Environmental Health Performance Improvement /Reporting Dashboard

State: KY Type: Promising Practice Year: 2014

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Regulatory activities are conducted to prevent disease transmission such as foodborne illness and recreational water illness, provide environmental health education, promote a safe food supply, minimize environmental impacts; protecting both human and environmental health in Metro Louisville. Prior to the implementation of this practice, the LMPHW Environmental Health Division did not have a formal or well defined performance improvement process. Environmental Health inspections and services were monitored on a regular basis the process required significant time and effort from employees and relied on queries from a combination of datasets as well as reviewing standard reports generated by the Kentucky Department for Public Health. In short, the process was tedious, cumbersome and did not always produce reliable results. Therefore, to determine whether we were attaining mandatory inspection requirements and appropriate service request response times, we needed a reliable method for data collection. The goals and objectives of this practice included determining methods to easily query data needed for measuring key performance indicators, determine the level of compliance with State inspection mandates, identify barriers and any limiting factors, provide supervisory staff with data and tools to better manage resources, drive employee inspection performance, meet programmatic operational goals and create a culture of continuous quality improvement. The implementation of this process began with the process of updating environmental health program performance measures and key performance indicators. The next steps were to determine and increase the level of compliance. Environmental Health was incorporated into a Metro Louisville performance management program entitled, Louisville Statistics (abbreviated LouieStat). LouieStat brings individual Metro departments before the Mayor and his senior leadership team every eight weeks to identify and discuss, through consistent metrics tracking and data analysis, what the department (and Metro Government) can do to continually improve the services it delivers to the citizens of Louisville. This process helped examine root causes using analytic tools such as “plan, do, check, act,” (PDCA), fish bone diagrams, Pareto analysis, lean process improvement, Six Sigma, staff surveys, project management, and further data collection and analysis. Environmental Health Program staff were engaged with barriers identification surveys and included in the root case analysis and other problem solving processes. Key Environmental Health leadership staff began weekly meetings with LMPHW Information Technology (IT) and LMPHW Office of Policy Planning and Evaluation (OPPE) staff which lead to the development, pilot, and launch of an environmental reporting dashboard. The resulting environmental health program reports automatically generate weekly and are emailed to key stakeholders. One such report allows the supervisors to see at a glance, the overall compliance for a program and the compliance for each individual geographic- inspector assigned area. By simply clicking on an area, a new report is generated; displaying the actual facilities due for an inspection.

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Louisville Metro Department of Public Health and Wellness
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Environmental Health Performance Improvement /Reporting Dashboard
The Louisville Metro Department of Public Health and Wellness (LMPHW) is located in Jefferson County, Kentucky which has a population of approximately 750,000 and the surrounding Louisville metropolitan area (MSA) has a corresponding population of 1.3 million. The LMPHW Environmental Health Division is tasked with regulating nearly 5000 State permitted facilities including restaurants, grocery stores, hospitals, daycares, schools, hotels, motels, swimming pools, mobile home parks, onsite wastewater treatment systems, tattoo studios, ear and body piercing studios. Regulatory activities are conducted to prevent disease transmission such as foodborne illness and recreational water illness, provide environmental health education, promote a safe food supply, minimize environmental impacts; protecting both human and environmental health in Metro Louisville. Prior to the implementation of this practice, the LMPHW Environmental Health Division did not have a formal or well defined performance improvement process. Environmental Health inspections and services were monitored on a regular basis the process required significant time and effort from employees and relied on queries from a combination of datasets as well as reviewing standard reports generated by the Kentucky Department for Public Health. In short, the process was tedious, cumbersome and did not always produce reliable results. Therefore, to determine whether we were attaining mandatory inspection requirements and appropriate service request response times, we needed a reliable method for data collection. The goals and objectives of this practice included determining