Roadmap to a Culture of Quality Improvement Preview

Transcription

1 Radmap t a Culture f Quality Imprvement Preview Lcal health departments (LHDs) are immersed in a changing envirnment with the ecnmic and plitical pressures, cmpeting public health pririties, and new and emerging public health issues. The need t achieve efficiencies and ther imprvements with the limited resurces available has magnified, increasing the imprtance f perfrmance management, and specifically quality imprvement (QI). Thugh QI has established a ntable presence in the field, islated QI prcesses are nt sufficient when respnding t budget cuts and cmpeting public health pririties. A much mre cmprehensive apprach is needed as LHDs wrk t transfrm rganizatinal culture wherein the cncepts f QI are ingrained in the shared attitudes, values, gals, and practices f all individuals in the agency. Mrever, successful attainment f accreditatin status frm the new Public Health Accreditatin Bard includes the embdiment f a QI culture. QI in public health is defined as the use f a deliberate and defined imprvement prcess which is fcused n activities that are respnsive t cmmunity needs and imprving ppulatin health. It refers t a cntinuus and nging effrt t achieve measurable imprvements in the efficiency, effectiveness, perfrmance, accuntability, utcmes, and ther indicatrs f quality in services r prcesses which achieve equity and imprve the health f the cmmunity. 1 In rder t assist LHDs alng their jurney t a culture f QI, NACCHO cnvened QI leaders frm health departments acrss the cuntry, as well as QI cnsultants wh have wrked with LHDs. Based n their cnsiderable cllective experience, these experts discussed the varius pints alng a spectrum regarding the uptake f QI in health departments, and strategies t mve LHDs twards a culture f QI. While this preliminary versin f the Radmap prvides a basic framewrk f this jurney, this is a dynamic resurce that will be refined and enhanced ver time, as it is cntinually updated with crrespnding tls and ther materials. ******************************** Successful culture change is mst readily achieved with the deliberate use f an established change management mdel, i.e., a structured apprach t transitining an rganizatin frm a current state t a future desired state. Cmmnly used change management mdels include stages f change which generally fall int the fllwing three brad categries: 1). identify the need fr change; 2). implement transitin plan; and 3). institutinalize the desired state. Agencies shuld determine which mdel is mst suitable based n its needs. The fllwing table summarizes three cmmnly used change management mdels. Cmmn Mdels f Change Management Lewin, 3 Stages f Change Ktter, 8 Steps fr Change Management Unfreeze Increase urgency fr change Build a team fr the change Cnstruct the visin Cmmunicate Prsci, ADKAR Steps fr Individual Change Awareness f the need fr change

2 Transitin Empwer Desire t make the change Knwledge n hw t change Ability t implement new skills and behavirs Freeze Create shrt-term gals Be persistent Make the change permanent Reinfrcement t retain the change nce it has been made Regardless f which change management mdel is used, it is imprtant t fcus n bth the human and prcess aspects f change within the agency. The fllwing key principles f change are imprtant t cnsider when seeking transfrmatin change t a QI culture: Leadership must cmmit t and drive the prcess A tp-dwn and bttm-up apprach is necessary t achieve a culture shift Managing the human aspect f change is critical t success Cmmunicatin is imprtant thrughut the change prcess The Radmap describes six key phases n a path t a QI culture, utlining cmmn characteristics fr each phase and strategies an LHD can implement t mve t the next phase. Incrprating principles f change management, the radmap identifies these characteristics n bth the human and prcess aspect f change within an agency. The radmap als includes several fundatinal characteristics which shuld ideally be present in an agency thrughut each phase, althugh agencies in the early phases will likely nt embdy sme f these characteristics and will need t cultivate them ver time. Fundatinal characteristics include: Engage emplyees wh are well-suited t learn and teach QI techniques; pinin leaders Cllabrative and innvative culture Same values QI shuld be integrated int rganizatin plans Data gathering and analysis skills Business results are mnitred and managed Leadership and gvernance are knwledgeable abut and engaged in QI Evidence-based practices are cmmnly used Theretical vs. practical balance (50,000 ft and 5 ft view) Flexibility in decisin-making is seen as critical piece t rganizatinal success, including at the frntline staff level Supervisrs are expected t engage in QI and see their jb nt as abut fighting fires but rather, imprving prcesses Custmer fcus (internal/external) QI shuld be integrated int funder requirements (expected as prgram wrk, nt extra ) The fllwing is the basic utline f the Radmap, and is intended t prvide a preview f the cnceptual framewrk fr the jurney t a culture f QI. NACCHO will further refine and ppulate the Radmap with input frm the practice field n an nging basis. *****************************************

