Forces of Change Assessment using QI Tools

State: KY Type: Promising Practice Year: 2016

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In 2008, the Franklin County Health Department began its community-wide strategic planning process for improving public health, referred to as Mobilizing for Action through Planning and Partnerships (MAPP).  The support generated from this endeavor has continued to flourish within the Kentucky’s capital city of Frankfort.  Franklin County MAPP now consists of approximately 113 community partners and growing. 

This year, 2015, marked the beginning of a new MAPP iteration and reassessment of our community.  Four assessments are used in the MAPP process, which provides a comprehensive picture of what is happening related to the health of a particular community and they include the following: The Community Health Status Assessment, The Community Themes and Strengths Assessment, The Local Public Health System Assessment and the Forces of Change Assessment.  

The affinity diagram process was utilized during the Forces of Change Assessment in order to provide a mechanism for generating the greatest partner response to identify those forces that may affect a community’s overall opportunities and threats.  This was a unique twist on capturing a large quantity of data and arranging it in manageable formats. 

 

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Franklin County Health Department
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Forces of Change Assessment using QI Tools
Franklin County Health Department (FCHD) is located in Kentucky’s capital city of Frankfort. The Franklin County community covers 207.75 square miles and has a population of 49,648 that surges with a daily influx of Commonwealth of Kentucky employees. Although Franklin County is the site of the State Capitol, the county itself is considered a rural area. FCHD has two work sites located in Franklin County housing our administrative and clinic in one building and our community outreach services in the other building. As an accredited health department we are tasked with providing continuous quality improvement and developing a culture of quality improvement that expands beyond our four walls. As a local public health department, the overarching issue remains to provide the Ten Essential Public Health services to meets our communities' needs in the most effective and efficient way possible. The Franklin County MAPP coordinators planned the Forces of Change Assessment on March 4, 2015 to include a QI tool - Affinity Diagram. The primary goal of this project was for community partners to experience the utilization of a new quality improvement tool. Four objectives were identified:   1. Capture as many "Forces” possible. 2. Collect data in a more efficient manner. 3. A better understanding of the partner’s role in the community assessments. 4. To grow in our community wide Culture of QI. The Franklin County MAPP Coordinators planned a quarterly MAPP meeting in which they planned to use an affinity diagram as the QI tool to work through the Forces of Change assessment. At the meeting the community partners were presented with a PowerPoint explaining the assessment, reviewed the 2009 Forces of Change results, brainstormed to identify forces – through an affinity diagram, and then ended the meeting by everyone completing the threats and opportunities worksheet. The Franklin county MAPP group reported positive feedback to the new twist on completing the forces of change assessment and many said they would be taking the affinity diagram tools and techniques back to their own offices to get a lot of ideas in a short period of time. The following objectives were met: 1. QI was incorporated into the Forces of Change Assessment through the use of the affinity diagram.  The number of forces generated during this new MAPP iteration increased by approximately 25%.  2. The partners were asked to commit 1 hour of time to complete the entire process and the affinity diagram allowed for streamlining the process of acquiring information. 3. The incorporation of QI in the assessment provided a better understanding of the role that each MAPP partner plays in the identification of forces that impact a community’s overall health.  4. By incorporating FCHD’s culture of QI in all facets of operation and collaboration we stand to better meet community needs.   The public health impact and practice involves the community wide culture of QI that FCHD would like to start implementing in our community. By understanding QI tools and learning to make better more informed decisions as well as ensuring to be doing a process in the most effective possible way will not only help our agency, our community partner’s agencies but also impacts our community’s health outcomes. FCHD's website is currently being remodeled but can be found at www.fchd.org.    
Franklin County Health Department (FCHD) is located in Kentucky’s capital city of Frankfort. The Franklin County community covers 207.75 square miles and has a population of 49,648 that surges with a daily influx of Commonwealth of Kentucky employees. Although Franklin County is the site of the State Capitol, the county itself is considered a rural area. FCHD has two work sites located in Franklin County housing our administrative and clinic in one building and our community outreach services in the other building. When doing assessments within our community, we get a lot of strong personalities at the table and people with agendas. We have over 100 community partners we work with during these assessments. The day we had our Forces of Change Assessment we had 35 participants at the meeting, meaning about 55 different community partners were represented.  Several people in attendance are representatives from multiple organizations and groups. We were able to reach about 50% or so of our community partners with this QI technique and Assessment. Serving the community that holds the capital of the state can present challenges in many different forms. One way it can be challenging is that you have a few people that overpower the meeting/assessment while others are not heard. A way we thought we could address this situation was not having an open floor discussion as it was in the last assessment - but to make it a table discussion so that those that may not get to speak up, have the opportunity to speak up and write their idea on a post-it note and stick it on the wall  The current practice is not evidence based nor is it new to the public health field. The last two years at FCHD we have had a lot of change and it’s been a change for the better. Part of that change is to incorporate as much QI as possible in our daily activities, meetings, etc. to really work on a complete culture of QI. When thinking about a culture of QI we realize it is not just about a culture between our four walls but who we are involved with outside of our four walls. Incorporating QI tools in our assessments has really helped improve our response rate, our assessment data and overall willingness to participate. In the case of using the affinity diagram in the Forces of Change assessment we received an increase of 25% in responses and had to cut the responses short due to the overwhelming amount of responses and time allotted on the agenda for the specific activity.
