1. health and fitness

Convening the Community of Practice for
Public Health Improvement (COPPHI)
O P E N FORU M for
QUA L I T Y I MP ROV EM EN T in Public Health
March 19–20, 2015
San Antonio, Texas
#COPPHI
M A R C H 19, 201 5
Welcome to the Open Forum for Quality Improvement in Public Health, the
eleventh national meeting on accreditation and quality improvement hosted
by the National Network of Public Health Institutes (NNPHI), with support
from the Robert Wood Johnson Foundation.
We are delighted you have joined us in San Antonio to learn, and share
experiences, resources, and tools among a broad range of stakeholders in the
field of public health performance improvement. We extend a warm welcome
first time attendees and returning colleagues alike as we continue to strive for
growth and improvement and facilitate collaboration across the field.
The voluntary accreditation movement, which incorporates QI as its foundation,
continues to gain ground with the successful accreditation of 67 state and
local health departments in 26 states and the District of Columbia to date.
The Open Forum is an important part of the Community of Practice for Public
Health Improvement (COPPHI), which facilitates the exchange of best practices
and builds momentum for accreditation and ongoing QI among the nation’s health departments
and key partners. We designed this meeting to advance promising practices in accreditation and QI,
with the ultimate aim of strengthening contemporary public health practice.
In this Open Forum, you have the opportunity to see the innovative tools and resources that
practitioners across the country are using to advance public health improvement efforts. We are
fortunate to welcome two leaders who spearheaded successful voluntary accreditation efforts in
their respective state health departments; we will continue to look forward at challenges coming
down the pike with perspectives on the future of financing public health as well as the context in
which public health may operate in 2030.
We hope you will actively take part in the meeting’s sessions and other opportunities to connect
and share with colleagues. We are confident that you will find our newly implemented practices
supporting healthy and responsible network learning events, including our move to paperless
meeting materials, positive and enriching. During the meeting and after, we encourage you to share
examples of your quality improvement work on the Public Health Quality Improvement Exchange
(PHQIX), an online communication hub for practitioners interested in learning and sharing quality
improvement information.
We look forward to another successful Open,
President & CEO
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
Hyatt Regency San Antonio
F LOOR PLA N
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Rio Grande
Ballroom
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123 Losoya Street
San Antonio, TX 78205
USA
T +1 210 222 1234
SF +1 210 227 4928
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OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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Agenda
Thursday, MA RCH 1 9, 2 01 5
6:30am – 7:30am
Group Exercise Option: Yoga for All Levels
Guadalupe
A local instructor will lead a one-hour class for participants
at all levels of fitness and yoga experience. Mats and blocks
will be provided. Space is limited, so please sign up in
advance at the Registration table.
7:00am – 5:00pm
Meeting Registration Open
7:30am – 8:30am
Rio Grande
Breakfast 8:30am – 9:00am
Welcome to the Open Forum: San Antonio 2015
omas Schlenker, San Antonio Metropolitan Health District
Th
Camille Miller, Texas Health Institute
9:00am – 9:45am
The Journey to Accreditation
Regency East Foyer
Regency East
Regency East
on Chapman, Past Director and State Health Officer, California
R
Department of Public Health
Moderator: Les Beitsch, FSU College of Medicine
Preparing for accreditation is more than just collecting
documents. With leadership, vision, and hard work, this
transformative process can be a powerful force for
improvement that provides opportunities for systemic
change. In this plenary session Ron Chapman will share
his unique perspective on the road to accreditation and
what it means for health departments, a perspective
shaped by his experiences leading a large state health
department and a mid-sized county health department
and serving as a PHAB site visitor.
9:45am – 10:15am
Break
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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10:15am – 11:00am
Planning your Next Steps: Keeping the Momentum
Going after Achieving Accreditation
Regency East
Terry Cline, Oklahoma Commissioner of Health, Secretary of Health
and Human Services
Moderator: Les Beitsch, FSU College of Medicine
Attaining Accreditation is a proud achievement, but the
journey doesn’t stop once you get there. After hard work
and success, how can we make sure to keep improving?
What can we do to bring others along with us? As one
of the first two accredited state health departments in the
country, Terry Cline, Oklahoma Commissioner of Health,
will share experiences from a small state perspective on
where Oklahoma is going next, and how they’re supporting
county health departments to move forward across the state.
11:00am – 11:30am
Break
Hill Country Foyer
INTERACTIVE SHARING SESSIONS
11:30am – 12:30pm
1. Diving Deeper with Ron Chapman and Terry Cline
Nueces Frio
Moderator: Lee Thielen, Thielen Consulting
Track: Diving Deeper
This facilitated session will allow meeting attendees to
have deeper conversation with Ron Chapman and Terry
Cline following their plenary presentations. Attendees
are encouraged to bring their own questions and
participate actively in this discussion.
2. Using Performance Scorecards at Denver Public Health Pecan
Heather Weir, Colorado Department of Public Health & Environment
Moderator: Marni Mason, MarMason Consulting
Track: Performance Management
This session will highlight the approach Denver Public
Health recently used when implementing a new
performance management system across the department.
Using the software onFocus, Denver Public Health program
leaders were coached in the creation of program scorecards.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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Scorecards track the important program performance
measures using a standard format and are reviewed and
discussed at the Visual Management Boards (reviewed
monthly by executive leadership during gemba walks) and
during the Quarterly Reports. The scorecards offer leadership
and staff the ability to find areas needing improvement and
track performance in a convenient and transparent manner.
The materials created for training on the scorecards, the
project roll out plans, and a handout on how to select the
best program measures will be shared. The final version of
all 12 program scorecards will be available for review and
discussion. Lessons learned and future plans will also be
shared with the group.
3. Doctors and Dollars are Not Enough: Public Health’s Opportunity to Narrow the Disparity Gap
Live Oak
Fernando Guerra, Clinical Professor of Pediatrics/Former Director of
Public Health, San Antonio Metropolitan Health District
Moderator: Les Beitsch, FSU College of Medicine
Track: Health Equity; Accreditation
As health disparities across the country continue and
worsen, clinicians and public health practitioners alike are
becoming increasingly active in advocating for social
policy change in an effort to increase health equity. Data is
available from various government entities to inform and
influence resource allocation, and the integration of primary
care with public health is a promising strategy, but what
role can we as public health practitioners play in this
ideological shift towards social justice? Dr. Fernando Guerra,
a pediatrician, professor of pediatrics, former city health
department Director and current member of the PHAB
Board of Directors, has a uniquely holistic perspective of
these issues of equity and the future of population health.
Join him in this interactive session to discuss the importance
of social justice as an influencing factor of health and the
potential for accreditation to serve as a mechanism for
increasing health equity among populations.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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4. It’s all Fun and Games until Someone gets Accredited:
Engaging Staff in QI Efforts
Blanco/Llano
Ololade Coker and Robert Hines, Houston Department of Health and
Human Services
Moderator: Jennifer McKeever, NNPHI
Track: Building a Culture of QI
Whether dealing with quality improvement (QI) or
accreditation, engaging people around new ideas can be
challenging. This presentation will provide a potential
roadmap of conceptual and practical resources for health
departments wishing to better engage staff and colleagues
around QI and accreditation. Using the Houston Department
of Health and Human Services (HDHHS) as a case study
and employing interactive exercises, this presentation will
focus on using marketing and other strategies to engage
staff in order to obtain and maintain buy-in.
