Git-R-Done: To Be Safe - An Introduction to Quality Improvement Based on the PHAB SAT

State: KY Type: Model Practice Year: 2011

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The Git-R-Done: To Be Safe Team was formed as FCHD's mandated QI project as an accreditation beta test site for the Public Health Accreditation Board. The seven members were selected by FCHD's 13-member Accreditation Team, based on their experience with facility related issues, and after that team had met several times over many hours to determine a selected PHAB QI project. The target population include FCHD and staff. All team members successfully completed the assignment and have since introduced the product and an introduction to the QI basic processes to 25% of FCHD staff. The remaining 60% of FCHD's 85.5 FTEs will be reached by December 15, 2010. Those who live, work and pass through Franklin County are the ultimate target population, as it is assumed they will benefit from fully integrated QI processes within FCHD and the public health system.

The main goal of the formation of the PHAB QI beta project known as Git-R-Done is reflected in the team's Aim Statement: By December 4,2010 we will increase understanding of the repair request process to 52.2% and increase satisfaction with the repair request process to 68.9%. The Accreditation Team met in June, to learn about QI and the Plan-Do-Check-Act model, from the accreditation coordinator and two other FCHD facilitators. The team used prioritization matrices to identify "Maintain facilities that are clean, safe, accessible, and secure" as the leading project for the PHAB QI process, through creation of a "log of repairs". This was gleaned from the PHAB Self Assessment Tool, Accreditation Standard A1.6 B. Part A addresses administrative capacity and governance.

The three QI facilitators then brought this team together on July 21, 2010, using a cowboy theme, including a formal invitation from the FCHD director, or "Trailmaster", and decorating in Western attire and serving like food for the first breakfast meeting. A storyboard was developed by this team, based on PDCA, and including a detailed flow chart of the current process; followed by fishbone diagrams of potential solutions; then a pre-test post-test survey of 18 additional staff with a review of results exceeding the Aim Statement; and future plans to take the training on the completed log of repairs to employees in the remaining two FCHD buildings, as a basis for QI integration of all processes by all employees. A streamlined process was instituted.

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Franklin County Health Department
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Git-R-Done: To Be Safe - An Introduction to Quality Improvement Based on the PHAB SAT
The Git-R-Done: To Be Safe Team was formed as FCHD's mandated QI project as an accreditation beta test site for the Public Health Accreditation Board. The seven members were selected by FCHD's 13-member Accreditation Team, based on their experience with facility related issues, and after that team had met several times over many hours to determine a selected PHAB QI project. The target population include FCHD and staff. All team members successfully completed the assignment and have since introduced the product and an introduction to the QI basic processes to 25% of FCHD staff. The remaining 60% of FCHD's 85.5 FTEs will be reached by December 15, 2010. Those who live, work and pass through Franklin County are the ultimate target population, as it is assumed they will benefit from fully integrated QI processes within FCHD and the public health system. The main goal of the formation of the PHAB QI beta project known as Git-R-Done is reflected in the team's Aim Statement: By December 4,2010 we will increase understanding of the repair request process to 52.2% and increase satisfaction with the repair request process to 68.9%. The Accreditation Team met in June, to learn about QI and the Plan-Do-Check-Act model, from the accreditation coordinator and two other FCHD facilitators. The team used prioritization matrices to identify "Maintain facilities that are clean, safe, accessible, and secure" as the leading project for the PHAB QI process, through creation of a "log of repairs". This was gleaned from the PHAB Self Assessment Tool, Accreditation Standard A1.6 B. Part A addresses administrative capacity and governance. The three QI facilitators then brought this team together on July 21, 2010, using a cowboy theme, including a formal invitation from the FCHD director, or "Trailmaster", and decorating in Western attire and serving like food for the first breakfast meeting. A storyboard was developed by this team, based on PDCA, and including a detailed flow chart of the current process; followed by fishbone diagrams of potential solutions; then a pre-test post-test survey of 18 additional staff with a review of results exceeding the Aim Statement; and future plans to take the training on the completed log of repairs to employees in the remaining two FCHD buildings, as a basis for QI integration of all processes by all employees. A streamlined process was instituted.
