Transcript LC - NNPHI
WASHINGTON STATE BUILDING QUALITY IMPROVEMENT LESSONS LEARNED Rita Schmidt Department of Health Jane Lee Department of Health POPULATIONS SERVED Whatcom 193,100 San Juan Okanogan Skagit 16,300 Ferry Pend Stevens Oreille 7,800 44,000 12,900 Northeast Tri County 40,500 118,900 Island Clallam 80,300 704,300 Jefferson Kitsap 37,600 Seattle - King 247,600 Mason Kittitas Tacoma - Pierce Thurston 249,800 Pacific 21,800 Wahkiakum Lincoln Spokane 10,450 465,000 Adams Whitman 18,000 43,300 1,909,300 56,800 71,200 4,100 72,600 Chelan -Douglas 29,000 Grays Harbor 6,668,200 Snohomish 69,500 39,900 Grant 86,100 813,600 Lewis Yakima 75,200 238,400 Cowlitz 99,600 Clark 431,200 Garfield 2,250 Columbia 72,700 4,100 Asotin Walla Walla 21,500 169,300 Benton - Franklin 59,200 Skamania 10,800 Washington State Total Population April 2009 Klickitat 20,200 QUALITY IMPROVEMENT DEVELOPMENT 1993 Public Health Improvement Partnership Lawlanguage promotes performance improvement 1995-2010 Development of Public Health Standards and Measurement Processes 2005-6 MLC 1 Projects for improvement on Standards using QI strategies 2007-8 MLC 2 QI Projects and Collaborations 2008-11 MLC 3 QI Collaboration-three target areas BUILDING BLOCKS FOR IMPROVING PERFORMANCE HEALTH INDICATORS - How healthy are we? - How does our health compare to others? - What specific problems could we address Population level data STANDARDS AND MEASURES - What should a health department be able to do? - Do we provide basic expected functions? - How do we compare to others? - Where do we need to improve? System/organization level data QUALITY IMPROVEMENT EFFORTS – PROGRAM/SERVICE BASED - How can we improve the work we do, that will result in better health or protection? ACTIVITIES AND SERVICES - What does local public health do and how is it done? Example: Number of food safety inspections, WIC clients served, health assessments conducted Service-level data Levels of QI Integration Level 1- No interest or activities Level 2- Awareness, interest and one-time projects Level 3- Multiple teams and QI tools, but no repetition or saturation Level 4- Specific QI model integrated into agency management structure with continuous improvement Bill Riley and Russell Brewer MLC 1 -Awareness and one time projects QI Projects Improvements that address results from the 2005 Performance Assessment System –wide improvement priority to: Identify goals, objectives, and performance measures and establish regular monitoring, reporting, and use of results QI Training-one day, additional day of consultation on site Funding-$4000 for 3 system wide projects 6 Months follow-up phone calls QI Projects Grant County -All the Standards related to Access Cowlitz- Improvement in performance and processes on all standards that apply to Child and Family Health Garfield County - All the Standards that apply to the Immunizations Program Tacoma Pierce County- Quality Improvement processes and plan DOH Office of the Secretary- Quality Improvement processes and plan Lessons Learned Money matters Follow-up can make a big difference Teaching how to build infrastructure creates sustainability-Quality Councils Building infrastructure works better if there is continuity of staff MLC 2- Multiple Teams, tools, no repetition QI Projects funded Focus: Improvement identified in the 2005 assessment QI training, and coaching Collaborative work groups Selected Target Areas Training in logic models QI methods, which they will apply to identify appropriate measures for a few statewide health indicators. QI Projects 8 Projects-focused on program work Development of Logic Models, use of data, communicable disease 2 Projects focused on building QI infrastructure Spokane Mason County 3 Collaborations around focused topics Immunizations-2 counties Chlamydia-2 counties Birth Certificates-Hospital and DOH Lessons Learned Money definitely matters Monthly follow-up sustains projects Collaboration improves outcomes Content experts make a difference Quality improvement isn’t always the “right” strategy-Ex: Birth Certificate Project MLC 3-Some Repetition and integration into agency structures Nine Projects –selected through RFP Process Overlap with legislative mandate Investigation of notifiable conditions Improvement of immunization rates Reduce obesity and risk for chronic disease Health problems identified through data Additional funding received for prenatal care Funding- Each project receives $12,000 a year for 2.5 years PROJECT REQUIREMENTS Senior leadership involvement and support Community partnerships Team effort Participation in web conferences with peer project teams and Learning Congresses Review and understand data Community involvement and partnerships OVERALL PROGRESS TO DATE AIM statements Web conference sessions every six weeks with consultants Work plans State participation on each team Learning Congress - August 2009 For three of the projects-part of larger agency-wide QI efforts MLC3 Lessons Learned - Projects Teams of 4-7 people kept everyone motivated Prizes can make a difference Aim statements are difficult to write and take time Start with a small idea for improvement Know the population you are targeting for improvement Need better access to best practices Staff like the opportunity to work on special projects Projects put on “back burner” with H1N1 Staffing changes significantly affect the project success MLC3 Lessons Learned - Consultation Emphasize and teach the Breakthrough Method for Collaboratives so everyone will understand the process Plan for support if a crisis arises, such as H1N1 or the economic downturn Consider alternating content expertise with QI expertise Ensure that the Collaborative has sufficient support from state-level or other (PHI) staff Plan for several Learning Sessions for the Collaborative WHAT WORKS IN WASHINGTON Provide training on Quality Improvement Provide funding-even if small Create Quality Councils and infrastructure Use the collaborative method and provide regular training Create projects with similar aims Connect to other initiatives and work Involve Leadership THANK YOU RWJ and NNPHI for the support to make a difference