Quality Improvement for Maternal Child Health Home Visiting Models
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The What, How, Why and When for South Carolina. A. Brock presentation given at the 2012 South Carolina Home Visiting Summit
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Quality Improvement for Maternal Child Health Home Visiting Models
- 1. Quality Improvement for MCH Home Visitation Models: The What, How, Why, and When for South Carolina Amy Brock Martin, Dr.P.H. Deputy Director & Research Associate Professor Nathan Hale, Ph.D. Research Assistant Professor SC Rural Health Research Center Department of Health Services Policy & Management Arnold School of Public Health University of South Carolina SouthHealth Research Center Rural Carolina
- 2. Presentation Objectives Describe the Institute for Healthcare Improvement’s (IHI) Breakthrough Series concept on quality improvement as it relates to home visitation services; Identify the IHI activities proposed for South Carolina’s home visitation programs; Describe why IHI quality improvement activities are important for successful and sustainable home visitation programs; and Identify the client and program-level outcomes home visitation programs should expect from the IHI quality improvement activities. South Health Research Center Rural Carolina
- 3. Who we are… South Carolina Rural Health Research Center 1 of 6 Rural Health Research Centers funded by the Health Resources and Services Administration Administratively located in the Arnold School of Public Health at the University of South Carolina Mission: to increase knowledge of the persistent inequities in health status among populations of the rural US, with an emphasis on factors related to socioeconomic status, race and ethnicity, and access to healthcare services. South Health Research Center Rural Carolina
- 4. Why Do QI? – What a difference a year makes… South Health Research Center Rural Carolina
- 5. Lucas Gregory Martin 8lbs, 6 oz Lucas squealing.3gp Lucas watching SpongeBob.3gp 5/1/12 South Health Research Center Rural Carolina
- 6. South Health Research Center Rural Carolina
- 7. South Health Research Center Rural Carolina
- 8. Why do CQI? Because what you do matters in the lives of people …with insurmountable crises …having challenges with coping with stress …who may not have a voice …who have few or no advocates …who have very complex physical, emotion, and psychosocial needs. South Health Research Center Rural Carolina
- 9. What is Quality Improvement? “QI involves both prospective and retrospective reviews. It is aimed at improvement -- measuring where you are, and figuring out ways to make things better. It specifically attempts to avoid attributing blame, and to create systems to prevent errors from happening” Department of Family Medicine, Duke Medical Center South Health Research Center Rural Carolina
- 10. Your Critics: NGA Lack of a Cohesive Strategy to Promote Program Quality and Effectiveness. Most states lack an overarching statewide strategy to ensure and promote the effectiveness of home visiting programs and to provide accountability for public funds. …most states do not have a coordinated infrastructure to support home visiting programs in achieving ongoing quality improvements. http://www.nga.org/files/live/sites/NGA/files/pdf/1103HOMEVISIT.PDF South Health Research Center Rural Carolina
- 11. Who is IHI? The Institute for Healthcare Improvement (IHI) is an independent, not-for-profit organization whose work is to help lead the improvement of health care around the world. The IHI Breakthrough Series uses a learning collaborative model that includes: Selecting a topic Convening an expert meeting Developing a framework for change Providing learning sessions for program participants Action period using Plan, Do, Study, Act cycles to test small changes A series of follow-up learning sessions followed by action periods with formal PDSA cycles Dissemination of findings/spreading and holding the gains South Health Research Center Rural Carolina
- 12. Proposed MIECHV Implementation Evaluation Framework Secondary Client Data Survey Sources Composite Client Record Aggregate Maintained by ORS Benchmark/ Construct Reporting Program Program Continuous Data Process Quality Matrix Improvement South Health Research Center Rural Carolina
