On June 2, 2011, the DPH QI 101 Training Program was piloted as a 5-month (June–October) interactive learning program for (NCDPH sections and branches interested in improving their day-to-day activities and the quality of the services they provide. Through this training program, our participants learned about QI methods and tools (Model for Improvement and Lean) and applied what they have learned to their selected projects. The overall objectives of the program are to help participants accomplish the following:
- Understand, select, and use QI methods and tools in their daily activities to improve the efficiency of activities and services within their organization as well as health outcomes.
- Coach others within their setting to use QI methods and tools.
- Develop a plan to incorporate QI methods and tools within their organization so that it becomes "the way we do business."
CPHQ staff began the training process by conducting a needs assessment of training needs of NCDPH staff. Meetings were held with staff of various sections and branches to introduce the CPHQ and gain an understanding of staff interests and needs for participating in the DPH QI 101 training program.
Following the assessment, CPHQ staff began adapting and revising the DPH QI 101 Training Program (for local health departments) curriculum to meet the needs of NCDPH staff. Major revisions to the curriculum focused primarily on content delivery and shortening the timeline of the program.
Teams were then recruited to participate in the program, targeting branches and departments that expressed interest or had prior experience with QI. Interested parties were encouraged to attend an information session, where Branch/Section leaders and QI team leaders learned about the program, how to identify a QI project, and how to select a QI team.
An important component of the DPH QI 101 Program is coaching. The QI teams received extensive hands-on coaching from CPHQ faculty throughout the program. Coaches are responsible for providing guidance and assistance to teams throughout their QI training as well as helping them identify strategies to overcome barriers and challenges.
The training portion of the program began with a kickoff meeting, a half-day meeting where Branch/Section leaders, QI team leads, and newly recruited QI team members learned about program expectations and their important role in creating a culture of continuous quality improvement (CQI). QI tools such as a Project Selection Matrix and Aim Statement were introduced. Following this meeting, teams completed a CQI culture survey to identify cultural factors that support or hinder CQI within their organization and identify target areas for improvement. These data were then compiled and presented to leadership, and CPHQ faculty recommended strategies for any culture change targets the leaders identified.
Following the kickoff meeting, teams participate in two pre-work planning sessions. The sessions are designed to teach teams QI concepts and tools and provide an opportunity to immediately apply the tools. Teams shared progress on completing key project millstones and received feedback from their peers and CPHQ faculty. Concepts and tools presented during the planning phase of the program included aim statements, project charters, stakeholder analyses, and developing a measurement plan. These tools were important to help teams narrow the scope of their QI project as well as define the direction and responsibilities for their team.
The third pre-work planning session was a full-day onsite session that introduced the concept of conducting a Gemba Walk (a Lean tool for observing a process where it happens). During the Gemba Walk, teams were introduced to tools such as a Waste Walk/Observation Collection Tool, a data collection form used to describe a particular process and identify areas of waste (potential areas for improvement or change). Teams also began creating a value stream map (a detailed map of the process as it is actually observed, which includes the time required for all steps [broken down into valuable time and wasted time]) to identify areas for improvement and prioritize changes or “improvement ideas.”
Teams then attended a 2-day, face-to-face workshop where they continued to learn QI/Lean methods and tools (PDSA cycles, Run Charts, 5S, Kanban, General Change Concepts) and developed a plan to apply these tools in their organization. Teams also engaged in a number of interactive team-building activities.
Following the workshop, teams enter the 2–3 month Action Period phase of the program, where they began testing and implementing their change ideas and participated in an onsite Lean Kaizen Event (a 4-day rapid cycle improvement event that allowed teams to test numerous changes using PDSA cycles). Teams also attended three meetings monthly to share project progress and discuss barriers and challenges they experienced. Coaches also prepared teams to begin calculating the return on investment (ROI) for their project.
The official training component of the DPH QI 101 program ended with a final 2-day, face-to-face workshop to allow teams to celebrate and share their success and lessons learned. During this workshop, the teams developed a plan to spread and sustain their improvements. Several months later, teams attended a celebratory poster session where they presented their results to other DPH leaders and staff and were recognized by DPH leaders. CPHQ also used this celebration event as an opportunity to educate staff about QI and to recruit future program participants.