One Wheel, Many Drivers: An Organizational Approach to Improving Staff Knowledge and Internal Communications for the Austin/Travis County HHSD

Summary

Impact Statement:

An urban local health department found that 35% of mid-level staff did not know who to contact for questions about new department programs and services. This workforce development QI project led to development of a common resource packet that enabled staff to respond more quickly and effectively to community members’ requests for information.

Summary:

After engaging in brainstorming and prioritization exercises based on focus areas for improvement from the beta accreditation process, the Austin/Travis County HHSD’s Continuous Quality Improvement and Public Health Accreditation Committee identified that it is essential to improve communication and collaboration throughout the department. The improvement theory was that if Austin/Travis County HHSD managers and supervisors increased their knowledge of the organizational structure of the health department and each area or unit’s roles and responsibilities, then they will be able to find the information they need and communicate with each other more readily. Although the allotted time for the QI intervention was a challenge, results revealed a 6% increase of managers and supervisors reporting that they knew whom to contact if they had questions about new department information and an 11% increase reporting that they knew what procedure to follow when distributing pertinent information. In addition, there was a 20% increase reporting the need for a centralized information source. The QI project enabled development of a Departmental Resource Packet, a living and working document that includes information and point-of-contact information for internal and external services provided throughout HHSD. Although the aim statement of a 25% increase of managers and supervisors reporting they knew whom to contact when questions about new Austin/Travis County HHSD information arose was not attained, the QI team is continuing to assess, update, and educate while managers and supervisors thoroughly review and apply the knowledge gained from the Resource Packet. The Resource Packet motivates staff to learn more about services provided throughout the department, to collaborate with each other, to maximize resources, and to have a resource for which to refer when assistance is needed to help staff and the community. HHSD is committed to updating and continuously improving its Resource Packet to inform staff and to support greater and more effective internal communication.

Organization that conducted the QI initiative:

Austin/Travis County Health and Human Services Department

Citation:

Viswanathan, V. Public Health Quality Improvement Exchange. One Wheel, Many Drivers: An Organizational Approach to Improving Staff Knowledge and Internal Communications for the Austin/Travis County HHSD. Wed, 12/26/2012 - 16:53. Available at http://phqix.org/content/one-wheel-many-drivers-organizational-approach-improving-staff-knowledge-and-internal. Accessed April 19, 2024.

Background and Aim

Aim statement:

By November 30, 2010, the percentage of Austin/Travis County Heath and Human Services Department (HHSD) managers and supervisors reporting that they know the responsible parties to contact for departmental resources and information (e.g., HHSD news, events, announcements, plans, new policies or procedures) will increase from 65% to 90%.

Need For The QI Initiative:

Throughout the PHA Beta Process, the CQI-PHA team facilitators worked with each division and area in the department to learn about their benefits and challenges. Knowing what others do and navigating through the health department were among the top challenges. The team realized the need for a formal communication resource or plan that is made available and accessible to departmental staff, kept updated, and utilized as a key information source.

Area for Improvement:

The Austin Travis County HHSD Managers and Supervisors reported, via computer-based survey, that 35% reported not knowing the responsible parties to contact for questions on new department resources and public health information. This lack of knowledge represents an opportunity to improve the Core Public Health Competencies of the Austin Travis County HHSD’s Managers and Supervisors per the Core Competencies for Public Health Professionals (Public Health Foundation, 2010). This QI project is a demonstration of our local health department’s use of the Core Competencies to identify and meet Workforce Development needs for these mid–tier 2 staff professionals with program management and supervisory responsibilities. Through the development and use of the Resource Packet, the mid–tier 2 managers and supervisors could enhance their work performance in order to better protect and promote the health of the Austin and Travis County communities. Proposed areas of impact would include the following from Core Competencies for Public Health Professionals 2010. Analytical/Assessment Skills: • References sources of public health data and information • Uses information technology to collect, store, and retrieve data Policy Development/Program Planning Skills: • Develops policies for organizational plans, structures, and programs Communication Skills: • Solicits information from individuals and organizations • Uses a variety of approaches to disseminate public health information Community Dimensions of Practice Skills: • Uses group processes to advance community involvement Financial Planning and Management Skills: • Applies basic human relations skills to the management of organizations, motivation of personnel and resolution of conflicts

Root Cause:

Root causes include: (1) poor staff knowledge of internal resources and expertise; (2) lack of knowledge of program locations; and (3) lack of a central communication structure, tool, or plan.

Planning and Execution Details

QI Implementation:

The team developed a Department Resource Packet that delineates each area’s internal services and external services and includes the department organizational chart. The team implemented the project with managers and supervisors before expanding the intervention to all department staff members. The team continues to have unit and program education and feedback opportunities, and the team continues to make the Resource Packet available for managers and supervisors. The packet is reported as useful because it has increased knowledge and collaboration opportunities. The packet has been used for new employee orientation, education internally and externally, internal auditing purposes, and to assist in grant writing. In the upcoming months, the packet (now in its third iteration) will be made available to all employees via the Intranet, and the team will have education and feedback sessions in order to continue to improve, measure change, and identify outcomes.

Focus activities

Administration:

Communications

Workforce development

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Prioritization Matrix

Surveys

QI Tool Documentation:

Force Field 6.23.10.doc

Initiative Dates:

6/10/10 to 11/10/10

Initiative Duration:

Less than 6 months

Methods of evaluation:

Post surveys, feedback sessions, and customer satisfaction surveys/feedback. In addition, tracking reports identified improved telephone wait time for referrals.

Other Information:

In order to garner input from each area of the health department for a holistic public health approach to advance quality, the Executive Leadership Team recommended representatives from all divisions in the department to participate with the Continuous Quality Improvement and Public Health Accreditation (CQI-PHA) team. The CQI Coordinator and Accreditation Coordinator facilitated monthly team meetings and were available for support, education, and guidance.

