Getting Started
The Public Health Improvement Resource Center (PHIRC) website provides resources and tools for evaluating and building the capacity of public health systems. More than 100 accessible resources organized here support the initiation and continuation of quality improvement efforts. These resources promote performance management and quality improvement, community health information and data systems, accreditation preparation, and workforce development.
The Quality Improvement Quick Guide
In August 2010, PHF released a free web-based Quality Improvement (QI) Quick Guide to help public health practitioners in determining which resources to use as they pursue QI initiatives within their organizations. The QI Quick Guide consists of a QI User Guide and a Tutorial, which both link to a personalized selection of resources based on assessments and topics presented in the slides. Both tools provide a gateway to hundreds of resources linked from PHF’s Online Resource Centers — the Public Health Improvement Resource Center and the National Public Health Performance Standards Program Online Resource Center. Contact us at PHF_Resources@phf.org to share your comments or suggest a resource.
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Recent QI Books
Quality Function Deployment & Lean Six Sigma Applications in Public Health
The newly released book entitled Quality Function Deployment & Lean Six Sigma Applications in Public Health, developed by PHF Consultants Grace L. Duffy, John W. Moran, and William Riley, is designed to help public health agencies implement quality improvement while using limited resources. It introduces the concepts embedded in Quality Function Deployment (QFD) and Lean Six Sigma to help you in the implementation of quality improvement within your agency. The tools and techniques explained in this book provide insights into customer needs and wants, the design and development of customer-centric processes, and mapping value streams.
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Building on the success of our Public Health Memory Jogger, PHF in partnership with the American Society for Quality released The Public Health Quality Improvement Handbook in May 2009. The Handbook, with contributions from many of our public health colleagues, contains 28 chapters chock full of QI stories, tools, methods, and practical applications in public health. The Handbook is being offered at a 25 percent discount through PHF’s online store. This is a limited time offer, so please spread the word among your colleagues.
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Recent QI Articles
White Paper Written on Utilizing the Advanced Tools of Quality Improvement
Quality Improvement Authors Highlighted in Quality Newsletter
The Mid-State Health Center Quality Improvement Case Study
“Modified Approach” Article Promotes Lean Processes and Identifies Lean Wastes
The ABCs of PDCA
Team Chartering Article Published in April, 2010 Quality Texas Foundation Update
Team Chartering
20 Questions to Ask Your Teams
Team Process Review Checklist
The Public Health Quality Improvement Handbook Learning Tool Included in American Society for Quality’s Healthcare Update
Force and Effect Diagram Guides Team through Addressing Barriers
SIPOC+CM Diagram Offers High-Level View of “As Is” State of a Process Under Investigation
Flow Chart Summary Matrix
Utilizing the Advanced Tools of QI to Solve Problems: Understanding the Challenges Public Organizations Will Face in 2010
Using Tools to Make a Difference in H1N1 Flu Immunization Clinics
Authors Featured in Journal of Public Health Management and Practice
Northern Kentucky Health Department Quality Improvement Success
Review, Refresh, and Revitalize: Your Pandemic Flu Plan for Fall 2009
The Continuum of Quality Improvement in Public Health
Ready, AIM, Problem Solve: Focusing/Issue/Problem Statements – A QI Initiative
TAPP into the PDCA Cycle to Make Improvements in Public Health
Rapid Cycle PDCA
Quality Texas Foundation Update
The Thirty Pitfalls of Strategic and Operational Planning And How To Overcome Them
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White Paper Written on Utilizing the Advanced Tools of Quality Improvement
Ron Bialek, John W. Moran, and Louise Kent, Planning Administrator for the Northern Kentucky Independent District Health Department, conducted an interactive workshop for 100 participants on “Utilizing the Advanced Tools of Quality Improvement to Leverage the Power and Reach of Public Health” at the NACCHO 2010 Annual Conference. Their information is available in this white paper that introduces advanced QI tools and their uses in the public health arena. The advanced tools of QI are designed to deal with complex issues in a manner which guides those analyzing the issues to focus on hidden interrelationships that are not obvious without detailed analysis.
