Continuous Quality Improvement: An Institute’s Experience in Creating Quality
Improvement Projects
New Orleans, LA • May 22, 2012
Catherine ShoultsGianfranco Pezzino
Kansas Health Institute
What To Expect From ThisPresentation
! An example of application of qualityimprovement principles
! A new way to look at grant process
! Pointers for integrating QI in routinepublic health practice
In the Beginning…
Immunize
Kansas KidsCoalition
QualityImprovement
Efforts(MLC)
Immunize Kansas Kids
Goal: Protect every Kansas child fromvaccine-preventable diseases
Multistate Learning Collaborative
Goal: Improve public health services byimplementing quality improvement practices
Immunizations Plus QualityImprovement
Immunize
Kansas KidsCoalition
QualityImprovement
Efforts(MLC)
IKK QI
Projects
+
QI Project Goals! Goals:
" Improve immunization practices
" Disseminate Plan-Do-Study-Act cycleand QI Culture
! Public and private immunizationclinics targeted
Project Details! Project grants range from $5,000-
10,000 " Funded by Kansas Health Foundation
! Up to 10 projects awarded! Project completed in 12 months
" All projects are currently active
Eligible Organizations ! Must deliver immunization services OR! Must coordinate or support vaccination
activitiesProjects can be submitted jointly as a
partnership between providersor as an effort by a public health
preparedness region
Use of Project Funds! Direct and personnel costs for:
" Improvements in vaccination activities• Change workflow to improve efficiency• Create reminder system for parents
" Marketing campaign targeted to specificat-risk populations• Increase parental awareness of vaccines• Explain vaccine importance/safety
Marketing of Projects! Sent RFP to stakeholders
" KDHE Community Health Bureau" KS AAP and AFP
! Outreach efforts" Booths at conferences" Webinar" Website
! IKK Partners
IKK Projects Must Do theFollowing
! Use PDSA cycle! Incorporate evidence-based
practices! Include measurable objectives! Include evaluation measures
Institute for Healthcare ImprovementPlan-Do-Study-Act Cycle
! What are we trying to accomplish?
! How will we know that a change is animprovement?
! What changes can we make that willresult in improvements?
Preliminary QI ProposalProcess
Request forProposals
Receiveand ReviewApplication
ApproveProposal
RejectProposal
Current QI ProposalProcess
Request forProposals
ReceiveApplication
ApproveProposal
ProvideTechnical
Assistance
ApplicantMakes
Changes
ReviewProposal
Project One! Application rewrite: Determined root
cause, integrated PDSA model! End product: Improve full coverage
of vaccines in preschools! Surprise: Fully integrated PDSA
Project Two! Application rewrite: Major limiting of
scope, integration of QI and PDSA! End product: Try multiple reminder
and recall systems! Surprise: Major changes from initial
proposal to approved project
Project Three! Application rewrite: Determine root
cause, proof texting is best solution! End product: Use texting to remind
parents to come in for vaccinations! Surprise: Research based
interventions lend themselves to QI
Project Four! Application rewrite: Root cause
analysis! End product: Integrate immunization
nurse into WIC clinic! Surprise: Embraced root cause
analysis and created multiplepossible solutions
Project Five! Application rewrite: No rewrite!! End product: Target policy
change??? ‘may vs. shall’! Surprise: Well-versed in QI so
wanted to do improvement instead ofsolution
Wait, Isn’t That QI?
QualityImprovement
for KHI!
QualityImprovement at
the Project Level
KHI PDSA – What We Have Learned
! Applicants don’t immediatelyunderstand QI projects
! Application process of normal grantdoes not suit QI projects
! Most work in proposal stage! Applicants need help with root cause
analysis! KHI internal processes can be slow
KHI PDSA – Solutions
! Next QI projects will have twophases" May integrate projects into larger grant
! Midterm report gave feedback area" Need to shorten our internal approval
processes! Documented lessons learned
throughout the process" Used OneNote to track the process and
find bottlenecks
One Of Our Best LessonsLearned Has Been…
QI Is Infectious!
Take Away Messages! Process of approving proposal was
great learning opportunity:" For the applicants
" For the reviewers
! New-to-QI folks learn quickly
! Old-to-QI folks try new approaches(and keep learning!)
! You may already be doing QI!
Conclusions! Integrating QI into ongoing activities
is possible AND beneficial ! Be flexible
! Practice what you preach
Information for policy makers. Health for Kansans.
Kansas Health Institute
Photo Citations! Slide 4 and 5: KALHD emblem, http://www.kalhd.org/! Slide 4 and 5: KDHE emblem, http://www.kdheks.gov/! Slide 12: PDSA cycles,
http://health.state.tn.us/MCH/MedicalHome/improvement.shtml! Slide 16: 30 Mini colorful envelopes,
http://www.etsy.com/listing/53015608/30-mini-multi-colored-envelopes! Slide 21: PDSA cycles,
http://health.state.tn.us/MCH/MedicalHome/graphics/plan_do_study_act.png! Slide 24: Woman Sneezing,
http://www.guardian.co.uk/science/2008/dec/19/reproduction-neuroscience
