Improving Coalition Communication

This project was initially chosen as part of a department-wide training process for QI and building a QI culture. Because of the department-wide involvement, four divisional QI projects were conducted simultaneously. This QI project was completed by the Wellness Promotion division. Preparations for this project began in December when KCHD was awarded the National Association of County and City Health Officials' (NACCHO’s) Accreditation Support Initiative grant. This grant allowed KCHD to contract with the Illinois Public Health Institute (IPHI) for training and technical assistance throughout the grant. IPHI conducted a 1.5-day QI boot camp for the four QI teams. During the training, the QI coach helped the teams to develop meaningful QI projects that would allow the team members to learn the PDSA process. After the training, the QI coach met with the QI teams for four learning collaboratives in which all teams would come together to improve the QI projects and learn new QI tools. Using techniques learned in the second learning collaborative, the Wellness Promotion QI team worked to identify a root cause using a fishbone diagram and the 5-Whys. After completing a draft of the fishbone diagram, the Wellness Promotion QI team decided that the best way to select a root cause and intervention must include input from all WCH Coalition members. During a conference call, all five WCH members, four site specialists, and one WCH coordinator reviewed the work completed by the Wellness Promotion QI team. The site specialists expanded on the QI team's work by adding a new branch or major cause category to the existing diagram. Once everyone was satisfied with the fishbone diagram, the root cause became apparent as different expectations of communication appeared in four of the six categories within the diagram. The five WCH members and the Wellness Promotion QI team thought that establishing group norms that fit the Coalition’s need and not any one agency’s needs was the best opportunity for improvement in communication (theory for improvement). Together, the two groups outlined what the WCH members expected from one another. The group discussed all the norms and came to a consensus on their WCH Coalition's purpose, norms, and deadlines. The WCH Coalition developed a formal Coalition Charter instituting set rules for all Coalition members to follow, including specific direction on communication within the WCH Coalition as an intervention to improve communication. On March 12, 2014, all WCH Coalition members met for a final review of the WCH Coalition Charter, and all members formally accepted the rules outlined in the charter by signing the official document. After the charter was signed, all members were held accountable to the group rules outlined in the charter by all WCH members, not just the lead agency. A second survey was given to the WCH Coalition members in June to assess the effectiveness of the intervention. Four of the six metrics showed improvements, whereas two of the metrics stayed the same as the baseline. Overall, the intervention worked, but because of the end of grant funding for the WCH initiative, the team could not continue monitoring the project for further improvement in the six metrics.

The Wellness Promotion QI team developed an electronic survey focusing on communication. The survey used a Likert scale ranging from "very satisfied" to "very dissatisfied," and options for "not applicable" were included on the survey. This survey was used for the intervention pre-test and post-test. The six metrics identified for successful communication were covered on the survey.