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Developing a Continuous Quality
Improvement Framework for
Public Health InspectorsCanadian Institute of Public Health Inspectors
Ontario Educational Conference
October 4th, 2017
Public Health ServicesCommunicable Disease Control & Wellness
Presenter
Jennifer Snow, MPH, CPHI(C)Supervisor, Infectious DiseasesCommunicable Disease Control & Wellness DivisionCity of Hamilton Public Health Services
Public Health ServicesCommunicable Disease Control & Wellness
Agenda
• Background• Framework Development• The Framework• Implementation • Moving Forward
Public Health ServicesCommunicable Disease Control & Wellness
Background
• Master of Public Health Practicum Project
• Supervisor: Dr. Jessica Hopkins, former AMOH for Hamilton Public Health Services
• Health Protection Division – now Healthy Environments
Public Health ServicesCommunicable Disease Control & Wellness
Purpose: • To foster a commitment and coordinated approach to CQI
within Healthy Environments• To help establish a culture of Continuous Quality Improvement
within Healthy Environments• To provide divisional management and staff with the
mechanisms and tools to effectively implement Quality Improvement into the everyday work of the division.
• To use Continuous Quality Improvement as a way to enhance the effectiveness and efficiency of our performance and achieve our defined outcomes.
Public Health ServicesCommunicable Disease Control & Wellness
What is Quality Improvement?• QI is the “use of a deliberate and defined improvements process which
is focused on activities that are responsive to community needs and improving population health…”
• QI applies interventions to improve the efficiency or effectiveness of a program, process or organization, including by eliminating inefficiency, error and redundancy
• Assists in decision making on how to use limited resources “More with Less” to maintain essential public health services and how to improve most effectively the health of populations through services provided
Public Health ServicesCommunicable Disease Control & Wellness
What is Continuous Quality Improvement?
• CQI is both a philosophy and a framework designed to achieve increasing levels of performance (i.e. outcomes of greater and greater value).
• A culture of quality improvement• A continuous and ongoing effort to achieve measurable
improvements in the efficiency, effectiveness, performance, accountability, outcomes and other indicators of quality in services or processes which achieve equity and improve the health of the community.
Public Health ServicesCommunicable Disease Control & Wellness
Why is CQI Important to Us?
• Concepts such as CQI provide a tool for health departments to clearly demonstrate the value of public health to the public and policymakers
• CQI can help guide departments through a process to improve efficiency and effectiveness, and provide measurable outcomes that build the case for public health
• Aligns with direction of PHS, for example improvement of culture and evidence informed decision making. It also allows for improved ability to do more with less.
Source: Bialek, R., Duffy, G.L., Moran, J. (2009). The Public Health Quality Improvement Handbook. ASQ Quality Press. Milwaukee, Wisonsin.
Public Health ServicesCommunicable Disease Control & Wellness
How is this different from Quality Assurance work?
• Quality Assurance and Quality Improvement are complimentary endeavours for attaining continual improvement.
• QA is a way to warrant that predefined standards are met. QA is the first step toward quality improvement.
• Is about prevention of quality problems through planned and systematic activities including documentation
Source: https://www.mphiaccredandqi.org/wp-content/uploads/2013/06/An-Overview-of-QA-Accreditation-and-QI-8-26-08-with-color.pdf
Public Health ServicesCommunicable Disease Control & Wellness
Draft 2017 OSPHPS• In February, the MOHLTC released draft OPHS• CQI taken much more prominent position with standards
Public Health ServicesCommunicable Disease Control & Wellness
Source: MOHLTC. (2017). Ontario Standards for Public Health Programs and Services (Draft).
What Did Project Entail?
• Review of Literature• Distribution of Modified QI Maturity Survey
and Analysis• Qualitative Interviews with Staff• Rapid Environmental Scan of Ontario Public
Health Units• Writing of Framework• Presentation to Division Management
Public Health ServicesCommunicable Disease Control & Wellness
QI Modified Maturity Tool Survey
• Modified established Maturity Tool from U.S. (Joly et al., 2012)
• 57.8% response rate from staff• 70% response rate from management• Overall, results spoke to significant need to build
capacity, competencies and an empowered frontline across the division with commitment required for building skills and devoting resources, mainly time, to any QI initiative.
Public Health ServicesCommunicable Disease Control & Wellness
Qualitative Interviews with Staff
• Interviewed 7 volunteer staff members within division• Questions around:
• How would you define quality improvement?• Do you feel QI is important for Health Protection? If yes, why? If not, why
not?• Is Quality Improvement Important?• How do you foresee the implementation of QI in the division? What do you
see as your personal role in QI? On your team? Within the division? • What barriers do you foresee in the implementation of QI in the division?• What strengths do you see in the division in the implementation of CQI?• If CQI were implemented well in the division, what impact will it have on
you as an individual/team/division/community?
