The vision of the Quality Council is to aid in creating, implementing, maintaining, and evaluating the quality improvement efforts at Spokane Regional Health District with the intent to improve the level of performance of key processes and outcomes. Our goals are to identify, review, monitor, and make recommendations on quality improvement processes and efforts; identify and meet quality improvement staff training needs; provide guidance, support, and resources for quality improvement efforts; recognize and acknowledge staff quality improvement efforts; review the quality improvement plan at least annually and adjust as required. Quality Improvement (QI) is an integrative process that links knowledge, structures, processes, and outcomes to enhance quality throughout an organization. The Quality Council heard 20 reports during the year covering administrative functions, After Action reviews, customer service, HIPAA compliance, results from our standards review, and division activities around program evaluation (each division reported and submitted two QI projects).
The Council monitored 22 project objectives in 2007 and 12 projects completed in 2008. Some examples of 2008 project objectives are as follows: achieve influenza vaccination of at least 50 percent of children in five pilot child care sites by November 21, 2008; increase the percentage of programs with a logic model by 20 percentage points by December 31, 2008; increase the percentage of HIV/AIDS case charts that are timely, accurate, and complete to 70 percent by April 30, 2008; decrease the average time spent processing as-built requests by 30–40 percent by February 2008. The Quality Council reviewed the year to see what worked, what didn’t, and what we needed to improve. We also filled out an evaluation tool to rate the council as to our level of performance. Positive outcomes included good council participation, Council kept on track with plan and reporting structure, good support from executive team, management training on the plan and process was well-received, forms were continually revised for improvement, the members themselves have a deeper understanding of quality improvement, and best of all, project reports from agency staff.
Our 2009 areas for improvement include strengthen the check/act piece of program evaluations throughout the agency by getting staff to pull their baseline data for their completed logic models, develop QI assistance program for staff conducting quality improvement projects, formalize ongoing training for new directors and managers, keep communication going about quality improvement—create opportunities to showcase projects, especially those that can be replicated, and revise the quality improvement plan to clarify sections.
The Washington State Public Health System has been working on quality improvement efforts through a standards process. Public Health Standard 12 is Leadership and Governance with Measure 9: There is a written quality improvement plan in which specific objectives address opportunities for improvement identified through health data including core indicators, program evaluations, outbreak response or after action evaluations, or the strategic planning process; and Measure 10: An annual review of the plan includes: performance measures are tracked, reported, and used to assess the effect of improvement actions; meaningful improvement is demonstrated in at least one objective; and the plan is revised based upon the review.
Through the public health standards, a review of our agency was conducted in 2005 and 2008 demonstrating needed work in the areas of quality improvement, including being more data driven within our programs. The Quality Council wrote a quality improvement plan to formalize our improvement activities and to meet Standard 12: Measures 9 and 10. This effort has moved our agency forward in its improvement activities, realizing we still have work to do. After the last Public Health Standard’s review, materials considered exemplary practice were compiled from the other local health jurisdictions to use in their own agency. We considered the quality improvement plans and processes on the exemplary practice Web site and then modified them to meet our needs.
We also obtained training and technical assistance from a state consultant on how to put together a council and plan. Our local health department is structured differently than the models we looked at to replicate. There was only one other department in Washington State at the time with a functioning council.
Agency Community RolesEveryone has a role in SRHD’s quality improvement efforts. Staff are responsible for completing a program logic model or other framework to evaluate activities; compiling program data for measures; participating in logic model reviews; working with managers to identify areas for improvement and suggesting improvement projects to address these areas; conducting quality improvement projects in conjunction with managers and other appropriate staff (program evaluator, community health assessment staff, HIPAA coordinator, etc.); and reporting QI training needs to managers. Managers are responsible for orienting all staff to Quality Council process, plan, and resources; developing an initial logic model and/or work plan for each program; reviewing the data from logic models and/or work plans on an annual basis with staff; initiating problem solving processes and/or QI improvement projects; identifying staff QI training needs, providing access to training, and tracking attendance 6. Reporting to their directors their findings from their logic model review, QI projects, and identified QI trainings with no resources available; revising program logic models and/or work plans based on findings from annual review and QI projects.