methods to easily query data needed for measuring key performance indicators, determine the level of compliance with State inspection mandates, identify barriers and any limiting factors, provide supervisory staff with data and tools to better manage resources, drive employee inspection performance, meet programmatic operational goals and create a culture of continuous quality improvement. The implementation of this process began with the process of updating environmental health program performance measures and key performance indicators. The next steps were to determine and increase the level of compliance. Environmental Health was incorporated into a Metro Louisville performance management program entitled, Louisville Statistics (abbreviated LouieStat). LouieStat brings individual Metro departments before the Mayor and his senior leadership team every eight weeks to identify and discuss, through consistent metrics tracking and data analysis, what the department (and Metro Government) can do to continually improve the services it delivers to the citizens of Louisville. This process helped examine root causes using analytic tools such as “plan, do, check, act,” (PDCA), fish bone diagrams, Pareto analysis, lean process improvement, Six Sigma, staff surveys, project management, and further data collection and analysis. Environmental Health Program staff were engaged with barriers identification surveys and included in the root case analysis and other problem solving processes. Key Environmental Health leadership staff began weekly meetings with LMPHW Information Technology (IT) and LMPHW Office of Policy Planning and Evaluation (OPPE) staff which lead to the development, pilot, and launch of an environmental reporting dashboard. The resulting environmental health program reports automatically generate weekly and are emailed to key stakeholders. One such report allows the supervisors to see at a glance, the overall compliance for a program and the compliance for each individual geographic- inspector assigned area. By simply clicking on an area, a new report is generated; displaying the actual facilities due for an inspection. Another report set to automatically generate and email, displays the two year inspection history for self-contained mobile food units (food trucks). This provides valuable information to environmental health specialists assigned to inspect food trucks. A third report contains the list of all individuals currently certified as food managers by LMPHW; local regulation requires a certified food manager to be on duty during operation of food service facility. Environmental Health, IT and OPPE staff continue to meet weekly to improve division performance. LMPHW also remains in the LouieStat performance management program, meeting every 8 weeks with the Mayor and his senior leadership team. Since implementing this practice we have experienced an increase in our ability to meet key performance goals at all levels within the environmental health division. Managerial staff can more effectively assign resources, address data entry issues and monitor performance. Front-line staff can better plan their workweek and easily identify facilities due for inspection; providing critical education, promoting safe practices, regulating operations and reducing disease transmission.
The Louisville Metro Department of Public Health and Wellness (LMPHW) is located in Jefferson County, Kentucky which has a population of approximately 750,000 and the surrounding Louisville metropolitan area (MSA) has a corresponding population of 1.3 million. The LMPHW Environmental Health Division is tasked with regulating nearly 5000 State permitted facilities including restaurants, grocery stores, hospitals, daycares, schools, hotels, motels, swimming pools, mobile home parks, onsite wastewater treatment systems, tattoo studios, ear and body piercing studios. Regulatory activities are conducted to prevent disease transmission such as foodborne illness and recreational water illness, provide environmental health education, promote a safe food supply, minimize environmental impacts; protecting both human and environmental health in Metro Louisville. The Environmental Health Division specifically serves businesses, residents and visitors, who purchase food from grocery stores, dine out, visit a hotel, swim at an aquatic facility, obtain a tattoo, receive a body/ear piercing or utilize a waste water/onsite facility. Essentially millions of people each year are affected by the services provided by the LMPHW Environmental Health Division staff. The 138th running of the Kentucky Derby, in 2013 recorded a crowd of 165,307 in attendance. Averages of 625,000 people have attended the Thunder Over Louisville Fireworks and Air Show, the annual one day kickoff event of the Kentucky Derby Festival, each year since 1997. The Kentucky State Fair experienced a paid attendance of 615,648 in 2013. Over 1200 food safety inspections were conducted at the 2012 Kentucky State Fair. Food safety education was provided to over 160 Kentucky State Fair food vendors. During the 2012 Kentucky Derby Festival events a total of 361 food safety inspections were conducted for temporary food service vendors resulting in 271 lbs. of food