5. Achieving Together through Tribal Engagement: Lessons from the Gaining Ground Initiative
Pecos Jamie Ishcomer, CRIHB; Hannabah Blue, North Dakota State University
Moderator: Aleena Hernandez, Red Star Innovations
Track: Accreditation; Tribal Health
National accreditation requires community engagement
to identify and address health problems collaboratively.
Local public and state public health agencies are being
reviewed against PHAB standards that show the public
health expectation of collaborative relationship with tribal
communities. This panel discussion with representatives
from the COPPHI Gaining Ground Initiative will discuss
strategies, benefits and advice related to collaborative
efforts at all levels of government.
12:30pm – 2:00pm
Lunch
Rio Grande
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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ROUNDTABLES AND INTERACTIVE SHARING SESSIONS: PART 1
All Roundtable sessions will be held in the Regency East Ballroom. See page 15 for Roundtable titles and descriptions.
The following interactive sharing sessions will be held at the same time as the Roundtable Sessions.
2:00pm – 3:00pm1. Implementing the CHIP: Keeping the Plan off the Shelf Live Oak
Reena Chudgar, NACCHO; Linda Conlon, Oneida County
Health Department
Track: CHA/CHIP
The development of a community health improvement
plan (CHIP) is a milestone for many communities. However,
the work does not end there! As communities move from
planning to action, they may find it challenging to keep up
the momentum and implement the strategies and programs
outlined in the CHIP. At this roundtable, NACCHO will share
resources from the CHA/CHIP Resource Center and the
MAPP Clearinghouse that local health departments of all
sizes can use as they implement their CHIP and monitor
progress. Roundtable participants will also learn about the
Community Health Improvement Matrix as a tool that can
be used to help health departments address the social v
determinants of health through their community health
improvement planning.
2. Tribal Public Health Accreditation: The Road Less Traveled! Pecan
ickie Bradley, Aneva Hagberg, and Martha Salyers, Eastern Band of Cherokee
V
Indians Public Health and Human Services Division
Moderator: Lee Thielen, Thielen Consulting
Track: QI, Tribal Health
The new Tribal Public Health Accreditation initiative across Indian
Country has provided tremendous opportunities as well as
challenges to Tribal Public Health Departments. The Eastern Band
of Cherokee Indians has committed its Public Health and Human
Services Team to this process. In this session, EBCI representatives
will talk about the decision to seek Public Health Accreditation
and the successes thus far in their journey: the completion of the
first Cherokee Tribal Public Health Assessment; gaining buy-in
from key Tribal, regional, and state stakeholders; and the decision
to use the MAPP process for the development of a Tribal Health
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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Improvement Plan. Participants will gain insight into Tribal Health
Department synergies with key stakeholders and the differences
with Tribal Health Departments that make the journey a
challenging task.
ROUNDTABLES AND INTERACTIVE SHARING SESSIONS: PART 2
All Roundtable sessions will be held in the Regency East Ballroom. See page 15 for Roundtable titles and descriptions.
These interactive sharing sessions will be held at the same time as the Roundtable Sessions.
3:00pm – 4:00pm1. Demonstrating a Framework for Aligning Local Public
Health and Healthcare Efforts to Address Community
Health Challenges Live Oak
Micaela Kirshy, Jack Moran; Public Health Foundation
Track: QI; Performance Improvement and Communication
This session will describe how a driver diagram can be
developed and implemented to increase health services in
a community. The driver diagram is a tool to facilitate
collaborative strategies and interventions by public health
and health care community organizations to improve an
aspect of the community’s health. A driver diagram
identifies primary and secondary drivers of a population
health goal. The Public Health Foundation’s public health
driver diagram approach articulates actions that can be
used by public health and health care to address a specific
community health challenge in a visual manner that shows
the interconnection of various strategies.
2. Quality Improvement in the Real World: Lessons
Learned from the Public Health Quality Improvement
Exchange (PHQIX) Pecan
Jamie Pina, RTI International; Pamela Russo, Robert Wood Johnson Foundation
Moderator: Jennifer McKeever, NNPHI
Track: QI
Hearing about the experiences of other QI practitioners
can help you improve your own projects, avoid pitfalls, and
better plan for future work. The Public Health Quality
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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Improvement Exchange (PHQIX) has analyzed fifty recently
published Quality Improvement projects and identified
significant and overarching experiences, impressions, and
lessons learned shared by submitters implementing projects
in real-world settings. Hear these insights and share your
own in this interactive, discussion-based session aimed at
informing your Quality Improvement journey.
5:00pm – 6:30pmSupporting the Performance Improvement Workforce:
A Design Lab for the Future
Regency East
Facilitated by staff from the Illinois Public Health Institute
With the conclusion of the National Public Health
Improvement Initiative (NPHII), the CDC is seeking input into
future strategies to provide support to the performance
improvement in public health workforce. In 2014, a study
was conducted to explore whether the creation of a
professional association could be a source of resources
and education. The results identified a need for continued
support; however, it is not clear that an association would
be the best source of that support. Please join us for an
interactive discussion/design session to help the CDC and
its partners determine strategies to support you in your
performance improvement/accreditation readiness.
6:30pm – 8:00pmPoster Reception and Hors d’oeuvres
Rio Grande
View our poster presentations and meet poster presenters
while enjoying light hors d’oeuvres.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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Friday, MA RC H 2 0, 2 01 5
6:30am – 7:30am
Group Exercise Option: Yoga for All Levels
Guadalupe
A local instructor will lead a one-hour class for participants
at all levels of fitness and yoga experience. Mats and blocks
will be provided. Space is limited, so please sign up in
advance at the Registration table.
6:30am – 7:30am
Group Exercise Option: Running or Walking around
the Riverwalk
The Hyatt Regency San Antonio Riverwallk General Manager
will lead a running group around the Riverwalk, while two
of his staff members will lead a walking group along the
same path. Please meet in the Los Rios foyer at 6:20 to join
either of these groups.
8:00am – 9:00am
Rio Grande
Breakfast 8:00am – 9:00am
PHAB Breakfast with Small/Rural/Frontier health departments
Kaye Bender, Public Health Accreditation Board
Live Oak
As a follow-up to a suggestion made at one of PHAB’s
Town Hall sessions at a past COPPHI Open Forum, PHAB is
holding an informal listening/discussion session during this
year’s Open Forum. The session will be focused on the
barriers that small/rural/frontier health departments have
encountered about accreditation. Later in this year, PHAB
will be holding a Small/Rural/Frontier Think Tank on this
topic. The discussion session at the upcoming Open
Forum will help PHAB prepare for that Think Tank. PHAB
encourages representatives from health departments serving
50,000 population or less to come join us for this most
important conversation!
