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Session Title: Evaluating Quality Improvement Projects in Public Health Departments: Lessons From the Robert Wood Johnson Foundation's Quality Improvement Collaborative
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Panel Session 881 to be held in Lido C on Saturday, Nov 5, 9:50 AM to 11:20 AM
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Sponsored by the Health Evaluation TIG
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| Chair(s): |
| William Riley, University of Minnesota, riley0011@umn.edu
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| Discussant(s):
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| Brenda Henry, Robert Wood Johnson Foundation, bhenry@rwjf.org
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| Elizabeth Lownik, University of Minnesota, beth.lownik@gmail.com
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| Abstract:
Quality improvement (QI) is an increasingly important competency for local health departments, and multiple initiatives are currently taking place to implement QI projects health departments around the country. As this work continues, evaluation of these QI projects is an essential component to assess success and elucidate lessons for QI implementation and scaling up in public health departments around the country. The Robert Wood Johnson Foundation funded a collaborative of 13 public health departments across the country to implement QI projects and to hire evaluators to begin the important work of assess the projects and compiling information for dissemination. This session brings evaluators from several of the projects in this collaborative to present their findings regarding how to evaluate Quality Improvement projects in local health departments.
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Evaluating a Family Planning Quality Improvement Project: Lessons Learned
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| Kelli Kenison, University of South Carolina, kenison@mailbox.sc.edu
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| Doug Taylor, South Carolina Department of Health and Environmental Control, taylordj@dhec.sc.gov
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The South Carolina Department of Health and Environmental Control (SC DHEC) conducted a quality improvement (QI) project in two of its local health department family planning clinics. The goals were to increase caseload, improve customer satisfaction, increase staff satisfaction, through the use of a QI training and support used in combination with a CDC software-supported system called WinPFA. Quality improvement consultants provided training and technical assistance to staff in the two intervention family planning clinics. The evaluation was designed to document delivery, reach, and impact of the Quality Improvement Intervention and included two comparison family planning clinic sites. In this presentation, the evaluators will share the qualitative and quantitative evaluation measures used and the numerous lessons learned about the process of evaluating Quality Improvement projects in health department clinic settings.
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Improving the Efficiency of Local Public Health Using Quality Improvement Processes: Small Change Yields Significant Success in Berrien County, Mi
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| Theresa Green, Berrien County Health Department, tgreen@bchdmi.org
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| Angela Martin, Michigan Department of Corrections, martina3@michigan.gov
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In collaboration with Robert Wood Johnson Foundation, the Berrien County Health Department (BCHD) completed an eighteen month initiative to explore whether purposeful continuous quality improvement would increase efficiency and quality in public health delivery. Specific focus areas were the Children Special Health Care Services (CSHCS) and Environmental Health Food Inspections Service.
BCHD employed the Institute for Healthcare Improvement's Model for Improvement as the framework for our CQI intervention. The evaluation has assessed both processes and outcomes using static analysis including comparison measures but also dynamic analysis including trend lines and run charts to examine process variation.
Findings show that initiating continuous quality improvement interventions yielded significant improvements in both efficiency and quality in two unique service areas that far exceeded expectations. Through CQI efforts, health departments are better equipped to serve their clients, and to keep people safe from health threats thus improving the health of a community.
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The Engineer, the Evaluator, and the Epidemiologist: An Evaluation of a Six Sigma Intervention in a Public Health Clinic
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| Sarah Stawiski, Center for Creative Leadership, stawiskis@ccl.org
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| Tracy Patterson, Center for Creative Leadership, pattersont@ccl.org
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| Emily Hoole, Center for Creative Leadership, hoolee@ccl.org
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In 2009, The Center for Creative Leadership, the Guilford County Department of Public Health and NC A&T University partnered on a project to evaluate the effectiveness of Six Sigma for process improvement within the clinics. Of particular interest to the evaluation was how leadership culture within a public health setting may help or hinder successful implementation of Six Sigma. Additionally, the evaluation provided real-time data to the team including key stakeholders' attitudes and knowledge about QI, perceptions of health department leadership, and patient and employee satisfaction. In addition, the evaluation documented broader successes and challenges of implementing a QI effort in a public health setting. This project provides insight about the effectiveness of implementing Six Sigma in a healthcare setting, leadership culture and its relationship to QI success. This session would benefit anyone interested in better understanding and measuring context as a key variable in process improvement efforts in healthcare.
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Implement Performance What?: Strategies for Launching a Quality Improvement Learning Collaborative in a Large Urban Health Department
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| Dawn Jacobson, County of Los Angeles Department of Public Health, djacobson@ph.lacounty.gov
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| Debra Lotstein, RAND Corporation, lotstein@rand.org
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The Los Angeles County Public Health Department established an internal learning collaborative to implement multiple ongoing quality improvement (QI) projects. Teams from eight divisions worked together for ten months to apply QI methods to a priority issue unique to their division. A participant self-assessment (n=25) showed 90% of participants are likely/very likely to use QI methods in future work and nearly 80% believe their team was successful/very successful in achieving their project aims. One quarter of participants wanted more training and coaching and no participants thought there was too much training or coaching. These results confirm the feasibility of introducing a formal QI approach in a collaborative setting for a diverse group of public health staff through interactive group learning sessions and team specific coaching sessions. A higher intensity of coaching may be needed initially, which may decrease over time as department staff becomes familiar with QI methods.
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Summative Evaluation Results for a Local Public Health QI Initiative to Improve Immunization Rates
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| William Livingood, Georgia Southern University, william_livingood@doh.state.fl.us
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| Radwan Sabbagh, Duval County Health Department, radwan_sabbagh@doh.state.fl.us
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A Plan-Do-Study-Act (PDSA) approach to Quality Improvement (QI) was applied to a county health department (CHD) with particularly low 4/3/1/3/3/1 series immunization rates (75%) for children, 19 to 35 months old. The Duval CHD launched a RWJF supported QI evaluation to demonstrate the benefits and lessons learned from implementing QI processes in June, 2009. Our evaluation employed a Mixed Method Participatory Design involving: 1) quantitative data on immunizations and factors influencing immunizations, and 2) qualitative data including observations of staff engaged in QI activities and interviews of staff. A pilot clinic, the lowest performing CHD clinic (74% rate) at the start of the project, exceeded over-all CHD performance within four months and exceeded the target (90%) in less than 18 months. The overall CHD rate exceeded 85% within 18 months and is on target to exceed 90% by 2 year anniversary. Lessons learned and insights will be discussed.
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Evaluation of a QI Initiative in an Urban Health Department: Challenges and Lessons Learned
| Courtenay Kessler, University of Wisconsin, Madison, courtenay.kessler@aurora.org
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| Geoffrey Swain, City of Milwaukee Health Department, gswain@milwaukee.gov
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In collaboration with the Robert Wood Johnson Foundation, the City of Milwaukee Health Department and the Center for Urban Population Health have partnered to implement and evaluate a quality improvement initiative focused on improving the outcomes and effectiveness of school-based immunization clinics. The project focused on standardizing procedures through process mapping and developing common data collection tools, and implementing and evaluating several interventions aimed at increasing parental consent rates through rapid Plan-Do-Study-Act (PDSA) cycles. Evaluation embedded within the PDSA cycles ("Study") examined processes and outcomes related to the specific interventions. More broadly, the evaluation team evaluated changes in staff attitudes and beliefs about QI, as well as challenges and lessons learned related to implementing and integrating a QI approach within a local health department. The presentation will review the roles of both embedded, rapid evaluation ("Study") and the broader (systemic) evaluation of this QI initiative.
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