Agency Community RolesThe community in this practice was the staff of the Franklin County Health Department (FCHD). This was an internal project addressing the administration and governance of FCHD. The approach taken by this project is unique in that it included a broad range of employees at all levels and from all internal FCHD divisions. Ultimately local health departments in Kentucky are responsible for their governance and administration through oversight from their local boards of health and with input from the Kentucky Department for Public Health. Therefore, FCHD's 13 member Accreditation Team recognized its role as identifying needed administrative improvements based on the PHAB SAT standards/measures that were either partially or not demonstrated and forming a QI team from FCHD staff members who were knowledgeable about the area for improvement. The 7 member QI team then undertook the role of completely implementing the P-D-C-A QI process with the guidance of 3 additional FCHD staff members who served as QI facilitators. Updates on this project were provided at quarterly Board of Health meetings. Addressing QI processes that impact local health department staff and operations is consistent with the Robert Wood Johnson Foundation's efforts "to evaluate the effect of applying QI on not only process and health outcomes but also on staff and organizations" (Russo, 2009). Costs and ExpendituresThe Git-R-Done: To Be Safe Team was formed as FCHD';s mandated QI project as an accreditation beta test site for the Public Health Accreditation Board. The seven members were selected by FCHD's 13-member Accreditation Team, based on their experience with facility related issues, and after that team had met several times over many hours to determine a selected PHAB QI project. The target population include FCHD and staff. All team members successfully completed the assignment and have since introduced the product and an introduction to the QI basic processes to 25% of FCHD staff. The remaining 60% of FCHD's 85.5 FTEs will be reached by December 15, 2010. Those who live, work and pass through Franklin County are the ultimate target population, as it is assumed they will benefit from fully integrated QI processes within FCHD and the public health system. The main goal of the formation of the PHAB QI beta project known as Git-R-Done is reflected in the team's Aim Statement: By December 4,2010 we will increase understanding of the repair request process to 52.2% and increase satisfaction with the repair request process to 68.9%. The Accreditation Team met in June, to learn about QI and the Plan-Do-Check-Act model, from the accreditation coordinator and two other FCHD facilitators. The team used prioritization matrices to identify "Maintain facilities that are clean, safe, accessible, and secure" as the leading project for the PHAB QI process, through creation of a "log of repairs". This was gleaned from the PHAB Self Assessment Tool, Accreditation Standard A1.6 B. Part A addresses administrative capacity and governance. The three QI facilitators then brought this team together on July 21, 2010, using a cowboy theme, including a formal invitation from the FCHD director, or "Trailmaster", and decorating in Western attire and serving like food for the first breakfast meeting. A storyboard was developed by this team, based on PDCA, and including a detailed flow chart of the current process; followed by fishbone diagrams of potential solutions; then a pre-test post-test survey of 18 additional staff with a review of results exceeding the Aim Statement; and future plans to take the training on the completed log of repairs to employees in the remaining two FCHD buildings, as a basis for QI integration of all processes by all employees. A streamlined process was instituted. ImplementationThe community in this practice is the entire staff of the Franklin County Health Department (FCHD), but the first step was a commitment from our Board of Health and Management Team to both quality improvement (QI) and accreditation. To help embed QI in the culture of FCHD a broader 13 member Accreditation Team was formed including the entire management team and key staff from the business office, clinic, home health, health education, environmental health and emergency preparedness teams. This broader Accreditation Team ensured thoroughness and breadth in the completion of the Public Health Accreditation Board (PHAB) Self Assessment Tool (SAT). The process for implementing a QI project was largely based on the PHAB Beta Test Site guidelines and followed the Plan-Do-Check-Act cycle. The planning phase included utilizing the PHAB SAT results to identify areas in need of improvement. The Accreditation Team completed prioritization matrices to weigh standards/measures that were either partially or not demonstrated against a set of decision criteria. The prioritization matrix revealed that Standard/Measure A1.6 B (Maintain facilities that are clean, safe, accessible, and secure) best met our decision criteria of time, improved quality, probability of success and lowering costs. Seven Git-R-Done: To Be Safe QI project team members were then selected based on their experience with facility related work orders. Three staff members served as QI facilitators and they provided an introduction to QI utilizing a cowboy theme to integrate fun into the process. The current approach was examined by developing a detailed flowchart and an AIM statement was developed. Potential solutions were identified using fishbone diagrams that analyzed the root cause of the problem and an improvement theory was developed. During the Do phase a survey and training was developed to test the improvement theory and data was collected. The Check phase included an analysis of the survey results that led to FCHD adopting and standardizing the new process in the ACT phase. This project was utilized as an introduction to QI for all FCHD. Timeframe: The PHAB Beta Test Site requirements included a 6 month timeframe for completing a QI project including mid-term and final reports as well as the development of a storyboard. Therefore, time was considered from the outset and was included as a heavily weighted decision criterion in the prioritization matrix that identified a focus for improvement efforts. The Plan phase of the PDCA cycle was completed in approximately two and a half months followed by one month for the Do phase and one month for the Check and Act phases.
