State Laboratory Quality Improvement project

1. State Laboratory Quality Improvementproject Association of Public Health Laboratories (APHL) Laboratory System Improvement Program (L-SIP) Jill Power New Hampshire Public Health Laboratories Presented 5/26/09

2. In the Beginning… • National Public Health Performance Standards Program (NPHPSP) • Establish & Implement national performance standards for state and local public health systems • Collaborative effort of 7 national public health organizations • NH Public Health Division assessment – 2005

3. …thus created… • State Public Health Laboratory Systems Performance Standards Program • Collaborative effort that targets improvement of the public health laboratory system • Assess, plan, implement & re-evaluate improvement performance and strategies • NH Public Health Laboratories assessment - 2007

4. Name Change In 2008, the State Public Health Laboratory System changed it’s name to: Laboratory System Improvement Program a.k.a L-SIP

5. Quality Improvement in NH PHL • Quality Assurance manager – Lab • Quality Improvement committee – Lab • Public Health Improvement Team (PHIT) – Division* • Liaison to PHIT, APHL & other professional organizations - Lab

6. *Public Health Improvement Team(PHIT) • Internal quality improvement team • Meets regularly to discuss quality issues • Team approach • Multiple state agencies within Public Health

7. Purpose of PHIT To establish, within Division of Public Health Services (DPHS), a process to manage change and achieve quality improvement in public health policies, programs, and infrastructure.

8. HOW? • Use a Plan, Do, Study, Act approach to performance improvement • Use the Institute for Healthcare Improvement’s Model for Improvement • PHIT Team Tracking Database

9. Road to Improvement

10. PDSA Work Plan • Identify a problem • Initiate work plan • Do research • Perform intervention • Measure changes

11. New Hampshire Division of Public HealthPerformance Improvement Workplan ACT– Refine and Spread the Change PLAN - Based on problem identification, analysis and root causes described on the PDSA Worksheet DO – STUDY – Observe/Evaluate the Results of the Change Try the Change on a Small Scale Problem statement defined: Performance measure(s) with baseline data: : List change(s) to be implemented: Who, What, When, Where, How? What is the anticipated change and by when? What data will be collected? Who, What, When, Where, How? Gather the data on the change Analyze the date on the change Was the change carried out as planned? Did you obtain the anticipated results? What new knowledge did you gain as a result of this change cycle? What actions will be taken as a result of this change and evaluation cycle? If successful how will you spread the change? What systemic changes and training needs to take place for full implementation? What is the plan for ongoing monitoring? Are there incremental improvements to refine the change? What improvement opportunities come next? Current baseline: Name of Program and Person(s) Responsible: Date: Cycle #: Cycle #

12. EXAMPLE

13. QI REPORT: MYCOBACTERIOLOGY (TB) LAB MONITOR: QNS OF SPUTUM SPECIMENS Peggy Sweeney, TB Technical Supervisor April 2009

14. Public Health Problem • Tuberculosis infection is a public health concern • Early Detection = Early Treatment • Early Treatment = Decreases Transmission • Decreased Transmission = Healthy People!

15. Testing for TB • Analyze human specimens in laboratory • Skin testing • Radiological examinations

16. Laboratory TB testing in NH • NH Public Health Laboratories is one of two labs in the state that tests and identifies the TB microorganism • Dependent on providers sending proper specimens • Specimens sent in by mail, courier or hand delivered

17. Specimen Collection • Providers can order test kits from NH PHL • Instructions on proper collection provided with each test kit • Providers submit specimens in the NH PHL kit collection containers or submit their own

18. Problem Respiratory specimens sent in for the detection, identification and/or confirmation of Mycobacteria tuberculosis ( the TB bug) does not always have the appropriate amount of sample submitted as recommended by the Centers of Disease Control and Prevention.

19. INTERVENTION ATTENTION!! For SPUTUMS & BRONCHIAL WASHINGS Minimally place enough specimen to reach GREEN line (3ml) Specimen will be rejected if less than 3ml Add label to collection tube

20. TB PDSA

21. Public Health Improvement Team Tracking Database

22. Tracking Measures

23. Recording Data

24. Report & Graph Generated

26. Conclusion • After reviewing the data, it has been determined that our intervention did not improve specimen submission volumes. • When an intervention proved it did not gain improvements, the PHIT team reviews and discusses means to change or alter the intervention often involving participation with stakeholders and partners. • In reviewing the success of findings involving quality improvement, the PHIT team makes recommendations whether to continue the monitor or not, dependent on the criticality of the monitor.

27. QUESTIONS ??????????????????????????????????????????????????????TB???????????????????????????QA???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????PHIT???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????QI???????????????????????????????????????????????????????????????????LSIP???????????????????????????????????????????????????????????