Transcript Women’s Health Branch Uboreshaji Project

QUALITY
IMPROVEMENT:
FOOD PROTECTION & FACILITIES BRANCH
Larry Michael, NC Division of Public Health
Food Protection & Facilities Branch Head
Jim Hayes, NC Division of Public Health
Pools, Tattoos, and State Institutions Program Head
Center for Public Health Quality
• Focuses on building workforce QI capacity
• Develops, leads, and supports strategic QI initiatives for
the DPH and local public health agencies
• Incorporates QI methods (e.g., Lean, MFI) that are
commonly used by public health system partners
• Ultimately, aims to help all public health agencies have
ability to continuously improve
Program Objectives
Participants will be able to:
• Use QI methods & tools in daily activities to improve the
effectiveness & efficiency of services
• Coach others within their organization/department to use
QI methods & tools
• Develop a plan to incorporate QI methods & tools so that it
becomes “the way we do business”
What is QI?
“A continuous and ongoing effort and culture
to best achieve measurable improvements
in the efficiency, effectiveness, quality, performance,
and outcomes of services and systems
with the goal of improving the health
of North Carolinians and our communities.”
NC DPH Management Team, 2009
Adapted from Accreditation Coalition QI Subgroup Consensus Agreement
Why QI?
• Reduce costs and redundancy
• Eliminate waste
• Streamline processes
• Increase accountability
• Boost morale and teamwork
• Enhance ability to meet service demand
• Improve outcomes
- Public Health Memory Jogger, 2007
Key Features of QI
• Focus on systems, not individuals
• Ideas/changes from customers & front line staff
• Focus on small tests of change
• Frequent, ongoing measurement and data-driven
decision making
• QI is a never-ending process…it’s continuous
• It should help staff, not hinder
Model for
Improvement
QUALITY
IMPROVEMENT
PROJECT
Customer Satisfaction Survey
• Conducted January 2013
• Positive Comments:
• Staff effort
• CIT & other training
• Program evaluation
• Authorization process and timeliness
• Consultation
• Response time to inquiries
• Accessibility
• Food Code
• What We Need to Work On
• Consistency and Communication
Comments from the Survey
Consistency.
Advice is vague
at times
We need
MORE
PEOPLE!
Be more of the
mindset to educate
rather than just to
regulate.
A WORKING
COMPUTER
DATABASE FOR
FOOD AND LODGING
INSPECTIONS
TECHNOLOGY
………!!!!!!!
To better improve consistency
from one part of the state to
another when a regional makes a
decision about an interpretation
or something else, it should be
sent on the listserv so others can
benefit
The Food Protection & Facilities Branch
AIMS To:
• Improve consistency of interpretation and
enforcement of the North Carolina Food
Code by better communicating
interpretations of the food safety standards
to local Environmental Health Specialists
by September 30, 2013.
Better Consistency Will…
• Maintain program integrity
• Build public trust
• Protect public health
• Reduce liability
• Build credibility
• Potentially improve use of regional specialists’ time
Quality Improvement Program
• Establish Clearinghouse Committee to research and
answer questions about interpretation and enforcement of
NC Food Code
• Use a standard template for communicating questions
and answers
• Organize all documents about interpretation and
enforcement of the NC Food Code in searchable online
NC Food Code Annexes
• Evaluate for possible expansion to other programs
Position Statements
• Clearly defines the topic
• Law or Rule
• Question/Issue
• Discussion and Rationale
• Response/Interpretation
• References
North Carolina Food Code Annexes
Website
• Makes all documents about interpretation and
enforcement of the NC Food Code available online
• Documents are sorted by which subchapter(s) of the
Code they pertain to
• Links to documents from FDA
• Goal—To make it quick and easy to find answers to any
questions that have already been asked
What We Hope to Learn
• Will formal position
statements improve
consistency of information?
• Will online access to program
documents allow answers to
be found quickly?
• Will the NC Food Code
Annexes be a popular and
useful tool that could be
applied to other programs?
• Will regional staff see fewer
repeat questions if initial
answers are more widely
distributed?
Goals
Goal 1: Decrease # of Questions Received
Question Mode
43
80
159
8 Consultants
# Emails
# Face
Questions Received
300
282
250
# of Questions
# Calls
200
150
100
50
0
Mar-13
Jun-13
Sep-13
Dec-13
Mar-14
Goal 1: Decrease Response Hours
Time to process questions
120
# of Hours
100
102
80
60
40
20
0
Mar-13
May-13
Jul-13
Sep-13
Nov-13
Jan-14
Mar-14
8 Consultants
282 Questions
Goal 2: Increase # of web hits
Webhits
Webhits to Annexes
100
90
80
70
60
50
40
30
20
10
0
Mar-13
May-13
Jul-13
Sep-13
Nov-13
Jan-14
Mar-14
Goal 3: Improve Communication
Inadequate Communications
100
90
% LHD EH Staff
80
70
60
50
40
30
20
10
0
Jan-13
Jan-14
Goal 4: Improve Consistency
"Lack of Consistency..."
100
90
% of LHD EH Staff
80
70
60
50
40
30
20
10
0
Jan-13
Jan-14
Goal 5: Improve Quality of Consultation
Quality of Consultation Services rated as "Excellent or Good"
100
90
% of LHD EH Staff
80
70
60
50
40
30
20
10
0
February-March
Jun-10
Sep-10
Dec-10
Mar-11
Assessment – Value Stream Map
Current State
Assessment – Improvement Ideas
1. Web-based Food Code Annexes
2. SOPs for responding to customer questions
3. Question Submission form
4. Position Statements
5. Memo review
6. Q&A database
7. Clearinghouse Committee
8. Roll out to stakeholders
PDSA to Test Changes
Question Submission Form
• PDSA cycle
• Feedback applied
• Planning another PDSA cycle
(technical challenges)
SOP - Clearinghouse Committee
1.
Review and make final decision for draft position statements
2.
Maintain Q & A database after questions are answered
3.
Q & A and Position Statements will indicate training needs
4.
Review and maintain jurisdiction chart for the Web
5.
Maintain awareness of trade secrets for firms
Position
Statements
Classifying Memos
Revise…Review…Rescind
Classifying Memos
Q & A Database
• 200+ questions received so far from LHDs EH staff
• “frequently asked questions”
• Sorting ability eliminates duplicate efforts
• Resource on web for quick reference
Anticipated Benefits for ROI
(Return on Investment)
• Reducing time in Q&A will increase face to face time
• Improving consistency is a customer satisfier
• “Real Time” web access reduces inequities across NC
• Website promotes public awareness and trust
• Creates transparency
• Creates a standard for other states
• Portable for other entity use (states, industries, public)
• Compliant with FDA food standards 4, 6, & 7
• Builds program integrity and credibility
• Reduces liability
Next Steps
• Develop customer request tracking log to
promote transparency
• Reprioritize performance plans to support QI
• Finalize flow chart routing, etc.
• Evaluate web approach adaptability to other EH
programs
• Develop web maintenance plan and protocol for
updating information
• Conduct follow-up customer satisfaction survey
AHA!
• We can see how it is all coming together
• More productive being together vs silos
• Understand how the different components of our
project link together
• Question Submission Form will help us save time
and be more efficient
• This identifies our program weaknesses
• Realized the need for standardized processes
• Outstanding issues not being high priority