Through the NACCHO Accreditation Support Initiative project, the Knox County Health Department contracted the Illinois Public Health Institute to lead 6 face-to-face learning collaborative meetings with the 4 teams, 6 face-to-face Quality Improvement Council meetings, and trained 100% of health department staff.
Through this effort, the Knox County Health Department convened a Board of Health appointed Quality Improvement Council to guide all Quality Improvement efforts for the department. This Council serves to support and foster a culture of quality in our organization.
The Quality Improvement Council was tasked with creating an agency-wide Quality Improvement Plan. The plan was adopted by our Board of Health in May 2014.
Knox County Health Department
KCHD’s Experience with the NACCHO ASI Grant: A 6 Month Collaborative Resulting in 4 Completed QI Projects and a QI Plan
Knox County Health Department serves Knox County, Illinois, a rural county in west-central Illinois with approximately 52,247 residents as of the 2010 Census. Knox County residents are predominately Caucasian (87.5%) with African-Americans (7.5%) being the next largest racial group. With decreasing funding for local health departments the effectiveness of public health programs, and the effective use of resources is becoming more important than ever. In order to counteract this trend quality improvement is becoming an essential tool to improve the effectiveness of programs and resources. Additionally with quality improvement being included in accreditation domain nine the focus on accreditation both in Illinois and Nationally, further adds to the importance of quality improvement. The overall goal of this project was to build a culture that embraces and operates in quality improvement. The identified objectives to meet this goal were to train 100% of staff in quality improvement, create a Board of Health approved Quality Improvement Plan, and to complete four quality improvement projects. To achieve these objectives Knox County Health Department partnered with the Illinois Public Health Institute to hold a day and a half training session, four face-to-face learning collaborative with 4 quality improvement teams, and six face-to-face Quality Improvement Council Meetings. By the conclusion of the partnership 100% of Department staff had been trained in quality improvement tools and concepts, each of the four quality improvement teams had completed a full PDSA cycle on their projects, and the Board of Health had approved the Quality Improvement Plan created by the Quality Improvement Council. The success of this project can be attributed to the work of those participating in the quality improvement teams and the Quality Improvement Council, the support of management and the Board of Health, and the Illinois Public Health Institute’s teaching methodology and technical assistance. The impact of this project on public health will be seen from improvements in Department practices that come as a result of the quality improvement process. More information on the Knox County Health Department is available on our website http://www.knoxcountyhealth.org.
With increasing focus on accreditation coinciding with decreasing funding for local health departments, quality improvement is becoming more important to make public health more effective while meeting accreditation standards. In the past the Knox County Health Department has participated in collaborations focusing on quality improvement and workforce development as well as had select staff trained in quality improvement. This project improves on past efforts as it brought a focus to the Health Department, and included all Health Department staff instead of a few select staff. This Project is believed to be an innovative one in that, while no one part of the project may be new, the combination of the learning collaborative, drafting the Quality Improvement Plan, and simultaneously completing four quality improvement projects is new and creative. While the project as a whole may not be evidence-based, several of the techniques used during the project were. This includes the Quality Improvement Maturity Tool used to assess the Department’s quality improvement culture, and the PDSA model for improvement used during the quality improvement projects.
The immediate overarching goal of this project was to build and establish a culture of quality improvement in the Department where employees use quality improvement techniques and processes during the course of their everyday work. An additional long term goal of this project was to help prepare the Health Department for national accreditation. In order to achieve these goals, three objectives were identified. The first was to train 100% of staff in quality improvement tools and concepts. The second objective was to conduct four quality improvement projects to completion using PDSA model. The third objective was to create a Quality Improvement Plan for the Health Department approved by the Board of Health. To meet these objectives Knox County Health Department partnered with the Illinois Public Health Institute. Through this partnership the Illinois Public Health Institute lead a day and a half training, four face-to-face learning collaborative meetings with the four quality improvement teams, and six face-to-face meetings with the Quality Improvement Council. The training session was held at the start of the project to train the four quality improvement teams and Quality Improvement Council on quality improvement techniques as well as helping to identify attainable projects for the newly trained quality improvement teams.
