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Home My WebLink AboutAgenda - 04-12-2011 - 4aAhIC~ ~UNT1C ~~~~D aF' a1~~~~aNE~ AT~aN -~CNDA ITEIV~ A~TRAT ee~E~ Dafe: April ~ ~, ~g~ ~ Ao~~on Ager~ a ~~er~ No; UB~IT: Qu~lit~r Irr~pravement depart From Health Department D~PART~~EVT~ Health Department PUBL~ H~A~I~VC: ~'~1N~ Flo ATTAHE~VT~}; ~ovuerpoint Present~tian IN~a~MAT~aN a~VT~T: ~asemary urr~n~ers, ~--~~41 ~ Toni I~onsler, ~~~~g Carla Julian, ~4~-434 PURPa~: To receive repart an recent quality improvement praect implemented by the Health Department. B~A~~~l1ND: The North aralina tenter far Pub~ia Health C~uality ~ PHC} eras founded in gg9 as a partnership between the Narth aralina public Health Faundation ~N~HF} and the north aralina Divisian of Public Health ~DPH}, It is funded ~~ the flue dross Slue shield Faundation of North Carolina, The Duke Snda~vment, The l~Sate S~ Reynolds charitable Trust and The Centers for Disease antral and Prevention. N PH collaborates Frith state and Ivcal partners to provide training in qualify improvennent {~I~ methods and tools, grange Jaunty was chosen to be ane of the initial ~ g counties that ~rere invited far training in the summer of ~O~a. bounties participating v~rere required to choose an initial project and appoint ~ team to receive the training and implement the project. The first pra~ect chosen by the Health Department to address during this training eras improving the Uvasteater Treatment Management Program ~11UTMP} billing process. Subsequently, the Department eras selected as ane of four counties to engage in another ~I project as part of a multistate learning collaborative for public health initiatives. Sath of those selections brought small amounts of funding ~rvith them to help fund a consultant from NC State lJniversity to facilitate a intensive four day sessions called "~taizen" events far firvo separate projects. The Department chose to rr~ake the remaining funds available for implementation interventions that the Qi Learns might identify as being needed. The presentation vuill provide the Soard ~vith an overvie~r of three quality in~pravement projects that the Health Department has formally engaged in over the past year. Tvuo of these pra~ect vuere internal to the depar~rnent~ but the third project is an ongoing interdeprtmantal project that focuses on improving the permitting process for grange County residents. Jaunty staff have also presented these projects and principles of CSI to department directors and senior County n~anagen~ent, L Tf~e Health Deprtrent believes this praess ~rili he increasingly valuahfe to imprave services to residents ~hraugh the people v~ha are pravidin~ those services and gill enable franc line staff to gravy as future leaders. The department has several pra~ets "in the pipeline" ~ staff has re~ogni~ed the value this pro~es~s has far irnpraving their ~rark. lNANIAL lMPI~T: There is na financial ir~pac~ assacia#e~ v~~th receiving this repar~. Rl~~E~DAT~~I~~~: `the Manager recar~men~s that the Baar~ receive the repast and pro~ride can~n~ents and guest~ans to staff. 3 Continuous Quality Improvement: Principles and Applications Orange County Health Department April 12, 2011 What is Quality Improvement (QI) Continuous and ongoing effort and organizational culture to best achieve measurable improvements in the: ~ efficiency, ~ effectiveness, quality, performance, and outcomes of services and systems 4 Key Features of QI Focus on systems, not individuals Ideas/changes from customers & front line staff The "intervention" is designed through testing of ideas/changes Frequent, ongoing measurement and data driven decision making Never ending process (never "done" 0 Elements of QI Hands on experience Managers believe in the value of QI Experts are those on the front line Staff buy-in and staff involvement critical to success Small changes can create big results 5 What QI is NOT Quality Assurance (QA) Monitoring and evaluating a service to assure minimum quality standards are met (i.e. audits) Measuring programs and services against protocols or policies & procedures Principles of Improvement ~. Know why you need to improve (AIM) 2. Have feedback mechanism to show improvement (MEASURES) 3. Develop effective changes for improvement (IDEAS) a. Test changes before implementing (TEST) 5. Know when & how to make changes spread (IMPLEMENT/SUSTAIN) Source: The Improvement Guide, pg. 25 6 QI Teams Members should be knowledgeable of & involved in the process Teams typically 3 to 5 members Team role assignments Senior Leader (Senior Management -not day to day member but supports process and receives reports) Team Leader Frontline staff "Outside" person QI consultant (if necessary) Team Member Qualities Formal or informal influence Willing to try new things Credibility with peers Interested in improvement History of success on teams Understands the process want to change 7 Role of Senior Leaders in Driving CQI Role of Senior Leaders Provide the Vision Communicate so all staff and managers understand the vision Ensure mission and strategic plan are guided by the vision 10 8 Role of Senior Leaders Become knowledgeable about QI Build time in for QI work in daily processes Provide resources and training for staff Assure managers empower staff to continuously make improvements with small tests of new ideas Ask QI teams to brief them regularly on their improvement work Reward and recognize successes 11 QI Methodologies "Lean" thinking Identify and eliminate wasteful activity Create an efficient and waste-free continuous flow system PDSA cycles Plan, Do, Study, Act