Project Description

new york dept of health

“Participation in accreditation has supported and strengthened the New York State Department of Health’s efforts to adopt a culture of quality improvement”

Quality Improvement Strengthens State Aid Program for Local Health Departments

By Jan Chytilo, MS; Ryan Tarr, BA; Sylvia Pirani, MPH, MSUP;and Robert Schmidt, MS

Participation in accreditation has supported and strengthened the New York State Department of Health’s efforts to adopt a culture of quality improvement. Led by the Strategic Planning and Performance Improvement Group, the department has established a performance measurement system and has implemented a quality improvement program that includes staff training as well as the use of quality improvement techniques to assess and improve department programs. This office supported the Office of Public Health Practice to conduct a Lean exercise to improve the process by which this reimbursement program conducts its work, with impressive results.

The New York State Department of Health’s Article 6 State Aid Program provides aid to the state’s 58 local health departments (LHDs) for the provision of essential public health services.  Article 6 provides crucial funding for LHDs to provide public health services that improve the health of New Yorkers, including services in six core areas: Chronic Disease Prevention; Communicable Disease Control; Emergency Preparedness and Response; Environmental Health; Family Health; and Community Health Assessment.

The program is statutorily required to reimburse LHDs per a formula established in Public Health Law (PHL), currently 100% reimbursement up to an amount established in law, then 36% reimbursement for any additional expenditures. This currently amounts to the payment of about $195 million per year of state funds, with the largest 10 LHDs accounting for about 80% of all payments. To receive these funds, LHDs must annually complete and submit a state aid application for review and approval, as well as submit and get approval on four quarterly vouchers.

In 2014, the program began a redesign project that included updating the program’s public health law and regulations, the guidance documents, and the forms submitted by the LHDs to collect reimbursement.

To continue the quality improvement effort, in 2016 the Article 6 Unit requested an internal review by the department’s Audit Unit to identify any areas, either fiscal or programmatic, which could be strengthened. Knowledge sharing among all levels of staff to ensure continuity of operations in the event of staff changes was the key recommendation. The Article 6 team had recently added two staff members who needed training, including learning more about the program, and this provided an additional opportunity to learn from our employees which areas of our operations required improvements. Based on these factors, a decision was made to examine both internal and external operations of the program. A Lean Kaizen event was viewed as the best way to evaluate, review and improve current procedures while sharing knowledge internally.

Staff reviewed the basic tracking information for reviewing and approving the 2016 State Aid Application (SAA), and it was clear thatimprovements were needed in processing time. The first step was to enhance the tracking mechanism for 2017 to identify the specific problem areas. A survey of customers was conducted to assess the time and effort required by LHDs to complete the SAA process. All of this information was used in the Kaizen to identify changes that could reduce the cycle time from receipt and final approval of application, including changes that could increase the initial quality of the submissions and the time involved in required corrections.

As a result of this process, the program made structural changes to the SAA to improve initial quality of submissions and reduce burden on the customer:

  • Implemented a Mandatory Checklist to reduce the number of corrections required

  • Removed/revised required components of the submission to reduce the burden on both state staff and the LHDs

  • Improved conditional formatting within the SAA to highlight potential problems areas

Additionally, process changes were made to reduce cycle time. For example, staff:

  • Created template responses for items needing to be corrected

  • Shortened timelines available for county responses

  • Developed a risk-based review process

  • Further optimized the tracking mechanism to identify bottlenecks in the review process

The Lean exercise produced impressive results.The approval cycle time for 2018 SAAs was reduced by over 60%, with fewer corrections required. This focus on improving performance has led to a “culture of continuous improvement” within the Article 6 program, and the program remains committed to identifying additional areas for enhancements.  Finally, a Voice of the Customer follow-up survey indicated that changes have been positively received by the local health departments.

Other benefits gained as a result of going through the accreditation process:

  • Accreditation strengthens communication and team work across a large public health agency

The New York State Department of Health in Albany, New York, was awarded national accreditation through PHAB on September 17, 2014.