9:00am – 10:00am
he Dark Age Continues: Strategies for Surviving
T
Austerity and Moving Towards the Light
mily Holubowich, Executive Director, Coalition for Health Funding;
E
Senior Vice President, CRD Associates, L.L.C.
Moderator: Les Beitsch, FSU College of Medicine
Regency East
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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Years of budget cuts at the federal, state, and local level
have taken a toll on the public health enterprise, and fiscal
and political dynamics in the nation’s capital indicate that
more dark days are ahead. The public health system
continues to be expected to do more with even less, despite
growing demands and higher expectations to deliver results
that improve health, save money, or both. As competition
for limited health dollars becomes even fiercer the public
health community will need to fight to protect what’s left
and begin to rebuild what is lost, and we must do so while
effectively demonstrating public health’s value to justify
continued investment. In a follow-up to her June 2014 Open
Forum plenary, Emily Holubowich will provide an updated
overview of the political and fiscal trends in public health,
and review the considerations that shape budget decisions
in Washington.
10:00am – 10:30am
Break
Regency Foyer
10:30am – 12:00pmThe Futures of Public Health: Public Health 2030
Regency East
Clem Bezold, Institute for Alternative Futures
Moderator: Lee Thielen, Thielen Consulting
Public health, and the challenges and opportunities it faces
are evolving. Practitioners working to address current
goals with increasingly limited resources must also prepare
for the threats and opportunities public health will face.
Scenarios of public health identify different likely and
preferable threats and opportunities. Using scenarios can
lead to better preparation for current challenges as well as
enhanced views of more visionary futures, the pathways
to those, and the actions needed now to achieve those
preferred futures. In this plenary presentation Clem Bezold
from the Institute for Alternative Futures will share
information from the Public Health 2030 Project about the
likely, challenging, and visionary scenarios the public health
field might expect in the years to come.
12:00pm – 1:00pm
Lunch
Rio Grande
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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INTERACTIVE SHARING SESSIONS
1:00pm – 2:00pm1. Diving Deeper with Clem Bezold Nueces Frio
Clem Bezold, Institute for Alternative Futures
Moderator: Lee Thielen, Thielen Consulting
This facilitated session will allow meeting attendees to have
deeper conversation with Clem Bezold following his plenary
presentation. Attendees are encouraged to bring their own
questions and participate actively in this discussion
2. Findings and Reflections from Four Years of NPHII Pecan
Chelsie Huntley, Minnesota Department of Health; Rebecca Henry, Maricopa
County Health Department; Lindsey Krywaruchka, Montana Department
of Health
Moderator: Dianne Ochoa, Centers for Disease Control and Prevention
Through the Prevention and Public Health Fund, the Centers
for Disease Control and Prevention (CDC) launched the
National Public Health Improvement Initiative (NPHII). From
2010 – 2014, CDC awarded $141 million to 73 state, tribal,
local, and territorial public health agencies to support quality
improvement, accreditation readiness, and performance
management activities. In addition, NPHII encouraged
awardees to initiate cross-jurisdictional collaborations and/
or provide support to other health agencies to advance
effective and efficient delivery of public health services.
This moderated question and answer session will focus on
grantee experiences with achieving the NPHII objectives.
The discussion will also address agency accomplishments,
challenges and barriers, sustainability of efforts, and lessons
learned that can be applied in other contexts.
3. CHIP Collaboration with Multiple Stakeholders: Tools from the Bexar County Health Collaborative
Live Oak
Liz Lutz, The Health Collaborative; Palmira Arellano, Methodist Healthcare
System; Pilar Oates, Community Member; Aurora Sanchez, Bexar County
Department of Community Resources; Anil Mangla, San Antonio
Metropolitan Health District
Moderator: Rose Swensen, Health Resources in Action
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
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Collaboration is key when trying to reach a broad audience
with increasingly limited resources. We often hear about the
challenges surrounding collaboration, but the opportunities
collaborative work can yield can be even more powerful.
This roundtable is about what makes this particular
collaboration work from the perspectives of community,
hospital, and public health stakeholders, and how the
CHA/CHIP process provided a mechanism and framework
for organizing and solidifying the partnership.
4. Keys to Successful Cross-Jurisdictional Sharing
Blanco/Llano
Arrangements
Pat Libbey and Grace Gorenflo, Center for Sharing Public Health Services
This session provides an opportunity to learn from three
different stories about the pre-requisites, facilitating factors,
and project characteristics that increase the likelihood
of establishing successful cross-jurisdictional sharing
arrangements. Participants also will discuss potential barriers
to, and strategies for, enhancing the presence of these
factors in the exploration, planning and implementation
of CJS arrangements.
5. Collaborating Across Local Health Departments to Pecos
Build A Culture of Quality Philip Mason, Clackamas County Public Health Division; Claire Smith,
Multnomah County Health Department; Erin Mowlds, Washington County
Public Health Division
Moderator: Liljana Johnson, NNPHI
Accreditation Coordinators from three county health
departments in the Portland, Oregon Metro region introduce
and share how they have used the NACCHO Roadmap to
a Culture of Quality to identify where their department is
at in building a culture of quality. This session will describe
the benefits of participating in a regional accreditation
collaborative. Local health departments, each with varying
strengths and areas for improvement, will share stories,
tools, training opportunities and ways they support each
other in this interactive panel discussion.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
Roundtable Sessions
All Roundtable sessions will be held in Regency East
and will be offered in both Session 1 (2:00 – 3:00) and
Session 2 (3:00 – 4:00) unless otherwise indicated.
1. Developing and/or Transforming a Tribal
Public Health System via Completing the Public
Health Accreditation Process
Laura Sawney, Cherokee Nation Public Health
Track: Accreditation, Tribal Health
Cherokee Nation Public Health will provide a
presentation about their journey through the
public health accreditation process. That
includes lessons learned, which best practices
were implemented, and how challenges were
overcame in order for CNPH to successfully
submit the application. Insight and suggestions
about Tribal-State collaborations and partnerships
will also be discussed.
2. Intersecting Public Health Accreditation
and the FDA Voluntary National Retail Food
Regulatory Program Standards: A Local Health
Department Perspective
Hillary Hanson, Flathead City-County Health Department
Track: Accreditation, Tribal Health
The Flathead City-County Health Department
(FCCHD) provides public health services to
both residents (population 91,301) and visitors
in Flathead County, Montana. FCCHD has been
preparing for public health and submitted an
application in October 2014. In addition, in 2013
FCCHD enrolled in the U.S. Food and Drug
Administration Voluntary National Retail Food
Regulatory Program. This program is aimed at
promoting greater uniformity in food regulatory
15
programs through the achievement of recognized
standards. Similar to accreditation, the Voluntary
National Retail Food Regulatory Program pushes
FCCHD to implement performance management
and strive for continuous quality improvement.
FCCHD has been actively working to intersect
the process of accreditation and achievement
of the Voluntary National Retail Food Regulatory
Program Standards. FCCHD’s experience
provides a local health department’s perspective
on the crosswalk between the two programs
and how achievement of accreditation standards
and Voluntary Retail Food Regulatory Program
Standards can be accomplished simultaneously.
