creating a culture of quality improvement los angeles county department of public health division of...
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Creating a Culture of Quality Improvement
Los Angeles County Department of Public Health
Division of Quality Improvement
Goal #1: Develop an understanding of what Quality looks like in Public Health
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Quality in Public Health is…
The degree to which policies, programs, services, and research for the population increase the desired health outcomes and conditions in which the population can be healthy
-PHQF, 2008
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Quality at LACDPH
Quality is the result of Worthy Work Well Done• Worthy= We must have a clear direction (Strategic
Plan)
• Work= Our work should have an intelligent direction based on evidence and best practices.
• Well Done= Our work should be carried out by a skilled and competent workforce and measured to track our performance.
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Goal 2: Develop a clear understanding of
Quality Improvement and why it is necessary
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Quality Improvement
• Quality Improvement (QI) is an integrative process that links knowledge, structures, processes and outcomes to enhance quality throughout an organization.
-National Committee for Quality Assurance
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Why QI?
• In a time of decreased funding and increased demand, QI can help answer key questions in public health: – Are we using our resources (staff, money, time) in
the best way?• We often hear “work smarter, not harder”
– Are we getting the intended outcomes?
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Are we actually improving the health of the public in the most
effective and efficient way possible?
And if not, how can we do it better?
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QA & QI -They are not the same!!!
Quality Assurance:
• Reactive; works on problems after they occur
• Regulatory• Led by management• One point at a time
Quality Improvement:• Proactive – works on
processes before problems occur
• Self-determined
• Led by staff
• Continuous
• Exceeds expectations
9Source: Public Health Foundation
3 Levels of Quality Improvement
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Topic Organization-Level Program-Level Individual-Level
Improvement
System Focus Specific project focus Daily work level focus
Quality Improvement Planning
Tied to the Strategic Plan
Performance Measures tied to program-level Strategic Plan
Tied to yearly individual performance
Evaluation of Quality
Responsiveness to a community need
Performance of a process over time
Performance of daily work
Processes
Cut across all programs and activities
Delivery of a service Daily work
Quality Improvement Goals
Strategic Plan Individual Program level Strategic Plans
Individual Performance Evaluations
Importance of Quality Improvement
Quality Improvement positions an agency to achieve:
o Customer satisfactiono Efficient use of resourcesoMeasurable outcomeso Community impact
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Goal #3
Connect staff with the benefits of Quality
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Quality in Public Health Benefits Everyone
• Customers/Clients
• Employees
• The Organization
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Benefits of quality to clients
• Improved services
• Improved choices
• Expectations met or exceeded
• Client oriented employees
• Friendlier atmosphere
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Benefits of quality to employees
• Pride in services delivered• Job satisfaction• Improved communications• Streamlined work processes• Happier clients • Strong client relationships
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Benefits of quality to the organization
• Improved/expanded services• Client oriented employees• Improved client relations• Improved community relations =
better political relations• Lower costs/cost contained• Improved funding
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Goal #4Develop a clear structure and
framework for quality management
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Continuous Quality Improvement Efforts
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Determine Priorities and Goals
1. What are the healthy behaviors and outcomes we want for people who live in LA County?
2. What would these conditions look like if we could see them?
SPA/SPA/ProgramProgram
Strategic PlanStrategic Plan
DPH Strategic Plan
County Strategic PlanCounty Strategic Plan
Performance Measures
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Results Based Accountability
AND
Public HealthMeasures
POPULATION INDICATORS(measures of population-level
health outcomes)
PERFORMANCE MEASURES(measures of program
effort and output)
Population Indicators
• Longer life span• Increased quality of life• Increased health equity• Less disease• Less premature death• Healthier choices• Safer environment• Healthier homes
POPULATION-LEVELHEALTH OUTCOMES
& BEHAVIORS
Population Indicators
• Percent of students who had at least one drink of alcohol in the past 30 days
• Rate of foodborne illness hospitalizations each year (per 100,000)
• Percentage of children covered by health insurance
• Death rate from colorectal cancer
Performance Measures
• Policies Created
• People Informed
• Improved Behaviors
• Surveillance Performed
• Investigations Completed
• Increased Access to Services
• Client satisfaction
MEASURES OF PROGRAM
EFFORT & OUTPUT
Performance Measures
• Percent of outbreaks (excluding scabies) investigated within standard timeframe
• Percentage of children under 6 years who participate in fully operational population-based [immunization] registries
• Number of cities that adopted a policy that prohibits smoking in outdoor areas
Reporting of Progress
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Performance Improvement Process
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Who Manages Quality at DPH?
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Who Manages Quality at DPH Everyone Plays a Role in Quality Management:•Director of Public Health•Division of Quality Improvement•Strategic Directions Council•Executive Team•Performance Improvement Team•Program Directors•Managers/Supervisors•All Staff
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In order to establish a lasting culture of Quality, you must:
• Have a clear direction of what quality should look like in your organization
• Understand Quality
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Goal #5:
Clearly communicate your Quality Improvement plan and efforts throughout the organization
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Step 1:• Create a Quality Improvement Program
Description Document – Give an overview of Quality at the organization
– Describe the structure for managing quality throughout the organization
– Establish roles and responsibilities for all levels of staff in relationship to Quality Improvement efforts.
– List and describe the organization’s QI efforts
– Establish QI goals for the organization
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Step 2: Train staff
• Introduction to Quality Improvement for all employees
• Incorporate QI into existing trainings
• Conduct orientation sessions to orient staff to the QI Plan
• Provide advanced QI training to prepare staff to conduct quality improvement projects
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Step 3: Provide Support
• Technical Assistance
• 1:1 Consultation
• Presentations at program-level meetings
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Summary• In order to establish a culture of quality, you
must first decide what quality in your organization will look like and communicate that vision to others
• The structure and process for quality improvement should be visible and easily understood by everyone in the organization
• Buy-in and support at all levels is essential to successfully establishing a culture of Quality
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Thank you!
Emily Peach, MPH, CHES
Performance Improvement Manager
Quality Improvement Division
(213) 989-7243