The Evolution of QI in North CarolinaThe Evolution of QI in North Carolina

Denise Pavletic RD, MPH

Greg Randolph MD, MPH

2010 MLC Grantee MeetingKansas City, Missouri

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

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

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

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.

The NC Center for Hospital Quality and Patient Safety

The NC Division of Public Health

PartnersPartners

Staff

Andrea Cordova, BAProgram Coordinator

Amanda Cornett, MPHAssociate Director

Denise Pavletic, RD, MPH, ASQ-CQIA, ASQ-CMQ/OESenior Quality Improvement AdvisorDivision of Public Health (DPH)

Greg Randolph, MD, MPHDirector

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

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

Lessons LearnedFacilitators • 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

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

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

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