Quality Improvement Authors Highlighted in Quality Newsletter
John W. Moran and Grace Duffy wrote an article entitled “Starting and Sustaining a Complete Quality System” that was featured in the August 2010 Quality Texas Foundation Update. The article describes a complete quality system and focuses on the processes that need to be in place to maintain consistency in quality. It introduces the use of an improvement model and focuses on the importance of assessing customer needs. Leadership buy-in is crucial for a quality improvement initiative to work in starting and sustaining this system.
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The Mid-State Health Center Quality Improvement Case Study
The Mid-State Health Center Quality Improvement Case Study by Sharon Beaty and John W. Moran shows how QI tools and techniques can be applied in a Federally Qualified Health Center (FQHC) Look-a-Like. The two quality improvement projects highlighted in this case study are obtaining a behavioral health authorization before the patient leaves, scheduling dual appointments for INR and clinician visit, and providing seamless check-ins and pre-examinations for patients scheduled for more than one appointment. This case paper shows how the PDCA cycle can be applied in a clinic.
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“Modified Approach” Article Promotes Lean Processes and Identifies Lean Wastes
“Modified Approach,” written by John W. Moran and Grace L. Duffy, will be included in the August 2010 edition of the Six Sigma Forum Magazine. This article presents the goal of a lean culture: “to build a better, faster, more efficient and streamlined process.” The article shows work flow processes and demonstrates areas where challenges may arise and how those challenges may be overcome. The authors identify lean wastes with pertinent examples for the public health field. These authors show knowledge and understanding of the obstacles faced by public health professionals in planning for the future as well as meeting everyday challenges.
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The ABCs of PDCA
“The ABCs of PDCA,” by Grace Gorenflo and John W. Moran, provides a wonderful introduction to quality improvement through the Plan-Do-Check-Act cycle (PDCA). This quality improvement tool offers a solid foundation for and introduction to quality improvement for public health departments. As noted in the article, “the Public Health Accreditation Board (PHAB) has a voluntary accreditation program that emphasizes the importance of quality improvement and has catalyzed health department activity in this arena.” The article further offers a clear definition of quality improvement as it relates to public health.
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Team Chartering Article Published in April, 2010 Quality Texas Foundation Update
“Team Chartering,” written by John W. Moran and Grace L. Duffy, was published in the April, 2010 edition of the Quality Texas Foundation Update. The article focuses on the idea that “teams are formed with the understanding that improved quality can be achieved using the skills, talents, and knowledge of appropriate individuals.” Process Improvement Teams are utilized to create or improve a specific business process. Developing a draft Team Charter is an important first step in the construction of effective Process Improvement Teams.
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Team Chartering
A Team Charter provides the start-up direction a team needs to be successful in tackling the task it has been assigned. Too often teams spend a considerable amount of their valuable resources figuring out what they are supposed to do. A well developed Team Charter can save an enormous amount of time and reduce confusion for a team by defining clear goals, expressed duties, and desired outcomes.
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20 Questions to Ask Your Teams
Too often teams struggle and fail because of unclear performance expectations that management has of teams. It's not hard to find a "disconnect" between how teams view themselves and how managers and supervisors view the team. This questionnaire can help you identify the expectation gaps between reality and organizational views of team performance.
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Team Process Review Checklist
The Team Process Review Checklist covers the essential items that need to be in place for launching a team. It is designed to give the team sponsor and team leader a list of essential items that need to be considered at the startup of a team and during the team’s life cycle. The team leader and sponsor should review the checklist at their regular update meetings to ensure they are considering the essential items needed for a successful team.
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The Public Health Quality Improvement Handbook Learning Tool Included in American Society for Quality’s Healthcare Update
In the March issue of ASQ’s Healthcare Update, the “Spaghetti Diagram” was publicized as a useful quality improvement learning tool. A spaghetti diagram is “a visual representation using a continuous flow line tracing the path of an item or activity through a process. The continuous flow line enables process teams to identify redundancies in the work flow and opportunities to expedite process flow.” The information about this learning tool was excerpted from The Public Health Quality Improvement Handbook.
