The Evolution of QI in North Carolina

1. The Evolution of QI in North Carolina Denise Pavletic RD, MPH Greg Randolph MD, MPH 2010 MLC Grantee Meeting Kansas City, Missouri

2. Challenges of Conducting QI in NC • Reporting structure of QI office/person • Being an “office of one” • Doing “little QI” (project specific) • Organizational culture assessment (i.e., using a tool such as The Baldrige Criteria) • Change in the way we “do business” as leaders • Running mini-collaboratives

3. Clarifying Terms • CQI • a structured organizational process for involving staff in planning and executing a continuous flow of improvements to provide quality that meets or exceeds the expectations of communities --adapted from: McLaughlin and Kaluzny, 2006

4. CQI • A link to the organization's strategic plan • A quality council made up of the organization's top leadership • Quality improvement training programs for staff • A mechanism for prioritizing quality improvement projects and launching quality improvement teams • Staff support and motivation for quality improvement activities --McLaughlin and Kaluzny, 2006

5. Mission : NC CPHQ will create an infrastructure to foster and support continuous quality improvement and learning among all pubic health professionals in North Carolina. Vision: All local and state public health agencies will have an embedded culture of continuous quality improvement that will help North Carolina become the healthiest state in the nation.

6. Partners The NC Center for Hospital Quality and Patient Safety The NC Division of Public Health

7. Staff Denise Pavletic, RD, MPH, ASQ-CQIA, ASQ-CMQ/OE Senior Quality Improvement Advisor Division of Public Health (DPH) Andrea Cordova, BA Program Coordinator Amanda Cornett, MPH Associate Director Greg Randolph, MD, MPH Director

8. Three-Year Goals • Creating and engaging state and local quality councils • Training for more than 50 local health department teams and 5 NCDPH teams • Providing ongoing technical assistance for QI teams • Launch 2 strategic statewide quality initiatives • Creating a NCDPH and statewide local health agency dashboard of quality measures • Creating a robust website for state and local staff with improvement modules, tools, and EB practices • Celebrating successful improvement teams and efforts

9. Progress to Date • Reporting to DPH Deputy Director and DMT member • Advisory board and quality councils operating • Trained 53 leaders and 10 frontline staff at DPH and 20 frontline staff and managers at local level • New wave of training this month for 45+ local frontline staff and managers plus 5 NCs • Supporting NC MLC mini-collaboratives • Developing website and resources • 30+ Stakeholder interviews • Created evaluation plan • Enacting communication plan

10. Lessons Learned Facilitators • Doing stakeholder interviews at state and local level critical • Relationship building • Learning • "Practice what we preach" – doing lots of tests (PDSA) • Interest in QI is high in local agencies • Successful projects can lead to interest in CQI among leaders • ROI and/or efficiency can be big motivators • Public health professionals want to see public health examples

11. Lessons Learned Barriers • This work is a huge undertaking • Be flexible and build on successes • Partners are critical • Build on existing resources • Confusion about QI, esp. vs. QA and accreditation

12. What would we do differently? • Report to top leadership and engage them from beginning • Identify resources to provide adequate FTEs and strong QI expertise • Organizational culture assessment (i.e., using a tool such as The Baldrige Criteria) • Communicate, communicate, communicate

13. Where do we go from here? • Integration with local accreditation • Focusing on two priority health conditions in our state • Funding for statewide initiatives to address priority health conditions using QI • Expanding QI efforts at state (NCDPH) level • Expanding and growing our partnerships