1. Direct Effects of Quality Improvement in Public Health
Ali Reed Compliance Analyst
Irmine Reitl
Communicable and Infectious Disease Program Manager
September 15, 2011
Think Health. Act Now! . CITY OF MILWAUKEE HEALTH DEPARTMENT .
© Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission.

2. QI in Public Health? QI vs. QA- what is the difference?
Public Health tendency towards Quality Assurance, reaction to problems or challenges
No history of organized QI process in the Milwaukee Health Department

3. So Why Now? Accreditation Initiative at the MHD QI as good practice
Need early start, large health department
QI as good practice
Grant Funding to help support initiative
STD Clinic experiencing high “turnaway” rates at clinics, opportunity to initiate a QI process to examine issue

4. First Steps: Form a Committee
Develop QI committee
Ensure equal representation
Designate a facilitator
Notify senior management for support
Schedule kick off meeting
Funding Opportunities
Grant from the State of Wisconsin

5. Potential Challenges of QI in a LPHD
Management Supportive?
Challenge of “change” in public setting
Lack of knowledge, what is Quality Improvement?
Pressure for a rapid cycle
Resources
Fiscal
Staffing
Time

6. MHD Experience

7. MHD STD Clinic Overview
Free standing STD clinic serving approximately 7500/year
60%male, 40% female, years of age
“Nurse run” clinic; medical protocols
CDS (7) conduct field investigations and participate in clinic operations

8. First Meeting February 2011 at STD Clinic
Train QI Committee on Plan-Do-Check-Act
Train QI Committee on Accreditation and how QI fits in
MHD unique experience, “test run” on QI process
Understand the power of the group, emphasis on thinking “outside the box”
Discuss logistics for future meetings
Photo by David LaHaye

9. QI Committee Meetings GOALS: Make meetings fun
Consistency: meetings at 8:00 am on Tuesdays
Feed the Team!
Meet on site, make convenient for staff
Photo by David LaHaye

10. Create an AIM statement
To improve the overall quality of client service and clinic efficiency at the STD/HIV Clinic at the City of Milwaukee Health Department
Photo by David LaHaye

11. Create a Project Plan
Brainstorm: what is happening at clinics that can improve efficiency and reduce the client turn away rate?
Identify top 5 priorities
Define “Turnaway” for data purposes
Identify “low hanging fruit”
Create flow charts, understand process
Plan a CHANGE: hire a Medical Assistant to do triage work

12. Example: Addition of a Medical Assistant
Current process had Nurses and CDS staff running triage. This took away valuable time to spend with clients, therefore increasing MHD turnaway rates
Group planned to hire and train a MA for triage function with carryover grant money from previous year.
MA would also serve in other capacities, for example referring clients to appropriate clinics or giving immunizations to clients if needed.
Question of Sustainability: if clinic could prove a MA would reduce turnaway rates and increase efficiency, hope for budget office to support position with tax levy dollars in future.

13. MHD Initiatives Improve PHN and CDS capacity:
Triage run by MA position
Fill vacant nurse positions
Improve Overall Efficiency:
File room organized and alphabetized
Workflow charts created for all areas of STD Clinic: Nursing, Registration, Communicable Disease Specialists, Medical Assistant, and LAB
Improve Technology:
Use of STD-MIS as main data source
Only required data into WEDDS
Ease of reporting

14. Motivation Meet continuously Celebrate successes with entire program
Commissioner visits staff meetings
Discuss changes, did they work?

15. MHD Results: QI in STD Measures of Success in MHD QI process:
# of clients turned away from services:
In March of 2011 the clinic turned away 200 clients. In July of the clinic turned away 30 clients.
# of clients seen by nursing staff:
In April 2011 the nurses saw 345 clients. In June of 2011 the nurses saw 552 clients
# of clients see by CDS staff in the field: In March 2011 the CDS staff saw 92 clients in the field, by July of 2011 they saw 144 clients in the field.

16. MHD Results: QI in STD Success in a Public Health Setting? Yes!
Lesson Learned at MHD:
Small improvements, one at a time can happen using a QI process. Provides power to staff to make changes that really work!

17. Next Steps QI as part of MHD culture, it won’t be easy!
Integration into daily activities
Future projects
Accreditation

18. Questions?

19. Ali Reed Compliance Analyst afreed@milwaukee.gov
September 15, 2011
Think Health. Act Now! . CITY OF MILWAUKEE HEALTH DEPARTMENT .
© Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission.