Quality Improvement, Performance Management, and Accreditation
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Transcript of Quality Improvement, Performance Management, and Accreditation
Quality Improvement, Performance Management,
and AccreditationRon Chapman, MD, MPH
Director and State Health OfficerCalifornia Department of Public Health
The goal of the national public health accreditation program is to improve and protect the health of the public by advancing the quality and performance of state, local, territorial and tribal health departments.
Accreditation will drive public health departments to continuously improve the quality of the services they deliver to the community.
National Accreditation Program
Evaluate and continuously improve health department processes, programs, and interventions.
Standard 9.1: Use a performance management system to monitor achievement of organizational objectives.
Measure: Engage staff at all organizational levels in establishing or updating a performance management system.
Domain 9
• Pipes where demand for services goes in one end and a service/product comes out the other end.
• History and a series of decisions makes the pipes long and tortuous.
• The pipes need to be straightened and shortened.
What is the System?
• People create systems:–“Each system is perfectly designed to
serve the purpose for what is was intended.”
• People are not the system.
• Need to analyze and improve the system.
Systems Run Our lives
Actively use performance data to improve the public’s health.Strategic use of performance measures and standards to establish performance targets and goals.Performance management practices can also be used to: prioritize and allocate resources; inform managers about needed adjustments or changes in
policy or program directions to meet goals; frame reports on the success meeting performance goals.
Performance Management
Quality improvement (QI) in public health is the use of a deliberate and defined process which is focused on activities that are responsive to community needs and improving population health.
QI is a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, and outcomes of services and processes which achieve equity and improve the health of the community.“Defining Quality Improvement in Public Health.” Journal of Public Health Management and Practice, Jan/Feb 2010.
Quality Improvement
QI is a set of tools to help people understand, analyze, and transform systems.
Need to tear apart the house to see the pipes.
QI principles◦Systems and customer focus◦Evidence-based and data driven◦Shared decision making◦Multidisciplinary process (many eyes!)◦Continuous!
The Tools
Continuous Quality Improvement (CQI) AKA Plan-Do-Check-Act (PDCA) or Plan-Do-Study-Act (PDSA)
Baldrige Performance or Balanced Scorecard ISO 9000 Lean Six Sigma Total Quality Management Turning Point Performance Management
Framework Kaizen
Quality Improvement Methods
People will learn and use the tools to analyze and transform systems.
People will be empowered to use these tools and to make the systems changes.
The system will be changed to provide better and faster services for our customers.
Process will not be sacrificed for product.
QI Expectations
Not a replacement for:◦ Leadership skills◦ Functional teams (team building)◦ Governance
What Performance Management and QI Are Not
Childhood Immunizations 1993 Congestive Heart Failure 1995 Childhood Asthma 2002 Solano County 2004-2010 CDPH Contracts 2012
QI Examples
Problem: Contracts are not being executed timely (3,000 contracts in CDPH)
Baseline Data:◦ DGS routinely rejected 60 – 70 % of contracts◦ Review all of the DGS Rejections for past year
Unclear and/or Poor Scope of Work and Budget 75% Conflicting Exhibits – 25%
Contracts
Discussed Issues with DGS
Contacted another Departments Contract Units◦ How do they do business?
Understand problem
Major root causes identified◦ No Inventory of contracts
No data source of contract activities that could provide guidance
◦ CMU Managers were not available to staff and review contracts to send to DGS; time spent in meetings with program
◦ Lack of contract knowledge both internally and externally
◦ Performance measure requiring CMU review in 15 days placed focus on quantity, not quality
Reasons for the problem (Root Causes)
No Inventory of contracts Inventory Contracts and develop meaningful reports
CMU Managers were not available to staff and review contracts to send to DGS CMU Managers need to be available to provide guidance to
CMU staff Lack of contract knowledge both internally and
externally Training Program for CDPH Staff involved with Contracts
CMU Performance measure focused on quantity, not quality Focus on quality not quantity
Possible Solutions to the Problem
Monitored DGS rejection rate of contracts ◦ Measured % of contracts approved by DGS in
first submission Monitored if contracts moved through
process◦ CMU Manager available to provide Quality
Control◦ Feedback to CMU staff more valuable and
efficient
Plan to Measure
Better Use of Information Technology◦ Develop processes to ensure:
All contract information accurately entered into CAPS Staff Training
◦ Classes developed for program staff and CMU staff Streamline Contracting Process
◦ Increased use of DGS established templates◦ Updating “Exhibit” language to remove conflicts
Implement solution & collect data for evaluation
Ongoing inventory and clean up of CAPS◦ Ability to generate contract status reports
CMU Managers and shift in responsibilities◦ Managers available to CMU & Program staff to provide guidance
Ongoing training for CMU and program staff◦ Series of classes covering contracts and procurements
Eliminated redundant review of approved contracts◦ Saved approximately 2-3 hours of contract processing time
Philosophical shift from “just send to DGS” to “do it right” ◦ Executive management support is key to promote shift in attitude
Analyze data and develop conclusions
Of last 600 contracts only 2 were returned from DGS.
Some programs given streamlined contract authority from DGS.
Customers have noted improved contracting process.
Results