Conducting Timely Investigations of Health Problems and Environmental Health Hazards in Fillmore County

Summary

Impact Statement:

In Fillmore County Public Health department, the time from notification to investigation of health problems and environmental health hazards (animal bites, infectious diseases, and nuisances) took longer than desired. Data was collected to understand the current state; investigations ranged from 24-144 hours following notification. The QI project approach included the creating, tracking, applying, and auditing of standard operating procedures; updating of agreements; condensing of incident management guidelines; acquiring legal documentation related to health and environmental hazards; and developed a tracking system for recording labs, investigation results, and referral outcomes (PH-Doc). The team exceeded their goal; 100% of notifications were investigated within 24 hours.

Summary:

Fillmore County Public Health (FCPH) in Minnesota used the rapid-cycle improvement method (Plan, Do, Check, Act [PDCA]/Plan, Do, Study, Act [PDSA]) to improve processes that will reduce response time, improve partnership collaborations, and reduce negative outcomes associated with public health issues and environmental health hazards. Collaboration among public health and local partnering agencies produced standard operating procedures and tracking procedures for public health issues and environmental health hazards. The new processes and tools developed were deployed, monitored, and adjusted to protect the well-being of the public and to reduce response time to hazards. FCPH used assessment tools within the Public Health Documentation System (PH-Doc), a real-time system with reporting features that can track both response time and efforts, to record cases and extract reports. This quality improvement (QI) project built agency capacity because all staff members are able to initiate these investigations and turn them over to appropriate staff within the department. This QI project served as a way to improve public health services while also assisting FCPH with completing measures associated with Public Health Accreditation Board (PHAB) Standard 2.1, which advances FCPH's accreditation efforts.

Organization that conducted the QI initiative:

FCPH

Citation:

Pohlman, B. Public Health Quality Improvement Exchange. Conducting Timely Investigations of Health Problems and Environmental Health Hazards in Fillmore County. Thu, 12/17/2015 - 11:03. Available at http://www.phqix.org/content/conducting-timely-investigations-health-problems-and-environmental-health-hazards-fillmore. Accessed April 24, 2024.

Background and Aim

Aim statement:

By November 2012, 90% of initial investigations regarding health problems and environmental health hazards conducted by FCPH will occur within 24 hours after notification as compared with the current investigation onset time of 38.4 hours. Documentation and monitoring of health problems and environmental health hazards will take place using PH-Doc. FCPH will provide these resources and reporting tools to other public health agencies in Minnesota that use PH-Doc so that they may better respond to health problems and environmental health hazards.

Need For The QI Initiative:

Fillmore County has no formal environmental health services or a fully adopted building code. Multiple county and state departments respond to various health problems and environmental health hazards, which makes investigations complex, response time delayed, and health consequences high. Protocols exist for issues such as meth lab cleanup and septic system failure but not for issues such as mold exposure, garbage houses, and so forth. In July 2011, FCPH completed an organizational self-assessment using the tracking tool for standards. This tool assesses the level at which the local health department has demonstrated each PHAB domain. The top three standards most in need of improvement were Develop and Implement a Health Department Organizational Strategic Plan (Standard 5.3), Identify and Implement Strategies to Improve Access to Health Care Services (Standard 7.2), and Conduct Timely Investigations of Health Problems and Environmental Public Health Hazards (Standard 2.1). From April to November 2012, FCPH worked through the National Network of Public Health Institutes (NNPHI) Community of Practice for Public Health Improvement (COPPHI) award program alongside a QI team and coach to determine the best course of action for improving the response to public health issues and environmental health hazards. Current tools from other health departments and the Minnesota Department of Health were collected and used as examples. Assessment tools were developed in PH-Doc for animal bite, disease, clandestine laboratory, and nuisance investigations.

Area for Improvement:

FCPH did not have a uniform system in place to respond to public health issues and environmental health hazards or to refer them to the appropriate response agency within a specifically allotted time frame. Such a system is warranted to protect all Fillmore County residents from health problems and environmental health hazards while improving the efficiency and effectiveness of FCPH. A 2011 assessment process conducted by FCPH also corroborated this need. Also, more staff needed to be able to initiate response to these types of public health events because only one or two staff members within FCPH work closely with this process.

Root Cause:

The root causes impairing the ability to meet standards and measures associated with PHAB Domain 2 were lack of staff depth in starting initial investigations for public health issues and environmental health hazards, lack of policies and/or procedures available to manage public health issues and environmental health hazards, and lack of a system or tools to document and follow up with public health issues and environmental health hazards.

