Transcript Flow Charting

MLC-3 States Teleconference/Webinar
November 7th, 2008
The Key Components of Quality Improvement
Project: A Step by Step Process
John W. Moran – Senior Quality Advisor
Public Health Foundation
Grace L. Duffy – Quality Consultant
Public Health Foundation
…PHF Mission:
Improving public
health infrastructure
and performance
through innovative
solutions and
measurable results.
Innovative Solutions.
Measurable Results.
Objectives
By the conclusion of this MLC-3 Call, participants
will develop a better understanding of how to:
• Plan For A Quality Improvement Project
• Build AIM QI Project Statements
• Move from Priorities to Action
• Track the Quality Improvement Project
Planning For A Quality Improvement Project
• Think about the end state before you start –
Telling Those Not Involved:
– Why you picked the problem
– What you focused on
– How you analyzed it
– Difficulties or roadblocks
– How you improved it
– What the improvements will accomplish
Planning For A Quality Improvement Project
• What are the key components of a
quality improvement project?
– Technical Content and Team Dynamics
Must Be In Sync
Questions?
Please change the “feedback” color
to purple (top right side of your
screen) if you have a question.
Planning For A Quality Improvement Project
•
•
•
•
•
Creating an AIM statement
Developing a theory for improvement
Testing the theory / intervention
Analyzing results
Standardizing improvements
Progression to the AIM Statement
Focusing Statement: Strategic data gathering level to describe
current state of process(es) involved in the area of opportunity/discomfort.
Issue Statement: Strategic statement of desired future
state once the opportunity/discomfort is successfully addressed.
Aim Statement: Operational definition of
measureable outcomes that will move the current state situation to the future
state desired by the project champions.
Driving Forces
Current State:
Pathway
Consequences
Benefits
Future State:
Issue and Focus Statements
• Developing the AIM of the QI Project:
–
–
–
–
–
–
What is the Issue?
What are the current state conditions?
What is driving us to change?
What are the consequences of not changing?
What are the benefits of changing?
What will the future look like?
Developing Focusing, Issue, and AIM Statements
• When developing the Focusing and Issue
Statements, stay at a strategic level in the
explanation and try not to get too
operational – let the participants move to
the details.
• Also, try not to suggest or imply any
solutions.
Focusing Statement – Current State
• Describe some background around the
issue/problem that has been selected for
those who will be working on it.
–
–
–
–
–
What is the current state?
Why is this important?
What is it costing us – time/dollars/staff/etc?
What is the impact on our clients?
What is the impact on our division/agency?
Focusing Statement – Current State Example
• Too few state and local public health agencies are
measuring their success based on improvements in
community health outcomes. Through development
of agency-wide performance management systems
and the routine employment of quality improvement
(QI) techniques, public health agencies can improve
their performance, become more accountable to the
public and policy makers, and achieve better
community health outcomes. At the present time,
performance management and QI are not wellintegrated into most public health agencies
Issue Statement – Moving To The Future State
• Want to give the participants working on the issue
some of your thinking, in broad terms, on what the
future state should look like. What needs to improve,
change, or be created. Want to describe:
– What are the important aspects of the future state?
– What is driving us to this future state?
– What might be the consequences of not moving to the future
state?
– What might change?
– What is the proposed timeline?
Issue Statement – Moving To The Future State Example
• To improve the current public health situation
and begin moving public health to the "cutting
edge of quality and innovation," how will XYZ
accomplish this within the next 3 years?
Components of the Issue Statement
• Describe the components of the issue statement in
discrete high level elements. In this section we want
to answer the questions:
– Do we as a group have complete control over the element?
– Can we implement a solution to this element when we finally
develop it?
– Do we have to involve and influence others to get the
element resolved?
– Is this element outside our control and influence ability?
Components of the Issue Statement
Element
Control
Implement
Involve &
Influence
Outside Our
Control &
Influence
For each element check which column(s) apply
From this, select the area(s) of focus, develop a ranking of the elements to focus on,
and write the AIM statement for the Quality Improvement project to be started.
AIM Statement
• At this level we begin to look more operationally
rather than strategically.
Example:
• How to focus our department’s resources on the
shifting socio-economic clients now requiring services
from us.
• How will we serve people now needing health
services?
• How will we implement a property maintenance
program to preserve our community’s character?
Questions?
Please change the “feedback” color
to purple (top right side of your
screen) if you have a question.
Measurement
How do we currently
measure this area and
what is the current
baseline data telling
us about the situation?
Time Frame
• What are the key critical dates when things
must be completed?
• Who is responsible?
• Use a Gantt Chart
Driving Forces:
Current State:
• What is the current
state?
• Why is this important?
• What is it costing us –
time/dollars/staff/etc?
• What is the impact on
our customer/clients?
• What is the impact on
our division/agency?
• Economy
• Practice Standard
• Morally Right
Pathway
Consequences
• Could become
irrelevant
• Others drive the agenda
• Those in need still struggle
Benefits
• Understand true costs
• Better able to respond
• Qualify for grants
• Increased budget
•Those in need get services
Future State:
• What are the
important aspects of
the future state
• What is driving us
to this future state?
• What might be the
consequences of not
moving to the future
state?
• What might
change?
• What is the
proposed timeline?
