National Public Health Improvement Initiative, funded through the Prevention and Public Health Fund of the Affordable Care Act, has allowed the District of Columbia Department of Health (DOH) and 73 other state, tribal, local, and territorial health departments to make fundamental changes and enhancements in their organizations and practices that improve the delivery and impact of public health services. Following initial QI training in March and June 2012, PHF caught-up with Heather Reffett to find out how their early QI work is progressing.
Q: What initiatives did the QI training kick start?
We had three issues to address: we were not meeting the requirements for food safety inspections, we did not have a streamlined grants management process, and we lacked a department-wide QI plan. In the QI training, we broke into teams to work on these three issues. Since we applied the QI tools to timely and relevant projects, we were able to create a new sense of understand and familiarity with them that will not soon be forgot.
Q: Has leadership been supportive of the QI initiative?
The QI team presented its progress to the Health Department Director. He supports this work and has asked the team to present at a senior staff meeting to ensure department-wide support for these QI projects as well as those in the future. In May 2012, the Director presented to a City Council Budget Hearing meeting and stated “[we are] committed to strengthening our QI efforts in order to strengthen the services we provide to the public.”
Q: How has leadership support changed the department?
Because we have senior leaders on-board with this initiative, employees are empowered to make changes and ask questions about challenging the status quo. Empowering employees is leading us towards a culture shift; people are talking about the benefits of QI and how they can utilize QI principles to address department-wide challenges, team-wide challenges, or individual daily challenges. By using QI at all levels of the department, we are building a culture of quality.
Q: What advice would you give to other health department employees who are beginning QI initiatives?
Many of us are very organized planners who don’t want to start something without knowing how it will end. Quality improvement has weaned me from this desire and it showed me that once I started the QI journey, the right people would be there to support me and give me the tools I need. I’ve learned to help foster discussion among team members so that they come up with the solution and they are empowered to make it work. I’ve spent more time building the capacity of my QI teams and checking on their progress than I imagined—but in return, they are owning the solutions and creating innovative ways to perform better.
Q: What are three lessons that you’ve learned about QI?
1. QI is about changing processes and situations; not about changing people.
2. QI should be started now because it helps you figure everything else; it is not something to be done later.
3. Once you begin, you will have support from the people you are working with; they will surprise you with their buy-in.
PHF will be providing additional training to DC in fall 2012 to educate more staff about QI tools and methods.