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QUALITY IMPROVEMENT:FOOD PROTECTION & FACILITIES BRANCH
Larry Michael, NC Division of Public Health
Food Protection & Facilities Branch Head
Jim Hayes, NC Division of Public Health
Pools, Tattoos, and State Institutions Program Head
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Center for Public Health Quality• Focuses on building workforce QI capacity
• Develops, leads, and supports strategic QI initiatives for the DPH and local public health agencies
• Incorporates QI methods (e.g., Lean, MFI) that are commonly used by public health system partners
• Ultimately, aims to help all public health agencies have ability to continuously improve
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Participants will be able to:
• Use QI methods & tools in daily activities to improve the effectiveness & efficiency of services
• Coach others within their organization/department to use QI methods & tools
• Develop a plan to incorporate QI methods & tools so that it becomes “the way we do business”
Program Objectives
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“A continuous and ongoing effort and culture
to best achieve measurable improvements
in the efficiency, effectiveness, quality, performance, and outcomes of services and systems
with the goal of improving the health
of North Carolinians and our communities.”
NC DPH Management Team, 2009Adapted from Accreditation Coalition QI Subgroup Consensus Agreement
What is QI?
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• Reduce costs and redundancy
• Eliminate waste
• Streamline processes
• Increase accountability
• Boost morale and teamwork
• Enhance ability to meet service demand
• Improve outcomes
- Public Health Memory Jogger, 2007
Why QI?
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Key Features of QI
• Focus on systems, not individuals
• Ideas/changes from customers & front line staff
• Focus on small tests of change
• Frequent, ongoing measurement and data-driven decision making
• QI is a never-ending process…it’s continuous
• It should help staff, not hinder
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Model for Improvement
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QUALITY IMPROVEMENT PROJECT
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Customer Satisfaction Survey• Conducted January 2013• Positive Comments:
• Staff effort• CIT & other training• Program evaluation• Authorization process and timeliness• Consultation• Response time to inquiries• Accessibility• Food Code
• What We Need to Work On• Consistency and Communication
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Comments from the Survey
Consistency. Advice is vague
at times
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We need MORE
PEOPLE!
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Be more of the mindset to educate rather than just to
regulate.
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A WORKING COMPUTER
DATABASE FOR FOOD AND LODGING
INSPECTIONS
TECHNOLOGY………!!!!!!!
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To better improve consistency from one part of the state to
another when a regional makes a decision about an interpretation or something else, it should be
sent on the listserv so others can benefit
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The Food Protection & Facilities Branch AIMS To:
• Improve consistency of interpretation and enforcement of the North Carolina Food Code by better communicating interpretations of the food safety standards to local Environmental Health Specialists by September 30, 2013.
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Better Consistency Will…• Maintain program integrity• Build public trust• Protect public health• Reduce liability• Build credibility• Potentially improve use of regional specialists’ time
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Quality Improvement Program• Establish Clearinghouse Committee to research and
answer questions about interpretation and enforcement of NC Food Code
• Use a standard template for communicating questions and answers
• Organize all documents about interpretation and enforcement of the NC Food Code in searchable online NC Food Code Annexes
• Evaluate for possible expansion to other programs
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Position Statements• Clearly defines the topic• Law or Rule• Question/Issue• Discussion and Rationale• Response/Interpretation• References
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North Carolina Food Code Annexes Website
• Makes all documents about interpretation and enforcement of the NC Food Code available online
• Documents are sorted by which subchapter(s) of the Code they pertain to
• Links to documents from FDA• Goal—To make it quick and easy to find answers to any
questions that have already been asked
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What We Hope to Learn
• Will formal position statements improve consistency of information?
• Will online access to program documents allow answers to be found quickly?
• Will the NC Food Code Annexes be a popular and useful tool that could be applied to other programs?
• Will regional staff see fewer repeat questions if initial answers are more widely distributed?
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Goals
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80
159
43
Question Mode
# Calls # Emails # Face
8 Consultants
Goal 1: Decrease # of Questions Received
Mar-13
Apr-13
May-13
Jun-13
Jun-13Jul-1
3
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Jan-14
Feb-14
Mar-14
Apr-14
0
50
100
150
200
250
300282
Questions Received
# of
Que
stion
s
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Goal 1: Decrease Response Hours
Mar-13
Apr-13
Apr-13
May-13
Jun-13
Jun-13Jul-1
3Jul-1
3
Aug-13
Sep-13
Sep-13
Oct-13
Nov-13
Nov-13
Dec-13
Jan-14
Jan-14
Feb-14
Mar-14
Mar-14
Apr-14
0
20
40
60
80
100
120
102
Time to process questions#
of H
ours
8 Consultants282 Questions
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Goal 2: Increase # of web hits
Mar-13
Apr-13
Apr-13
May-13
Jun-13
Jun-13Jul-1
3Jul-1
3
Aug-13
Sep-13
Sep-13
Oct-13
Nov-13
Nov-13
Dec-13
Jan-14
Jan-14
Feb-14
Mar-14
Mar-14
Apr-14
0102030405060708090
100
Webhits to Annexes
Web
hits
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Goal 3: Improve Communication
Jan-13 Jan-140
102030405060708090
100
Inadequate Communications
% L
HD
EH
Sta
ff
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Goal 4: Improve Consistency
Jan-13 Jan-140
10
20
30
40
50
60
70
80
90
100
"Lack of Consistency..."
% o
f LH
D E
H S
taff
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Goal 5: Improve Quality of Consultation
Feb-ru-ary-
March
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
0
10
20
30
40
50
60
70
80
90
100
Quality of Consultation Services rated as "Excellent or Good"
% of LHD EH Staff
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Assessment – Value Stream Map Current State
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Assessment – Improvement Ideas
1. Web-based Food Code Annexes
2. SOPs for responding to customer questions
3. Question Submission form
4. Position Statements
5. Memo review
6. Q&A database
7. Clearinghouse Committee
8. Roll out to stakeholders
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PDSA to Test Changes
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Question Submission Form
• PDSA cycle• Feedback applied• Planning another PDSA cycle
(technical challenges)
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SOP - Clearinghouse Committee
1. Review and make final decision for draft position statements
2. Maintain Q & A database after questions are answered
3. Q & A and Position Statements will indicate training needs
4. Review and maintain jurisdiction chart for the Web
5. Maintain awareness of trade secrets for firms
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Position Statements
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Classifying Memos
Revise…Review…Rescind
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Classifying Memos
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Q & A Database
• 200+ questions received so far from LHDs EH staff• “frequently asked questions”• Sorting ability eliminates duplicate efforts• Resource on web for quick reference
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Anticipated Benefits for ROI (Return on Investment)
• Reducing time in Q&A will increase face to face time• Improving consistency is a customer satisfier• “Real Time” web access reduces inequities across NC• Website promotes public awareness and trust• Creates transparency• Creates a standard for other states• Portable for other entity use (states, industries, public)• Compliant with FDA food standards 4, 6, & 7• Builds program integrity and credibility• Reduces liability
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Next Steps
• Develop customer request tracking log to promote transparency
• Reprioritize performance plans to support QI• Finalize flow chart routing, etc.• Evaluate web approach adaptability to other EH programs
• Develop web maintenance plan and protocol for updating information
• Conduct follow-up customer satisfaction survey
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AHA!• We can see how it is all coming together• More productive being together vs silos• Understand how the different components of our project link together
• Question Submission Form will help us save time and be more efficient
• This identifies our program weaknesses• Realized the need for standardized processes• Outstanding issues not being high priority