3. We’re Accredited! Kent County Health
Department’s Tips for PHAB Success
Chelsey Chmelar, Kent County Health Department
Track: Accreditation
The Kent County Health Department (KCHD)
began its journey toward national public health
accreditation in January 2012. Since then, the
KCHD has filled large PHAB evidence gaps;
identified, gathered, reviewed, and submitted
evidence to PHAB; completed a site visit to
determine the Department’s accreditation status;
and has become one of the first 54 health
departments in the United States to be
accredited by PHAB!
This session will review the infrastructure and
strategies implemented by KCHD to achieve
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
national accreditation through PHAB. The intent
of this session is provide insight and guidance
for health departments that have yet to begin
their journey to national accreditation, or are
early in the process and would like some guidance
on how to structure their efforts. Tools and
templates used by the KCHD will be shared.
4. Creating A Culture of QI — The Long and
Winding Road
Ali Reed, City of Milwaukee Health Department
Track: Building a Culture of Quality
The Milwaukee Health Department is taking the
long and winding road towards a culture of QI.
Our story begins in 2011 when the MHD had a
client turn-away rate in our STD Clinic of over
70%. Over half of the people who presented
were not receiving treatment. This raised many
questions about our workflow, staffing and data
collection. This was the start of a journey —
creating a culture of QI and our documenting
our first project. Although this was a reaction
to a problem, it got us thinking about how we
could move from being reactive to proactive
health department. Starting with existing
issues, a QI group was identified, trained and
completed a full Plan-Do-Check-Act process
with much success, reducing the rate to under
10%. Since this time the department has
implemented four different projects and trained
over 40 staff members on QI. For the first time
staff realizes that they are empowered to
improve processes that will positively affect the
way they do their work and the health of our
community. The MHD’s Strategic Plan includes
QI training and QI participation in all job
classifications. Although we have a long way to
go, QI has become an accepted practice and staff
are now asking to work on projects motivated by
visions of a better department and a healthier
community.
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5A. SESSION 1 ONLY
Engaging Staff in QI through the Provision of
Discrete One-Hour Training Sessions
Tamara Bannan, Public Health Institute
Track: Building a Culture of Quality
Following the completion of the Quality
Improvement (QI) Self-assessment Tool
developed by the National Association of
County and City Health Officials (NACCHO),
one large local health department sought to
improve staff engagement in QI. A key finding
from this assessment was that although all staff
members were trained in QI using a one-hour
online video training, they did not feel comfortable
conducting QI projects. This also was true for a
subset of staff that participated in more intense
QI trainings that were a week-long in duration
and resulted in them receiving green belts. This
led to the development of discrete one-hour
training sessions to support staff throughout the
entire QI project cycle, called the QI Knowledge
Hour. These trainings occurred twice per month
for a total of 21 trainings (including one pilot)
over a ten-month period of time. Staff completing
15 or more trainings received a certificate as a
QI Knowledge Worker. The initial training was
treated like a pilot where participants provided
in-person feedback and online feedback via
Survey Monkey ®. This feedback was used to
make adjustments and improvements to the
training. Each of the following sessions also
included a similar feedback loop, and results
will be shared. To date, staff have found these
session valuable in assisting with their QI work.
Topics ranged from the discussion about the
elements of the team charter to the use of
quality tools and reporting results using the
storyboard format.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
5B. SESSION 2 ONLY
Connecting the Dots: Using Logic Models as a
Framework to Link Performance Measures and
Long-Term Community Health Outcomes in a
Performance Management System
Tamara Bannan, Public Health Institute
Track: Performance Management
Participants will learn how to use logic models
as a framework to determine program level
performance measures and link them to
measurable long-term community health
outcomes. This sets the stage for a wellorganized and clear performance management
system that can be used at the program level,
department level, and in the community health
improvement planning process. Lessons
learned from 3 health departments in CA will be
shared including the following applications of
logic models: 1) how logic models can establish
a set of linked measures to build a functional
performance management system; 2) how logic
models can help re-assess and update existing
measures; and 3) how logic models can be used
for team-based selection of measures for a
community-based PDSA QI project.
6. Common Ground: Public Health and
Hospitals Collaborating Successfully on Rural
Community Health Assessments
Ken Hall, Center for Rural Health, University of North Dakota;
Erin Ourada, Custer Health
Track: CHA/CHIP
Conducting a community health assessment in
small, rural communities presents challenges
not amenable to one-size-fits-all solutions. Rural
communities offer unique characteristics in
terms of communication dynamics and available
resources, and information is largely disseminated
through word of mouth. These important
characteristics were considered when designing
a model for conducting community health
assessments in rural areas: the Rural Community
Group Model (RCGM). Dozens of rural
communities have used the model, which is
17
centered on a Community Group that leads
the process and helps build enthusiasm in the
community at a grass-roots level for a broadbased assessment. With hospitals conducting
assessments as a result of new legal requirements,
and public health departments conducting
assessments with an eye toward accreditation,
a ripe opportunity for collaboration exists. One
key to the assessment process is an effective
survey tool. In North Dakota, with the aim of
designing a survey tool that would meet the
needs of both public health assessments and
hospital-sponsored assessments, a statewide
group teamed up to develop a uniform survey
tool to be used throughout the state by various
assessing entities. Representatives from the
state health department, two major research
universities, the state office of rural health,
hospitals, and local public health units were
convened to develop a standardized survey
tool. Building on the strengthened relationships
as a result of this collaboration, those conducting
assessments are working together at local
community levels to lessen duplication and
survey fatigue while also bolstering the validity
of assessment results.
7. Envisioning a Community Chief
Health Strategist
Judith Foley, Health Resources in Action; Jack Moran, Public
Health Foundation
Track: CHA/CHIP
Policymakers and the public expect health
departments and health care organizations to
perform better and improve community health
outcomes with decreasing funding. The desired
outcome of better community health cannot
be achieved under the current design and
operation of our fragmented and non-aligned
health delivery system. A community multicollaborative health transformation is an
approach for operating and managing the
community’s health from an access, assistance,
protection, preventive, and treatment perspective.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
It involves a major alteration of the leadership
mindset, especially post accreditation, of all
involved organizations impacting a community’s
health. Also critical are the introduction of quality
improvement (QI) methods to help improve
teamwork and culture of the a multi-collaborative
designing and implementing solutions. This
session will introduce the Community Chief Health
Strategist as the lynchpin of such an approach.
8. Lessons Learned for Successful
Collaborative CHA/CHIPs in Urban, Suburban
and Rural Settings
Laurie Call, Illinois Public Health Institute
Track: CHA/CHIP
IPHI has provided coaching, technical assistance,
facilitation and planning support to over 25
collaboratives for CHIP efforts led by health
departments, non-profit hospitals and other
community health partners. This work has been
conducted in a variety of geographic settings
including rural, suburban, urban communities
as well as state-wide efforts. Through this work in
designing and facilitating CHA/CHIP processes,
including Mobilizing Action Through Planning
and Partnerships (MAPP), we have compiled
lessons learned to improve effectiveness and
advance collective impact. The lessons shared
will be prioritized by those relating to PHAB
accreditation requirements for CHA/CHIP and
the “Principles to Consider for the Implementation
of a Community Health Needs Assessment”
(Rosenbaum, Sarah.) Join this session to hear
about the lessons learned to integrate into your
work to overcome common barriers and challenges
and increase successful CHA/CHIP work.
