QI Methodologies: Determining the Best Approach for Incorporating QI Into Your Agency’s Practice

What’s in a Method?
Kaizen, Lean, Six Sigma, and Lean Six Sigma methods are often used by health departments to make measurable improvements in their business processes. Some health departments simply use a Plan-Do-Study-Act (PDSA) cycle. All of these methods are interrelated and understanding the similarities can help distinguish the differences.

As a starting point, it’s helpful to think of PDSA as a summary of the steps involved in the other four methods. Kaizen, Lean, Six Sigma, and Lean Six Sigma were created initially for the manufacturing industry, and PDSA is a more generic framework that captures the progression of thoroughly examining a current process and its problems, followed by developing solutions, then testing the solutions and measuring the results, and ending by institutionalizing a new process. The steps in the other four methods conceptually are quite similar and many differences largely are a matter of semantics.
Furthermore, all four methods focus on improving processes and require participation from all employees involved in the process in order to achieve maximum effectiveness. They rely on data to understand the problem and whether changes result in improvement. Moreover, the methods essentially all use the same tools and often combine approaches. Finally, all are grounded in a philosophy of continual improvement; therefore, QI is not merely a series of discrete improvement efforts but rather is part of an organization’s culture.

However, there are some useful distinctions to understand, related to philosophy and specific objectives.  Click here to download a comparison framework highlighting these differences so that you can determine the best approach for incorporating quality improvement into your agency’s practice.

QI Corner: December 2019: Keeping QI Fun During the Holidays and Throughout the Year

In this installment of Quality Improvement Corner, PHAB Accreditation Specialist April Harris, MPH, CHES, talks about the importance of keeping the fun in QI.

During this season of gatherings and festivities with your colleagues, it’s a great time to include quality improvement! As staff come together to celebrate the holidays and a productive year of work, try finding ways to discuss improvement or highlight QI accomplishments with your team.

In this edition of the QI Corner, the Orange County Health Care Agency, accredited in 2016, shares several approaches for keeping QI at the forefront of their health department. David Souleles, Deputy Agency Director for the Public Health Division, is a PHAB Site Visitor and also serves on PHAB’s Evaluation and Quality Improvement Committee, which reviews and provides feedback on health department Annual Reports, among other activities. Jane Chai, OCHCA’s Public Health Projects Manager, serves as the Accreditation Coordinator and has developed key strategies for keeping staff engaged through communication, activities and training.

Describe how staff – at all levels – stay engaged and motivated with QI.

There have been three major elements that have helped to engage and motivate staff to be involved with QI:

  1. Fun. When we started our QI program, our approach was to lead with FUN. We kicked off our program in 2013 with a Quality Academy, which included 45 staff working on seven cross-divisional teams on various QI projects. Participants in the Academy attended two two-day trainings. The trainings were infused with games and activities and the emphasis was on learning while having fun – we even dressed up as American Idol judges to listen to and provide feedback on the final day of the training. We have since had many QI 101 trainings and another Quality Academy. We try to keep all trainings and activities fun and light-hearted. We also send out regular newsletters called “Quality in Action” to share our QI activities. The newsletter always features a 2-3-minute video that shares lessons learned from a completed QI project.
  2. Leadership. Our leadership team, including our Deputy Agency Director, Deputy Health Officer, and Chief of Operations, has been incredibly supportive of QI since the beginning. Our QI Committee now includes our Chief of Operations, Health Officer, and management from each division; they attend meetings and are often present or assist with QI Trainings. Having leadership present at these activities sends a strong message that QI is an important part of our job.

We’ve also had trainings specific to managers to help them learn about how to support and reinforce a culture of QI. A key part of leadership training is also making sure to let supervisors and managers know that QI is about learning about what works and doesn’t work; and sometimes our change ideas don’t work as well as we had planned. Staff should feel supported in trying new things and know that if it doesn’t work, it’s okay because they have learned something new.

  1. Linking QI to Programs. Fun really helps with starting up a QI program, but to ensure that staff continue to be engaged, it was important for us to incorporate QI into program planning and implementation. For us, this began with including a QI objective and expectation of a QI project in our new performance management system, Public Health Initiative for Results and Excellence (PHIRE), which was launched in 2016.

 What has been your health department’s biggest QI success?

Last year, we started incorporating sharing of QI successes and stories as part of Public Health Week. Staff created posters to share their stories and compete for prizes (and pride) in an Open House setting. This has kept with our QI theme of keeping things fun and has been very well received by staff.

Describe how QI is specifically prioritized in your health department?

QI is linked to our performance management system, PHIRE, which includes quality improvement, program plans, and our department strategic plan. This means that key programs identify goals and objectives for their programs and then look at what key process is keeping them from meeting their objectives, which is what QI is all about. The QI Committee serves as the leadership group assisting with training and technical assistance. Program supervisors and managers lead program goal and objective development as part of PHIRE.

Best advice for keeping QI fun and not just “something else I have to do!”

Incorporate games. Consider ways to incorporate games and activities into QI trainings to set the tone for QI projects. The National Quality Center’s Game Guide is a great resource. If staff’s first interaction with QI is fun, we hope that they will approach their QI projects and activities with a lighter approach as well.

Start small. Encourage staff to start small with projects that are most meaningful to them.

Celebrate successes. We often don’t celebrate our successes enough in public health, so we encourage staff to wrap up their projects with a celebration. This also reinforces the idea that QI projects are not expected to last forever and it is okay to wrap things up with some fun.