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Force and Effect Diagram Guides Team through Addressing Barriers
The new quality improvement tool created by Grace Duffy and Jack Moran is called the “Force and Effect Diagram” and is described in the article entitled “Force and Effect Chart Guides Team Through Addressing Barriers.” This tool helps teams who are completing AIM statements by combining steps and then using the result in developing cause and effect headers. Combining force field analysis with a cause and effect diagram has led to a new useful tool.
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SIPOC+CM Diagram Offers High-Level View of “As Is” State of a Process Under Investigation
The SIPOC+CM Diagram, included in The Public Health Quality Improvement Handbook, is a learning tool publicized by the American Society for Quality. It is a data collection form that assists in gathering information about suppliers, inputs, processes, outputs, and customers of a process and is used when first investigating a process and when a team needs a way to record collective knowledge about a process in a user-friendly format. It helps to identify the process under study and define the process boundaries so that everyone involved understands the limits of the analysis.
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Flow Chart Summary Matrix The Flow Chart Summary Matrix is a quality improvement tool that helps those individuals who have constructed a flow chart understand variables at each process step that could impact changes in costs, time, or people. A comparison of actual and proposed costs indicates whether the process change is an improvement and by how much. It takes data analysis to develop a value for each part of the matrix. The effort to complete the matrix gives a problem-solving team a far deeper understanding of the process under study.
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Utilizing the Advanced Tools of QI to Solve Problems: Understanding the Challenges Public Organizations Will Face in 2010 The advanced tools of QI are designed to deal with complex issues by focusing on hidden interrelationships that are not obvious without detailed analysis. This detailed analysis guides away from the simple answer and into a process of continual refinement of the issue. To make the best possible decisions, information analysis is crucial; the advanced tools of QI help to synthesize and refine information to focus on the critical pieces before developing potential solutions in the public health arena.
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Using QI Tools to Make a Difference in H1N1 Flu Immunization Clinics
Experts have written a paper about successful H1N1 Flu Immunization Clinics, citing a clear example of quality improvement practices introduced and implemented by the Northern Kentucky Independent District Health Department with assistance from PHF. As a result of the work with this program, the Health Department has become an example of quality in its efficiency and effectiveness in serving public health needs, specifically in preventing the spread of H1N1. The Health Department, engaged in a quality improvement Exemplar program with PHF, shows continued momentum in its success as a positive introduction to quality improvement practices in public health.
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Authors Featured in Journal of Public Health Management and Practice
Les Beitsch, John Moran, and William Riley are guest editors as well as authors of articles such as “Quality Improvement in Public Health: Where Are We Now?” that are featured in the January/February 2010 Special Edition on Quality Improvement of the Journal of Public Health Management and Practice. The journal focuses on the current and future states of QI in public health. These authors provide current information regarding issues that affect quality improvement in public health and processes that can serve to implement effective change.
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Northern Kentucky Health Department Quality Improvement Success
Dr. Les Beitsch and John W. Moran provided extensive quality improvement technical assistance to the Northern Kentucky Health Department in September 2009 as part of PHF’s Exemplar program. The health department was featured in an editorial in Cincinnati, Ohio’s Business Courier on Monday, November 30, 2009 as an example of how to improve quality processes and systems designed to benefit public health and how QI can work wonders in practice. Dr. Beitsch and Mr. Moran have helped this health department with rapid cycle improvement, customer satisfaction surveys, and the use of the stop/start/continue matrix. After every H1N1 clinic, the health department reviewed its processes and data and made improvements for the next clinic. The Kentucky state health department is exemplifying their work as a model for quality improvement in public health.
