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Publish not Perish: Improving the Publication Process at Kansas Health Institute
Summary
Impact Statement:
Kansas Health Institute (KHI) strengthened their ability to share information with clients by increasing the efficiency of its publication process and reducing staff stress associated with it.
Summary:
To deliver credible information and research to policy leaders, KHI produces different types of publications including issue briefs, fact sheets, and technical reports. On the basis of results of the 2015 KHI employee satisfaction survey, the employees perceived the current publication process to be lengthy, labor intensive, and stressful. As a result, the Kaizen project focused on enhancing the publication process by improving writing quality (target: zero to one rework), eliminating scope change (target: zero), increasing compliance with the new communications process (target: complete 90% of the steps), decreasing the length of the process (complete 80% of the steps within the time allotted), and improving employee satisfaction by 20%. The project demonstrated reductions in amount of labor and stress involved in the publication process.
Organization that conducted the QI initiative:
KHI
Citation:
Lin, T. Public Health Quality Improvement Exchange. Publish not Perish: Improving the Publication Process at Kansas Health Institute . Wed, 08/23/2017 - 11:09. Available at https://www.phqix.org/content/publish-not-perish-improving-publication-process-kansas-health-institute. Accessed September 15, 2024.
Background and Aim
Aim statement:
By March 2017, improve the publication process by reducing the amount of labor by 30%, reducing the length of time it takes to develop and complete publications, and decreasing frustration and stress while maintaining high-quality products. The goal of completing a Kaizen quality improvement (QI) project on KHI’s publication process was to develop methods for consistent, accurate, and effective production of published work. This would result in a system where publications require fewer changes during the end stage of review. This will also improve the efficiency of KHI’s publication process, increase staff satisfaction by reducing stress and the number of project delays, and increase learning opportunities for staff by increasing their confidence in developing high-quality products at KHI.
In addition, the QI initiative aimed to reach the following outcomes:
• Decreased labor
• Decreased project costs
• Fewer missed timelines
• Decreased stress levels
• Increased staff satisfaction
• Increased timeliness of information received by the KHI audience
• Increased number of KHI products
• Increased reliance on KHI for information
Need For The QI Initiative:
KHI has an interest in systematically evaluating and improving the quality of programs, processes, and services to achieve a high level of efficiency, effectiveness, and stakeholder satisfaction. To achieve this culture of continuous improvement, QI efforts should target the department level and the program- or project-level efforts.
In 2013, KHI included QI-related activities in its 2013–2015 Strategic Plan. The objectives listed in Goal 7.7: Quality Improvement Culture are intended to guide QI efforts across the organization. In December 2014, a QI plan was developed that further detailed KHI’s commitments in the area of QI. KHI has contributed resources to improving its QI efforts through programs like Kaizen.
To identify an appropriate project for QI efforts, KHI conducted an employee satisfaction survey that identified areas for improvement within the organization. Using the results from the survey, KHI established a QI team and conducted a facilitated training to prioritize a QI project for the organization to focus on. The themes from the employee satisfaction survey were prioritized during this training, based on the greatest areas for potential growth. The areas included individual productivity, team productivity, benefits, stress level, and recognition of personnel. After the prioritization process was conducted, stress level was selected as the top priority because it affects team and individual productivity. A root cause diagram was developed to identify the sources of stress in the workplace. Criteria for evaluating potential QI projects were developed. The criteria included political will (staff and management), impact (number of people), cost, visibility (number of staff aware), impact on job satisfaction, and impact on productivity. Using these criteria to evaluate a variety of processes at KHI, the publication process was selected as one that met the criteria for selecting a QI project, and it could have an impact on reducing stress levels.
Area for Improvement:
The Kaizen project assessed the internal publication process. The mapping of the current process showed that developing a shorter publication (four-page issue brief) required about 257 hours (32 days) of combined effort spread over as many as 68 days. The development of a longer publication (35 pages or more) required about 1,150 hours (144 days) of combined effort spread over as many as 211 days. To understand opportunities for improving this process, the team determined that a QI initiative was needed.
Planning and Execution Details
QI Implementation:
QI Tools Used
• The Kaizen event process was used to collaboratively examine the issue, diagnose its causes, and identify solutions. The KHI team worked through the process during the 4-day event.
• The process mapping tool was used to understand and visualize the current process and create a new process. Specifically, both maps detailed a sequence of steps, who performs each step, and how long it takes to complete each step.
• The 5-Whys tool was used to determine the root cause of each issue by repeating the question "Why?" Each question formed the basis of the next question.
• The 2x2 prioritization matrix tool was used to prioritize issues and wastes based on their severity and impact on the overall problem (publication process). This tool was also used to prioritize solutions based on their impact to eliminate a problem, as well as speed and cost to implement the solution.