- 13. South Carolina MIEC Home Visitation Program-CQI Process Chart Home Visiting Coalition (1) Home Visiting Coalition (1) Program Coordinator Program Coordinator Roles and Responsibilities Eric Bellamy, CTSC Roles and Responsibilities Eric Bellamy, CTSC •Oversight •Oversight •Etc •Etc ECCS State Implementation/Coordination Outcomes/Benchmarks (3) Implementation/Coordination Outcomes/Benchmarks (3) Coordinator (2) Roles and Responsibilities (2) Roles and Responsibilities Rosemary Wilson Roles and Responsibilities •Data collection Roles and Responsibilities •Data collection •Coordinate •Reporting (Q) Project Evaluation Team •Coordinate •Reporting (Q) •Implement •CQI Feedback loop Nathan Hale •Implement •CQI Feedback loop •? Amy Brock Martin •? State CQI Oversight Team (4) State CQI Oversight Team (4) Expert faculty for the IHI Breakthrough Expert faculty for the IHI Breakthrough Series Learning Collaborative Client Data Series Learning Collaborative •Survey (E, 6, 12, 24 months) •Secondary data runs (Q) Funded Service Sites (5) Funded Service Sites (5) Greenville/Pickens (NFP,HFA) Key Greenville/Pickens (NFP,HFA) Greenwood Catchment (HFA/PAT, HS, NFP) Q – Quarterly Greenwood Catchment (HFA/PAT, HS, NFP) Charleston (Trident) (NFP) M – Monthly Charleston (Trident) (NFP) Program Reporting E- Enrollment Spartanburg/Union (NFP) Spartanburg/Union (NFP) •Client roster (M) Aiken Aiken •Program Process Matrix (Q) Charleston (FC-U) Charleston (FC-U) South Health Research Center Rural Carolina
- 14. IHI Breakthrough Series (6 to 18 months time Select Participants (10-100 teams) frame) Topic (develop Prework mission) Develop P P P Framework A D A D Dissemination A D & Changes S S S Publications, LS 1 LS 2 Congress. etc. Expert Planning LS 3 Meeting Group AP1 AP2 AP3* Holding Supports the Gains Email (listserv) Phone Conferences LS – Learning Session *AP3 –continue Visits Assessments reporting data as AP – Action Period needed to document success Monthly Team Reports South Health Research Center Rural Carolina
- 15. Learning Session Objectives Learning Session 1 Learning Get Ideas Session 2 Get Methods Learning Get More Ideas Session 3 Get Started Get Better at Celebrate Methods Successes Test all Get a “Stride” changes on Test & Get ready to implement small scale all changes Sustain and Spread Action Period 1 Action Period 2 South Health Research Center Rural Carolina
- 16. Why Test? Increase your belief that the change will make improvement Predict how much improvement you can expect from the change Learn how to adapt the change in your setting Figure out the costs and side-effects of the change Minimize resistance upon implementation South Health Research Center Rural Carolina
- 17. Timeline for Activities Sep/Dec 2012 Jan 2013 Feb 2013 Expert Faculty/ Learning Session1 Action Period 1 Planning Phase Mar 2013 Apr 2013 May 2013 Learning Session2 Action Period2 Action Period 2 June 2013 July 2013 Aug 2013 Learning Session3 Action Period 3 Data collection South Health Research Center Rural Carolina
- 18. Summary Quality improvement must guide our work to prevent our contributions to ‘Amir Jenning’ cases. The IHI Breakthrough Series is a respected, evidenced-based process for facilitating a culture that promotes collaborative quality improvement in systems. Learning cycles should feel like a natural and obvious extension of effective program implementation The process allows us to understand our performance relative to the benchmarks while giving us opportunities to optimize home visitation outcomes South Health Research Center Rural Carolina
- 19. Contact information Amy Brock Martin, Dr.P.H. brocka@mailbox.sc.edu Nathan Hale, Ph.D. halen@mailbox.sc.edu SC Rural Health Research Center 220 Stoneridge Drive, Suite 204 Columbia, SC 29201 803-251-6317 (telephone) South Health Research Center Rural Carolina
Notas do Editor
- Amir Jennings
- 4 4 4 Tech content is developed prior to LS 1
- 1. Testing provides evidence that a change really does result in the improvement that was expected. Even though a change may sound like a good idea, you don’t know until you actually use it in practice. There are often multiple changes that are needed in order to produce the desired effect on your system. Testing a change, or a group of changes, gives you information about how much improvement can be expected from a change or set of changes. It allows you to evaluate whether you need additional changes to reach your aim. 3. Even though a change may have produced the desired effect in a different setting, you don’t really know how it will work in your particular environment until you try it. 4. Change sometimes produces unintended consequences. Testing allow you to observe the costs (resources, time, equipment, etc.) that the new process might involve as well as the side-effects that might accompany the change. For example, providing same-day access for clinic patients may affect the process for locating medical records. 5. It is often easier for people to agree to try a new way of doing something if the change is presented as a short-term, small scale trial. “Let’s just try it with the next three patients…” In this way, they don’t have to immediately abandon the old way of doing something. Testing often shows people that the new way is really better and they are then more willing to embrace the new process.