Ms. Louise A. Kent, Planning Administrator for the Northern Kentucky Health Department states, “Receiving compliments from your customers is always a pleasing experience. Discovering that someone took the time to have those compliments published so others can read them takes that praise to a higher level. Putting the pandemic flu plan into action at the Northern Kentucky Health Department kindled aspirations for success as well as a watchfulness for anything that didn’t go as originally planned. When these public health professionals used QI tools to make ongoing improvements during their H1N1 community flu clinics, the results were captured by a satisfied customer – a local newspaper reporter.”
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Review, Refresh, and Revitalize: Your Pandemic Flu Plan for Fall 2009
Preparing for the 2009-2010 H1N1 flu season might seem like a foreboding task without the correct tools and knowledge. Quality improvement practices promote efficiency and effectiveness in strategically planning for and implementing programs that address public health problems. This white paper provides crucial information about ways in which you can use quality improvement methods and tools to improve your community’s pandemic flu plan.
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The Continuum of Quality Improvement in Public Health
"The Continuum of Quality Improvement in Public Health,” co-authored by PHF quality improvement consultants Jack Moran, Grace Duffy, and Bill Riley, was recently published in the Quality Management Forum, a Peer-Reviewed Publication of the Quality Management Division of the American Society for Quality. The article addresses the benefits of an overall approach to building an improvement culture. It is necessary not only to change the details in smaller processes practiced by individuals but also to change systemic processes that hamper flow of efficient work practices. It takes time and talent to accomplish the continuum, but the rewards are more than worthwhile.
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Ready, AIM, Problem Solve: Focusing/Issue/Problem Statements – A QI Initiative
Narrowing a problem statement to a discrete issue promotes a focus for effectively applying QI tools. A lack of focus on real issues can cause a loss of valuable problem-solving time. The October, 2009 edition of the Quality Texas Foundation newsletter includes an article on this quality improvement process. Written by the Public Health Foundation’s quality improvement consultants, Jack Moran, Grace Duffy, and Les Beitsch, it provides valuable information on how to create and maintain focus on the relevant problems and implement processes to solve them.
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TAPP into the PDCA Cycle to Make Improvements in Public Health
This article, written by PHF’s Senior Quality Advisor, Jack Moran, and quality improvement experts Grace Duffy and William Riley, describes how to improve the management of public health processes through setting performance targets, measuring key quality characteristics, and monitoring processes. The target, act, process and performance (TAPP) and plan, do, check, act (PDCA) cycle integration model can assist with detecting shifts or sudden changes that may cause a deviation from the process performance target that has been set. It also can assist with closing the gap in performance one may encounter between the observed process performance and the actual performance. Read more….
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Rapid Cycle PDCA
Rapid Cycle PDCA (Plan-Do-Check-Act) is the act of applying the recurring sequence of PDCA in a brief period of time to solve a problem or issue facing a team or organization in order to achieve breakthrough or continuous improvement results quickly. PDCA should be repeatedly implemented in spirals of increasing knowledge of the system to converge on the ultimate goal, each cycle closer than the previous one. This process was implemented in Texas with the Quality Texas organization and is publicized in the Quality Texas Foundation Update of August, 2009.
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Quality Texas Foundation Update
Use of the Rapid Cycle PDCA model is noted in the Quality Texas Foundation Update for August, 2009. The article shows reasons for using the model as well as ways in which the model can be used effectively toward the improvement of public health programs. Rapid Cycle PDCA works in progressing quality improvement in public health processes.
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The Thirty Pitfalls of Strategic and Operational Planning And How To Overcome Them
“The Thirty Pitfalls of Strategic and Operational Planning And How To Overcome Them,” written by Jack Moran, introduces in a very relatable way the many ways in which organizational planning can be derailed, postponed, or sabotaged. Take a moment to read this enjoyable article about ways in which strategic and operational planning can be affected negatively in order to be aware of what to avoid during the planning process. See if you can identify with any of the pitfalls in your own planning attempts.