quarantined. These are just of a few of the tourism events held in Louisville each year. All of which bring visitors to the city staying in hotels, motels, RV parks and campsites. Food service sales greatly increase during large events for restaurants, concession trailers, food stands and mobile food units (food trucks). The Environmental health inspections conducted serve as the foundation for meeting the National Public Health Performance Standards Programs (NPHPS) and 4 of the 10 Essential Public Health Services: #1.Monitor health status to identify and solve community health problems. #2. Diagnose and investigate health problems and health hazards in the community. #3. Inform, educate, and empower people about health issues. #6. Enforce laws and regulations that protect health and ensure safety. It is crucial for LPMHW to have the ability to determine if State inspection mandates are being met and how to improve overall service delivery. Prior to the implementation of this practice, the LMPHW Environmental Health Division did not have a formal or well defined performance improvement process. Environmental Health inspections and services were monitored on a regular basis but the process required significant time and effort utilizing various data queries and reviewing standard reports generated by the Kentucky Department for Public Health. In order to tailor the reports to measure a specific element, several hours were spent querying each data element, typically requiring them to be manually generated. The process was tedious, cumbersome and we were not always confident in the results. Therefore, to determine whether we were attaining mandatory inspection requirements and appropriate service request response times, we needed a reliable method for data collection. Field staff were able to view which of the individual facilities assigned to their geographic area were due or past due for an inspection on their notebook computers but supervisors were not able to view the performance of the Division or programs as a whole; just view the individual pieces. The environmental reporting dashboard affords supervisors and staff a reliable method for data collection and a compressive view of programmatic performance along with each inspector’s geographic area compliance results. The dashboard also allows employees to see how they perform compared to their peers, driving performance. The new environmental health program reports automatically generate weekly and are emailed to key stakeholders. One such report allows the supervisors to see at a glance, the overall compliance percentage for a program and the compliance percentage for each individual geographic- inspector assigned area. By simply clicking on an area, a report for that geographically area is generated; displaying a list of the name, type and address of actual facilities due for an inspection and the dates the most recent inspections were conducted. Another report set to automatically generate and email, displays the two year inspection history for self-contained mobile food units (food trucks). This provides valuable information to environmental health specialists assigned to inspect food trucks. A third report contains the list of all individuals currently certified as food managers by LMPHW; local regulation requires a certified food manager to be on duty during operation of food service facility. Numerous tools and practices are available for addressing performance improvement for public health programs. NACCHO’s toolbox contains many pertaining to quality improvement. While reporting dashboards have also existed for some time, this practice identified performance shortcomings and delivered the reporting products needed by incorporating numerous analytic tools such as “plan, do, check, act,” (PDCA), fish bone diagrams, Pareto analysis, lean process improvement, Six Sigma, staff surveys, and project management. The combination of the environmental health reporting dashboard and collaborative performance management program, LOUIESTAT, provides a tailor made system for LMPHW to track and analyze key performance indicators (KPIs) and strengthen the use of data to improve results data-driven decision making. The interactive reports can be set to automatically generate to meet the user’s needs. The data reports display the most current data available and can be easily searched by date range and program area.
Food Safety
The goals and objectives of this practice included determining methods to easily query data needed for measuring key performance indicators, determine level of compliance with State inspection mandates, identify barriers and any limiting factors, provide supervisory staff with data and tools to better manage resources, drive employee inspection performance, meet programmatic operational goals and create a culture of continuous quality improvement.The implementation of this process began in early 2012 with the process of updating environmental health program performance measures and key performance indicators (KPI’s). Environmental Health Division leadership worked together to develop program performance plans which consisted of specific, measurable, attainable and timely (S.M.A.R.T.) goals, measures and metrics. The performance