Following the initial training session, monthly face-to-face meetings were held between the quality improvement teams and an Illinois Public Health Institute consultant. During each meeting, the teams would provide updates on the progress of their project followed by receiving feedback from the consultant and other quality improvement teams. Additionally, each face-to-face meeting a new quality improvement tool was presented to further their understanding and abilities in practicing quality improvement.
After each meeting with the teams the consultant would meet with the Quality Improvement Council on the development of the Quality Improvement Plan. The meeting would consist of a review of items drafted since the previous meeting followed by group feedback. An informational session on items to be drafted for the next meeting would follow the review and feedback of current drafts.
The majority of Department staff work on this project took place between the meetings with the Illinois Public Health Institute consultant. The quality improvement teams would meet individually to work on their projects. Early in the project period teams met to identify their root cause, select and implement an intervention, and track the progress of the intervention towards achieving the AIM statement. The Quality Improvement Council would meet to assign drafting items to members, and to approve drafted items before having them reviewed by the Illinois Public Health Institute Consultant.
This project occurred between December 2013 and May 2014. The outside stakeholders involved with this project were NACCHO by providing funding, and the Illinois Public Health Institute by participating in the learning collaborative. However this project also required a great deal of collaboration within the Health Department. Each of the Department’s four divisions has its own quality improvement team, which participated together in the meetings with the Illinois Public Health Institute consultant. This allowed staff to learn about the other division’s projects, the everyday work of the division as well, and provide an outside viewpoint. The Quality Improvement Council also showed collaboration as its membership had representation from every division, and the drafting of items for the plan was often done in pairs resulting in staff members working together which would not occur in their usual work. In order to conduct this project the Knox County Health Department received funding from the NACCHO Accreditation Support Initiative grant. The budget for this project was roughly $22,000; $17,300 of which came from the grant and the $4,800 came from an in-kind match. Staff salaries accounted for majority of the budget, $7,000. The partnership with the Illinois Public Health Institute cost $13,700 and $600 was used on printing and supplies. The remaining $1,000 went to pay for a staff member to attend Public Health Improvement Training, a required cost of the grant.
In order to meet the overall goal of this project, to build and establish a culture of quality improvement, three objectives were identified. The first was to train 100% of staff in quality improvement tools and concepts. The second was to conduct four quality improvement projects to completion using the PDSA model. The third was to create a Quality Improvement Plan for Knox County Health Department, and have that plan approved by the Board of Health. All three of these objectives were fully completed within the six month project period. In order to evaluate this project, participants were given evaluation forms following each meeting and training with the Illinois Public Health Institute. The evaluation form included questions on a Likert Scale pertaining to the effectiveness of the Illinois Public Health Institute consultant, the effectiveness of the learning collaborative, and the participant’s ability to use quality improvement tools. The evaluation form also included two open-ended questions on what was needed from the consultant, and what was needed for the next step in their team’s quality improvement project. The answers on the evaluation forms were compiled following each meeting, and sent on to the Illinois Public Health Institute for their information.
Over the course of the project several lessons were learned that could improve future iterations of the project. Lessons relating to the makeup of the quality improvement teams included having more members per team as each member had to take on several roles, and having team members alternate roles in order to gain experience in each role. Potential improvements to the training materials were also identified. These improvements were to have sufficient area for note-taking in the materials, and to make sure that the materials are sent out to participants before the meetings. The final potential improvement to the project is giving participants more opportunities to practice with the different quality improvement tools to allow them to become more comfortable with the tool, and be able to better use the tool in the future. A lesson learned during this project that proved to be helpful was to schedule deadlines at the beginning of the project. This was helpful as it gave the project some urgency so the work did not keep getting put off in favor of the participants’ day to day work. There is sufficient commitment within the Department and the Department’s Board of Health to sustain the results of this project. The quality improvement teams established during this project will continue to meet, and monitor their interventions. Additionally the established Quality Improvement Plan outlines the process to initiate new quality improvement projects, hold additional trainings on quality improvement, and maintain the Quality Improvement Plan. These activities will foster the continued growth of the quality improvement culture within Knox County Health Department, and sustain the results of this project.