9. Keeping it Simple — Communicating about
Performance Improvement
Pooja Verma, National Association of County and City
Health Officials
Track: Performance Improvement and Communication
18
As local health departments engage in
performance improvement, including quality
improvement, community health improvement
planning, and accreditation preparation, they
may encounter challenges communicating
about the rationale for and benefits of these
activities. These difficulties can be internal
with agency leads and staff or external with
governing entities, community partners, and the
public. To help LHDs overcome these challenges,
NACCHO developed a Guide to Communicating
about Performance Improvement. At this
roundtable, NACCHO will present a jargon-free
overview of important performance improvement
activities and demonstrate how the guide aids
local health departments in crafting tailor-made
messages and strategies to help build support
and understanding of performance improvement.
Roundtable participants will have an opportunity
to share their communication challenges and
solutions with their peers.
10. Building a Sustainable Performance
Management and Quality Improvement System
and Culture
Kirsti Bocskay, Chicago Department of Public Health
Track: Performance Management
Citywide performance management (PM) was
initiated in Chicago in 2005. It was limited
to reporting of universal metrics and some
department-specific measures. Indicators
focused on administration, customer satisfaction
and operations. Only half of all Chicago
Department of Public Health (CDPH) programs
were engaged in the process, and fewer than
25 measures were being collected monthly.
Almost 10 years later, CDPH is an accredited
local health department and our performance
management and quality improvement (PQI)
system involves all 47 programs with over 400
metrics being reported on a monthly basis.
In addition, QI has become a key component
of the system with more than 20 projects
underway at any one time. What factors lead to
the successful development of a PQI system
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March 2015 • San Antonio, Texas
at CDPH? How did citywide PM evolve into
PQI at CDPH? What features have been built
into the system to make it sustainable? We
will answer these questions, and discuss the
important roles leadership and multi-level
engagement had in building a continuous
improvement culture at CDPH.
11. Using a Results-Based Accountability
(RBA) Tool for Generating Agency-wide
Performance Measures
Chelsie Huntley, Minnesota Department of Health
Track: Performance Management
This session will explain how the RBA fourquadrant performance measures tool has
been used within all divisions at the Minnesota
Department of Health (MDH) to generate
both quantity and quality-based performance
measures. Use of this simple tool has led to:
• a common understanding of the difference
between population indicators and program
performance measures
• the foundation for a performance
management system
• teams identifying customers and customer
satisfaction-related measures
12. Started from the Bottom Now We’re Here:
A Department’s First Attempt at Developing
Program Level Performance Measures
Rebecca Husney, Springfield-Greene County Health Department
Track: Performance Management
Where to begin? Instituting a formal Performance
Management Plan for a local health department
without any current formal performance
measures across all divisions can be a daunting
task. Beginning this process takes patience
and planning to utilize staff time and energy
efficiently. This interactive session will share
how the Springfield-Greene County Health
Department was able to develop program level
measures through a 2 hour workshop and the
lessons learned from this undertaking. Staff
utilized a step by step worksheet that went
through developing program goals, logic models
and designing measures. Starting small and
utilizing logic models enabled the department
to go beyond counting widgets in designing
optimal program level performance measures.
This session will foster discussion about first
starting with performance measures and working
with staff to develop meaningful measures.
• an awareness of the value of program
efficiency and effectiveness measures
13. Where are we headed and how will we know
when get there? A local health department’s
journey in performance management
• key measures from divisions populating an
agency-wide SharePoint site for management
and executive leadership use
Alex Eichman, Washington County Department of Public Health
and Environment
Track: Performance Management
A train-the-trainer approach will be used,
with the goal of participants leaving feeling
confident that they can lead this exercise and
generate useful program performance measures
with teams. An initial overview of the fourquadrant exercise will be presented, followed
by a simulated exercise. Tips and resources
on facilitating the exercise will then be shared,
followed by 5–10 minutes of Q & A.
A strong performance management system
provides the necessary framework for actively
using performance measures to improve the
public’s health. This session focuses on the way
of thinking adopted by a local health department
to demystify performance management and
make it meaningful for key stakeholders and
staff. Like many others, Washington County
Department of Public Health and Environment
staff were overwhelmed with the endless jargon
and countless approaches to performance
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OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
management. The department lacked a
disciplined way of thinking and taking action
that the department is using to improve the
performance of its programs and services.
By starting with ends and working backwards
towards means, staff are continuously reminding
themselves of how promoting the well-being
of their client and stakeholder populations
contributes to the well-being of whole populations
in the community. The presenter will share the
department’s successes and lessons learned as
well as an overview of the method used, their
performance management framework and policy,
and training resources. Session participants will
be provided with basic templates and have the
opportunity to engage in a brief exercise that will
allow them to apply basic concepts.
14. Quality Improvement Project: Electronic
Quality Assurance Tools
Gurleen Roberts, GA DPH — North Central Health District 5–2
Track: QI
North Central Health District’s (NCHD) Quality
Improvement (QI) project is focusing on
improving the internal quality assurance (audit)
process to make it easier to compare and
contrast data over time. The current audits use
paper-based tools that are not quantifiable,
which makes it difficult to track trends. By
converting tools to an electronic format and
quantifying the audit findings, a grade can be
given for each program and an overall grade
can be given for the audit. This data can be
compared to audit results from previous years
and/or to other counties within our district,
and can help prepare staff for a potential
external audit. This project is based on the
PDCA cycle and reflects several QI tools
(process map, root cause analysis, S.M.A.R.T.
objectives) used to discover improvement
opportunities. This project was implemented
in Houston County, Georgia in June 2014, and
received positive feedback from both county
and district staff involved. Since this project
was successful in one county, we plan to
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implement it in the remaining 12 counties within
our health district in the upcoming year.
15. Using QI Techniques to Create a
Comprehensive Workforce Development Plan
Rebecca Henry, Maricopa County Dept Public Health
Track: Workforce Development
This presentation will give you a checklist/
template that documents the processes that
Maricopa County Department of Public
Health used to create a multi-year workforce
development (WFD) plan that meets public
health accreditation standards. This process
included an online WFD assessment than
includes the core public health competencies
and staff/supervisor training needs. Then, multiple
QI techniques were used with workgroups
and a WFD committee to identify key issues,
prioritize needs, and create a viable workplan.
16. What are the Workforce Development
Differences Between Those Serving 1,247
and Those Serving 544,000? The Kansas
Experience
Cristi Cain, Kansas Department of Health and Environment
Track: Workforce Development
In Kansas, the local health department public
health workforce serves counties that range
in size from 1,247 residents in frontier and rural
environments to 544,000 residents in the urban
core. The Kansas Public Health Workforce
Competency Assessment was conducted in
2014. Results will be shared which will examine
the demographics of the workforce in Kansas
and a variety of perspectives on the results.