plans were reviewed and approved by the LMPHW Director’s team. The Director’s team comprised of the Agency Director, Agency Chief of Staff, Deputy Director of Community Health and Prevention, Deputy Director of Environmental Health and Emergency Preparedness Programs, Communication and Community Relation’s Director, Director of the Office of Policy Planning and Evaluation, Information Technology Administrator,and the Director of the Office of Health Equity. The next steps were to determine and increase the level of compliance. Key Environmental Health leadership staff began weekly meetings with LMPHW Information Technology (IT) and LMPHW Office of Policy Planning and Evaluation (OPPE) staff which ultimately lead to an environmental reporting dashboard. The LMPHW IT Administrator worked diligently to develop, pilot, refine and launch a product which resolved operational handicaps. It required focused thought and persistence to distill the problem statement into an actionable set of operational requirements. An estimated 80 hours of dedicated time was spent. The resulting reporting dashboard provides management with information; allowing them to make informed programmatic operational decisions such as resource allocation, program standardization, and training implementation. The report views are appropriate for directors who want a broad, overall perspective of division performance as well as supervisors who need to narrow down to the programmatic or individual employee performance level. The views also allow field staff to observe how they perform relative to their peers and ultimately drive performance. In 2013, Environmental Health was incorporated into a Metro Louisville performance management program entitled, Louisville Statistics (abbreviated LouieStat). LouieStat brings individual Metro departments before the Mayor and his senior leadership team every eight weeks to identify and discuss, through consistent metrics tracking and data analysis, what the department (and Metro Government) can do to continually improve the services it delivers to the citizens of Louisville. This process helped examine root causes using analytic tools such as “plan, do, check, act,” (PDCA), fish bone diagrams, Pareto analysis, lean process improvement, Six Sigma, staff surveys, project management, and further data collection and analysis. The Mayor’s senior leadership team included the Mayor’s Chief of Staff, Chief of Community Building, Chief of Strategic Initiatives, Chief of Public Services, Chief Financial Officer, Chief of Performance Improvement, and leaders of the following Louisville Metro agencies: Human Resources, Technology Services, and Office of Management and Budgets. In between LouieStat forums, the Office of Performance Improvement (OPI) supported the department through management consulting, measurement identification, data analysis, performance reporting, training and coaching. OPI maintains the LouieStat website (www.louiestat.louisvilleky.gov), which communicates LPMW's performance to the public. Environmental Health Program staff was engaged in the process during monthly program meetings. Root cause analysis tools were used to help identify the barriers for achieving inspection mandates, complaint response time goals and other performance measures. Staff was also surveyed anonymously using Survey Monkey. The collaborations identified the elements needed for the environmental health report dashboard. The new reports automatically generate weekly and are emailed to key stakeholders. One such report displays the percent of nearly 5000 permitted establishments receiving the required number of inspections annually. The annual compliance rate is also broken out by program area and into each of the 19 individual geographic-inspector assigned areas. By simply clicking on an area, a report for the geographic area is generated; displaying a list with the name, type and address of actual facilities due for an inspection and the dates the most recent inspections were conducted. Another report set to automatically generate and email, displays the two year inspection history for self-contained mobile food units (food trucks). This provides valuable information to environmental health specialists assigned to inspect food trucks. A third report contains the list of all individuals currently certified as food managers by LMPHW; local regulation requires a certified food manager to be on duty during operation of food service facility. While away from the office, staff has the ability to query certified food manager data including facility name, facility address, employee name, certification test schedule, certification expiration date, and test score. Since implementing this practice we have seen an increase in our ability to meet key performance goals at all levels within the environmental health division. Program managers re-assigned staff, addressed data entry issues and continue to monitor performance. The Public Facilities Program monthly compliance rate reached 99% in August of 2013. Front-line staff can better plan their workweek and easily identify facilities due for inspection; providing critical education, promoting safe practices, regulating operations and reducing disease transmission.