Directors are responsible for reporting to the QC on program evaluation efforts, QI projects, audit results (if applicable), customer service evaluation, and QI training needed by staff; identifying and selecting up to two areas needing improvement to bring to the QC as priorities annually; assuring implementation of QI projects. Division Directors must give annual division report to the QC personally or jointly with staff. QI project reports during the year can be presented by designated staff. Directors may be asked to participate in QI committees and work groups. The Executive Team will be notified of the QC’s activities periodically and hear recommendations for revision to the QI plan annually. Through the Strategic Plan Review, the Team will forward recommended QI initiatives to the QC to incorporate into the QI Plan. The Board of Health receives a report annually on health data with recommended actions for health policy decisions (Standard 12.2L); progress toward program goals (Standard 12.3L); recommendations based on after-action reviews (Standard 12.4L); and other QI efforts. Board members may be asked to attend and participate in meetings. Most recently a board member joined our council and has agreed to participate in the monthly meetings.ImplementationTo achieve goal 1, identify, review, monitor, and make recommendations on Quality Improvement (QI) projects, we maintained a reporting system (from divisions, administrative services, and other groups) on QI activities; reviewed data reports to identify potential QI areas; requested and reviewed additional information in identified areas for appropriate action; tracked and monitored data reports and outcome variances, and inquired about lessons learned; made recommendations to appropriate entities; compiled (and made available) information on all QI efforts/documentation.
To achieve goal 2, review the QI Plan at least annually and adjust as required, we obtained approval through Executive Team and engagement of Board of Health; reviewed plan annually and updated as necessary.
To achieve goal 3, identify and meet QI training needs, we solicited information from managers on needed QI training; identified QI training resources; and when identified in QI Plan, facilitated training as needed; and oriented Joint Management to the QI Plan.
To achieve goal 4, provid guidance, support, and resources to QI efforts, we created a “resource” list to access, disseminate, and support the process for QI efforts; informed all new and existing agency workforce members of QI process; identified and supported science-based methodologies.
To achieve goal 5, recognize and acknowledge QI efforts, we publicized QI stories; and submitted applications for broader acknowledgements of QI efforts through national and state entities.
The tasks are mostly ongoing processed through monthly meetings. Training is provided throughout the year in various venues, such as articles in newsletters, workshops, and one-on-one meetings with new managers. The 2009 Quality Council reporting calendar included the following tasks and dates: Administrative Responsibilities, September 2, 2008; Standards Review, November 4; After Action Reviews, February 18; Report to Board of Health, February or March; Customer Service (Training and Evaluation), November 4; HIPAA Compliance,- January 21; Division Reports Administration, June 3; Community and Family Services, July 1; Community Health Intervention and Prevention Services, May 6; Disease Prevention and Response, April 1; Environmental Public Health, March 4; Health Promotion, October 7; Laboratory, August 5; Quality Improvement Projects: Log maintains dates to report to QC; Strategic Plan Review, June 17; QC Evaluation, November 4; QI Plan Review and Annual Report, December 2; Report to Executive Team, Joint Management, Board of Health (January 2010).
Our forms were continually modified to clarify the information/data for which the council was asking. In some cases, the projects did not have a baseline to provide until after the project was over. Staff needed assistance on their projects. Improved reporting forms, more clarity provided to what the Quality Council was looking for, development of a project assistance program, and work to move projects to be more quantitative. The council revised the quality improvement plan to clarify sections and to update reporting dates. Minor plan changes were needed.
The Washington State Public Health Standards are currently being revised to reflect more of the national accreditation measures, which are strong in program evaluation and quality improvement. Our agency is committed to fulfilling the standards and eventually to moving to meeting accreditation. Sustainability will be driven by management and administrator commitment to allow staff to participate in the council and in quality improvement activities. The support is strong in the agency at this time.