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Memory Jogger II
 PHF partnered with a leading performance improvement organization, GOAL/QPC, to develop a quality improvement pocket guide, The Public Health Memory Jogger II. This pocket guide contains 22 quality control and management and planning tools, with real-life examples that relate specifically to public health. The Jogger uses graphics and easy-to-understand text to show how and when to use these tools to improve performance. Since its publication in mid-2007, over 4,000 copies of the Jogger have been sold. One of PHF’s partners, NACCHO, has provided Joggers to most of its members and requested that PHF provide technical assistance and training to local health departments using the Jogger as the main “text” for this training and assistance. Click here for more information on how to order.
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Turning Point: Performance Management Project and Publications
Public health systems can save lives, cut costs, and get better results by managing performance. PHF has collaborated with the Turning Point Performance Management National Excellence Collaborative since 2000 to study how organizations manage performance and to develop a series of publications to help public health organizations better understand and apply these techniques.
The performance management resources below are available online or may be ordered in print from the PHF Online Store at (877) 252-1200.
- From Silos to Systems: Using Performance Management to Improve the Public’s Health (PDF)
 This guide is essential reading for anyone who wants to achieve better results throughout their organization or public health system. Using an easy-to-understand model designed by the Turning Point Performance Management National Excellence Collaborative (PMC) for public health agencies, this guide explains the benefits, practical applications, and four components of performance management: 1) performance standards, 2) performance measurement, 3) reporting of progress, and 4) a process for improvement. Geared for busy leaders, this compact guide will give your management team or board an understanding of what it takes to start managing performance.More info, order print copies
- Performance Management in Action: Tools and Resources (online only)
This March 2004 toolkit aims to assist state health agencies and others in implementing the four components of the PMC's performance management model. It includes sample performance improvement plans, standards and measures, reports, and other helpful documents from public health agencies. The links in this toolkit are accurate as of March 2004 and are no longer being updated. To access more up-to-date resources, visit this searchable database.
- Performance Management Self-Assessment Tool (online only)
This self-assessment tool will help you and your team identify the extent to which you have components of a performance management system. Developed by and for public health agencies to aid their performance improvement efforts, this tool is organized around each of the four components of performance management identified in the PMC's model. The four components are 1) Performance Standards, 2) Performance Measurement, 3) Reporting of Progress, and 4) Quality Improvement Process.
- Guidebook for Performance Measurement
This user-friendly guidebook covers all the basics of performance measurement in public health. It offers useful definitions, worksheets, and methods to help your team select performance measures and set objectives, and involve internal and external stakeholders in the process. More info, order print copies
- Selected Literature of Performance Management
This time-saving review highlights some of the most influential articles, books, and other references on performance management from the public health, business, government, education, and non-profit sectors. More info, order print copies
- Survey on Performance Management Practices in States
This report presents results of the PMC's baseline survey of state health agency practices in performance management. It characterizes the types of performance that agencies manage, the frameworks they use, and the outcomes they report as a result of their efforts. More info, order print copies
- Performance Management Case Studies (online only)
These case studies illustrate performance improvement efforts in five states. They are designed to help public health professionals gain a better understanding of how to implement the four components of the PMC model. Each case study includes discussion questions for use as a learning tool in trainings and team meetings.
For more information about this project please contact Jacalyn Carden.
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EZ/EC Project Findings and Tools on the Web
Building Healthy RC/EZ/ECs
Information and Tools to Link Health Improvement to Economic and Community Development
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EZ/EC Health Planning Capacity Survey: Final Report, a report providing results of the survey that assessed EZ/EC efforts to improve health, their interest and capacity to undertake health improvement planning, and what types of assistance could help EZ/ECs better address health as part of their economic revitalization efforts.
Improving Health in Empowerment Zones and Enterprise Communities: Lessons Learned from the EZ/EC Health Benchmarking Demonstration Project, a report highlighting 12 lessons learned, opportunities, and challenges of undertaking a community health improvement process.
Tools and Resources from the Empowerment Zone/Enterprise Community (EZ/EC) Health Benchmarking Demonstration Project, a compilation of the tools and resources used.
For more information, please e-mail Ron Bialek.
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