A focus will be placed on comparing the
small and rural health department workforce
development needs with those of larger urban
health departments.
With a statewide participation rate of 73%, the
assessment resulted in a rich compilation of
information and many lessons learned. In total,
96% of all health departments had staff who
participated at some level. Successful strategies
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March 2015 • San Antonio, Texas
for developing an assessment, testing, encouraging
participation, promoting the process, and
reporting of results will be shared.
Participants will be invited to share their QI
plans with each other through a web-based
sharing site.
One unique feature of the Kansas assessment
included questions about the relevance of
each of the competencies to daily work. We
will discuss how these particular findings
are informing the strategies for workforce
development in Kansas.
17B. SESSION 2 ONLY
Drive Out Fear: Sharing Performance Measure
Data with Your Staff and Governing Body
17A. SESSION 1 ONLY
Quality Culture 2.0: A Major Revision to
Tacoma-Pierce’s QI Plan and QI Council
Cindan Gizzi, Tacoma-Pierce County Health Department
Track: Building a Culture of Quality
In 2006 the Tacoma-Pierce County Health
Department (TPCHD) developed its first formal
QI plan and began formal QI Council meetings.
After eight years of using its original QI plan
model and council structure, TPCHD realized
their model was in need of its own improvement
process. Using QI tools and a Plan-Do-StudyAct approach, TPCHD’s QI Council members
developed a new structure that empowers more
staff to conduct process improvement work,
engage in the department’s performance
management system and move the department
further on its journey toward a quality culture,
intentionally involving both frontline staff and
management in this process to maximize staff
engagement and reinforce a major component
of its quality culture.
This session will provide an overview of
TPCHD’s process to improve its QI plan and
governance structure and will highlight the
department’s new QI infrastructure and how
it differs from the previous model. The presenter
will then facilitate a discussion among participants
about the current structure of QI plans and
governance at their agencies and the pros and
cons of each model. She will also share at least
one QI plan and infrastructure from a small,
rural health department and resources for other
examples of QI plans and governance structures.
21
Cindan Gizzi, Tacoma-Pierce County Health Department
Track: Performance Management
Performance management is all about what you
do with the data and information collected to
measure performance. Performance measure
data help supervisors and managers better
understand what outcomes and metrics they’re
accountable for and help staff know how
well their programs are working. This session
will share examples of how health agencies
(including a small, rural health department)
share their performance measure data and
results with their staff and governing bodies.
Roundtable participants will share their own
experiences and lessons learned with reporting
out performance measures. Questions for
discussion include: What challenges have you
had with reporting performance measure data?
How do you talk about performance measures
with staff? What is your governing body most
interested in when it comes to performance
measure data? Participants will be invited to
share their reporting tools and performance
measure presentations to staff and Boards/
Commissioners through a web-based sharing site.
18. Tribal public health services and systems:
Findings of case study research and
implications for performance improvement
and health equity
Shannon Laing, Michigan Public Health Institute; Donna
Norkoli, Sault Ste. Marie Tribe of Chippewa Indians
Track: Health Equity; Tribal Health
A growing number of tribal agencies are taking
steps to organize and improve their public
health systems. Those striving for PHAB
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March 2015 • San Antonio, Texas
accreditation encounter challenges related
to the unique context in which they operate.
Results of the 2010 NIHB Tribal Health Profile
suggest tribal agencies are interested in
data-based decision making and providing
public health services in partnership with other
agencies. However, there is little information
available about promising practices in this
area. With a Robert Wood Johnson Foundation
Public Health Services and Systems Research
(PHSSR) grant, the Michigan Public Health
Institute (MPHI), Sault Ste. Marie Tribe of
Chippewa Indians, and Inter-Tribal Council of
Michigan are engaged in a community-based
participatory research study that aims to
describe the infrastructure, organizational
relationships, performance, and outcomes of
the Sault Tribe’s public health system in
alignment with the Ten Essential Services. The
study will contribute to a small but growing
body of research on tribal public health
systems and, more importantly, to help inform
improvements in policy and practice for more
effective and efficient public health services in
Indian Country. This session will provide a brief
22
overview of the study and preliminary results.
The co-presenters will engage participants in
dialogue about the findings and seek input
on the types of tools and information-sharing
opportunities that would be useful to tribal
public health practitioners and partners. In
addition, we will discuss the implications of
the findings as they relate to improving tribal
public health systems and alignment with PHAB
accreditation standards.
19. Accreditation Collaboration: Moving
Nebraska’s Health Departments Forward
Together
Colleen Svoboda, Nebraska Department of Health and
Human Services
Track: Accreditation
This discussion will focus on strategies to move
public health departments toward accreditation
in a purposeful manner. We will cover the
development of a community of practice,
the creation of accreditation resources, and
how some of Nebraska’s small, rural health
departments are preparing for accreditation.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
Posters
1. Building a Culture of Quality Improvement
at a Rural Health Department
2. Streamlining the Certification Application
Process
Kim Chandler, District Health Department #10
Track: Building a Culture of Quality
Sharita Hill and Alexandria Hart-Smith, Oklahoma State
Department of Health
Track: Building a Culture of Quality
District Health Department #10 is located in
the northwest lower peninsula of Michigan and
serves about 261,184 residents in ten counties. It
is in a rural area and has a high rate of poverty.
Several years ago, the QI effort began. Along
with it came many challenges, including a lack
of coordinated effort, low priority, and limited
staff involvement. There was an increased focus
and strong commitment by management to
conduct the QI process and develop a culture
of QI. This was coordinated with a commitment
to performance management and accreditation,
which led to a solid foundation within the Health
Department. The steps used in this process will
be illustrated in this poster session, including
assigning a QI coordinator, commitment by all
division directors, developing a QI policy, and
involvement by the majority of the 170 staff
members. Last year, ten QI projects were led
by staff across all divisions. After the first year
of increased QI effort and communication, staff
members are aware of the role of QI within the
Health Department. By presenting our successes
and lessons learned, our experience can serve
as an example of how to build a QI culture in a
rural Health Department.
23
The Revenue Collection Team (RCT) was
created in an effort to eliminate barriers and
streamline the Certification Application Process.
Problem: We recognized that we need to
better meet our customer needs by reducing
the time of the licensure application process by
implementing the following standards:
• T
rack data to reduce the customer
application wait time.
• A
ccurately track the % of stamped mail to
better streamline the certification process.
• S
treamline the standardization of the
website address information to reduce the
application process time.
3. On the fast-track to a culture of quality
improvement
Alex Eichman, Washington County Department of Public
Health and Environment
Track: Building a Culture of QI
The Washington County Department of Public
Health and Environment recognizes that in
order for staff at all levels of the organization
to engage in QI efforts, the processes and tools
need to be user-friendly, participatory, and fun.