Planning For A
Quality Improvement Project
•
•
•
•
Developing a theory for improvement
Testing the theory / intervention
Analyzing results
Standardizing improvements
Plan–Do–Check–Act
Plan
Plan changes aimed at
improvement, matched to
root causes
Do
Carry out changes; try first on
small scale
Check
See if you get the desired
results
Act
Act
Plan
Check
Do
Make changes based on
what you learned; spread
success
Also called Plan-Do-Study-Act
(PDSA), PDCA, PDCA Cycle, or
Shewhart Cycle
Plan–Do–Check–Act
Expanded in 7 Steps
 Select the problem or improvement
Plan
opportunity
 Describe the current process
 Describe all of the possible causes of the
problem, and agree on the root cause(s)
to address
 Develop a workable solution and action
plan, including targets or measures to
know if the change is an improvement
Plan–Do–Check–Act
PLAN: 3 questions to use in any order
Model for Improvement*
What are we trying to
accomplish?
What change can we make
that will result in improvement?
How will we know that a change
is an improvement?
What happens when we need to
just sustain current practice?
*Associates in Process Improvement.
(Langley, Nolan, et al, 1996.)
Plan–Do–Check–Act
Do
 Implement the solution or
process change
Check
 Review and evaluate the result
of the change
Act
 Reflect and act on learnings
Measures of changes that lead to improvement in…
CAPACITY
• Health dept.
workforce
turnover
• Completion of
annual health
profile by
every LHD
PROCESS
• No-show WIC
appointments
• % women
who receive
adequate
prenatal care
OUTCOME
• Influenza
deaths
• Multi-drug
resistant
tuberculosis
cases
Continuous Improvement
Act
Plan
Check
Do
The continuous
improvement phase of a
process is how you make a
change in direction. The
change usually is because
the process output is
deteriorating or customer
needs have changed
Maintenance and Standardization
Act
Standardize
Check
Do
The Maintenance and
Standardization phase of a
process is how we hold the
Gains. If our process is producing
The desired results we standardize
What we are doing.
Integrated Cycle
The SDCA and PDCA cycles are
separate but integrated. Once we have
made a successful change we
standardize and hold the gain.
When the process is not performing
correctly we go from SDCA to PDCA
and once we have the process
performing correctly we standardize
again.
This switching back and forth between
SDCA and PDCA provides the
opportunity to keep our process
customer focused.
Successful improvement efforts
“check in” along the way
• Know if you are on
track to reach your
destination
• Make mid-course
adjustments
• See how one thing
affects another
Questions?
Please change the “feedback” color
to purple (top right side of your
screen) if you have a question.
Integrating the Gantt Chart and the PDCA Cycle
Milestones
Quarters
Achieve measurable improvements in health department
performance through application of quality
improvement methods
Select Target Areas
Conduct RFP process for mini-collaborative participation
Hold 2-day kickoff QI training for mini collaborative grantees (for
grantees and other interested LHDs)
Develop collaborative work plans
Hold routine technical assistance teleconferences with
collaborative participants
Conduct 1-day follow-up QI training
Rapid cycle improvements in participating LHDs
Develop semi-annual progress reports on mini-collaborative QI
activities, through storyboards and other approaches
Promote and sustain QI efforts statewide through the IPHI
Center for Community Capacity
Development and the “ambassadors” program
Year 1
(2008-2009)
1
2
3
Year 2
(2009-2010)
4
1
2
3
Year 3
(2010-2011)
4
1
2
3
4
Integrating the Gantt Chart and the PDCA Cycle
Select Target Areas – 1st Qtr 2008
Conduct RFP Process – 2nd Qtr 2008
Develop Semi-Annual
Reports 2nd Qtr 2009
Act
Check
Plan
Do
Hold Routine Technical
Assistance Calls 4th Qtr 2008
Original Concept developed by Livingston County Department of Health , NY
Hold 2-day Kickoff QI Training
3rd Qtr 2008
Develop Collaborative Work
Plans 4th Qtr 2008
Helpful Resources
• MLC Webpage: www.nnphi.org/mlc
• NNPHI eCatalog: www.nnphi.org/eCatalog
• NPHPSP User Guide: Fall 2007:
www.cdc.gov/od/ocphp/nphpsp/Documents/NPHPSPuserguide2004Apr.pdf
• Guide to Community Preventive Services:
www.thecommunityguide.org/
• Healthy People 2010 Information Access Project:
phpartners.org/hp/
• NACCHO Model Practices:
www.naccho.org/topics/modelpractices/index.cfm
• NPHPSP Online Resource Center: www.phf.org/nphpsp/
• Public Health Infrastructure Resource Center:
www.phf.org/infrastructure/
• Public Health Memory Jogger II:
www.goalqpc.com/shop_products_detail.cfm?PID=754&PageNum_GetPro
ducts=1&ProductShopBy=7
Thank You
For additional information:
• Jack Moran, Senior Quality Advisor, PHF:
202.218.4423; [email protected]
• Grace Duffy, PHF Consultant;
352.406.8262;
[email protected]
Questions?
Please change the “feedback” color
to purple (top right side of your
screen) if you have a question.
Announcements
 Additional Opportunities for Sharing: Your input is requested
 RWJF Call for Proposals
 Update on Site Visits
 MLC Wiki
 Important Dates





Quarterly Report due 11/17
Semi-annual financial report due 11/17
December 12th at 12:00 ET: Planning Call for Open Forum
December 12th at 1:00 ET: Webinar by Spitfire Strategies
January 9th, 2009 at 1:00 ET: Teleconference (Accreditation focus)