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Performance Management and Building QI into Your Agency Culture

Performance Management and Building QI into Your Agency Culture. MCPP Healthcare Consulting. Marni Mason BSN, MBA. More than 30 years in private healthcare and public health as clinician, manager and consultant Primary & specialty care clinic nurse and nursing director (15 years)

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Performance Management and Building QI into Your Agency Culture

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  1. Performance Management and Building QI into Your Agency Culture MCPP Healthcare Consulting

  2. Marni Mason BSN, MBA • More than 30 years in private healthcare and public health as clinician, manager and consultant • Primary & specialty care clinic nurse and nursing director (15 years) • Consultant in healthcare performance measurement and improvement (18 years) • Public health performance management – since 2000 • Surveyor for NCQA (11 years) and Senior Examiner for state Baldrige Quality Award • Consultant for PHAB Standards Development (2008-2009) MCPP Healthcare Consulting

  3. Learning Objectives • In today’s session the participants will develop a better understanding of: • Components of Performance Management • Methods and Tools for Building QI Culture • Preparing for Accreditation MCPP Healthcare Consulting

  4. Performance Management Standards for Public Health Public Health Indicators QI Plans & Councils QI Methods & Tools Improving PH processes Performance Assessment Business Process Analysis MCPP Healthcare Consulting

  5. Performance Management MCPP Healthcare Consulting

  6. Application of P-D-S-A MCPP Healthcare Consulting

  7. Performance Standards 1st Quadrant • Establish Performance Standards • NACCHO – Operational Definition and Standards • National Public Health Performance Standards (CDC) • Public Health Accreditation Board Standards • Local, State and Tribal Health Departments • Establish and Define Outcomes and Indicators • Process and Intermediate Outcomes • Health Status Indicators MCPP Healthcare Consulting

  8. Performance Measurement2nd Quadrant MCPP Healthcare Consulting

  9. Performance Measurement Definitions MCPP Healthcare Consulting

  10. Quality Improvement Process 3rdQuadrant • Use data to identify opportunities for improvement and to make decisions • Quality Improvement Methods: • Improvement Collaboratives • Adapting or Adopting Model Practices • Establishing QI Councils, Plans, and Teams • Logic Models, RCI, Business Process Analysis • QI Tools; Data Analysis and Root Cause

  11. Principles of Quality Management MCPP Healthcare Consulting Know your stakeholders and what they need Focus on processes Use data for making decisions Understand variation in processes Use teamwork to improve work Make quality improvement continuous Demonstrate leadership commitment

  12. Learning and Improvement Cycle Act Plan • What changes are to be made? • Next cycle? • Objective • Questions and predictions • Plan to carry out the cycle • (who, what, where, when) • Plan for data collection DOCUMENTATION OF CHANGE - MINUTES REVISE LOGIC MODEL LOGIC MODEL REVISE LOGIC MODEL Study Do • Complete the data analysis • Compare data to • predictions • Summarize lessons • Carry out the plan • Document problems and • unexpected observations • Begin analysis of the data DATA REPORT WORK PLAN MCPP Healthcare Consulting

  13. Tools to Link Work and Outcomes • Logic Models and detailed high level flow charts • Identify customer-supplier relationships • Client flow, information flow, materials flow, decision making flow • Data and Analysis tools • PH Memory Jogger MCPP Healthcare Consulting

  14. Adopt or Adapt Model Practices MCPP Healthcare Consulting • Use data to identify need for improvement • Identify exemplary practices in: • Other local and state health departments, • CDC and other national organizations, www.naccho.org/topics/modelpractices • Other industries • Describe your process (Logic Model or Flow Chart) • Study the exemplary practice process • Adopt or adapt as appropriate

  15. Reporting Progress4th Quadrant • Reporting of Performance (Local and State Standards and Program Evaluation) • Reporting of Indicators and Outcomes • Health Indicators • Program Evaluation Data • Requires regular tracking, analysis and review to tell you if you are achieving your agency goals • Provides the basis for deciding on QI efforts and the baseline information for measuring the impact of quality improvement activities MCPP Healthcare Consulting

