Using Quality Improvement to Increase Community Connections Through Digital Communications

Summary

Impact Statement:

The public health community has lagged in using digital communications to make its presence and services delivered known to the general public. Gwinnett, Newton, and Rockdale County Health Departments found that creating a better experience and better information for website visitors was better than just pushing themselves out via social media. This QI project showed that better web design that results in easier navigation can optimize the use of a web site.

Summary:

The project focused on digital communications, specifically Facebook and Twitter. Gwinnett, Newton, and Rockdale County Health Departments (GNR Health) looked to optimize a new website and social media presence to increase awareness and knowledge about the health department and its services, promote healthy behaviors, create a dialogue between the community and the health department, and increase service use.

Aim statement: By November 30, 2012, GNR Health aims to increase the number of monthly unique visitors to the website to 10,000, register 200 Facebook followers, and register 200 Twitter followers.

The implementation of the improvement involved creating several small, rapid-cycle quality improvement (QI) projects. During the implementation, the focus shifted from pushing the website via social media to creating a better experience and better information for website visitors.

Although the numbers in the aim statement were not realized, several of the small QI projects had dramatic results. A review of the attached tracking chart/immunizations page and accompanying run chart shows the value of creating local content and keeping website visitors on the site instead of linking to an external source.

Another benefit appears on the tracking chart/environmental health (EH) stats page. One of the goals of the EH section redesign QI project was to make certain pages more easily located. Before the modifications, the restaurant page hits (inspections) were not as easy to find, causing visitors to search other pages. The redesign redirected these visitors, increasing the number of visitors going directly to the inspections page.

The benefits of applying QI to every project—large or small—will be felt throughout all communications projects going forward. The use of the tools and knowledge gained over the course of the initiative will impact future communications programs, eventually affecting every area of the organization.

Organization that conducted the QI initiative:

Gwinnett, Newton, and Rockdale County Health Departments

Citation:

Russell, C. Public Health Quality Improvement Exchange. Using Quality Improvement to Increase Community Connections Through Digital Communications. Mon, 03/25/2013 - 17:56. Available at http://phqix.org/content/using-quality-improvement-increase-community-connections-through-digital-communications. Accessed April 19, 2024.

Background and Aim

Aim statement:

By November 30, 2012, GNR Health aims to increase the number of monthly unique visitors to the website to 10,000, register 200 Facebook followers, and register 200 Twitter followers. The specific population that the QI initiative affects is the entire population served by the district: 990,494.

Need For The QI Initiative:

GNR Health wanted to introduce QI to the organization. It was determined that a small, focused project could be a good way to do this. A redesigned website had recently been launched and social media sites activated. Although the website had a newer appearance, the information had not been updated recently. Although social media sites had been activated, they had no structure for the postings. Additionally, most social media posts and website links directed visitors away from the organization’s site. This was due to a lack of original information on the site. The QI initiative would look at plans and processes to keep visitors engaged and directed to GNR Health’s website. The ultimate goal of this engagement would be to increase awareness and knowledge about the health department and its services, promote healthy behaviors, create a dialogue between the community and the health department, and increase service use.

Area for Improvement:

In preparation for applying for public health accreditation, GNR Health is working to complete a community-wide health assessment utilizing the Mobilizing for Action through Planning and Partnerships (MAPP) strategic planning process. Preliminary results of the Community Themes and Strength Assessment (CTSA), and the Local Public Health System Assessment (LPHSA) indicate a clear disconnect between the community surveyed and the public health department. In the fall of 2011, 99 participants from eight focus groups were asked about the benefits and services of GNR Health. The focus groups consisted of a wide range of community members, including seniors, youth, Latinos, Asians, and homeless individuals using substance abuse services. Overwhelmingly, participants were unaware of services offered at GNR Health and had misconceptions about the cost and value of services. None of those surveyed relied on GNR Health as a source of health information. During a drive-through flu clinic in September 2011, 32 individuals and families were surveyed; none learned about the event from the website and only seven (22%) learned about it directly or indirectly via the GNR Health media release. Overall, results from a number of community assessments indicate a disconnect between GNR Health and the community it serves.

Root Cause:

The root cause was initially identified as a lack of connection with the community through digital communications. As the QI project proceeded, a new root cause was found: lack of timely, locally relevant information in all digital communications. Thus, lack of engagement became a secondary goal, with an increase in local, original, and timely information the primary goal.