cycles of rapid improvement Kaizen event Intensive multi-day focused improvement efforts by QI team 12 9 QI Initiative 1 Public Health Quality Improvement 101 February 2010 to Present Orange County Health Department Environmental Health Division Wastewater Treatment Management Program 13 WIMP QI Team Carla Jullan (Quality Improvement/ Risk Manager) Tom Konsler - EH Director Albert Mills - EH Program Specialist Barbara Hawksworth - EH Technician GI'eg GCI171@S - EH Program Specialist (retired -Not Pictured) 14 10 AIM Statement By September 1, 2010, we aim to increase the fee collection rate of the Wastewater Treatment Management Program (WIMP) by 20% over the 2009 rate. This is important for: Orange County taxpayer equity for this mandated service; Departmental collection of budgeted revenue; and Orange County cost recovery for mandated inspections. 15 AIM Statement We will achieve this by closely examining and improving the current process for client notification of WIMP inspections the time interval between the time of inspection and the mailing of the report and invoice the current format of the report and invoice the payment reminder process. 16 11 Goals Include Decrease the time interval between the time of inspection and mailing the report/invoice to < 3days; Increase the number of people paying the WIMP payment within 30 days by 50% Reduce the time interval for rebilling of WIMP delinquent payments to 30 days 17 Value Stream Mapping is 12 Project Measures Number of days from time of inspection to mailing the report/invoice Number of WIMP clients that pay within 30 days of inspection & billing Number of days from time of initial invoice to mailing of late notice 1~ Project Measures Balancing Time required to conduct a WIMP inspection with owner in attendance Time required to manage billing/payment tracking Cost of publishing the improved printed material zo 13 Key Improvements # Days From Inspection to Billing 6.0 - 4.0 - 2.0 - 0.0 -~ ~ 0 Before QI QI Days 2~ Key Improvements zz 14 Other Measures Comparing Payment of Fees 100.00% 80.00% 60.00% ^ 2009 QI 40.00% ^ 2010(2nd) 20.00% 0.00% ~~ •,a o ry,~a ,~o 23 Ke Im rovements Y p WTMP Percent Collections 100% 90% ~ QI Goal ................. ~ 80% 88% ~ 70% 0 60% ~ 50% ~ 40% 30% m 20% a 10% 0% 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year percentage 24 15 Balancing Costs WTMP INSPECTIONS COMPLETED 120% 100% 80% 60% 40% 20% 0% 1st 2nd 3rd 4th 1st 2nd 3rd tPercent 2009 2009 2009 2009 2010 2010 2010 Inspections zs Key Learnings Current tracking system cannot capture essential data points for comparing inspection date to billing date to receipt date Significant balancing measure of low 3rd quarter inspections Staff retirement Intensive effort tracking and implementing QI changes in current system 2~ 16 Documentation Improvements - Notification of Inspection ~. Letterhead format with mail merge form 2. Generic postcard notice One size fits all 3. Postcard notice Color coded System specific z~ Documentation Improvements - Inspection Report ~. Combined detailed report and bill 2. Separated invoice from report s. Simplified "Report Card" format Summary information only Over-simplified a. Moderate detail s. Reversed order of summary info and detail 28 17 Documentation Improvements - Billing Invoice Attached to report form -often ignored Separated invoice and mailed with report Colored ink for visibility Three step billing ~. Invoice z. Past Due Notice s. Final Notice z~ Future Plans Concentrate on completing inspections as a priority over billing until additional staff is available Advocate for resources to do the following: Merge databases Pursue electronic reporting to customers, electronic billing, and credit card payment Pursue collections through new county process 30 18 QI Initiative 2 Southern Human Services Center Clinic Flow Quality Improvement Project and Kaizen Event Orange County Health Department Quality Improvement Program November 2010 31 SHSC Clinic ~~im Statement What do we want to do? Improve client flow Decrease wasteful activities Reduce wait time for client, clinicians, and staff Whv is this important? Improve client satisfaction and staff morale Demonstrate productivity to supervisors and policy- makers Demonstrate value to the community Improve client outcomes 32 19 Issue -nurses walking a lot to pick up charts from medical records "window" Plan/Do -put all records in basket inside left side of check-out window Study -Assigned MOA okay with trial; nurses like new location Act -need to think about possible redesign of front desk area to make more space and find permanent method to put team charts left of check-out window 33 Issue: Door Bell Notification Issue: nurse do not consistently hear notification that client has arrived Plan/Do -use two-way radios: receptionist notify teams when client ready Study -preferred method to door bell, less wasted steps, frees up time to do other things, reduced stress trying to determine if door bell rung Act -implement with temporary family radio system and find similar method with more user-friendly equipment 34 20 QI Initiative 3 Environmental Health, Planning, Inspections, and Information Technology Central Permitting QI Initiative Orange County permitting process in same building but essentially separate processes Duplicity in application process Permits Plus software application same for all but lacks integration Requires movement of files, printing copies, and multiple duplicative paper files 35 Central Permitting Aim (Goal) Statement What do we want to do? 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