  16. Stages of Organizational Performance MCPP Healthcare Consulting

  17. Does Size of Department Matter? • Good News! Smaller LHDs can demonstrate standards at same level as large LHDs • “Money (and staff) matter, but they aren’t all that matters” (Joan Brewster) • In Washington, 40% of the higher performers in the 2008 review cycle were smaller LHDs (less than 2 million annual budget). A couple of higher performers were LHDs with annual budgets of approximately $600,000 MCPP Healthcare Consulting

  18. Correlation of Budget & FTEs • Relationship of budget and FTEs to overall performance in the Standards is nearing random (little or no correlation) • Five non-urban LHJs with budgets of $2 million or less had > 60% demonstrated • There is variability not connected to budget or size, other drivers of high performance are local priority-setting; leadership; local funding; staff skill, training and experience; and documentation and data systems MCPP Healthcare Consulting

  19. Correlation of Budget to Performance Slight correlation and relationship between annual budget and overall performance in the Standards MCPP Healthcare Consulting

  20. Correlation of Per Capita Budget 20 MCPP Healthcare Consulting No correlation or relationship of per capita budget to overall performance in the Standards

  21. Building QI into Your Culture MCPP Healthcare Consulting

  22. Definition of Quality Improvement* • “A management process and set of disciplines that are coordinated to ensure that the organization consistently meets and exceeds customer requirements.” • Uppercase QI = top management philosophy resulting in complete organizational involvement • Lowercase qi = conduct of improving a process at the microsystem level * Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009 MCPP Healthcare Consulting

  23. Demonstrate Leadership Commitment • Build a QI culture • Connect the organization’s strategic plan to performance improvement • Know and use quality principles • Encourage all staff to use quality improvement in daily work • Reward improvements • Ensure adequate QI infrastructure for quality assessment and improvement activities MCPP Healthcare Consulting

  24. Demonstrate Leadership Commitment • Clearly stated and enacted constancy of purpose—a deep understanding of the vision and mission • Regular review of key indicator data • Decisions made on data rather than hunches or opinions • Long range view supports search for root causes and permanent solutions rather than quick fixes MCPP Healthcare Consulting

  25. Demonstrate Leadership Commitment • Focus on systems rather than individuals • Continued identification of improvement opportunities • Publicize successes • Clear communication agency-wide regarding the commitment to quality and the change processes necessary to implement improvement MCPP Healthcare Consulting

  26. QI Infrastructure • Governance (formal/informal) • Oversight and accountability • Program structure • Who will do what when, with what processes for recommending or deciding • Staff • Support for ongoing monitoring and analysis, for training and facilitating improvement activities • Data system • Collect data and report in a user friendly way MCPP Healthcare Consulting

  27. Quality Improvement Plan • Goals and objectives • Monitoring activities associated with important aspects of programs/services • Planned QI efforts (in process, new) and timelines • Evaluation of current QI efforts • Annual evaluation of QI work plan and program description, with proposed revisions MCPP Healthcare Consulting

  28. Tacoma-Pierce County Health Department Quality Improvement (QI) Initiative

  29. QI Time Line at TPCHD MCPP Healthcare Consulting

  30. QI Training & Tools • QI Principles, Methods and Tools • Just-in-time training for QI project teams, RCI method • Performance measures • QI Council training on QI concepts • QI concepts staff can use in daily work MCPP Healthcare Consulting

  31. QI Infrastructure • Must have director and other senior management LEADING the initiative • Establish a steering committee or leadership group to direct and oversee agency efforts (e.g. QI Council) • Leadership and key staff on QI Council • QI Plan and regular evaluation of QI efforts • Assessment staff is an excellent resource • Start small; get people excited about a single project • Celebration of successes is important MCPP Healthcare Consulting