Agency Community RolesThe community in this practice was the staff of the Franklin County Health Department (FCHD). This was an internal project addressing the administration and governance of FCHD. The approach taken by this project is unique in that it included a broad range of employees at all levels and from all internal FCHD divisions. Ultimately local health departments in Kentucky are responsible for their governance and administration through oversight from their local boards of health and with input from the Kentucky Department for Public Health. Therefore, FCHD's 13 member Accreditation Team recognized its role as identifying needed administrative improvements based on the PHAB SAT standards/measures that were either partially or not demonstrated and forming a QI team from FCHD staff members who were knowledgeable about the area for improvement. The 7 member QI team then undertook the role of completely implementing the P-D-C-A QI process with the guidance of 3 additional FCHD staff members who served as QI facilitators. Updates on this project were provided at quarterly Board of Health meetings. Addressing QI processes that impact local health department staff and operations is consistent with the Robert Wood Johnson Foundation's efforts "to evaluate the effect of applying QI on not only process and health outcomes but also on staff and organizations" (Russo, 2009). Costs and ExpendituresThe Git-R-Done: To Be Safe Team was formed as FCHD';s mandated QI project as an accreditation beta test site for the Public Health Accreditation Board. The seven members were selected by FCHD's 13-member Accreditation Team, based on their experience with facility related issues, and after that team had met several times over many hours to determine a selected PHAB QI project. The target population include FCHD and staff. All team members successfully completed the assignment and have since introduced the product and an introduction to the QI basic processes to 25% of FCHD staff. The remaining 60% of FCHD's 85.5 FTEs will be reached by December 15, 2010. Those who live, work and pass through Franklin County are the ultimate target population, as it is assumed they will benefit from fully integrated QI processes within FCHD and the public health system. The main goal of the formation of the PHAB QI beta project known as Git-R-Done is reflected in the team's Aim Statement: By December 4,2010 we will increase understanding of the repair request process to 52.2% and increase satisfaction with the repair request process to 68.9%. The Accreditation Team met in June, to learn about QI and the Plan-Do-Check-Act model, from the accreditation coordinator and two other FCHD facilitators. The team used prioritization matrices to identify "Maintain facilities that are clean, safe, accessible, and secure" as the leading project for the PHAB QI process, through creation of a "log of repairs". This was gleaned from the PHAB Self Assessment Tool, Accreditation Standard A1.6 B. Part A addresses administrative capacity and governance. The three QI facilitators then brought this team together on July 21, 2010, using a cowboy theme, including a formal invitation from the FCHD director, or "Trailmaster", and decorating in Western attire and serving like food for the first breakfast meeting. A storyboard was developed by this team, based on PDCA, and including a detailed flow chart of the current process; followed by fishbone diagrams of potential solutions; then a pre-test post-test survey of 18 additional staff with a review of results exceeding the Aim Statement; and future plans to take the training on the completed log of repairs to employees in the remaining two FCHD buildings, as a basis for QI integration of all processes by all employees. A streamlined process was instituted. ImplementationThe community in this practice is the entire staff of the Franklin County Health Department (FCHD), but the first step was a commitment from our Board of Health and Management Team to both quality improvement (QI) and accreditation. To help embed QI in the culture of FCHD a broader 13 member Accreditation Team was formed including the entire management team and key staff from the business office, clinic, home health, health education, environmental health and emergency preparedness teams. This broader Accreditation Team ensured thoroughness and breadth in the completion of the Public Health Accreditation Board (PHAB) Self Assessment Tool (SAT). The process for implementing a QI project was largely based on the PHAB Beta Test Site guidelines and followed the Plan-Do-Check-Act cycle. The planning phase included utilizing the PHAB SAT results to identify areas in need of improvement. The Accreditation Team completed prioritization matrices to weigh standards/measures that were either partially or not demonstrated against a set of decision criteria. The prioritization matrix revealed that Standard/Measure A1.6 B (Maintain facilities that are clean, safe, accessible, and secure) best met our decision criteria of time, improved quality, probability of success and lowering costs. Seven Git-R-Done: To Be Safe QI project team members were then selected based on their experience with facility related work orders. Three staff members served as QI facilitators and they provided an introduction to QI utilizing a cowboy theme to integrate fun into the process. The current approach was examined by developing a detailed flowchart and an AIM statement was developed. Potential solutions were identified using fishbone diagrams that analyzed the root cause of the problem and an improvement theory was developed. During the Do phase a survey and training was developed to test the improvement theory and data was collected. The Check phase included an analysis of the survey results that led to FCHD adopting and standardizing the new process in the ACT phase. This project was utilized as an introduction to QI for all FCHD. Timeframe: The PHAB Beta Test Site requirements included a 6 month timeframe for completing a QI project including mid-term and final reports as well as the development of a storyboard. Therefore, time was considered from the outset and was included as a heavily weighted decision criterion in the prioritization matrix that identified a focus for improvement efforts. The Plan phase of the PDCA cycle was completed in approximately two and a half months followed by one month for the Do phase and one month for the Check and Act phases.