The goals and objectives of this practice included determining methods to easily query data needed for measuring key performance indicators, determine level of compliance with State inspection mandates, identify barriers and any limiting factors, provide supervisory staff with data and tools to better manage resources, drive employee inspection performance, meet programmatic operational goals and create a culture of continuous quality improvement. The resulting environmental reporting dashboard and performance improvement practice provides a convenient, reliable method for querying data needed for measuring key performance indicators. We can now easily determine the level of compliance with State inspection mandates. The collaborative performance improvement process allowed us to identify barriers and limiting factors and gain buy in from front line staff. In order to improve our process we needed a way to examine the data around it more closely. We have a data set from our State Environmental Health Management Information System (EHMIS) that includes tables of Inspection, Establishment and Inspector information. In addition we created a reference table to hold inspection frequency information so we could leverage it later to make calculations to demonstrate compliance of lack of compliance. One of the process outcome measures are % of Inspections in Compliance. There is one for our Food Safety Program and the same for our Public Facilities Program. The measure is made from a set of inspection data that includes the prior 12 months. Some of our facilities require an inspection once in a 12 month period and some twice in a twelve month period. We filtered out establishments that were opened within the last 12 months because they would not have a complete history within that period. Finally we identified the earliest and latest inspection dates within the year. For a facility requiring one inspection the difference between the maximum and minimum date had to be 0 or more for a facility to be in compliance. For a facility requiring two inspections the difference would have to be greater than 0. With those pieces of information we were able to calculate compliance percentages. We stratified that information so that we could produce compliance measures for each inspector according to the geographic are they work in. Our Microsoft SQL Server Reporting Services Report is a dashboard with results for each area and type of inspection plus overall compliance measures. Each areas measure can be clicked on to drill down to compliance rates for each type of inspection (Restaurant, Mobile Food truck, Swimming Pool, School, etc…) and then each of those measures can be clicked on to display information about the establishments that are not in compliance. The data/information presented allows for managers to more effectively manage the inspection program. It also allows for very detailed one on one meetings between managers and inspectors. It also allows inspectors to quickly see where areas of weakness are. And finally, the measures are made public. We have found anecdotally that this creates some competition among inspectors which leads to better performance. Performance measures used for evaluating Environmental Health Program Improvement: % Permitted Establishments Receiving the Required Number of Inspections % of General Complaints Responded to w/in five business days % of Foodborne Illness and Other Urgent Complaints Responded to within two business days % of Emergency Response Requests Responded to in within one hour % Facilities operating without a Certified Food Manager on duty % of Permitted Swimming Facilities with critical water quality violations
The most important lesson learned in relation to this practice is expertise in data management and environmental health program knowledge is essential for developing environmental reporting dashboards. It is critical to know relative inputs and outputs from both a data evaluation perspective and programmatic perspective. Another lesson learned was that successful collaborators must understand each other's discipline related language and terminology. It is also important to have buy in from all levels of the organization. Upper management must be willing to support the practice, supervisory staff must manage the practice and front line staff must drive the practice to be successful. Front line should be brought in early, during planning phases and educated on why performance measuring tools are needed. It was very beneficial for front line staff to have their voices heard and concerns addressed. They provided valuable information during root cause analysis. Prior to the implementation of this practice, the LMPHW Environmental Health Division did not have a formal or well defined performance improvement process. Environmental Health inspections and services were monitored on a regular basis the process required significant time and effort from employees and relied on queries from a combination of datasets as well as reviewing standard reports generated by the Kentucky Department for Public Health. In short, the process was tedious, cumbersome and did not always produce reliable results. Therefore, we were unable to determine if we were attaining mandatory inspection requirements and appropriate service request response times. The resulting environmental reporting dashboard and performance improvement practice provides a convenient, reliable method for querying data needed for measuring key performance indicators. Currently, we can easily determine the level of compliance with State inspection mandates. The collaborative performance improvement process allowed us to identify barriers and limiting factors and gain buy in from front line staff. A complete cost /benefit analysis was not conducted but the time devoted in the development of the environmental reporting dashboard is justified by the numerous hours that will be saved by not using the previous, cumbersome data query methods. There is sufficient stakeholder commitment to sustain the practice. The LMPHW Environmental Health Division leadership meets monthly to review Environmental Health program performance measures and key performance indicators (KPI’s) contained in the environmental reporting dashboard as well as develop additional KPI’s for continuous quality improvement. Environmental Health leadership staff continues to meet for one hour a week with LMPHW Information Technology (IT) and LMPHW Office of Policy Planning and Evaluation (OPPE) to improve and incorporate additional data elements in the environmental report dashboard. The LMPHW Environmental Health Division will maintain participation in Metro Louisville’s performance management program Louisville Statistics (LouieStat) forums, presenting to the Mayor and his senior leadership team every eight to twelve weeks to identify and discuss, through consistent metrics tracking and data analysis, what the division (and Metro Government) can do to continually improve the services it delivers to the citizens of Louisville. In between LouieStat forums, the Office of Performance Improvement (OPI) has pledged to support the division through management consulting, measurement identification, data analysis, performance reporting, training and coaching. OPI will also maintain the LouieStat website (www.louiestat.louisvilleky.gov), which communicates LPMW's performance to the public.
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