Implementing Successful QI: Lessons Learned featuring RiverStone Health

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Implementing Successful QI: Lessons Learned featuring RiverStone Health. December 12, 2013 Hannah Silveus – RiverStone Health Lea Ayers LaFave, RN, PhD – Community Health Institute/JSI Grace Gorenflo, MPH, RN – Public Health Consultant - PowerPoint PPT Presentation

Text of Implementing Successful QI: Lessons Learned featuring RiverStone Health

  • AgendaWelcome and webinar overviewPresentation from Hannah Silveus (QI Champion at RiverStone Health)Presentation from Lea LaFave (QI Consultant at Community Health Institute/JSI) Discussion with Grace Gorenflo, PHQIX Expert Panel MemberQ&A

  • Quality Improvement in Public Health

    Successes and Lessons Learned from Women, Infants, and Children (WIC) Quality Improvement Project

    Hannah Silveus RiverStone HealthPublic Health Associate for the Centers for Disease Control and Prevention

    December 12, 2013PHQIX Webinar

  • Two Goals

  • Six Questions to AnswerWhat tools were used?Who participated in the QI team?What data/measures were used?How did we come up with solutions?How did we test the solutions?How were the improvements sustained?

  • Assembling a QI Team

  • Team members in many placesHome visiting nurseWIC clinic nutrition educator

  • Front WIC Desk

  • QI GoalThe initial aim statement was:

    By August 1, 2013, RiverStone Health will increase the percentage of participants ages 1-5 who meet the WIC definition for active participation from 85% to 90%.

  • Our Timeline

  • 50% of the project time spent in the Plan phase25% of the time spent in the Do PhaseThe remaining 25% divided between the Study and the Act phasesOur Timeline

  • Meeting EvaluationsMeeting EvaluationDid we address the agenda?Did we meet the goals for our meeting?After this meeting, how do you feel about the projects progress?Rate todays meeting from 1-10. (10= best possible meeting).

  • Group BrainstormingGroup brainstorming builds trust, promotes participation of all team members, and is time-efficient.

    One idea: Pass the Paper

  • What does the data say?

  • Keepin Motivated

  • Maintaining Progress

  • Maintaining Progress

  • Project EvaluationOn a scale of 1-10, how would you rate the success of the WIC QI project? Why?

    In your opinion, what were the positive aspects of the project?

    Is there anything that could be improved for future QI projects? This could include QI tools used, meeting times and frequency, etc.

    Did you learn anything new about QI projects from your participation on the QI team?

    Are there any parts of the QI process, tools, or other parts that you are confused about or wish you could have learned more about?

    Was there anything you expected to do as part of the team that didnt happen?

    Do you have any additional comments, suggestions, or feedback to improve future projects?

  • Honestly, it felt a little intimidating being the only non-supervisor staff. Data tells a whole new story. When done properly, people really can like QI. I have appreciated the blended effort between public health divisions and the expertise. The improvement may include the addition of additional WIC staff in the project. Project Evaluation (cont.)

  • QI in AccreditationPHAB Standards:Domain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the communityStandard 1.4 Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or InterventionsMeasure 1.4.1 A Use data to recommend and inform public health policy, processes, programs, and/or interventions

    Domain 9: Evaluate and continuously improve health department processes, programs, and interventionsStandard 9.2 Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and InterventionsMeasure 9.2.2 A Implement quality improvement activities

  • Storyboards for Accreditation Documentation

  • Was it a success? YES! Because.Successfully standardized a procedureIncreased excitement surrounding QIFostered a working relationship with the Montana State WIC epidemiology departmentTools and data for future projects

  • Did we answer the questions?

    What tools were used? Meeting evaluations, flowcharts, brainstorming, group multi-voting.Who participated in the QI team? A blend of staff, as well as supporting QI coach and the state dept.What data/measures were used? Used data from state WIC office to track appointments made.How did we come up with solutions? We used brainstorming tools and multi-voting to decide. How did we test the solutions? Over a three month time period, we changed the way we scheduled appointments.How were the improvements sustained? We made arrangements with state office to continue receiving data, and staff are updated on a monthly basis.

  • Need a place to start? Start here:Presenter Information: Hannah Silveus, Prevention Health Specialist:

    General Resources:Embracing Quality In Public Health: A Practitioners Quality Improvement Guidebook is a downloadable document that contains great information about identifying customers, clients and stakeholders, drafting valid surveys and interview questions, and developing flowcharts. It can be accessed by following this link: The Public Health Memory Jogger II provides detailed information on how to use tools such as the Nominal Group Technique (NGT), or multi-voting. For any documents used during RiverStones WIC QI project, contact Hannah at the email above or by phone at (406) 651-6537.

  • A COACHS PERSPECTIVELea Ayers LaFave, PhD, RNCommunity Health Institute/JSI Research & Training,

    PHQIX WebinarDecember 12, 2014*

  • Coaching Framework Four categories of coaching actions:explore the context build relationships offer support to the improvement process, reinforce the QI process by providing TA.

    Godfrey, M. M., B. Andersson-Gare, et al. (2013). "Coaching interprofessional health care improvement teams: the coachee, the coach and the leader perspectives." Journal of Nursing Management: Available at*

  • The Coach Explores the Context Context was the unique system of the Montana Department of Health and RiverStone,roles of team members (providers, consumers, directors, etc.), gaps in staffing and implications for the project,challenges for engaging team members (busy schedules, competing priorities, geography).*

  • The Coach Builds RelationshipsGood communication helps build relationshipsestablished regular phone meetings, provided template questions to guide each call,supported development of strategies to foster team member engagement in the QI process, assured team member time was well-spent, strategized ways to engage the group in building their team, used Skype.*

  • The Coach Supports QI Process Facilitated team function, learning, leading, capacity buildinghelped when teams got stuckencouraged teams, clarified process and taskskept teams on trackdeveloped strategies for meetings that maximized use of time & fostered maximum engagement of stakeholdersreviewed and provided feedback on qualitative data collection (questions & process),tracked timeline and deliverables (PHQIX submission).*

  • The Coach Provides TA TA to reinforce the QI process and team learningprovided tools for meeting skills (roles, evaluation)supported/provided feedback in developing NNPHI/QI Award Presentationprovided input/feedback on PHQIX submission,reinforced bigger picture positive outcomes.


  • THANK YOU!Lea Ayers LaFavellafave@jsi.com603.573.3335*

  • Questions


    Thank you!The date of our January webinar will be announced on our home page.