State-level Collaborative – IDPH staff  Local-level Collaborative – Data Warehouse Lead User Group members

5. Work of the Mini-Collaboratives Mini-collaborative launch  State-level work – began in March 2009  Local-level work – began in April 2009 Mission accomplished  Anticipated completion date – October 2009

6. Mini-Collaborative Timeline

7. BLACK HAWK COUNTY HEALTH DEPARTMENT QUALITY IMPROVEMENT PROJECT

8. Background  Setting the Stage  Reorganization 2008-2009  Process Improvement  Motivators  Community Health Needs Assessment (CHNA)  Essential Services Annual Work Plan (ESAWP)  Accreditation  Problem Statement: Indicators currently tracked do not measure public health status of the community.

9. Resources  CQI experience – Eileen Daley  Timing  Capacity Assessment completed June ‘09  Information Systems  Collective team experience/background with QI  Materials provided  Templates, examples, etc as a guide  Timing  Public Health Information Management project  Capacity Assessment completed June ’09

10. Developing the Storyboard  Followed PDSA work sheet  Notes from meetings in spreadsheet  Small group prepared guidance to QI team ensuring that all aspects of PDSA were addressed  AIM = Develop criteria, team exceeded the original goal and tested 15 (11 passed)

11. Plan  AIM Statement: By June 30 th, 2009, at least 9 agency wide public health status indicators will be developed.  Tools Used  Root Cause Analysis (5 Whys)  Process Flow Charts  MindJet, SmartMapper (software)  Pie charts (results of testing criteria phase)

12. Current approach perpetuated reporting/tracking of data that isn’t a true measure of public health status 397 data points currently tracked for many years with no deliberate planning of what the data would be telling us about public health status.

13. Improvement Theory: If a standard set of criteria are applied to evaluate indicators, we can assure that the measure is a health status indicator.

14. Do Tested 15 indicators (submitted by QI team, cross-divisional)

15. Study  Testing Criteria  Consistent evaluation method  Continued to develop the criteria  Indicators that don’t pass can be re- evaluated to ensure quality or simply used elsewhere  Testing Results:

16. Act  Education/Implementation  Apply the criteria to evaluate existing and future indicators starting in FY2010  Separate process/productivity reporting from health status indicators Future Plans:

17. Improvements and Changes

18. State-level Storyboard

19.  Local and state collaboration Accomplishments  Gained experience in using the PDSA cycle and QI tools  Planted the seed QI champions

20. Challenges and Lessons Learned ChallengesLessons Learned  Completion timeline tied to a larger department project.  Political environment  “Pinpoint” QI  Conduct an assessment of the situation before beginning QI activities  Agencies found QI intriguing --- even though the experience was not in an ideal QI environment.  QI is a new territory for most agencies…providing a QI guide will help ensure survival.

21. Thank You!

22. Erin Barkema, MPH MLC Coordinator Iowa Department of Public Health 515-242-5524 ebarkema@idph.state.ia.us Lisa Swanson Environmental Health Officer/GIS Black Hawk County Health Department 319-292-2202 lswanson@co.black-hawk.ia.us Questions?