Planning and Execution Details

QI Implementation:

A Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis was conducted regarding gaps related to accreditation, which identified PHAB Domain 2 as an area for improvement. It was noted that PHAB Standard 2.1 would be targeted, and the team brainstormed to determine strategies for improving this area within FCPH. The QI team reviewed flowcharts from other agencies and decided, using PDSA, that for the greatest ease of use and efficiency, PH-Doc would be used to report and manage public health issues and environmental health hazards. A logic model work plan and Specific, Measurable, Achievable, Realistic, and Timely (SMART) objectives were created and submitted to NNPHI for consideration as part of COPPHI. From April to November 2012, the FCPH QI team used the PDCA/PDSA process to plan, implement, and evaluate the project on an ongoing basis. Assessment tools were devised in PH-Doc that align with current paper forms used in foodborne illness, disease outbreak, and animal bite investigations. Additional tools for managing nuisances and clandestine laboratories were created to align with both state and local ordinances and requirements. Approximately 20 FCPH staff members were trained on using these tools, and the tools were pilot tested and are currently being used to handle all investigations. Tree and fishbone diagrams were used in October 2012 at the Minnesota Community Health Conference to share the FCPH project with other organizations and to train more than 20 professionals on using these tools to improve their own response to public health issues and environmental health hazards.

Focus activities

Disease Treatment Services:

HIV/AIDS

Other STDs

Tuberculosis

Data collection, Epidemiology and Surveillance:

Communicable/infection diseases

Environmental health

Foodborne illness

Reportable diseases

Other Environmental Health Services:

Animal control

Disaster/Emergency Preparedness

Food borne illness investigation

Indoor air quality

Nuisance complaints

Outdoor air quality regulations

Private water supply safety

Public water supply safety

Surface water protection

Vector control

Other Public Health Services:

Animal control

Collaboration / resource sharing

Administration:

Capacity Development

Data collection and management/Information Technology

Infrastructure

Organizational effectiveness

Policies / internal procedures and processes

Quality Improvement and Accreditation Readiness

QI Methods:

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

Rapid Cycle Improvement

QI Tools:

Brainstorming

Fishbone Diagram

Flow chart

PDPC (Process Decision Program Chart)

SWOT (Strengths-Weaknesses-Opportunities-Threats)Analysis

Tree Diagram

Other QI tools:

Logic model

SMART objectives

QI Tool Documentation:

FPCH aim statement process

FPCH COPPHI proposal

FPCH aim statement

FPCH animal bite investigation form

FPCH disease investigation form

Initiative Dates:

4/1/12 to 11/30/12

Initiative Duration:

Between 6-12 months

Methods of evaluation:

Process measures for this project were the number of policies and procedures obtained from partnering agencies, the number of case investigations entered into PH-Doc, and the number of staff members trained to use the reporting system for public health issues and environmental health hazards. The primary outcome measure was ensuring that 90% or more of initial investigations for public health issues and environmental health hazards occur within 24 hours. Evaluation of this project will take place through PH-Doc's reporting features. A case investigation is time stamped when it is initially entered in PH-Doc. As the case is managed, it is also time stamped for every subsequent entry. Time stamping entries allows for FCPH to determine the difference between the event occurrence and reporting of the public health issues or environmental health hazards. Reports can be created to determine whether 90% or more of initial investigations are occurring within 24 hours of them being reported to FCPH.

Other Information:

A presentation regarding this project was conducted at the 2012 Minnesota Community Health Conference. The conference theme was "Strengthening Public Health: Linking Past Successes to Future Challenges." Handouts, resources, and additional details from the PHABulous Response session conducted by Fillmore County can be found at http://www.health.state.mn.us/divs/opi/pm/conf/.

Supplemental Materials:

Sample of materials produced

Supplemental Files:

Attachment	Size
PHABulous Response Presentation 1042012.pptx	2.45 MB
PHABulous Response Handout 1042012.docx	43.48 KB

Results

Measurable QI Outcomes:

All staff have been trained, and policies and procedures have been obtained from partnering agencies to meet process measures. FCPH has not yet been able to fully measure outcomes from this project because of the infrequency of complaints and disease reports since the project implementation phase. During the pilot testing phase of this project, the team found that all investigations were started within 24 hours after notification.

Other QI Outcomes:

Another positive outcome from this QI project was increasing agency capacity so that all staff are trained and capable of using PH-Doc to document initial investigations and pass them on to appropriate staff for follow-up.

Lessons Learned, Observations and Insights:

The successes of this project were collaborating with team members and NNPHI to achieve SMART objectives, providing training so that all staff members have the capacity to initiate investigations, and having a system that now meets PHAB Standard 2.1 accreditation requirements. The difficulties with this project included understanding how to develop an appropriate and succinct aim statement, analyzing findings when complaints and investigations occur infrequently, and narrowing the project scope to include only areas for internal improvement when work also needs to be completed with agencies that refer issues to public health so that they are reported in a timely manner.

Future Plans:

FCPH plans to provide ongoing training to staff regarding this program so that they are comfortable using PH-Doc. Reports will be generated from PH-Doc to provide ongoing monitoring of response times and the number of cases investigated. This information will be reported annually in the Minnesota Local Public Health Planning and Performance Measurement Reporting System (PPMRS) for public health. In the near future, the assessment tools created by FCPH will be shared with other public health departments that use PH-Doc so that they may be able to align with PHAB Standard 2.1 for accreditation purposes.

Conducting Timely Investigations of Health Problems and Environmental Health Hazards in Fillmore County

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

Collaborations

Contact Information of the Submitter

QI Spotlight

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Conducting Timely Investigations of Health Problems and Environmental Health Hazards in Fillmore County

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

Collaborations

Contact Information of the Submitter

QI Spotlight