10/14/20 1 Center for Healthy Communities Office of Oral Health Applying Quality Improvement Methodologies in Dental Settings Part 2 1 Center for Healthy Communities Office of Oral Health Acknowledgements This training was produced by Jennifer Byrne, MSc, the Sonoma County Department of Health Services’ Dental Health Program, and the California Department of Public Health’s Office of Oral Health. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H47MC28480, Children’s Oral Healthcare Access Program for a total award of $1,000,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 2 Center for Healthy Communities Office of Oral Health Introductions • Chat Box – Technical difficulties • Q&A Box – Ask a question • Exercises – COHTAC Website: https:// oralhealthsupport.ucsf.edu 3
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Applying Quality Improvement Methodologies in Dental Settings
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10/14/20
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Center for Healthy CommunitiesOffice of Oral Health
Applying Quality Improvement Methodologies in Dental
SettingsPart 2
1
Center for Healthy CommunitiesOffice of Oral Health
Acknowledgements
This training was produced by Jennifer Byrne, MSc, the Sonoma County Department of Health Services’ Dental Health Program, and the California Department of Public Health’s Office of Oral Health. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H47MC28480, Children’s Oral Healthcare Access Program for a total award of $1,000,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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Center for Healthy CommunitiesOffice of Oral Health
Achievable Ambitious, but feasible given available resources (e.g., time, money, personnel, tools)
Relevant Aligned with team/organization mission
Time-Bound Has a clear timeframe and deadline.
Inclusive Brings traditionally marginalized people into the process in a power-sharing way.
Equitable Includes an element of fairness to address inequity and injustice.
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Not S.M.A.R.T.I.E. ExampleDecrease the number of dental appointment ”no-shows” among pregnant women.
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S.M.A.R.T.I.E. ExampleTo increase the number of pregnant women receiving dental care, Mt. Rose Dental Clinic will reduce the number of dental appointment no-shows among pregnant women referred by its Comprehensive Perinatal Services Program by 10 percentage points from the baseline (67%) by September 30, 2020, with at least 2% reduction among homeless women, as measured by Mt. Rose Dental Clinic’s appointment scheduling program.
Specific, Measurable, Attainable, Relevant,
Time-Bound, Inclusive, Equitable
Case Study
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Section Check-In: Q&A
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What changes can we make that may result in an improvement?
Model for Improvement
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PDSA Tool: PLAN
Refer to the Plan-Do-Study-Act Worksheet.
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The Purpose of Process Maps
• Flowcharts create a picture of the sequence of steps in a process
• Making the process visible helps to– simplify the steps – improve efficiency – decrease opportunity for error
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Process Mapping Benefits
• Engages all stakeholders• Replaces pages of written word with a
Over Production• Unneeded reports, duplication, leftover
Waiting• Waiting for others to complete work, test results
Not Used Talent• Unused creativity
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Types of Waste: DOWNTIME (2/2)
T
I
M
E
Transportation• Moving things (rather than pre-position)
Inventory • Over-/under-stock, expired supplies
Motion• Excess searching, gathering, walking
Excess processing• Over-using more supplies or information
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• No method to prevent/catch errors• Ineffective design/layout of facilities• Fragmented, poorly designed processes• Equipment failures• Unorganized workspace• No standards, non-compliance with
standards• Unbalanced workloads
Root Causes of Waste (1/2)
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• Lack of flexible workforce
• Inadequate or no training
• Poor communication• No visibility to performance
• Lack of integrated systems & poor systems functionality
Root Causes of Waste (2/2)
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Patie
ntCP
SP
Prov
ider
Dent
al F
ront
O
ffic
e St
aff
Participate in CPSP Appt.
Confirm Dental Appt.
Complete Dental Appt.
Schedules dental appt?
No Dental Appt.
No
Yes
Shows up for appt.?
No Dental Appt.
No
Yes
Explain Health Benefits of
Dental Care & Advise Patient to
Visit Dentist
Waiting
Not Used Talent
Perinatal Appointment Scheduling Process
Case StudyCurrent State
Waiting
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Patie
ntCP
SP
Prov
ider
Dent
al F
ront
O
ffic
e St
aff
Participate in CPSP Appt.
