Building Performance Management and Continuous Quality Improvement Capacity Among Alabama’s Title X Family Planning Providers at the Local Level in Order to Improve Health Care Delivery

Summary

Impact Statement:

The Alabama state health department trained local health department family planning clinic staff in QI. The QI tools provided helped staff analyze current procedures and identify service delivery bottlenecks and then design interventions resulting in increased capacity and a reduction in waiting times .

Summary:

Health departments face unprecedented fiscal challenges that threaten their ability to prevent disease and promote health in their communities. Approaches to maintaining a high level of performance and improving community health outcomes with the same or reduced resources are needed. State offices often are challenged to provide the technical expertise regarding performance management (PM) and quality improvement (QI) to every clinical site in a timely manner. A partnership between the Region IV, Title X Regional Training Center for Family Planning (RTC), Cicatelli Associates Inc., the Alabama Centers for Disease Control and Prevention (CDC)-funded National Public Health Improvement Initiative (NPHII), and the Alabama Department of Public Health (ADPH) afforded Alabama’s Title X Program an opportunity to offer state-wide training in PM and Continuous Quality Improvement (CQI) that resulted in increased staff capacity to maximize existing resources using basic CQI tools to improve health care delivery systems. These concepts provide the framework for an interactive Training-of-Facilitators (TOF) that supports implementation of strategies that increase access to services and reduce clinical wait times with the same or reduced resources at the local level. Participants received tools and guidance for analyzing and assessing clinic performance data; analyzing and understanding client cycle time, including contact and non-contact time; and use of best practices for managing clinic flow and appointment scheduling toward maximizing staff productivity, meeting program goals, and increasing access to services. Participants concluded the training by developing preliminary clinic improvement strategies (using Plan Do Check/Study Act [PDCA/PDSA]) that included elements for performance and impact measurement and maintaining sustainability of improvement efforts. At the close of the TOF, clinic teams (eight teams) were tasked with implementation of the CQI Improvement Plan within 8 weeks for their pilot county. Clinic teams were to then repeat the CQI process with implementation in two other clinic sites within their area by June 30, 2012. Currently, 27 county health departments are participating with expansion to 64 counties expected in 2013.

Organization that conducted the QI initiative:

Alabama Department of Public Health

Citation:

Jones, M. Public Health Quality Improvement Exchange. Building Performance Management and Continuous Quality Improvement Capacity Among Alabama’s Title X Family Planning Providers at the Local Level in Order to Improve Health Care Delivery. Mon, 12/31/2012 - 15:19. Available at http://www.phqix.org/content/building-performance-management-and-continuous-quality-improvement-capacity-among-alabama%E2%80%99s. Accessed April 18, 2024.

Background and Aim

Aim statement:

The aim of this initiative was to develop individual teams to provide ongoing evaluation and improvement planning for Family Planning clinical performance. The ultimate outcome would be to see an increase in clients served and a decrease in visit wait times according to clinic cycle time.

Need For The QI Initiative:

In July 2011, ADPH hosted a 2-day training on basic QI skills for the newly identified QI team supported by CDC’s NPHII. During the training, participants were asked to identify one challenge they were facing in their daily activities; everyone identified clinic wait times as a problem. At the same time, the State Title X Training Coordinator was conducting a clinic efficiency project in a limited number of county health departments that yielded promising results. Using Title X training funds and NPHII grant funds, State QI and Family Planning staff brought in Cicatelli Associates, Inc., to provide more in-depth QI training. This widened the scope of the clinic efficiency project so that it could be taken statewide by stakeholders from each public health area.

Area for Improvement:

In 2010, Alabama’s Family Planning Program patient and visit numbers dropped by almost 6% statewide during a time of economic hardship for the state when one would expect an increase in demand for such services. Some clinical sites had an ongoing decline in numbers each year without any significant reduction in clinic staff or increase in outside competition. A statewide customer satisfaction survey was distributed the same year for a 4-week period to Family Planning clients. The results of the survey were generally positive with the exception of wait times. Only 66% of the participants found the wait time to be “good” as defined by the survey tool. Clearly, wait times have been an ongoing challenge. Our question was, could the dissatisfaction with wait times be leading to our decrease in numbers? There were no data to indicate this dissatisfaction. It was identified by leadership that the department needed to look at each county’s individual clinic process to determine areas of inefficiency that could lead to barriers to clinic access and customer satisfaction. Unfortunately, the State Office did not have the capacity to evaluate 65 county sites to study clinic system processes, collect needed data, provide analysis, and develop an individualized plan so that staff would see the value of this quality improvement initiative.

Root Cause:

The root cause identified was the decrease in patient numbers and long clinic wait times due to inefficient use of the appointment template. For example, counties did not factor in the rate of patients who did not keep their appointments. They also did not schedule by provider which meant that there was no way to know who a patient really needed to see prior to their arrival at the clinic. In some sites there was no standardized time for an appointment, making scheduling complicated. It was identified that clinician contact time was not being used to develop the appointment template.

Planning and Execution Details

QI Implementation:

Each team chose three public health county Family Planning Clinic sites. Activities included using tools for analyzing and assessing clinic performance data; analyzing and understanding client cycle time, including contact and non-contact time; and use of best practices for managing clinic flow and appointment scheduling toward maximizing staff productivity, meeting program goals, and increasing access to services. CQI plans were developed for each analyzed county using a PDCA/PDSA format stressing measurable improvement activities. These activities were to designed to lead to increased visits and decreased client wait times. Each team reviewed or learned QI tools to help them analyze current procedures and understand service delivery bottlenecks and gaps. By thoroughly understanding their current situation, team members were able to make small changes which are hoped to lead to big results: increased capacity to see patients and a reduction in wait times (see preliminary result details in tables below). These changes come at a time when the state budget for fiscal year 2013 is being reduced and staff are challenged to provide at least the same level of services with fewer resources. By utilizing QI tools and techniques to help make operational changes, the staff are already serving more patients more efficiently.

Focus activities

Administration:

Capacity Development

Customer Service/satisfaction

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Brainstorming

Flow chart

Other QI tools:

Cycle time collection and analysis

QI Tool Documentation:

AL Appointment Scheduling Worksheet 2.doc

AL Appointment Worksheet 2.xlsx

AL Cycle Time Study Instructions.doc

AL Cycle Time Study TooL.doc

AL Observing Clinic and Patient Workflow.docx

AL Operations Staffing Users and Visits Worksheet 1.docx

AL Visit Work Flow Worksheet 3.xlsx

Initiative Dates:

11/1/11 to 9/28/13

Initiative Duration:

Between 18-24 months

Methods of evaluation:

Family Planning patient numbers/visits Cycle time analysis - decrease in client wait times

Other Information:

Building on the QI successes already experienced, four new QI projects are underway: (1) updating the medication accountability protocol to increase clinic efficiency; (2) updating the customer satisfaction survey mechanism; (3) analyzing and formalizing the tuberculosis protocol to increase clinic efficiency; and (4) using Lean Six Sigma methodology to write and institute a chlamydia fast track treatment protocol.

Building Performance Management and Continuous Quality Improvement Capacity Among Alabama’s Title X Family Planning Providers at the Local Level in Order to Improve Health Care Delivery

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

QI Spotlight

quality improvement together.

Search form

You are here

Building Performance Management and Continuous Quality Improvement Capacity Among Alabama’s Title X Family Planning Providers at the Local Level in Order to Improve Health Care Delivery

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

QI Spotlight