Implementation of the Kaizen Event
KHI’s Kaizen event was held from April 18 to 21, 2016. The team included 10 staff members representing all areas of the organization (team leaders, communications, grants/contracts, and the CEO). During the 4-day event, the team assessed and mapped the current process, identified and prioritized issues and solutions, and created a new process map. The mapping of the current process showed that there was limited use of job aids and templates, the process was guided by common knowledge rather than a defined structure, and the process sometimes varied for the different products. The team identified more than 20 key issues, causes, and potential solutions.
The team diagnosed the issues and identified 30 causes, including inconsistent peer-review/quality assurance standards, limited communications staff engagement early in the process, and lack of clarity about the process. To address these causes, the team identified 25 solutions. After the event, the team developed job aids for the first 11 solutions. The new publication process was piloted on June 1, 2016, and will last 9 months. During the pilot, the team will monitor and assess the impact of the new process on labor, length, quality of products, and staff satisfaction.
Affected Populations
By focusing QI efforts on the publication process from the beginning stages of a product (author draft) to the end product (publication), all staff (approximately 25) will be affected by improvements in efficiency through clarification and adjustments. Ultimately, clients and consumers (e.g., policymakers, government leaders, universities, public health providers, industry and advocacy groups, constituents, media) of KHI’s products will be affected, because KHI will be able to better serve their needs efficiently and effectively.
QI Methods:
QI Tools:
Initiative Dates:
8/1/16
Initiative Duration:
Between 6-12 months
Methods of evaluation:
The KHI QI team will use a pre-test/post-test evaluation design for all measures.
The team identified the following areas, targets, measures, and data sources:
1. Quality of writing
• Target: Zero to one rework
• Measures: (1) Number of times changes are made (e.g., rewriting sections) during the final approval phase, and (2) number of times changes are made (e.g., rewriting sections) after the peer-review process
• Data sources: Dissemination notification form (completed by CEO) and peer-review checklist (input from peer reviewer)
2. Scope change
• Target: Zero
• Measure: Number of times the scope changes after the outline is approved
• Data source: Publication process tracker
3. Compliance
• Target: 90% of steps are completed for the whole process
• Measure: Percentage of process steps completed
• Data source: Checklist for assessing the new publication process
4. Labor
• Target: 80% of steps are completed within the time allotted
• Measure: Percentage of process steps were completed within allotted time (labor)
• Data source: Checklist for assessing the new publication process
5. Length of process
• Target: No more than 20% of steps took longer to complete
• Measure: Percentage of process steps that took longer to complete (duration)
• Data source: Checklist for assessing the new publication process
6. Satisfaction
• Target: Increase satisfaction by 20%
• Measure: Increased satisfaction with the publication process
• Data source: Employee survey
Supplemental Materials:
Initiative photo(s)
Supplemental Files:
| Attachment | Size |
|---|---|
 _DSC0011_small.jpg | 217.55 KB |
| _DSC0059_small.jpg | 176.34 KB |
| image001_small.jpg | 44.38 KB |
 Areas for Improvement and Potential Solutions.docx | 30.56 KB |
 KHI Endnotes Guide_Kaizen.pdf | 434.96 KB |
| KHI Publication Process Tracker_Kaizen.pdf | 326.77 KB |
| KHI QA Guide and Checklist _Kaizen.pdf | 407 KB |
| KHI Writing Guide Approach to Writing Section_Kaizen.pdf | 740.46 KB |
Results
Measurable QI Outcomes:
In order to measure changes in labor, a sample of KHI post-Kaizen project budgets were compared with KHI pre-Kaizen project budgets. The results showed a reduction in labor between 10 and 15 percent. The percentage change depended on the type of publication. In addition, there was a slight reduction in stress levels based on the post-Kaizen survey results. About 65 percent of the respondents reported that their stress levels were as expected or less than expected, as compared to 55 percent of staff who responded to the same question during the pre-Kaizen assessment. Furthermore, KHI assessed changes in the length of the process. In general, the length of the publication process stayed about the same. However, the majority of publications experienced fewer changes later in the publications process than pre-Kaizen, as documented by the “new process tracker” form. In addition, 95 percent of the publications went through all applicable steps of the new publication process. Going forward, one key area is still in need of additional improvement: limit the number of substantial product revisions to meet the target of “zero to one rework.”
Other QI Outcomes:
The Kaizen project generated opportunities and new ideas for improvements within other processes at KHI. For example, KHI staff updated its computer-based filing system in order to allow employee easy access to project materials. The new publication process also helped to clarify what products should go through the full process (involving the communications staff), thus establishing a consistent approach across KHI strategic areas. As a result, KHI was able to increase accuracy of budgeting these products. In addition, the Kaizen project resulted in the development of more than 11 new guides that are widely used across the organization. Some of the guides include:
· Quality Assurance Checklist
· Endnotes Guide
· Publication Process Tracker
· Writing Guide
These guides are attached.
