Introduction to QA, QI and Performance Management A Mark Durand PIHOA Quality and Health Information Coordinator December, 2011.

Introduction to QA QI and Performance Management

A Mark Durand

PIHOA Quality and Health Information Coordinator

December 2011

Are you satisfied

QAQI- Program Development by Site

Am Samoa CHC

Am Samoa Hosp

Guam GMH

CNMI Hosp

Pohnpei DHS amp CHC

Yap DHS

Yap CHC

Palau MOH

Guam CHC

RMI- Ebeye

Kosrae DHS

FSM Natl

Guam DPHSS

Am Samoa DHS

CNMI PH

Chuuk DHS

0 05 1 15 2 25 3 35 4

Key0 = No activity yet1 = Preliminary plan 2 = Some progress3 = Program

components installed4 = Program running

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

QA amp QI amp PM

Church of God

Seventh Day Adventist

Congregational

Catholic

Orthodox

Presbyterian

Lutheran

Baptist

Church of Christ

Church of God

Seventh Day Adventist

Congregational

Catholic

Presbyterian

Lutheran

Baptist

Church of Christ

Quality Assurance

Quality Improvement

Continuous Quality Improvement

Total Quality Management

Performance Management

Lean

Six Sigma

Baldridge Criteria

Define Standards or Goals

Measure Monitor

amp Report

Change what you do until

you reach goals

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

QA amp QI amp PM

QA

Plan

Do

Study

Act

Define Quality

Standards

Monitor amp Report Quality

Correct Deficiencies

QI

QI Tools

Plan bull Objectivebull Questions and predictionsbull Plan to carry out the cycle (who what where when)bull Plan for data collection

Do bull Carry out the planbull Document problems and

unexpected observationsbull Begin analysis of the dataTrack progress on work plan or Gantt

Studybull Complete the data

analysisbull Compare data to predictionsbull Summarize lessons

Data analysis report

Actbull What changes are to be

madebull Next cycle

Documentation of recommendations report or minutes

Learning and Improvement Cycle

Logic model

Problem (Effect)

5 Whyrsquos Technique

Why

Why

Why

Why

Why

Fishbone Diagram

Lack of knowledge amp skill in QI

People

Culture

Methods

Materials

Resources

Cause and Effect Diagram for Low Use of HIV Screening

PoorHIV Testing

ClientTest Location

Donrsquot see benefit

Counseling

Not Client Centered

Not convenient

Staff

Not Respectful

Fearful

Not Offered Poor Experience

Not Private

Donrsquot Want Test

QA

Plan

Do

Study

Act

Define Quality

Standards

Measure Monitor amp Report

Correct Deficiencies

QI

QI Tools

Agency (Director) ----------------------

UnitsPrograms ----- (Supervisors)

Staff -------------

Key Point

bull What is the job of a health worker - Perform your duties to help your team to deliver services

bull What is the job of your health units and programs

- Perform specific tasks or deliver specific services

bull What is the job of your agency - Support the work of its units and staff

- Meet the needs of the population

Benchmark

Health Worker Unit Program AgencyQuestion to answer

How well does a health worker do hisher duties

How well does a unit or program do its tasks or services

How well does agency meet- community needs- needs of unitsstaff

Benchmark

Job Description(Yearly Individual Performance Plan)

Unit Standard Operating Procedures (QA)Goalsamp Objectives(QI)

Strategic Plan (Goals amp Objectives)

Improvement Planning

Yearly IndividualPerformance Plan

- Corrective action plan (QA)

- ldquoPrdquo in PDSA (QI)

Performance Management Plan (using PDSA as needed)

How to monitor Individual performance evaluation

- QA Survey (scores)- PDSA(Set indicators- ldquoPrdquo Measure results- ldquoSrdquo)

Perf Management Plan Reports

Incentives Recognize Merit $ Promote ldquoPerksrdquo

- Recognize team celebrate $$ (to team or individuals)

