Introduction to QA, QI and Performance Management

1. Introduction to QA, QI and Performance Management A Mark Durand PIHOA Quality and Health Information Coordinator December, 2011

2. Are you satisfied?

4. QA/QI- Program Development by Site Key: 0 = No activity yet = Preliminary plan = Some progress = Program components installed = Program running

5. QA & QI & PM

6. Church of God • Seventh Day Adventist • Congregational • Catholic • Orthodox • Presbyterian • Lutheran • Baptist • Church of Christ

7. Church of God • Seventh Day Adventist • Congregational • Catholic • Presbyterian • Lutheran • Baptist • Church of Christ Quality Assurance Quality Improvement Continuous Quality Improvement Total Quality Management Performance Management Lean Six Sigma Baldridge Criteria

9. QA & QI & PM

10. QA QI QI Tools

12. Learning and Improvement Cycle • Plan • Objective • Questions and predictions • Plan to carry out the cycle • (who, what, where, when) • Plan for data collection • Act • What changes are to be made? • Next cycle? Documentation of recommendations: report or minutes Logic model • Do • Carry out the plan • Document problems and • unexpected observations • Begin analysis of the data • Study • Complete the data analysis • Compare data to • predictions • Summarize lessons Track progress on work plan or Gantt Data analysis / report

13. 5 Why’s Technique Problem (Effect) Why? Why? Why? Why? Why?

14. Fishbone Diagram People Methods Resources Lack of knowledge & skill in QI Culture Materials

15. Cause and Effect Diagram for Low Use of HIV Screening: Test Location Client Don’t see benefit Not convenient Don’t Want Test Not Private Fearful Poor HIV Testing Not Client Centered Not Respectful Not Offered Poor Experience Counseling Staff

17. QA QI QI Tools

18. Agency (Director) ---------------------- Units/Programs ----- (Supervisors) Staff -------------

19. Key Point! • What is the job of a health worker? - Perform your duties to help your team to deliver services • What is the job of your health units and programs? - Perform specific tasks or deliver specific services • What is the job of your agency? - Support the work of its units and staff - Meet the needs of the population

20. Benchmark

22. PM • Agency or jurisdiction level • Examples: • 1. • Nursing shortage • Low $ collections • 2. • Access to care • NCD epidemic QI Tools

23. Key Point! • What is the job of a health worker? - Perform your duties to help your team to deliver services • What is the job of your health units and programs? - Perform specific tasks or deliver specific services • What is the job of your agency? - Support the work of its units and staff - Meet the needs of the population

24. Are we satisfied? Current situation? Needs Assessment What to do? Goals, strategies & objectives Assure success Performance Improvement System

25. Example: Situation: Nursing shortage 3 Levels of response: • Level 1: “reactive” response • Level 2: partial response • Level 3: performance management

26. Level 1: “reactive” response: Situation: Nursing shortage Needs assessment: Not done Goal: Not clear Objective: Not clear Strategy: 1. Train practical nurses whenever shortage becomes acute 2. Hire nurses off-island

27. Level 2: Partial response: Situation: Nursing shortage Needs assessment: Done Goal: A supply of high-quality, local nurses Objective: Not clear Strategy: 1. Recruit nurses to study off-island 2. Establish community college nursing pgm 2. Hire expat nurses

28. Level 3: Proactive response: • Situation: Nursing shortage • Needs assessment:Done • Goal: An adequate supply of high-quality, local nurses • Objective: 100% of ward nurses should have formal college nursing certificates or degrees by 2015 • Strategy: • Partnership between hospital and comm college • - define target group of nurses • - financing • - employment policies • - work-study scheduling, transport, classroom site

29. Are we satisfied? Current situation? Needs Assessment What to do? Goals, strategies & objectives Assure success Performance Improvement System

30. Community Health Assessment • Community Health Improvement Plan • Agency Strategic Plan • Performance Improvement System • (for 10 essential public health services) Assessment 􀂉 Monitor health status 􀂉 Investigate health problems 􀂉 Evaluate personal and population-based health services Policy Development 􀂉 To support individual and community health efforts 􀂉 Enforce laws and regulations that protect health. 􀂉 Research for solutions to health problems Assurance 􀂉 Link people to needed personal health services 􀂉 Assure a competent health care workforce 􀂉 Inform people about health issues 􀂉 Mobilize partnerships to solve health problems

31. Public Health Accreditation Board Standards and Measures

32. PH Accreditation Orientation (web-based): http://www.cecentral.com/phab

33. CDC Performance Management Reporting Tool • Type of measure (i.e., output or outcome measure) • Format of measure (e.g., Yes/No, count, proportion, time-based, other) • Measurement specifications (e.g., start/stop time, numerator/denominator, what is being counted) • Baseline value and associated date(s) • Target value and associated date(s)

35. Quiz: Is it QA-QI-PM?................ (or is it a “blind improvement attempt”?)

36. Behavioral health unit offers substance abuse counseling training to DHS staff. “Blind improvement attempt”

37. Staff in OPD put labels on supply shelves in clinic as part of corrective action plan from last survey. QA-QI-PM

38. Chief nurse arranges transportation to help night shift nurses get to work. “Blind improvement attempt”

39. Nursing team develops plan to help decrease absenteeism rate on medical ward QA-QI-PM (if impact is measured)

40. Team from Public Health goes to Mortlocks to do screening and health promotion to address NCD epidemic “Blind improvement attempt”

41. DHS works with legislature to pass increase in tobacco tax in hope of decreasing teen tobacco use 10% from current rate of 67% QA-QI-PM (if follow-up measurment is done)

42. Nursing Supervisor requires all nursing unit supervisors to take on-line QI course, and follows-up until all supervisors on her list have completed QA-QI-PM

43. DHS hosts training workshop to train doctors, nurses and health assistants to apply new NCD treatment guidelines “Blind Improvement Attempt”

44. HRH Committee develops strategy for recruiting 60 new students into COM-FSM nursing program by 2013. QA-QI-PM

45. durand@pihoa.org A Mark Durand