Quality Improvement Cohort

State: ID Type: Neither Year: 2015

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Description of LHD: Southeastern Idaho Public Health's 8-county jurisdiction has a total population of 165,000, and covers a territory of 11,441 square miles. The eight counties include Bannock, Bear Lake, Bingham, Butte, Caribou, Franklin, Oneida, and Power. In addition to those eight counties, services are also provided to residents living on the Fort Hall Indian Reservation. The largest county in the Health District is Bannock, which has a population of 82,839, and is the home of Idaho State University. Southeastern Idaho Public Health has a robust working relationship with the local university. With the university, we: partner with their student intern program in Health Care Administration, Health Education and the Master of Public Health program; provide preceptor training with their Nursing programs; provide hands-on learning roundtables with the Nursing program; and teach classes on epidemiology & public health preparedness. The population of Southeast Idaho consists mostly of Caucasians, Hispanics, and Native Americans. Public Health Issue: Quality Improvement is critical to the sustainability of Public Health to ensure that we are continually innovating our services, programs, and procedures in an economically viable way. Despite this critical need, the practice is not currently taught in public health programs in our local university. This missing educational link presents challenges in advances efforts in Quality Improvement. Goals/Objectives of Practice: The Quality Improvement Cohort was designed with four goals in mind: 1. To increase workforce understanding of QI. 2. To advance QI within our department. 3. To bring employees together across functional areas in a meaningful way. 4. To improve our overall organization. Implementation Strategy: Implementation hinged on finding a diverse group of participants. We focused on identifying employees across different functional areas, different geographical areas, and with varying levels of QI knowledge. This approach provided the opportunity to build a meaningful cross-functional team that could learn from each other and increase understanding of QI, in an effort to have that knowledge transfer back to their functional area. The cohort began with an intensive initial training that lasted two hours.  The training focused on utilizing the Deming Cycle (Plan-Do-Study-Act) model for QI projects, and introduced the use of tools like Fishbone Diagrams, Flow Charts, and Five Whys. After the initial training, the group met four times for one hour every three to four weeks to brainstorm and select an area of focus for their project.  As part of this process, the group was tasked with developing a project that would make an impact for the agency, and that they all felt they would be able to assist with.  The early stage of the project was facilitated by SIPH’s QI lead.  After the first round of meetings, the group began to meet for one hour each month to work through the PDSA cycle; with focus on collecting baseline data, conducting analysis, developing an improvement plan, implementing their plan, and evaluating the success of the intervention.  Group members were able to take on leadership roles to guide the team through the PDSA cycle, with support from SIPH’s QI lead. Results/Outcomes: The QI Cohort achieved our overall goals. The system allowed for employees to work with others across functional areas that they previously hadn't worked with. The project helped to increase understanding of QI tools and their direct use. The first iteration of the group also led to positive organizational change. The group was able to identify that employees were uncomfortable preparing content for social media because they didn't understand the platforms and/or the approval process to get information posted. The group was able to develop a template for social media submissions and an educational guide for staff. Public Health Impact: Quality Improvement initiatives have a direct impact on the sustainability of public health. The projects that various iterations of QI cohorts develop are limitless and impact our feasibility as an organization. QI projects run the gamut and help to remove administrative roadblocks, improve service delivery, improve economic vitality, etc. This is all done while increasing the knowledge base and understanding of QI amongst our staff. Website: www.siphidaho.org  
Public Health Issue: Quality Improvement is critical to the sustainability of Public Health to ensure that we are continually innovating our services, programs, and procedures in an economically viable way. Despite this critical need, the practice is not currently taught in public health programs in our local university. This missing educational link presents challenges in advances efforts in Quality Improvement. Target Population: The focus of our program is on workforce development and the application of Quality Improvement strategies to affect positive change within our programs, services, and day-to-day work. As a workforce development issue, our target population is our workforce of 91 employees. With each iteration of the cohort, the membership changes and provides opportunities to a new group of employees. This program will reach all employees directly over time. While currently not all employees are serving on the cohort in a direct capacity, they may still benefit from knowledge sharing from their peers on the cohort and peers on our Accreditation/QI team. Past Efforts: Our past efforts to develop understanding of QI were focused on organizational trainings and trainings within functional areas. In early 2013, our new agency QI Plan was made available to staff to assist in their understanding of QI. In addition, the formation of our Accreditation/QI team was intended to provide training to representatives of functional areas, with an intent that they would pass along information and lead a QI effort within their area every year. Innovative Change: As we have been working to developing a fully integrated culture of quality, we have assessed our position on the NACCHO QI Roadmap in an effort to identify where we can affect change. When we looked at our positioning, we began to assess how successful our past efforts have been. From that assessment, we noticed that we were receiving short term increases in understanding of QI after each staff training. The lack of hands on application made the trainings less impactful. We also recognized that the use of the QI Plan as a teaching tool was not an efficient use of time or easy to understand for employees who had limited understanding of/experience with QI. In looking at our Accreditation/QI team, we noticed an increase in understanding of QI, as they have received regular education and worked through projects within their functional area. While their knowledge increased, passing knowledge gained to others in their functional area was another area of weakness. In looking for an innovative way to make a positive impact on the understanding of QI concepts, tools, and strategies, we developed a list of over-arching goals to accomplish: 1. To increase workforce understanding of QI; 2. To advance QI within our department; 3. To bring employees together across functional areas in a meaningful way; and 4. To improve our overall organization. When comparing our goals and past challenges, we felt we had an opportunity to be innovative and creative in developing a new approach. Challenges in the past indicated to us that our primary hurdle in success was in hands on application of QI principles. With this and our over-arching goals in mind, we developed our QI cohort program. Implementation hinged on finding a diverse group of participants. We focused on identifying employees across different functional areas, different geographical areas, and with varying levels of QI knowledge. Once the group was selected, they were provided training, and then worked cohesively to implement a QI project that would promote positive change for the organization. The program provides the opportunity to acquire a vast amount of knowledge through hands on application that can be applied in their functional area and day-to-day work. As the program can be easily replicated and conducted in numerous iterations, it has been a successful way to make a meaningful impact on the development of our workforce in QI. Innovative to Public Health: Quality Improvement began in the manufacturing industry several decades ago, but is still relatively new in public health. Developing a mechanism that increases understanding and use of QI in public health is new and innovative. As we have seen in recent years, public health has been asked to do more with less. QI is the way to do that. QI provides opportunity to maximize strengths, and mitigate weaknesses. This opportunity and how effectively we use it will directly impact public health's feasibility and future sustainability. Evidence-Based: The QI cohort program is rooted in evidence based practice. The Deming Cycle (Plan-Do-Study-Act) has been used repeatedly, across industries, to implement effective improvement programs. Our cohort program was built with the Deming Cycle as the foundation of our education and project implementation.    
Goals/Objectives of Practice: The Quality Improvement Cohort was designed with four goals in mind: 1. To increase workforce understanding of QI. 2. To advance QI within our department. 3. To bring employees together across functional areas in a meaningful way. 4. To improve our overall organization. Implementation: Implementation hinged on finding a diverse group of participants. We focused on identifying employees across different functional areas, different geographical areas, and with varying levels of QI knowledge. Once the group was selected, they were provided training, and then worked cohesively to implement a QI project that would promote positive change for the organization. The program provides the opportunity to acquire a vast amount of knowledge through hands on application that can be applied in their functional area and day-to-day work. As the program can be easily replicated and conducted in numerous iterations, it has been a successful way to make a meaningful impact on the development of our workforce in QI. Selection Criteria: Selection criteria were decided upon by the two organizational QI Leaders in charge of the cohort program. The leaders were focused on included at least one participant from each functional area of our organization to ensure a diverse group. In addition to diversity in function, the selection process also focused on diversity of current QI knowledge. We believed it would be important to have participants with good understanding, some understanding, and no understanding. The identification of level of understanding was evaluated by participation in past QI projects, and self-reporting. Additionally, our health department covers a diverse population base with some very rural counties. We felt that it would be important to include participants from smaller counties as much as would be feasible. Timeframe: The timeframe for each iteration of the QI cohort varies dependent on the project that the group selects. We originally planned on each iteration lasting roughly 3 months, but discovered that a more accurate timeframe is 6-12 months. Depending on the projects selected by each group, the timeframe can fluctuate. Costs: As the training and facilitation of the cohort is done internally, the costs associated with our program our strictly in-kind costs. As the cohort pulls employees out of functional areas for roughly a few hours each month, the costs are limited to personnel time.        