The Performance Improvement Team (PIT)
serves as the department QI Council and has
worked hard to achieve just that through their
‘PIT Stop’ theme. In auto racing, the pit stop is
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
where cars stop during a race for refueling, new
tires, repairs, or mechanical adjustments from
the pit crew. In the department, the PIT, just like
a pit crew, is there to help staff to make quick
repairs, adjustments, and provide new resources
to improve the efficiency and effectiveness of
their work. This session will highlight how the
department communicates about QI, how they
celebrate and recognize QI successes, and
how the development of a simple toolkit that
incorporated staff feedback, made QI more
participatory and user-friendly. Finally, learn
how staff are actively engaged by the PIT in
decision-making, including providing feedback
on what is working and what isn’t, as part
of an annual evaluation of the department QI
Council and QI Plan.
4. A Small Local Health Department’s CHIP
Implementation: Lessons Learned, Strategies
Used and Evaluation Completed
Lisa Boettcher, Greenfield Health Department
Track: CHA/CHIP
Greenfield Health Department operated under
many constraints, particularly limited resources
such as time, staff and budget, as it launched
a long-term project in collaboration with City
and community partners to address 3 of 5 health
priority areas identified in the CHIP: nutrition,
physical activity and related chronic diseases.
The project team has worked diligently since 2012
to identify, implement and evaluate strategies
to address resident access to nutritious foods,
encourage physical activity and promote
education on chronic health conditions. Project
accomplishments to-date include commencement
and continuation of a community Farmers
Market, implementation of a SNAP benefit
redemption program, facilitation of group fitness
activity events, partnership development, targeted
health education outreach and instruction
24
focused on nutrition and healthy cooking. In
addition, components of accreditation and
performance management & improvement
have been top-of-mind such as documentation,
community partnerships and data collection.
In effort to implement viable, sustainable local
public health improvement plans, the department
has overcome some of its limitations utilizing
creative strategies to build partnerships and
maximize time.
5. Navajo Nation Health Systems Assessment
Anita Muneta, Navajo Nation Department of Health
Track: CHA/CHIP, Tribal Health
The Navajo Nation Department of Health
(NNDOH) was busy this year completing a
Navajo Nation wide Health Systems Assessment.
This assessment was completed over a three
period session in partnership with the University
of New Mexico Institute for Indigenous Knowledge
& Development (IIKD) program utilizing the
Ten Essential Services of Public Health as the
evaluation baseline and the NACCHO MAPP
(Mobilizing Action through Planning and
Partnerships) CHA tool. The last session resulted
in Action plans which were developed with
appended teams and are ripe for implementation.
This was truly a multi partner planning effort
which included representatives from the
NNDOH programs, NN programs, NNTC and
health committee specifically, Indian Health
Service, health services contracted organizations,
the state of New Mexico, non-profit community
health organizations, and the Navajo Nation
Vice-President’s office and tribal health
committee. This NNHSA is one of the processes
in the development of a CHA, a PHAB
accreditation prerequisite, and the action planning
that occurred will be integrated into our
NNDOH performance improvement program.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
6. Utilizing diverse methods to obtain
customer satisfaction data to drive
performance improvement
7. Is anyone better off? Results Based
Accountability: A Local Public Health Example
Meaghan Sherden, Olmsted County Public Health Services
Track: Performance Management
Lakisha Thomas, Florida Department of Health in
Miami-Dade County
Track: Customer Satisfaction, Customer Service
The Florida Department of Health in MiamiDade County (DOH-Miami-Dade) provides
community-based health services to the county’s
residents and is responsible for improving
the health of the community. The department
recognizes that there is a correlation between a
positive customer service experience and health
outcomes. As a quality driven organization
and Florida Governor’s Sterling Award recipient
(Malcolm Baldrige state equivalent), the DOHMiami-Dade has implemented methods to
determine customer satisfaction and encourage
customer engagement to drive performance
improvement.
The DOH-Miami-Dade collects information on
customer satisfaction via an electronic survey.
This survey may be accessed by clients on the
department’s website, on touch-screen kiosks
at clinic sites and by scanning a quick response
code with a smartphone. The department also
utilizes a customer telephone line to obtain
satisfaction data. Satisfaction data is displayed
on a dashboard, which may be accessed by
all team members and is monitored on a daily
basis.
A customer service week initiative is also held
annually to demonstrate customer appreciation
and promote engagement. Client interviews are
conducted during the week to gain insight on
how we can improve services and incentives are
distributed. The week also includes activities
among staff such as a customer service pledge,
nominations as a customer service star and
participating in a spirit week. These activities
allow for a more personable relationship with
our clients and boost employee morale.
25
In its pursuit of Accreditation and proactively
improving organizational performance, Olmsted
County Public Health Services has developed
a Performance Management System that
incorporates Results Based Accountability
(RBA) into the development of performance
measures and reporting results. RBA focuses
on using common language to answer a set of
questions: “How much do we do?”, “How well
do we do it?” and “Is anyone better off?” to
develop meaningful performance measures.
RBA also allows organizations to highlight
future performance measures that need to be
developed and that would help organizations
answer “Is anyone better off?” Using RBA
principles, Olmsted County Public Health
Services was able to move away from reporting
on population measures and reporting soling
on outputs to striving to answer “Is anyone
better off?” RBA also provides a simple
streamline approach for reporting results
through Storyboards that OCPHS has adopted.
This session will provide attendees resources
and lessons learned on developing a Performance
Management System to satisfy Accreditation
requirements (Standard 9.1) through sharing
Olmsted County Public Services process and
examples of developing performance measures
and reporting progress.
8. Public Health Nursing: how did it get this
bad? Using a quality improvement process to
improve public health nurse retention
Jessica Gathirimu and Jill Radowicz, City of
Milwaukee Health Department
Track: QI
As our local health department prepares for
accreditation we began to take a closer look
at workforce development and create goals and
strategies, specifically performance improvement
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
at the departmental and individual level. We
were faced with a grim statistic that in the last
three years we had experienced a 50% turnover
rate amongst our public health nursing staff.
We implemented a nurse retention quality
improvement committee. A diverse group of
nurses were invited to participate, along
with representation from management and
administration. The group learned about
the Plan-Do-Check-Act method of quality
improvement and over time developed a list
of issues needing to be discussed. The themes
identified included: communication, personal
learning and development, training, orientation,
career ladder and morale. The group is
responsible for creating quality improvement
projects to attempt to correct the issues.
Two projects have been implemented and
evaluated thus far, increasing nurse satisfaction
in the department.
9. Quality Improvement Project: Increasing
the Percentage of Tobacco Clerks Who Hold
Tobacco Handler Permits
Matt LaFrance, Tooele County Health Department
Track: QI
Our Health Department recently completed a QI
Project to increase the percentage of Tobacco
Clerks in the county who held current Tobacco
Handler Permits. Baseline data was collected
which revealed that only 42.5% of clerks were
permitted in November 2013. Our department
organized a QI team and began meeting weekly.
The PDSA cycle was conducted to develop an
AIM statement, examine the current approach,
identify potential solutions, and test the theory
for improvement. QI tools were utilized
throughout the process including a Cause and
Effect Diagram, Prioritization Matrix, and Flow
Chart Protocol. We developed new protocols
for conducting tobacco compliance inspections,
new form letters to issue to violators, and
26
developed an online tobacco handler test in
both English and Spanish. In the end we not
only met, but exceeded our AIM statement.