As an accredited health department we are tasked with providing continuous quality improvement and developing a culture of quality improvement that expands beyond our four walls. As a local public health department, the overarching issue remains to provide the Ten Essential Public Health services to meets our communities' needs in the most effective and efficient way possible. The primary goal of this project was for community partners to experience the utilization of a new quality improvement tool. Four objectives were identified:   1. Capture as many "Forces” possible. 2. Collect data in a more efficient manner. 3. A better understanding of the partner’s role in the community assessments. 4. To grow in our community wide Culture of QI.   Members of the FCHD’s Quality Improvement Team designed the agenda for the March 2015 MAPP meeting, which included use of the Affinity Diagram as a tool for completing the Forces of Change Assessment.  The efforts were led by the health department QI Coordinator who has attended numerous nation-wide trainings and workshops in developing a culture of QI.  The planning team met prior to the MAPP meeting in order to review the techniques of facilitating an Affinity Diagram.  In addition, this particular QI tool has been utilized during the FCHD staff trainings for practice and to educate other employees on process.   While FCHD’s QI Coordinator steered the MAPP group through the Affinity Diagram/Forces of Change Assessment process, the MAPP members serving as the stakeholders, were active participants providing the necessary input.  In order to ensure that all members were informed on the QI tool, a PowerPoint presentation with sample issue was presented to ensure comprehension and purpose of tool.   It is actually quite difficult to estimate a monetary cost associated with this particular project.  The time required to complete the Affinity Diagram during the MAPP meeting was approximately 1 hour.  The quality of the information gathered within that time period doubled that which was acquired during our Forces of Change Assessment 5 years prior.  The QI tool increased both the quantity and quality of the information.  
Our primary stakeholder, The Franklin county MAPP,  group reported positive feedback to the new twist on completing the forces of change assessment and many said they would be taking the affinity diagram tools and techniques back to their own offices to get a lot of ideas in a short period of time. The primary goal of this project was for community partners to experience the utilization of a new quality improvement tool.  The following objectives were met: 1. QI was incorporated into the Forces of Change Assessment through the use of the affinity diagram.  The number of forces generated during this new MAPP iteration increased by approximately 25%.  2. The partners were asked to commit 1 hour of time to complete the entire process and the affinity diagram allowed for streamlining the process of acquiring information. 3. The incorporation of QI in the assessment provided a better understanding of the role that each MAPP partner plays in the identification of forces that impact a community’s overall health.  4. By incorporating FCHD’s culture of QI in all facets of operation and collaboration we stand to better meet community needs. The public health impact and practice involves the community wide culture of QI that FCHD would like to start implementing in our community. By understanding QI tools and learning to make better more informed decisions as well as ensuring to be doing a process in the most effective possible way will not only help our agency, our community partner’s agencies but also impacts our community’s health outcomes. Upon evaluation, it was clear that objectives 1-3 were achieved using primary quantitative data.  Objective 4 would be considered more of a long-term measurable which we will continue to monitor in all of our community collaborations and interactions with MAPP.  Some of the comments received following the use of the Affinity Diagram were, “This was a great way to generate ideas for a large group”; “This method allowed those members that rarely speak in the large group setting to participate and share their thoughts and ideas in a non-confrontational manner by providing anonymous suggestions”; and finally, “I would like to take this QI tool back to my office and use with our staff!” It is apparent to FCHD, which serves as the MAPP facilitator, that the immediate outcome from use of the QI tool in completing the Forces of Change Assessment was both positive and generated an increase in response rate.  As a result of the findings, additional QI tools will be incorporated into the next steps in the new MAPP iteration as we move from the Community Health Assessment to the Community Health Improvement Plan.  
Continuing to use QI tools in our assessments (or anytime we need a lot of ideas) was the biggest lesson learned through using an affinity diagram at our Forces of Change Assessment. We did not issue a survey, but did hear from numerous community partners after the meeting how much they enjoyed this method and couldn’t wait to take it back and use it within their organizations. We are so excited that a culture of QI is expanding beyond our four walls and into the organizations we partner with. We have also had an increase interest with our partnerships and in the MAPP process. We have since extended invitations to a few partners and was able to take a community partner to a MAPP training in the Spring of 2015 and another community partner to a CHIP facilitation training in the Fall of 2015. This is allowing us to do two things: sustain our MAPP process and work closely with community partners to provide better services within our community.   FCHD will continue to use QI tools – especially affinity diagrams at our quarterly MAPP meetings when needed.  
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