The process objective of this project was to achieve a high level of satisfaction with the P-D-C-A QI process from the 7 QI team members and all FCHD staff. Anecdotal evidence was used to assess the success of this objective throughout the entire project. Meeting minutes from QI team meetings originally showed that some team members felt this process to be a burden on top of their already busy schedules. However, subsequent meeting minutes showed input from the same team members stating that they did in fact recognize and appreciate their role in the process. During the flowcharting of the current repair request process one team member remarked, "I'm glad I was here to point that out." During the root cause analysis another team member stated, "No one realizes how difficult it is to schedule these repairs." This qualitative evidence shows that satisfaction can be reached with all levels of staff concerning their participation in internal QI projects. Based on this evidence FCHD plans to continue their QI efforts and to continue engaging all FCHD staff members in such projects. In addition, the open response section on the survey issued to all staff members before and after receiving training on the improved repair request process was all positive comments. Some comments included, "I appreciate having a way to communicate problems I notice" and "Repairs will now be taken care of faster." We feel that this shows support of QI processes. The first outcome objective was that by December 4, 2010 we will increase understanding of the repair request process from 22.2% to 52.2%. Understanding of the repair request process was assessed using a pre-test/post-test survey methodology. On the survey understanding was rated on a likert scale from strongly agree to strongly disagree. Initially the survey was issued to 18 FCHD staff members who were located in one building. After the pre-test survey was administered training abou the streamlined repair request process was provided followed by a post-test survey. Survey results showed an increase of 61.1 percentage points in understanding, which greatly exceeded our initial objective of a 30 percentage point increase. These positive results led to the adoption and standardization of the improved repair request process and the pre-test/post-test survey methodology was replicated with all reamining full-time FCHD staff members. Policies will also be revised to reflect the improved process and a log of repairs will be maintained for accreditation documentation. The Safety Team has eagerly accepted the responsbility of reviewing all repair request forms and ensuring that repair issues have been completely resolved. The second outcome objective was that by December 4, 2010 we will increase satisfaction with the repair request process from 38.9% to 68.9%. Satisfaction with the repair request process was assessed using a pre-test/post-test survey methodology. On the survey satisfaction was rated on a likert scale from strongly agree to strongly disagree. Initially the survey was issued to 18 FCHD staff members who were located in one building. After the pre-test survey was administered training abou the streamlined repair request process was provided followed by a post-test survey. Survey results showed an increase of 55.5 percentage points with satisfaction, which greatly exceeded our initial objective of a 30 percentage point increase. These positive results led to the adoption and standardization of the improved repair request process and the pre-test/post-test survey methodology was replicated with all reamining full-time FCHD staff members. Policies will also be revised to reflect the improved process and a log of repairs will be maintained for accreditation documentation. The Safety Team has eagerly accepted the responsbility of reviewing all repair request forms and ensuring that repair issues have been completely resolved.
FCHD staff are committed and dedicated to continual QI efforts. For this particular QI project, plans were established during the Act phase of the PDCA cycle to sustain the gained achievements by having our Safety Team periodically review our log of repairs. Staff has recognized that this process directly impacts their working environment and the care of our clients and visitors. This QI project as well as an introduction to QI and the PDCA cycle were presented during mandatory staff meetings to develop commitment from all FCHD staff and stakeholders. We emphasized a desire to gain input from those most familiar with the work and staff responded enthusiastically. Ultimately this practice has developed our capacity to meet the standards identified within the PHAB SAT and it is already being replicated within FCHD with the establishment of a QI team focused on verifying and maintaining the qualifications of our employees. FCHD’s 13 member Accreditation Team has also evolved into our QI Steering Committee that has developed a comprehensive, department-wide QI Plan. The QI plan includes objectives, strategies, responsible persons and timelines for tasks. To further maintain stakeholder commitment the QI Plan provides for professional development of all staff in the areas of QI tools and methods. This team meets monthly to review issues and challenges associated with implementation of the QI Plan. During these times of limited resources it is more important than ever to sustain practices that improve quality and efficiency. Therefore, FCHD is committed to national voluntary public health accreditation, which promises to improve public health through ensuring the effective delivery of the Ten Essential Public Health Services. Our goal is to develop a culture of quality improvement and to empower staff at all levels to contribute to this evolution. QI principals and methods are being integrated into FCHD’s values, strategic plan, job descriptions and performance evaluations. Despite heavy workloads and an increased demand for services leadership will continue making quality improvement a priority.
 
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