Today 74% of Tobacco Clerks in our county are
permitted to sell tobacco products.
10. Planning for the next generation of the
public health workforce
Jason Wilcox, Columbia/Boone County Dept. of Public Health
& Human Services
Track: Workforce Development
The public health workforce is made up of a
diverse group of professionals and disciplines.
As the public health system faces urgent threats
both internally and externally, is the future public
health workforce prepared to assure the 10
Essential Public Health Services? This poster
presentation will provide an overview of the
Columbia/Boone County (MO) Public Health &
Human Services (PHHS) workforce development
plan. In December 2013, PHHS received a
NACCHO Accreditation Support Initiative grant
to adopt a set of department core competencies,
conduct a gap analysis against the core
competencies, and create a workforce
development plan with individualized staff
training plans. PHHS recognizes and acknowledges
that a well-trained staff is essential to providing
the optimal level of service to our customers. As
a result of the gap analysis, PHHS is prioritizing
training efforts in 2015 on communication
and cultural competency skills. Each PHHS
staff person has an individualized training plan
complete with department, unit, and core
competency-specific training. A course catalog
is integrated into the training log that allows
staff to easily find and sort training opportunities
by competency. These efforts will assist PHHS in
meeting PHAB measure 8.2.1.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
11. Workforce Development Planning for
Public Health Nurses
12. New Hire Orientation and Training/
Onboarding
Laura Layne, Georgia Department of Public Health
Track: Workforce Development
Tyler Brandow, New Hampshire Division of Public
Health Services
Track: Workforce Development
The steady decrease in the number of public
health nurses in Georgia during the past
decade (from 1794 in 2003 to 1218 in 2014, a
32% drop), prompted new thinking and priority
setting relative to how workforce development
planning was linked to the agency’s future
directions. This plan used a comprehensive
approach aimed at maximizing the potential
role and contribution of public health nurses
to achieving the public health mission. The
data used to inform the workforce development
planning process included the Council on
Linkages competencies, changes within the
agency that impacted rural, district and state
level public health operations and an analysis
of Strengths, Weaknesses, Opportunities and
Threats (SWOT) that focused on the following
six priority areas:
1. Added Value of Public Health Nursing
2. Online Public Health Nursing Database
3. Public Health Nursing Workforce Diversity
4. Technology-Savvy Skill Building for a
Multi-Generational Workforce
5. Baccalaureate Degree Preparation and
Clinical Placement
6. Public Health Nursing Career Track
The overall goal of the plan is to assure the
public health nursing workforce is competent,
caring and compassionate and is improving the
health and safety of the population. The plan
considered public health nursing workforce
capacity and capability, gaps and strategies for
addressing each, the changing environment,
core competencies, training schedules and
barriers, inhibitors and challenges, both current
and future.
27
In an era where agencies are engaging in new,
organization-wide initiatives in preparation for
PHAB Accreditation, and their sustainability
is directly related to the ability of new employees
to be both aware of and contribute to their
successes, we will discuss the need for an
efficient and flexible management process for
a Health Department’s Orientation and Training
program. Participants will see the process
the New Hampshire Division of Public Health
Services used to develop orientation-related
performance measures, collect data on the
measures, and develop objectives for subsequent
improvement (PDSA) cycles. Participants will
discuss the pro’s and con’s of several orientation
and training model alternatives proposed to
our executive management team.
13. FLASH: Empowering clients through usage
of external memory drives to promote health
educational and information access
Dria Abramson, Office of Health Policy & AIDs Funding
Track: QI
The Facilitating Learning About Self Health
(FLASH) Project is designed to empower
clients living with HIV to have access to their
healthcare information. Following Hurricane
Katrina, many of the clients displaced from New
Orleans could not get access to their medical
records to share with healthcare providers in
their new location. As a result, labs had to be
re-run and clients were prescribed different
medications than they had previously taken.
To prepare for future disasters and avoid the
consequences of lost medical records, the
Office of Health Policy and AIDs Funding has
piloted a program called FLASH, which
distributes flash drives with medical information
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas
to all Ryan White clients. These flash drives
are password protected and hold each client’s
lab results, prescriptions, eligibility forms for
services, and additional resources. Upon receiving
the flash drive, clients participate in an educational
session with their case manager to discuss the
program and understand the meaning of the
documents enclosed on the drive. These sessions
have also been instrumental in increasing
client’s understanding of HIV infection and the
relationships between viral load, CD4 count and
medication. Preliminary results from this pilot
have shown that clients feel empowered by
having access to their medical information and
a participating in more conversations with case
managers to better understand their disease.
14. What Gets Measured Gets Improved! Henry
County (OH) Health Department’s Pillars of
Excellence Performance Management System
Anne Goon and Marianne Shawley, Henry County Health
Department
Track: Performance Management
Henry County Health Department, located in
rural northwest Ohio, serves a population of
28,000 residents. It has been building a culture of
excellence and laying the foundation to achieve
public health accreditation since July 2010,
when it adopted Five Pillars of Excellence as
its performance management system. The Five
Pillars define agency goals in the areas of
People, Service, Quality, Growth, and Finance.
Henry County Health Department selected
initial performance measures for each Pillar of
Excellence after reviewing extensive lists of
indicators commonly used by other healthcare
organizations. Indicators have been refined
annually to drive performance and alignment
across the entire health department. Indicators
were cascaded from the agency to the
program level in 2012. In 2015, staff merit
increases are being based upon achievement
of key program indicators that cascade down
from agency goals.
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This poster session will introduce learners
to Henry County Health Department’s Five
Pillars of Excellence, provide examples of
indicators being used by a rural local health
department to drive performance, and
outline how it has improved its performance
management system over the past six years.
15. QI Coaching Model: Using a mentor system
to engage and train Public Health staff
Erin Moore, Kittitas County Public Health Department
Track: Building a Culture of Quality
Our Quality Improvement Leadership Team
(QILT) determined that the best way to
familiarize staff with QI concepts and tools was
to assist them in applying it to their day to day
work. Each division has a representative on
QILT who acts as their QI liaison and coach. QI
Coaches work within their divisions to generate
ideas and project proposals. As staff generate
ideas, they are recorded on project proposal
forms. The QI Coach assists them with determining
if it is an appropriate for a QI project and if
so, helps them to define the scope, timeframe
and project measures using a secondary
project definition form. Once a project has been
defined it is brought to QILT who then uses
a weighted criteria prioritization matrix to
determine if the project should be “greenlit”
or postponed until a future time. No project
submissions are thrown out; they are placed in a
prioritization queue which is reviewed regularly.
If the project is approved, The QI Coach works
with Staff to choose their team leaders that will
“own” the project and be responsible for data
collection and reporting. The QI Coach also
assists staff with choosing and utilizing the
most effective QI tools for the project (root
cause analysis, Process analysis, Cause and
Effect, Prioritization, etc.). The QI Coach reports
on project process though regular updates to
the Quality Improvement Leadership Team.
Successful projects are storyboarded and
shared with the Department.
OPEN FORUM FOR QUALITY IMPROVEMENT IN PUBLIC HEALTH
March 2015 • San Antonio, Texas