  32. QI Plan and Evaluation • Annual QI plan • Lists major activities • Includes calendar • Identifies persons responsible & time lines • Annual evaluation of QI plan • Evaluates QI Council meetings • Analyzes performance measure data • Examines completion rate of QI plan activities MCPP Healthcare Consulting

  33. Quarterly Reporting Form • Plan Item Name/No. • Indicator(s) • Baseline Data (if applicable) • Quarterly Data • Data Source • Methods Notes • Data Explanation/Other Comments MCPP Healthcare Consulting

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  35. QI Calendar (TPCHD example) MCPP Healthcare Consulting

  36. Performance Measures • Twelve department-level measures • Modeled after Healthy People 2010 Leading Health Indicators . . . plus two more • Approx. 10-20 performance measures per business unit • Percent of solid waste complaints responded to within 20 days • Reduce the rate of positivity at Infertility Prevention Project (IPP) sites • Percentage of Positive Steps clients who engage in services for 30. days or more who have a 10% reduction on three youth violence risk factors MCPP Healthcare Consulting

  37. TPCHD Performance Measures MCPP Healthcare Consulting

  38. QI Activities - TPCHD • Critical to make data/reporting meaningful to staff. • Performance measures: • More is not better • Resource level declines after the first data reporting period • Staff need lots of practice/training to develop good performance measures • RCI/QI projects: • Quality planning is more appropriate than QI for some projects with long-term outcomes MCPP Healthcare Consulting

  39. First RCI Project STD Reporting of Race/Ethnicity • Collected data to identify “root cause” of problem • Pilot tested an education intervention MCPP Healthcare Consulting

  40. Second RCI Project Final On-Site Septic System Inspections • Collected data to identify “root causes” of problem • Re-prioritized work duties • Monitored work flow MCPP Healthcare Consulting

  41. MCPP Healthcare Consulting

  42. TPCHD Results of QI Initiative • Most performance measures at department- and business unit-level achieved their stated target • Improvements sustained for RCI/QI projects • Health indicator projects met 100% of annual performance measures • Funding & staffing for QI has increased MCPP Healthcare Consulting

  43. Washington State Department of Health Quality Improvement (QI) Initiative

  44. PM System and QI Structure Performance Management System QI Structure Organizational Strategic Planning Quality Steering Committee Performance Management and Accountability PALS (Performance Accountability Liaisons) Project Mgmt. Resource Team Operational/Business Planning and Performance Process Improvement Teams Focused Quality Improvement Efforts

  45. Quality Improvement Organizational Structure • Primary responsibilities include: • Reviewing and approving the agency QI plan annually • Encouraging and fostering a supportive QI environment • Championing QI activities, tools and techniques • Selecting and supporting agency QI projects Quality Steering Committee MCPP Healthcare Consulting

  46. The Quality Improvement Process Step #1: Clarify the purpose. Step #2: Select & build the team. Step #3: Examine the process. Step #4: Analyze data and generate solutions. Step #5: Take appropriate action. Step #6: Provide closure. MCPP Healthcare Consulting

  47. Integration of QI into Agency Culture MCPP Healthcare Consulting

  48. Multilevel Model of Integration* • Spread can be defined as moving from common practices to best practices • Diffusion is the rate at which innovation is adopted within an organization or industry *Bill Riley and Russell Brewer, Review and Analysis of QI Techniques in Police Departments, JPHMP Mar/April 2009 MCPP Healthcare Consulting

  49. Levels of QI Integration MCPP Healthcare Consulting

  50. JPHMP Article Recommendations • Implement QI as a comprehensive management philosophy rather than a project-by-project approach • Top officials must set a vision for the agency and exhibit constant leadership, focus continuously on mission • Use the lessons/proven methods from others [police, etc.] to overcome barriers • Find creative ways to secure resources for QI • Build on existing PH tools and capabilities • Conduct a self-assessment for QI readiness in your agency Bill Riley and Russell Brewer MCPP Healthcare Consulting

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