Quality Improvement in a Large Local Health Department The San Diego Experience Tamara L.M. Bannan, MPH.

Quality Improvement in a Large Quality Improvement in a Large Local Health DepartmentLocal Health Department

The San Diego ExperienceThe San Diego ExperienceTamara L.M. Bannan, MPH Tamara L.M. Bannan, MPH

OverviewOverview

2

Review of San Diego County

Embarking on the Quality Improvement (QI) journey

Sustaining QI in a large local health department

San Diego CountySan Diego County• 3.1 million people; ~4,200 sq.

miles• 2nd largest in California• 5th largest in the U.S. • 18 municipalities, with several

other unincorporated cities• 2010 Census (10% growth): • white – 48%; blacks – 5%• Hispanic – 32% (from 27%) • Asians – 11%• Pacific Islanders – 0.5%• Nat. Am. – 0.9%

County County GovernmentGovernment• 5 Board of Supervisors5 Board of Supervisors

• Chief Admin Officer/General Chief Admin Officer/General Management SystemManagement System

• 5 Business Groups5 Business Groups• Health and Human Services Health and Human Services

AgencyAgency• Public Health ServicesPublic Health Services

• Includes Includes Emergency Medical Emergency Medical ServiceService

• DEHDEH & & Animal Services Animal Services are separate are separate departmentsdepartments

Accreditation ExperienceAccreditation Experience

San Diego was a beta test site for San Diego was a beta test site for national public health accreditationnational public health accreditation

Underwent first 4 steps of Underwent first 4 steps of accreditationaccreditation

Identified areas Identified areas to address to address before applying before applying for actual for actual accreditationaccreditation

San Diego’s QI ExperienceSan Diego’s QI Experience

Getting Started: Getting Started: Identifying the ProjectIdentifying the Project

Conducted a Self-Assessment as part of the beta test

Topics considered: Community Health

Improvement Plan Interpretation Policy

Getting Started: Getting Started: Identifying the TeamIdentifying the Team

Important to include stakeholders in Important to include stakeholders in the change processthe change process• Public Health Nurse ManagersPublic Health Nurse Managers• Statistician Statistician • Civil Rights CoordinatorCivil Rights Coordinator

Orient the team to the Orient the team to the QI process QI process

The Project: Customer The Project: Customer Interpretation NeedsInterpretation Needs

Reviewed our draft interpretation Reviewed our draft interpretation policypolicy

Analyzed the current process in each Analyzed the current process in each of 9 sitesof 9 sites

Determined to focus on establishing Determined to focus on establishing policy as 1policy as 1stst step step

Next step was to increase staff Next step was to increase staff awareness of the policy awareness of the policy

Team engagementTeam engagement Each site was to draft a

clinic flow chart of existing process

Each PHN manager was asked to review policy and provide feedback

Epidemiologist conducted survey and data analysis

Findings and ResultsFindings and Results

Lessons LearnedLessons Learned

Allow enough time for each phase of your project

Cultivate strong relationships with each team member

Try not to bias the process with a pre-identified solution

Incorporated into current FY goals Conduct ongoing QI training for staff Developing a team of staff to use the

PDSA process and quality tools HHSA is conducting green and black

belt training in Lean Six Sigma

Sustaining QI in San DiegoSustaining QI in San Diego

Thank YouThank You

[email protected]@sdcounty.ca.gov