Public Health ServicesCommunicable Disease Control & Wellness
Rapid Scan of other PHUs
• All different phases of QI and CQI• Toronto and Simcoe-Muskoka focus on CQI as a
component of an overall performance management plan• Peel is currently doing CQI “bursts” – small projects – most
current on rabies response• Many are in beginning phases similar to Hamilton• Found misconceptions and misunderstandings about QI
versus QA• Thanks to those that took the time to contact me
Public Health ServicesCommunicable Disease Control & Wellness
We’re already doing it!
• Simple definition of QI: learning why something does or does not work and applying lessons learned to the next strategy or planning session
• Causes “trusted” change and enhances cooperation by all for better outcomes
• Many are already doing this kind of reflective thinking and application and may not be calling it QI
• Examples: Vector Borne Diseases team – rabies forms• Leverage this
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Creating the Framework
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DEPARTMENT NAMEDIVISION NAME
Creating the Framework• Needed to create a framework that encompassed
the needs and strategic directions of the division, the department and the BOH
• Addresses requirements of MOHLTC and aligns with City of Hamilton’s vision for QI
• Based on results from QI Maturity Tool survey and qualitative interviews
• Based on literature and experiences of other PHUs
Leadership
Commitment
Employee
Engagement
Continuous
Learning
Community
of Practice
Continual
Improvement
& QI Plan
Measuring &
Celebrating
Success
CQI
Culture
MOHLTC
Community &
Board of
Health
Public Health
ServicesCity of Hamilton
Six Key Recommendations1. Outlining clear goals, expectations and the
commitment of leadership in establishing and encouraging a culture of continuous quality improvement
2. Providing a system of staff engagement to empower employees to take leadership roles in continuous quality improvement
3. Creating an environment of continuous learning within the Division to support the needs and professional competency development of staff and management in quality improvement methodologies and techniques.
Public Health ServicesCommunicable Disease Control & Wellness
Six Key Recommendations
4. Establishing a Continuous Quality Improvement Community of Practice within the division comprised of engaged staff to lead the implementation and maintenance of Continuous Quality Improvement
5. Creating a strategy for developing a quality improvement plan that includes ideas, project prioritization and project work.
6. Developing measures of success and ways in which to celebrate successes.
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Role of Senior Leadership within Department
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• Leaders & ChampionsHow?
• Commitment• Identify Gaps in CQI
Implementation• Support• Accountability
Role of Managers
Public Health ServicesCommunicable Disease Control & Wellness
• Leadership• Be a champion of quality
improvement• Show support through not only
words but actions• Honesty• “Open Doors”
• Empowerment & Encouragement of Staff • Listening
Role of Managers
Public Health ServicesCommunicable Disease Control & Wellness
• Balance• Knowing when to step in and knowing when to step out
• Identify areas for improvement• To identify gaps in supports and challenges in CQI work• Hold staff accountable• Paying Attention• Relating QI to your program
• Be sure to understand how QI relates to program• Share this with staff
Role of Quality Assurance
Public Health ServicesCommunicable Disease Control & Wellness
• Quality Assurance Advisor• Key to successful implementation of CQI • Recommendation to be facilitator for
divisional QI projects• Work with programs to establish how QA
can help inform QI• Help inform where data needs are for QI
projects
Role of Staff
Public Health ServicesCommunicable Disease Control & Wellness
• Active Participation in QI• Communication• Identify areas for improvement• Leading QI Projects• Work with management and
each other• Make it a part of everyday work!
Implementation
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• Professional Development• Leader & CQI Champions• Create Community of Practice• Establish methodologies• Prioritization of projects• Celebration of successes
Takeaways: Importance of CQI & Culture
Public Health ServicesCommunicable Disease Control & Wellness
• Culture of CQI enables everyone in the organization to identify, lead and participate in quality improvement initiatives
• Everyone in the organization must share clarity of purpose and support the institution’s goals
• A CQI framework with a comprehensive approach can foster a gradual shift in culture
• Make it routineSource: https://www.stmichaelshospital.com/quality/quality-strategic-framework.pdf
Takeaways: What CQI is Not…
Public Health ServicesCommunicable Disease Control & Wellness
• Another way to assess (read: criticize) your performance
• Just another trend that takes you away from your core work and adds a burden onto an already stretched staff
Takeaways
Public Health ServicesCommunicable Disease Control & Wellness
• CQI Projects are not all “BIG” projects• Important to remember the small, incremental
changes – these can often have biggest impact on every day work
• Smaller CQI projects can help make CQI intuitive
• Pick the “low hanging fruit”• Goal is to make CQI a natural part of the way
we do our work everyday
Where are we now?
Public Health ServicesCommunicable Disease Control & Wellness
• Restructuring of
Department
• Introduction of draft
standards
• City of Hamilton
commitments
Acknowledgements & Thanks
Public Health ServicesCommunicable Disease Control & Wellness
• Former Health Protection
Division with Hamilton Public
Health Services
• Dr. Jessica Hopkins, MOH,
Regional Municipality of Peel
PUBLIC HEALTH SERVICESCOMMUNICABLE DISEASE CONTROL & WELLNESS
PUBLIC HEALTH SERVICESCOMMUNICABLE DISEASE CONTROL & WELLNESS