3 N Knwledge f QI In this phase, agency staff and leadership are either unaware f QI and its imprtance r they cnfuse it with evaluatin, quality assurance, r quality cntrl. The cncepts f quality are nt cnsidered as a way f ding business and a reactive rather than practive apprach is used t address prblems. Prcess Side Leadership and staff dn t knw abut r understand QI Cmpeting pririties impede interest in QI Leadership and staff may be satisfied with status qu Leadership and staff dn t see the value r link f QI t PH practice Decisins are nt driven by data r frmal prcesses Decisins are made in sils Data are nt available and/r are nt used in prblem slving N resurces available fr QI Innvatin is rare Market QI t leaders Prvide QI training t leadership (e.g., via Survive and Thrive) Share success stries f QI in public health Intentinally manage change using a behaviral change mdel Prvide incentives fr learning abut and/r engaging in QI Engage and train lcal gvernance in QI Create a sense f urgency fr QI Transitin Strategies Develp a marketing plan fr staff Begin t identify and seek ut resurces fr QI Review QI training ptins fr agency Deselect resistant leaders Highlight the difference between QA/QC and QI Nt Invlved with QI Activities In this phase, leadership understands and discusses QI with staff but des nt enfrce the implementatin f, allw fr sufficient staff time and resurces t devte t, r hld staff accuntable t the use f QI. Leadership understands QI Staff are beginning t understand QI Leadership have little r n expectatins f staff t engage in QI Staff may view QI as the flavr f the mnth r a temprary activity Prcess Side Prblems are randmly r incnsistently addressed Leadership and staff dn t knw where r hw t access data Simple, infrmal elements f QI exist (e.g. evaluatin activities)

4 QI may be building resentment amng staff (i.e., sme may feel they are being left behind r staff are asking why QI is being impsed) Resurces and staff time allcated fr QI are limited Use f QI nt enfrced Transitin Strategies Utilize resurces ffered thrugh quality rganizatins (e.g. NACCHO, PHF, ASQ, etc.) Share external QI success stries with staff Engage in mentrship and caching Offer QI training and learning pprtunities t leadership and staff Make QI reading material and ther resurces readily available t leadership and staff Begin t build QI int agency planning Emphasize practive versus reactive prblem slving Include QI in value statement and guiding principles Prvide QI tls and templates Identify and engage natural QI champins Identify data needs and data surces Survey leadership and staff t identify areas fr imprvement Infrmal r Ad Hc QI activities Discrete QI effrts are practiced in islated instances thrughut agency, ften withut cnsistent use f data r alignment with the steps in a frmal QI prcess. Generally, there may exist resistance frm staff as they may lk at QI as an added respnsibility. Infrequent sharing f lessns learned amng staff Staff may view QI as an added respnsibility Leadership and/r staff are anxius abut implementing QI incrrectly r uncvering things they d nt like r want t admit Staff may be frustrated if effrts dn t result in immediate imprvement QI may nly be ccurring at the administrative staff level r ther islated instances Prcess Side Data are nt rutinely used in agency peratins Discrete QI effrts ccur but are likely nt fully aligned with frmal steps f a QI framewrk (e.g. PDSA) QI is nt aligned with rganizatin s strategy There have been multiple failed attempts t imprve Imprvement plans are ften stalled Share success stries thrughut the rganizatin Develp internal and external learning cmmunities Intrduce all staff t perfrmance management (e.g. Baldrige, Turning Pint, etc.) Cmmunicate t staff that QI is within their reach Cmmunicate and celebrate all imprvements with staff Encurage small successes Transitin Strategies Begin discussins n what data shuld be cllected Shw linkages between data, QI activity, and utcmes Ensure that leaders request data befre apprving changes Identify staff using QI prcesses and rganize a QI team Rutinely reprt results f QI effrts t leadership

