Program Details

Practice Type:	Promising
Program Name:	Strategic Quality Improvement Plan based on the NACCHO Operational Definition of a Functional Local Health Department
Organization:	Central Michigan District Health Department
Web site:
Overview:	The purpose for our program is toprovide strategies and direction for all staff to use to prepare for the National Public Health Accreditation process; more fully meet the Ten Essential Public Health Services (Operational Definition domains and standards; and to provide better health outcomes for the people within the jurisdiction. The goal of the quality improvement plan is to have strategies designed to build capacity/infrastructure that will enable Central Michigan District Health Department to improve performance and health outcomes. Our objectives included developing a five-year quality improvement plan by November 30, 2008, for implementation beginning January 1, 2009; developing within the plan, goals and strategies that are measureable, time specific, and closely related to the Operational Definition of a Functional Local Health Department domains; and providing a quality improvement (Plan, Do, Study, Act) emphasis throughout the plan. The former agency plan (35 pages) was checked in January 2008 and it was determined that the new plan would need to be more condensed—tie into the core functions of public health; be based on the Operational Definition; include strategies that would allow us to show improvements in performance and health status of the community; and show accountability and readiness for national accreditation. The new (10 pages) agency strategic quality improvement plan was completed, approved by the Central Michigan District Board of Health at its December 2008 meeting, and shared via a district-wide conference call and PowerPoint presentation with all staff. The plan includes seven goals that are based on the Operational Definition domains. Each goal has at least two time-specific objectives and strategies and a staff champion. These will be checked at the monthly administrative staff meetings. Every aspect of the plan will follow the PDCA process in accordance with the agency’s QI plan.
Year Submitted:	2009
Responsiveness and Innovation:	The community in this practice is the staff of the Central Michigan District Health Department (CMDHD). Two assessment tools were used: the Operational Definition Self-Assessment and the Baldrige Criteria for Performance Excellence “Are We Making Progress” surveys (companion surveys—one for front line staff and one for agency management). Facilitated discussions were held with the entire CMDHD staff to review the assessment results and to determine if additional concerns/processes needed to be addressed. Enhanced internal and external communication plans were identified as a cross-cutting issue and therefore communication objectives were included in the plan. The staff prioritized the top areas needing improvement as maintaining a competent public health workforce, helping people receive health services, protecting people from health problems and health hazards, giving people information they need to make healthy choices, and monitoring health status and understanding health issues facing the community. As a follow-up to the district-wide discussion, the management team met to further clarify the issues raised and to offer potential strategies to address the identified improvement areas. A proposed plan provided by consultant Janan Wunsch-Smith was reviewed and revised by management to further reflect the needs and actions of the department. The plan was presented the Central Michigan District Board of Health for endorsement and also to the staff, district-wide, to offer input into the plan and to receive staff support. The implementation plan of the SQIP when successfully executed will enhance CMDHD’s capacity to meet the standards identified within the Operational Definition of a Functional Local Public Health Department, which in turn will provide better public health outcomes and prepare the agency for national public health accreditation in 2011. The process used was largely based on the NACCHO Accreditation Demonstration Site grant guidelines. The completion of the self-assessment and identification of areas in need of improvement was a grant requirement. The improved electronic self-assessment process and reporting/sorting of results is new within the public health sector. The concept of using the results may not be innovative; the fact that CMDHD used the results of the self-assessments, seeking staff input and then adding quality improvement emphasis to the entire project is innovative. Necessary components of the Total Quality Improvement (Plan, Do, Study, Act) process are included in the plan. Components of planning (Plan) include completing a community health assessment and a community health plan, and planning activities for all programs and public health services. Implementation (Do) is included in improving access to care, implementing programs, providing culturally competent public health education and materials, and ongoing advocacy efforts. The goals in the plan that provide the Study are data collection and analysis, evaluation/quality improvement process, and updating and repeating the full community health assessment regularly. The Act component involves updating the programs and community health plans based on data collection and analysis, and health assessment. It is the intent that all planning and public health activities will use best practices when available. Strategies identified in the plan will have a companion planning grid developed that identifies a responsible person (champion), a timeline for specific tasks, a reporting frequency and to whom, and the measure or activity that will indicate the task has been completed. Every goal area incorporates the quality improvement elements of Deming’s Plan, Do, Study, Act process.
Agency and Community Roles:	The agency’s SQIP is, at least initially, an internal agency plan. The overall plan was designed with the input of the entire staff at a district-wide meeting on August 26, 2008, and a district-wide teleconference/PowerPoint Presentation on November 20, 2008. The details of the plan were developed by the agency’s administrative and supervisory staff, which is a 20-member multidisciplinary team. It was also presented to the Central Michigan District Board of Health on November 19, 2008, with anticipated endorsement on December 17, 2008. The role of stakeholders/partners will be vital in the completion of the overall plan, but especially in the development/implementation of the community health assessment process and the community health plan. CMDHD has long-term relationships and partnerships with its local colleges and universities, hospitals, and other human service agency providers, and also the media. Participation and collaboration with state health department staff/resources in collecting and analyzing data and developing culturally competent and linguistically appropriate materials will also be crucial to successfully implementing the plan. Local human service collaborative councils will be used as focus group facilitators/participants throughout the plan’s implementation, as will the faith-based community, local schools, and local/state policy makers. CMDHD staff is actively involved in various community collaboratives within the district and also advisory boards both locally and state-wide. Management staff is encouraged to take leadership positions on state and local advisory committees. Staff is also encouraged to make themselves available for public speaking engagements and to participate in public forums/focus groups to establish/maintain collaborative relationships and to facilitate networking while promoting local public health.
