The
National Public Health Improvement Initiative (NPHII), funded through the Prevention and Public Health Fund of the Affordable Care Act, has allowed the
District of Columbia Department of Health (DC DOH) and 73 other state, tribal, local, and territorial health departments to make fundamental changes and enhancements in their organizations and practices that improve the delivery and impact of public health services. Following initial quality improvement (QI) trainings in March and June 2012, the Public Health Foundation (PHF) caught-up with Heather Reffett, DC DOH Performance Improvement Manager, to find out how the early QI work is progressing.
Q: What initiatives did the QI training kick start?
We had three issues to address: we were not meeting the requirements for food safety inspections, we did not have a streamlined grants management process, and we lacked a department-wide QI plan. In the QI training, we broke into teams to work on these three issues. Since we applied the QI tools to timely and relevant projects, we were able to create a new sense of understanding and familiarity with them that will not soon be forgotten.
Q: Has leadership been supportive of the QI initiative?
The QI team presented its progress to the Health Department Director. He was very enthusiastic and started to suggest possible action steps. We had to explain that we were still in planning and not yet quite at the “Do” phase of the Plan-Do-Check-Act Cycle, but it was great to see his enthusiasm and have his support. He has asked the team to present at a senior staff meeting to ensure department-wide support for our current QI project as well as those in the future. In May 2012, the Director testified at FY 2013 City Council Budget Hearing and stated “[we are] committed to strengthening our QI efforts in order to strengthen the services we provide to the public.”
Q: How has leadership support changed the department?
Because we have senior leaders on-board with this initiative, employees are empowered to make changes and ask questions about challenging the status quo. Empowering employees is leading us towards a culture shift; people are talking about the benefits of QI and how they can utilize QI principles to address department-wide challenges, team-wide challenges, or individual daily challenges. By educating our employees and promoting the use of QI at all levels of the department, as well as actually building evidence of success, we are developing a culture of quality.
Q: What advice would you give to other health department employees who are beginning QI initiatives?
Many of us are highly organized planners who don’t want to start something without knowing how it will end. Quality improvement has weaned me from this desire and it has showed me that once I start the QI journey, the right people would be there to support me and give me the tools I need. I’ve learned to help foster discussion among team members so that they come up with the solution and they are empowered to make it work. I’ve spent more time building the capacity of my QI teams and checking on their progress than I imagined—but in return, they are owning the solutions and creating innovative ways to perform better. My biggest win was listening to one of our food inspectors give a presentation on accreditation and QI tools. It was reassuring to me to see my hard work paying off. I don’t feel alone anymore on this NPHII journey. This really is about the staff being educated and empowered to shape their department.
Q: What are three lessons that you’ve learned about QI?
1. QI is about changing processes and situations; not about changing people. I really had to learn to try and not control the outcome. As a performance person, I am always looking for products and results. In this experience, my focus has had to be on educating and supporting my teams so that they are successful in a way that is meaningful to them.
2. You just have to jump in and begin. QI should be started sooner than later; the only way to get good at this is through experience. This really is on-the-job training so start now because practice helps you figure everything else; it is not something to be done later.
3. Once you begin, you will have support from the people you are working with; they will surprise you with their buy-in, knowledge and enthusiasm.
PHF will be providing additional training to DC DOH in fall 2012 to educate more staff about QI tools and methods. To learn about more NPHII supported QI efforts, view examples from
Maine,
Alabama, and
Houston, TX.
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