5 Cmmunicate t staff that QI is nt abut placing blame r punishment Emphasize t staff that QI is a way t make the jb easier and mre efficient Understand why staff may cntinue t resist QI Offer rganized trainings in QI Prvide trainings in evidence based practices Increase the use f evidence based practices Cmplete a perfrmance management selfassessment Frmal QI Activities Implemented in Specific Areas Fllwing a frmal QI mdel, QI is being implemented in specific prgram areas where QI champins exist but QI is nt incrprated int an rganizatin-wide strategy. Leadership views peple as critical t success Select QI champins exist in specific prgram areas In-huse QI technical assistance is available as a frmal but separate functin Prcess Side There is sme data use but cnsistency and reliability issues exist Data-driven decisin making is emphasized ver reactive prblem slving QI is a part f the jb QI is well institutinalized in sme areas f the agency Transitin Strategies Rutinely hld team prject presentatins t share learning Establish a QI management divisin r a QI Cuncil Offer multiple training pprtunities t staff Reprt results t utside entities and lcal gvernance Rutinely reprt prgress t leaders and staff Find creative ways t wrk acrss sils (e.g. agency-wide Cnnect with and utilize QI rganizatins (e.g. ASQ, IHI, mdel fr custmer satisfactin survey) NACCHO, PHF, NNPHI, etc.) Increase agency-wide access t data Celebrate successes Engage staff at all levels in establishing a frmal perfrmance management system Begin t develp QI plan Link successive QI effrts (e.g. PDCA cycles) Develp strategic bjectives and actin plans Develp QI plicies Frmal Agency Wide QI The QI plan is integrated int verall agency plicies and the plans, including the strategic plan. An internal QI cmmittee versees the implementatin f a detailed plan t ensure QI thrughut the agency. Plicies and prcedures are in place and data are cmmnly used fr prblem-slving and decisin making. Prcess Side

6 Cncept f standardizing prcesses is embraced by Prblem slving and decisin making are data driven leadership and staff Detailed peratinal plans exist and are being used QI champins exist thrughut the agency QI plan is individualized t setting Sharing f best practices and lessns learned is cmmn QI plicies are in place thrughut the agency Systematic custmer satisfactin surveys are cnducted Prgress and utcmes are cmmunicated widely and A frmal perfrmance management system is in place rutinely QI effrts are identified frm perfrmance management Charts and graphs illustrating imprvement effrts are system visible thrughut rganizatin Quality cntrl, QI, the agency strategic plan, and evaluatin are part f peratinal plans Resurces and staff time are allcated fr QI Transitin Strategies Discuss QI at every leadership meeting in a standardized way Ask supervisrs t serve as a cach and mentr t staff Encurage frntline staff t prduce QI ideas that are aligned with the agency strategic plan Prvide nging QI trainings Incrprate QI cmpetencies in jb descriptins Ensure that leadership champins agency-wide QI Practice and encurage rle mdeling Evaluate prcesses and utcmes Demnstrate return n investment thrugh cst and time Incrprate QI int perfrmance evaluatins QI Culture QI is fully embedded int the way the agency des business, acrss all levels and services. Leadership and staff are fully cmmitted t quality and results f QI effrts are cmmunicated internally and externally. Even if leadership changes, the basics f QI are s ingrained in staff that they seek ut the rt cause f prblems. They dn t assume that an interventin will be effective, but rather they establish and quantify prgress tward measurable bjectives. Prcess Side Self-assessment and trainings are nging Prblems are gld Tp-dwn and bttm-up apprach t QI is prevalent Results are reprted t staff, stakehlders and custmers QI cmpetencies and actin plans are incrprated in jb descriptins Rle mdeling is cmmn Cautin: digressin is a lt easier than prgressin QI is integrated int all agency plans Data and tls are used in everyday wrk Custmer is frnt and center Innvatin is cmmn Agency peratins are utcme driven Return n investment is being demnstrated QI is included in perfrmance evaluatins