- Budget grants Promotiondemotion

PMStrategic

Goals

Measure Monitor amp Report

Correct Deficiencies

QI

Tools

Agency or jurisdiction level

Examples 1

bull Nursing shortagebull Low $ collections

2bull Access to carebull NCD epidemic

Key Point

bull What is the job of a health worker - Perform your duties to help your team to deliver services

bull What is the job of your health units and programs

- Perform specific tasks or deliver specific services

bull What is the job of your agency - Support the work of its units and staff

- Meet the needs of the population

Are we satisfied

Current situation Needs Assessment

What to do Goals strategiesamp objectives

Assure success Performance Improvement

System

Level 1 ldquoreactiverdquo response

Level 2 partial response

Level 3 performance management

Example

Situation Nursing shortage

3 Levels of response

Situation Nursing shortage

Needs assessment Not done

Goal Not clear

Objective Not clear

Strategy 1 Train practical nurses whenever shortage becomes acute

2 Hire nurses off-island

Level 1 ldquoreactiverdquo response

Situation Nursing shortage

Needs assessment Done

Goal A supply of high-quality local nurses

Objective Not clear

Strategy 1 Recruit nurses to study off-island 2 Establish community college nursing pgm 2 Hire expat nurses

Level 2 Partial response

Situation Nursing shortage

Needs assessment Done

Goal An adequate supply of high-quality local nurses

Objective 100 of ward nurses should have formal college nursing certificates or degrees by 2015

Strategy bull Partnership between hospital and comm college

- define target group of nurses - financing - employment policies - work-study scheduling transport classroom site

Level 3 Proactive response

Are we satisfied

Current situation Needs Assessment

What to do Goals strategiesamp objectives

Assure success Performance Improvement

System

Community Health Assessment

Community Health Improvement Plan

Agency Strategic Plan

Performance Improvement System (for 10 essential public health services)

Assessment1048713 Monitor health status1048713 Investigate health problems 1048713 Evaluate personal and population-based health servicesPolicy Development1048713 To support individual and community health efforts1048713 Enforce laws and regulations that protect health1048713 Research for solutions to health problemsAssurance1048713 Link people to needed personal health services 1048713 Assure a competent health care workforce1048713 Inform people about health issues1048713 Mobilize partnerships to solve health problems

BureausSections reponsibleDOMAIN 1 Conduct and disseminate assessments focused on population health status and public health issues facing the communityStandard 11 Participate in or conduct a collaborative process resulting in a comprehensive community health assessment

111 S Participate in or conduct a state partnership that develops a comprehensive state community health assessment of the population of the state

112 S Complete a state level community health assessment

113 A Ensure that the community health assessment is accessible to agencies organizations and the general public

Standard 12 Collect and maintain reliable comparable and valid data that provide information on conditions of public health importance and on the health status of the population121 A Maintain a surveillance system for receiving reports 247 in order to identify health problems public health threats and environmental public health hazards

122 A Communicate with surveillance sites at least annually

123 A Collect additional primary and secondary data on population health status

Public Health Accreditation Board Standards and Measures

httpwwwcecentralcomphab

PH Accreditation Orientation (web-based)

bull Type of measure (ie output or outcome measure)

bull Format of measure (eg YesNo count proportion time-based other)

bull Measurement specifications (eg startstop time numeratordenominator what is being counted)

bull Baseline value and associated date(s)

bull Target value and associated date(s)

CDC Performance Management Reporting Tool

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

Quiz Is it QA-QI-PM(or is it a ldquoblind improvement attemptrdquo)

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

Behavioral health unit offers substance abuse counseling training to DHS staff

ldquoBlind improvement attemptrdquo

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

Staff in OPD put labels on supply shelves in clinic as part of corrective action plan from last survey

QA-QI-PM

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

Chief nurse arranges transportation to help night shift nurses get to work

ldquoBlind improvement attemptrdquo

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

Nursing team develops plan to help decrease absenteeism rate on medical ward

QA-QI-PM (if impact is measured)

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

Team from Public Health goes to Mortlocks to do screening and health promotion to address NCD epidemic

ldquoBlind improvement attemptrdquo

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

DHS works with legislature to pass increase in tobacco tax in hope of decreasing teen tobacco use 10 from current rate of 67

QA-QI-PM (if follow-up measurment is done)

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

Nursing Supervisor requires all nursing unit supervisors to take on-line QI course and follows-up until all supervisors on her list have completed

QA-QI-PM

Define Standards or Goals

Measure Monitor amp Report

Change what you do until you

reach goals

DHS hosts training workshop to train doctors nurses and health assistants to apply new NCD treatment guidelines