Explain Health Benefits of Dental
Care & Initiate Scheduling Appt.
Patient Visited Dentist During
Pregnancy?
Schedule Next CPSP
Appt.
Identify Day & Time that Work Well for Patient
Respond to CPSP IM & Initiate
Video-Call
No
Yes
Send IM to Dental Front Office Staff
Confirm Appt. Time Works Well
for Patient
Book & Confirm
Appt.
Consent to Dental Appt.?
Schedule Next CPSP
Appt.
No
Yes
Perinatal Appointment Scheduling Process
Case StudyFuture State
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Case
Study
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Section Check-In: Q&A
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How do we know if a change leads to an improvement?
Model for Improvement
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Data for Quality Improvement
UnderstandHow does the current system
perform?
EvaluateDid our
intervention result in improvement?
MonitorIs our improvement
sustained over time?
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A data collection plan includes:
– Data elements and operational definitions– Collection method and data source– Due date
Data Collection Plan
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Types of Data
• Qualitative Data–Words
• Quantitative Data– #, %
CDPH Evaluation Resource Guide for Local Oral Health Programs
Chart 4: Daily Rate of Pregnant Women Seen in Dental Office
PDSA Cycle 1: Change Occurred
Two Trends
No Astronomical Points
Two Shifts
Visit Rate Median Goal
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QI Project: Case StudyCase Study
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0%10%
20%30%
40%50%
60%70%
80%
1-Sep
3-Sep
5-Sep
7-Sep
9-Sep
11-Sep
13-Sep
15-Sep
17-Sep
19-Sep
21-Sep
23-Sep
25-Sep
27-Sep
29-Sep
No-Show Rates for CPSP Patient Referrals
Case Study Results
No-Show Rate Median Goal
TrendsShift
Case Study
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QI Project: Case StudyCase Study
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CALL TO ACTION
Share the Quality Improvement (QI) Quick-Start Guide with your Dental Teams–Quality improvement overview– Plan-Do-Study-Act (PDSA) worksheet– How-to develop a process map template– How-to interpret data template
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Lessons Learned
•SMARTIE goals
•Process mapping
•Plan-do-study-act cycle•Interpreting run charts to determine if a change resulted in an improvement•Explain a case study example
•Share QI approaches, tools, and resources with your dental teams
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Section Check-In: Q&A
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Additional Resources (1/3)American Dental AssociationThe American Dental Association hosts the Dental Quality Alliance (DQA), which was established to develop performance measures for oral health care. The DQA hosts a variety of resources related to dental quality measures, educational resources, and improvement resources.
Association of State and Territorial Dental DirectorsThe Association of State and Territorial Dental Directors links to a variety of evidence-based quality improvement resources.
Centers for Medicare and Medicaid ServicesThe Centers for Medicare and Medicaid Services issued a report for improving oral health care delivery in Medicaid and CHIP. The report is a toolkit to help state’s achieve the CMS Oral Health Initiative through QI.https://www.medicaid.gov/sites/default/files/2019-12/oral-health-quality-improvement-toolkit-for-states.pdf
Health Resources and Services AdministrationThe Health Resources and Services Administration published a report in 2011 explaining what QI is, why it’s important, the role of organizational leadership, how to prepare for change, the Model for Improvement, and other topics critical to QI.https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf
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Additional Resources (2/3)Public Health FoundationThe Public Health Foundation provides QI tools, training, and resources.
Center for Healthy CommunitiesOffice of Oral Health
Additional Resources (3/3)National Network for Oral Health AccessThe National Network for Oral Health Access developed an operations manual for oral health programs; chapter six focuses on quality. Topics addressed in the toolkit include model for
improvement, PDSA cycles, sample quality measures, case studies and more.https://www.nnoha.org/nnoha-content/uploads/2013/08/OpManualChapter6.pdf
Population Health Improvement PartnersThe Population Health Improvement Partners has eLearning modules (videos), tools and templates to
learn about and apply improvement concepts to your work. https://improvepartners.org/toolbox/toolbox-details/qi-videos-tools/