Evaluation: As our QI cohort system is intended to develop QI skills/knowledge, it is a process that will be continually assessed and measured to make improvements over time. Outcomes from the QI cohort have both short-term and long-term impacts for our organization. Short term measures focus on the participants understanding of QI principles and measures. Depending on the nature of the QI projects chosen by each cohort, outcomes may be short term or long term measures. Evaluation Based on Goals/Objectives of Practice: The Quality Improvement Cohort was designed with four goals in mind: 1. To increase workforce understanding of QI. A survey of participants indicated that the majority of respondents felt that the cohort has increased their understanding of QI. The majority of respondents also indicated that they felt an increase in knowledge in using various QI tools, including: PDSA, Flow Charts, Fishbone Diagrams, and Five Why's. The majority of also indicated that their confidence in implementing QI tools had increased.  As the group’s participants were selected with varying skill levels in QI, we anticipated that we would not have 100% indicate their understanding/confidence had increased. 2. To advance QI within our department. The first cohort focused efforts on increasing the use of social media for programmatic marketing. To gather baseline data, the cohort developed and implemented a staff survey. The survey indicated that employees generally did not understand the different social media platforms and how they varied from traditional forms of marketing. The survey also indicated that employees generally did not understand who needed to approve content for social media posts. The cohort was able to streamline the approval process to one individual (the same employee who does our social media posting), and developed tools for staff utilization. The tools included a template for social media posts that walks staff through the key elements needed, and a social media user guide. 3. To bring employees together across functional areas in a meaningful way. The first cohort was able to work across functions on a project that has a diverse impact on the organization; with group composition covering functional areas in WIC, Environmental Health, Health Education, Information Technology, Public Health Nursing, Public Health Preparedness, and Public Information. Social media is a strong tool for promoting public health programs, and translates well across our various functions. Future iterations of the cohort will also be tasked with identifying a project that has relevance to the organization, but also is something they believe they can make a contribution to. 4. To improve our overall organization. QI projects that make an impact on our sustainability, outreach, service delivery, or efficiency help the organization to be more successful. Improving staff understanding and use of social media helps us to be more efficient with our community outreach. Evaluation Metrics: Our focus on assessing understanding of QI tools focused on PDSA, Fishbone Diagrams, Flow Charts, and Five Why's. Four out of six respondents said they felt understanding of PDSA, Flow Charts, and Five Why's had improved since joining the cohort, while three out of six said the same about Fishbone Diagrams. As the group’s participants were selected with varying skill levels in QI, we anticipated that we would not have 100% indicate their understanding/confidence had increased.  While we did initial training on these four tools, the group did not do hands-on practice using all of them due to the nature of the project they chose. For future iterations of the cohort, we plan on implementing a higher degree of hands on learning/practice on QI tools, and less focus on brainstorming/identifying the particular QI project to focus on. Evaluation of the cohort's specific QI project on social media will be on-going, and will focus on staff understanding of social media outreach, and the approval process.    
Lessons Learned: From the first iteration of our QI cohort program, we learned that the large variety in projects that a group could select can have variations in the timeframe and time invested in project completion.  Moving forward, this knowledge allows us to plan accordingly in facilitating future iterations.  It will help us to narrow the focus of the project selection phase, and focus more time on direct application of QI tools and principles. Cost/Benefit: For our program, we did not do a cost/benefit analysis because we anticipate that it will be an initial short term cost, that will help us to realize long term benefits.  As we analyze the impact of on-going and future QI initiatives, we will be assessing the benefits of those projects.  Benefits realized and improvements in realized benefits over time, will be compared to the costs of personnel time to run the program. Stakeholder Commitment: Presently, we have strong commitment from our local Board of Health and management team in regards to QI related activities.  Commitment from management and our employees helps to ensure continued focus on programs that build our QI capacity. Sustainability Plans: To ensure sustainability, each iteration of the cohort will be assessed to identify areas to improve upon for the next iteration.  Changing the membership of the cohort with each iteration also helps to ensure that the program is effectively reaching our target population and giving employees new opportunities to develop their knowledge, skills, and abilities.
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