Costs and Expenditures:	approximately $50,000
Implementation:	The community in this practice is the staff of the Central Michigan District Health Department (CMDHD). Two assessment tools were used: the Operational Definition Self-Assessment and the Baldrige Criteria for Performance Excellence “Are We Making Progress” surveys (companion surveys—one for front line staff and one for agency management). Facilitated discussions were held with the entire CMDHD staff to review the assessment results and to determine if additional concerns/processes needed to be addressed. Enhanced internal and external communication plans were identified as a cross-cutting issue and therefore communication objectives were included in the plan. The staff prioritized the top areas needing improvement as maintaining a competent public health workforce, helping people receive health services, protecting people from health problems and health hazards, giving people information they need to make healthy choices, and monitoring health status and understanding health issues facing the community. As a follow-up to the district-wide discussion, the management team met to further clarify the issues raised and to offer potential strategies to address the identified improvement areas. A proposed plan provided by consultant Janan Wunsch-Smith was reviewed and revised by management to further reflect the needs and actions of the department. The plan was presented the Central Michigan District Board of Health for endorsement and also to the staff, district-wide, to offer input into the plan and to receive staff support. The implementation plan of the SQIP when successfully executed will enhance CMDHD’s capacity to meet the standards identified within the Operational Definition of a Functional Local Public Health Department, which in turn will provide better public health outcomes and prepare the agency for national public health accreditation in 2011. The process used was largely based on the NACCHO Accreditation Demonstration Site grant guidelines. The completion of the self-assessment and identification of areas in need of improvement was a grant requirement. The improved electronic self-assessment process and reporting/sorting of results is new within the public health sector. The concept of using the results may not be innovative; the fact that CMDHD used the results of the self-assessments, seeking staff input and then adding quality improvement emphasis to the entire project is innovative. Necessary components of the Total Quality Improvement (Plan, Do, Study, Act) process are included in the plan. Components of planning (Plan) include completing a community health assessment and a community health plan, and planning activities for all programs and public health services. Implementation (Do) is included in improving access to care, implementing programs, providing culturally competent public health education and materials, and ongoing advocacy efforts. The goals in the plan that provide the Study are data collection and analysis, evaluation/quality improvement process, and updating and repeating the full community health assessment regularly. The Act component involves updating the programs and community health plans based on data collection and analysis, and health assessment. It is the intent that all planning and public health activities will use best practices when available. Strategies identified in the plan will have a companion planning grid developed that identifies a responsible person (champion), a timeline for specific tasks, a reporting frequency and to whom, and the measure or activity that will indicate the task has been completed. Every goal area incorporates the quality improvement elements of Deming’s Plan, Do, Study, Act process.
Sustainability:	The CMDHD and staff are committed and dedicated to the long-term implementation plan of the practice. Formal board endorsement occured on December 17, 2008. The administrative team, directed by the health officer, made the commitment to focus its monthly administrative staff meetings on addressing the issues and challenges associated with implementing the plan. It is a monthly planning session for objectives to be accomplished during the year, and a monthly study of the plan and the objectives/strategies implemented and also taking the necessary actions to improve the process and programs within the plan and the agency as a whole. CMDHD’s SQIP is a five-year plan and has the commitment and support from its board of health and leadership team. It also has the support and enthusiasm of the staff who are dedicated to the concept of quality improvement and prides itself on receiving excellent program reviews. We do not like to fail and make every effort to improve and succeed. Michigan is an MLC-3 state and as such, CMDHD has the opportunity to apply for a portion of Michigan’s funding for quality improvement processes. CMDHD plans to apply for this grant funding. The Northern Health Foundation is also committed to providing funding to improve local public health operations and funding is typically given annually to a select set of Michigan local health departments, one of which is the CMDHD. CMDHD also has the good fortune of being eligible to receive disbursement funding from the Saginaw Indian Chippewa Tribe, which provides 2 percent of its net slot revenue to local government entities in lieu of taxes. CMDHD has an excellent relationship with the Tribe and currently receives funding for cardiovascular disease screenings, breast and cervical cancer screenings, and HIV/AIDS screenings. CMDHD leadership is in the process of meeting with its colleagues at Central Michigan University to secure staff/student resources for assistance with community health assessment activities and public health marketing plans. Leaders are also meeting with Michigan Department of Community Health regional epidemiologists to seek their assistance and expertise in data collection and analysis.
Lessons Learned:	Information was not provided in 2009

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