Developing a Continuous Quality Improvement …...4. Establishing a Continuous Quality Improvement...

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

Agenda

• Background• Framework Development• The Framework• Implementation • Moving Forward

Background

• Master of Public Health Practicum Project

• Supervisor: Dr. Jessica Hopkins, former AMOH for Hamilton Public Health Services

• Health Protection Division – now Healthy Environments

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.

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

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.

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.

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

Draft 2017 OSPHPS• In February, the MOHLTC released draft OPHS• CQI taken much more prominent position with standards

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

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.

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?

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

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

Creating the Framework

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

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.

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.

Role of Senior Leadership within Department

• Leaders & ChampionsHow?

• Commitment• Identify Gaps in CQI

Implementation• Support• Accountability

Role of Managers

• 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

• 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

• 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

• 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

• Professional Development• Leader & CQI Champions• Create Community of Practice• Establish methodologies• Prioritization of projects• Celebration of successes

Takeaways: Importance of CQI & Culture

• 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…

• 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

• 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?

• Restructuring of

Department

• Introduction of draft

standards

• City of Hamilton

commitments

Acknowledgements & Thanks

• Former Health Protection

Division with Hamilton Public

Health Services

• Dr. Jessica Hopkins, MOH,

Regional Municipality of Peel

PUBLIC HEALTH SERVICESCOMMUNICABLE DISEASE CONTROL & WELLNESS

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