Creating a Culture of Quality Improvement

Los Angeles County Department of Public Health

Division of Quality Improvement

Goal #1: Develop an understanding of what Quality looks like in Public Health

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Quality in Public Health is…

The degree to which policies, programs, services, and research for the population increase the desired health outcomes and conditions in which the population can be healthy

-PHQF, 2008

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Quality at LACDPH

Quality is the result of Worthy Work Well Done• Worthy= We must have a clear direction (Strategic

Plan)

• Work= Our work should have an intelligent direction based on evidence and best practices.

• Well Done= Our work should be carried out by a skilled and competent workforce and measured to track our performance.

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Goal 2: Develop a clear understanding of

Quality Improvement and why it is necessary

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Quality Improvement

• Quality Improvement (QI) is an integrative process that links knowledge, structures, processes and outcomes to enhance quality throughout an organization.

-National Committee for Quality Assurance

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Why QI?

• In a time of decreased funding and increased demand, QI can help answer key questions in public health: – Are we using our resources (staff, money, time) in

the best way?• We often hear “work smarter, not harder”

– Are we getting the intended outcomes?

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Are we actually improving the health of the public in the most

effective and efficient way possible?

And if not, how can we do it better?

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QA & QI -They are not the same!!!

Quality Assurance:

• Reactive; works on problems after they occur

• Regulatory• Led by management• One point at a time

Quality Improvement:• Proactive – works on

processes before problems occur

• Self-determined

• Led by staff

• Continuous

• Exceeds expectations

9Source: Public Health Foundation

3 Levels of Quality Improvement

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Topic Organization-Level Program-Level Individual-Level

Improvement  

System Focus Specific project focus Daily work level focus

Quality Improvement Planning 

Tied to the Strategic Plan

Performance Measures tied to program-level Strategic Plan 

Tied to yearly individual performance

Evaluation of Quality 

Responsiveness to a community need

Performance of a process over time

Performance of daily work

Processes 

Cut across all programs and activities

Delivery of a service Daily work

Quality Improvement Goals 

Strategic Plan Individual Program level Strategic Plans

Individual Performance Evaluations

Importance of Quality Improvement

Quality Improvement positions an agency to achieve:

o Customer satisfactiono Efficient use of resourcesoMeasurable outcomeso Community impact

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Goal #3

Connect staff with the benefits of Quality

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Quality in Public Health Benefits Everyone

• Customers/Clients

• Employees

• The Organization

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Benefits of quality to clients

• Improved services

• Improved choices

• Expectations met or exceeded

• Client oriented employees

• Friendlier atmosphere

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Benefits of quality to employees

• Pride in services delivered• Job satisfaction• Improved communications• Streamlined work processes• Happier clients • Strong client relationships

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Benefits of quality to the organization

• Improved/expanded services• Client oriented employees• Improved client relations• Improved community relations =

better political relations• Lower costs/cost contained• Improved funding

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Goal #4Develop a clear structure and

framework for quality management

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Continuous Quality Improvement Efforts

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Determine Priorities and Goals

1. What are the healthy behaviors and outcomes we want for people who live in LA County?

2. What would these conditions look like if we could see them?

SPA/SPA/ProgramProgram

Strategic PlanStrategic Plan

DPH Strategic Plan

County Strategic PlanCounty Strategic Plan

Performance Measures

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Results Based Accountability

AND

Public HealthMeasures

POPULATION INDICATORS(measures of population-level

health outcomes)

PERFORMANCE MEASURES(measures of program

effort and output)

Population Indicators

• Longer life span• Increased quality of life• Increased health equity• Less disease• Less premature death• Healthier choices• Safer environment• Healthier homes

POPULATION-LEVELHEALTH OUTCOMES

& BEHAVIORS

Population Indicators

• Percent of students who had at least one drink of alcohol in the past 30 days

• Rate of foodborne illness hospitalizations each year (per 100,000)

• Percentage of children covered by health insurance

• Death rate from colorectal cancer

Performance Measures

• Policies Created

• People Informed

• Improved Behaviors

• Surveillance Performed

• Investigations Completed

• Increased Access to Services

• Client satisfaction

MEASURES OF PROGRAM

EFFORT & OUTPUT

Performance Measures

• Percent of outbreaks (excluding scabies) investigated within standard timeframe

• Percentage of children under 6 years who participate in fully operational population-based [immunization] registries

• Number of cities that adopted a policy that prohibits smoking in outdoor areas

Reporting of Progress

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Performance Improvement Process

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Who Manages Quality at DPH?

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Who Manages Quality at DPH Everyone Plays a Role in Quality Management:•Director of Public Health•Division of Quality Improvement•Strategic Directions Council•Executive Team•Performance Improvement Team•Program Directors•Managers/Supervisors•All Staff

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In order to establish a lasting culture of Quality, you must:

• Have a clear direction of what quality should look like in your organization

• Understand Quality

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Goal #5:

Clearly communicate your Quality Improvement plan and efforts throughout the organization

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Step 1:• Create a Quality Improvement Program

Description Document – Give an overview of Quality at the organization

– Describe the structure for managing quality throughout the organization

– Establish roles and responsibilities for all levels of staff in relationship to Quality Improvement efforts.

– List and describe the organization’s QI efforts

– Establish QI goals for the organization

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Step 2: Train staff

• Introduction to Quality Improvement for all employees

• Incorporate QI into existing trainings

• Conduct orientation sessions to orient staff to the QI Plan

• Provide advanced QI training to prepare staff to conduct quality improvement projects

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Step 3: Provide Support

• Technical Assistance

• 1:1 Consultation

• Presentations at program-level meetings

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Summary• In order to establish a culture of quality, you

must first decide what quality in your organization will look like and communicate that vision to others

• The structure and process for quality improvement should be visible and easily understood by everyone in the organization

• Buy-in and support at all levels is essential to successfully establishing a culture of Quality

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Thank you!

Emily Peach, MPH, CHES

Performance Improvement Manager

Quality Improvement Division

(213) 989-7243

epeach@ph.lacounty.gov37