Future Plans:
Develop and conduct a routine assessment of the process, develop additional tools and guides, increase frequency and quality of internal trainings for the publication process.
Training and Preparation
Technical Assistance Received:
KHI received comprehensive coaching and assistance from Pam Vecellio of Continual Impact, LLC. The coaching and technical assistance were provided via telephone and e-mail before, during, and after the KHI Kaizen event that was held from April 18 to 21, 2016. The coach assisted the KHI event leader in developing the event agenda, assigning time to each activity, providing templates, and answering questions.
QI Related Training Received:
KHI was selected to participate in the Kaizen for Public Health Institutes (PHIs) Program, which was managed by the National Network of Public Health Institutes (NNPHI) in partnership with Continual Impact, LLC, with funding by the Robert Wood Johnson Foundation. The Kaizen for PHIs Program is part of the Community of Practice for Public Health Improvement (COPPHI), which includes several activities and programs to support the field in preparing for accreditation and implementing QI.
During the program, one KHI staff member (Tatiana Lin, Kaizen event leader) received two in-person trainings for a total of 52 hours. The first training—QI Foundational Training—3 days and was conducted from September 29 to October 1, 2015. The second training—Essentials for Culture of Improvement and Kaizen Event Skills/Process Training—lasted 3.5 days and was conducted from October 27 to October 30, 2015. In addition, the KHI Kaizen event leader co-delivered a 5-day Kaizen event to the Louisiana Public Health Institute. The program helped Kaizen event leaders develop and enhance QI foundational skills and taught them the Kaizen approach needed to help make organizational changes and improvements. Training topics included goal setting, value and waste identification, measurement, process mapping, cause-and-effect analysis, data collection and testing, capturing lessons learned, process installation, change management, team facilitation, overview of improvement concepts and methods that can be used during the event, and the process of conducting a Kaizen event.
Although the full training is not available online, PHQIX hosted a Kaizen training on January 13, 2015. Please click on this link for more information: https://www.phqix.org/sites/default/files/u829/PHQIX_Kaizen_Webinar_Slides_2015_01_13.pdf
The QI team has also received training from the Kaizen event leader before and during the KHI Kaizen event.
Information about the Community
Population Size:
Population Characteristics:
KHI is a statewide, nonprofit, nonpartisan health policy and research organization based in Topeka (www.khi.org) and established in 1995 with a multiyear grant from the Kansas Health Foundation. The institute's mission is to improve the health of all Kansans by supporting effective policymaking; engaging at the state and community levels; and providing nonpartisan, actionable, and evidence-based information. As a part of that mission, KHI works to help policymakers understand how the health of Kansans is influenced by a wide range of factors, including socioeconomic status; cultural diversity; lifestyle choices; the quality of communities; and the financing, organization, and effectiveness of public health and health care systems.
According to the U.S. Census Bureau 2015 population estimates, Kansas has nearly 3 million residents. Most of the population identifies as non-Hispanic white (greater than 76%). Hispanics are the largest minority group, with about 12% of Kansans identifying as Hispanic or Latino, followed by around 6% identifying as black. American Community Survey 2010–2014 data show that 90% of Kansas adults aged 25 or older have a high school diploma or higher, and approximately 31% have a bachelor’s degree or higher. Kansas is performing slightly better than the nation in these measures; the national averages are at 86% and 29%, respectively. Less than 14% of the Kansas population lives in poverty compared with approximately 15% nationwide. The median annual household income in Kansas is $51,872, slightly lower than the national median household income of $53,482. Of the 105 counties in Kansas, more than half are designated as rural or frontier, and only 16 have urban or semi-urban status. Kansas ranks near the middle of the country (26th) in terms of overall health, according to America’s Health Rankings 2015, presented by the United Health Foundation. In terms of children in poverty, cardiovascular-related deaths, diabetes, infant mortality, and premature death, Kansas ranks near the middle.
Information about the Health Department
PHAB Accreditation Status:
Not Applicable
Annual QI Initiative Frequency:
QI activity level:
Organization Type:
QI Staff Information
Total number of Staff on QI Team:
3
Total number of FTEs on QI Team:
0.70
QI team members:
Role in the Initiative:
Lead
Role in Organization:
Senior Analyst and Team Leader
FTE:
0.50
Name (Optional):
Tatiana Lin
Role in the Initiative:
Support
Role in Organization:
Senior Analyst
FTE:
0.10
Name (Optional):
Sarah Hartsig
Role in the Initiative:
Support
Role in Organization:
Analyst
FTE:
0.10
Name (Optional):
Sheena Smith
Collaborations
Partner Organization Types:
Contact Information of the Submitter
First Name:
Tatiana
Last Name:
Lin
Organization:
KHI
Submission Status:
Completed
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Comments
KHI produces a large number
KHI produces a large number of publications. I'm curious to know how the pilot went.
Ty