Supplemental Materials:

Sample of materials produced

Storyboard

Supplemental Files:

Attachment	Size
ATCHHSD QIStoryBoard.pdf	79.81 KB
Demographics for City, County, and State.pdf	49.69 KB

Results

Measurable QI Outcomes:

As of November 2010, results illustrate a 6% increase of managers and supervisors knowing whom to contact when questions arise and an 11% increase in knowledge of how to send pertinent information. A 20% increase in support having a centralized information source and an increase of 11% in reports receiving information from seven or more sources.The next phase is currently in progress.

Other QI Outcomes:

Manager and supervisor appreciation for the Resource Packet, feedback sessions, and planning discussions. Executive support. Empowerment: Realization that workforce has the ability to affect positive change.

Lessons Learned, Observations and Insights:

One of the most valued lessons learned throughout the beta and QI processes was the fundamental importance of communication vertically, horizontally, and cross-sectionally. Also, executive leadership and staff buy-in is paramount to the heart of the process, and once a commitment is made, the dedication and positivism counteract difficulties such as short turnarounds, having many duties and obligations, and changes in staff, management, and leadership roles within the department. The Austin/Travis County HHSD has a profound respect for the process of documenting, saving, and maintaining files. The importance of sign-in sheets at staff meetings, trainings, and community events was made clear throughout the beta process and, although challenging, the team is working toward developing templates and tools to improve processes. The Austin/Travis County HHSD appreciates the beta test process and the site visit team’s exceptional review and consideration. The beta test process has increased staff motivation and appreciation for all the functions and services that the public health department offers. In addition, the departmental quality and performance continues to advance with the public health accreditation process. The Austin/Travis County HHSD is honored to be part of making history while working toward public health accreditation for a better and healthier future. During the QI project, the time to test the theory was very limited. Allocating adequate time for the “Study” and “Act” phases is essential for performance management.

Future Plans:

The team is adapting the intervention to allow more time for managers and supervisors to review the resource packet, to provide training, and to update the packet. The team continues to study the results and will hold engagement sessions with the managers and supervisors. By doing so, they will continue to measure the project’s successes and weaknesses as they gather additional input, including challenges and benefits of the project. The Resource Packet will be updated at least annually and will be reviewed department wide. The team will utilize lessons learned as they advance toward a centralized information system such as SharePoint. The department continues to follow the PDCA model as it advances QI to effect positive change throughout the department and to have such change positively impact the communities the department serves. The third edition of the Resource Pakcet is curerntly being edited for 2012/2013. After finalizing development of the third iteration of the Resource Packet and completing departmental education sessions, we plan to develop a public, reader-friendly packet for external services.

Training and Preparation

Information about the Community

Population Size:

1,000,000 +

Population Characteristics:

In addition to the description below, please see attached Demographics tables for City, County, and State. The City of Austin is the 14th-largest city in the United States according to the 2010 U.S. Census. With a population of 790,390, Austin is the county seat of Travis County and state capital of Texas. From 2000 to 2010, the City of Austin has grown by over 20% since 2000. The population of Travis County has experienced even greater growth over the past decade, increasing by over 25% from 812,280 in 2000 to 1,024,266 in 2010. Table 2-1 (see attached) summarizes the latest data on selected demographic characteristics from the 2010 U.S. Census for the city, county, and state. Although the racial and ethnic distributions of the Austin and Travis County populations are similar to the State of Texas, there are some noteworthy differences. As with the state, Whites comprise the majority of both the city and the county population (68.3 to 69.3%). Blacks at the city and county levels comprise a lower percentage of the population at about 8%, compared with almost 12% across the state. Both the city and county have a higher percentage of Asians (approximately 6%) compared with the state at about 4%. The proportions of Hispanics are lower for both the city and county (35.1% and 33.5%, respectively) than at the state level (about 38%). For the state, 2.7% of the population reported “two or more races” for their race, whereas the city and the county population reported 3.3% and 3.4%, respectively. Table 2-2 (see attached) summarizes the social, economic, and housing data from the American Community Survey. Children under 18 years of age are the most impacted by poverty. The percentage of “children less than 18 years” below the poverty level ranged between 25.5% and 27.7% at the city, county, and state levels. For “all people” combined, the percent in poverty was lower than “children under 18 years” with the difference between the city, county, and state, ranging from 18% to 21%. The percentage of families whose income was below the poverty level in the preceding 12 months was almost identical for the state and Travis County (13.8% and 13.7%) and slightly higher for the City of Austin at 15.1%. Other social and economic indicators show that the City of Austin and Travis County are similar to the State of Texas. For example, the unemployment rate is very similar across the city, county, and state with a range of 8.2% to 8.8%. The percent of the civilian non-institutionalized population with health insurance coverage is slightly higher in the city and county (approximately 78% to 79%) than the state (76%). More children under the age of 18 years are covered by insurance at the city and the county levels than at the state level. One area where Austin/Travis County differs from the state is in educational attainment. Over 27% of the city and the county populations have attained a bachelor’s degree compared with the state’s 17%. For graduate or professional degrees, the gap is somewhat wider, with 16% of both the city and the county population reporting advanced degrees versus approximately 9% of the overall state population.

One Wheel, Many Drivers: An Organizational Approach to Improving Staff Knowledge and Internal Communications for the Austin/Travis County HHSD

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

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One Wheel, Many Drivers: An Organizational Approach to Improving Staff Knowledge and Internal Communications for the Austin/Travis County HHSD

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Collaborations

Contact Information of the Submitter

Comments

QI Spotlight