Quality Improvement (QI )

1. Quality Improvement (QI) Understanding the Cause and Effect Diagram Gregg M. Reed, MPH QI Council

2. Quality Improvement in Accreditation “Quality improvement is the foundation of [Public Health Accreditation Board] PHAB’s accreditation program, to the extent that a health department attains accreditation status only if it embodies a culture of quality improvement.” American Public Health Association Quality Improvement in Public Health: It Works! (2012)

3. Summary Definition of Quality Improvement • Continuous/ongoing process • Measureable change • Monitor factors/disproportions impacting quality • Achieve equity/uniform processes within a system to improve health

4. Agenda • Review Quality Improvement Tools • 10 minutes • Group Work on Cause and Effect Diagram and 5 Whys • 30 minutes • Review Group Work • 10 minutes • Discussion and Next Steps • 10 minutes

5. Cyclical Continuous Improvement PLAN ACT DO CHECK/STUDY

6. Stating the Problem “A problem well stated is a problem half solved” Charles Kettering, an American inventor • An AIM Statement or Problem Statement If you can’t describe what you are doing as a process, you don’t know what you’re doing. – W. Edwards Deming • A Flow Chart Describing the Problem Process

7. General Approach Issue to Consider: Delay in Travel Reimbursement Flow Chart Existing Process (Examine Process to see where problem might be -Identified Delay) Brainstorm & Consolidate Data (Affinity Diagram) Cause & Effect Diagram – Greatest Concern Monitor new process and Hold the Gains Drill down to root causes (Five Whys) Analyze Information and develop solutions (Solution and Effect Diagram) Translate Data into Information Flow Chart New Process Gather Data

8. What is a Flow Chart • A diagram that represents the sequence of operations in a process. • Used to identify the actual flow/sequence of events in a process • Helps to determine: • What is going on? • Are there delays? • What are the next steps? • How can we improve this process?

9. Travel Reimbursement (Out-of-State) Return from travel Contact Accounting on how to proceed Gather Reciepts No Can you get the required original receipts? Yes No Do you have the required original receipts? 1 Yes 1 Give proper information and documentation to support person. No Do you fill out the travel voucher? 2 2 Yes 2 Complete Travel Voucher and paper clip original reciepts Employee review travel voucher and sign Give to division director and/or section cheif for signatures Employee receives check by inside mail Make copies and date stamp Employee emailed Submit original voucher and original receipts to accounting Accounting picks up check from state treasury office Accounting stamps with date received Employee account credited No Yes Entered into Peoplesoft No Yes Returned to Employee Unpaid Payment Processed Audited and determined acceptable? Direct Deposit set up for Employee?

10. March Flow Chart Findings • Bottlenecks • Hand-offs • Redundancy • Rework loops • Wait or delays

11. What is an Affinity Diagram? • A tool for assimilating and understanding large amounts of information. • Group large amounts of (team/partner generated) information into themes for further analysis. • Used to categorize and identify ideas. • Helpful after describing the process (flow chart). • Provides direction and impact

14. What is a Cause and Effect Diagram • Uses of this Diagram • Organize the themes and factors generated in an Affinity Diagram • Identify and categorize issues about the causes of problems • Display the information graphically

15. Cause and EffectStep 1 Write the problem statement on the right side of the page; this is known as the effect. DELAY IN TRAVEL REIMBURSEMENT

16. Step 2 Generate ideas about the main causes of the effect and write them to the left of the effect; these are the main cause headers. For example: “A” = Lack of Training and Unclear Process A = LACK OF TRAINING AND UNCLEAR PROCESS B DELAY IN TRAVEL REIMBURSEMENT C

17. Step 3 Draw arrows from each main cause header to the backbone. A = LACK OF TRAINING AND UNCLEAR PROCESS B DELAY IN TRAVEL REIMBURSEMENT C

18. Step 4 Under each main cause header, list ideas that support it as the sub-cause; Draw arrows from each sub-cause to the main branch header arrow. For example: 1= Employee Organizing/saving receipts needed A = LACK OF TRAINING AND UNCLEAR PROCESS B 1 = Not Knowing Policies and Procedures 1 2 2 3 DELAY IN TRAVEL REIMBURSEMENT 1 2 3 C

19. 5 WHYS Analysis Process will identify the root causes of the effect. Begin with a sub-cause selected by your group. Not Knowing Policies and Procedures_____ WHY? ___________________________________ WHY? ___________________________________ WHY? ___________________________________ WHY? ___________________________________ WHY?

20. Group Work (Divide Room into Half) • (Optional) Compile additional Main Cause Headers and sub-causes, if needed • Complete an applicable Cause and Effect Diagram • Hang the diagram on the wall using provided supplies • Complete 5-WHYS analysis on sub-causes of each Main Cause Header • Choose a group spokesperson to present • Please conclude by 1:40pm (30 minutes)

21. Discussion

22. Next QI Tool Learning Session • Solution and Effect Diagrams • June 17th • 11 am to 12 pm • Capital: AV Rooms 210 & 212 • Contact Susan Mormann or Kelly Nagel with questions