Planning and Execution Details

QI Implementation:

The QI method Plan-Do-Study-Act (PDSA) was used in multiple small QI projects, including concurrent and sequential ramps. Spreadsheets tracking PDSA were created to monitor and update all QI project participants on both the team's progress and what the team members' individual contributions would be. We used run charts based on “hits” to predetermined web pages. These charts enabled us to: • monitor data over time to detect trends, shifts, or cycles; • compare a measure before and after the implementation of solution to measure impact; • focus attention on vital changes, not normal variation; and • track useful information for predicting trends. The initiative was chosen because it was a small, contained project in which QI could be implemented in a relatively short time, with great impact. Because the project fell programmatically within the communications arena, the team chosen to work on the project was the communications team, which included the following staff members: Connie Russell, District Program Director: provided QI assistance and strategic direction Karen Shields, Communications Manager: provided project management/implementation and strategic communications planning, as well as technical expertise in web design and social media implementation Chad Conner, Communications Assistant: provided project implementation/data collection and analysis, along with technical expertise in web design and social media implementation Implementing a QI project in the communications department was a strategic decision, as the communications team works with every program and location within the three-county health district. As various small QI projects were implemented, individuals from the affected programs were introduced to the QI process. The initiative was implemented through modifications to the website and social media outlets. Timing varied by small QI project. All work took place at the health department main office in Lawrenceville, Georgia. The initiative addressed the problem by identifying areas within the website and social media that needed modifications to enable the engagement of the community. Outside of the original team of five, approximately 53 people were exposed to the initiative. This number includes 16 in the departments or programs where the QI projects were implemented, 25 in various program or district leadership roles, and 20 in the community (eight as solicited feedback and 12 in various collaborative meetings where the initiative was discussed).

Focus activities

Regulation, inspection and/or licensing :

Food service establishments

Septic systems

Swimming pools (public)

Administration:

Communications

Other QI Focus Activities:

Emergency preparedness

QI Methods:

Model for Improvement

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

Rapid Cycle Improvement

Other QI Methods:

Multiple rapid-cycle ramps

QI Tools:

Brainstorming

Run Chart

SWOT (Strengths-Weaknesses-Opportunities-Threats)Analysis

Surveys

QI Tool Documentation:

Run charts for initiative

Visual of rapid-cycle/multiple ramp

Spreadsheet used to track PSDA

Initiative Dates:

6/1/12 to 11/30/12

Initiative Duration:

Between 6-12 months

Methods of evaluation:

The impact was measured by tracking the number of visitors (hits) to various predetermined web pages, the number of likes on Facebook, and the number of followers on Twitter. Baseline data were collected at the beginning of the initiative, with measures taken at various intervals, depending on the project. For a week-long project involving hurricane preparedness, measurements were taken daily. For longer-term projects (like environmental health subsite redesign and immunizations information), measurements were taken monthly to track data changes over time.

Other Information:

Website URL: www.gnrhealth.com Prezi viewable: http://prezi.com/f-9cibc9fly8/gwinnett-newton-rockdale-county-health-departments-quality-improvement/

Supplemental Materials:

Quote from partner/participant

Website URL

Prezi

Supplemental Files:

Attachment	Size
GNRHealth-tracking-MFI-PDSA-QI.xlsx	39.99 KB
gnrhealth-qi-runcharts.pdf	75.36 KB
gnrhealth-rapid-cycle-multiple-ramp.pdf	132.36 KB
gnrhealth-qi-participant-quotes.doc	489 KB

Results

Measurable QI Outcomes:

Outcomes were measured via Google Analytics and Facebook and Twitter metrics. The original aim statement was as follows: By November 30, 2012, GNR Health aims to increase the number of monthly unique visitors to the website to 10,000, register 1,000 Facebook followers, and register 500 Twitter followers. When the project began, there were 7,000 average unique visitors to the website per month, 25 likes on Facebook, and 21 followers on Twitter. Actual numbers measured November 30, 2012 were 8,000 average unique visitors to the website per month, 71 likes on Facebook, and 51 followers on Twitter. The original numbers were ambitious. The initial thought was that there was simply a lack of pushing out information to the community. As the project progressed, the real root cause of needing to create local, original, and timely information was identified. As this cause came to light, the expectation of meeting the original aim goals was revised. The revised aim statement is as follows: By November 30, 2012, GNR Health aims to increase the number of monthly unique visitors to the website to 10,000, register 200 Facebook followers, and register 200 Twitter followers.

Other QI Outcomes:

While even the revised numbers were not met, the learnings from the QI project were immense. Changes in policy and practice were implemented. The change strategies that were developed during this project impacted many areas of the health department. Increase value by creating unique content that attracts visitors. 1. Determine type of unique content needed. • Health promotion: public awareness (PA), nutrition, tobacco cessation • Emergency preparedness: seniors, disabled, pets, zombies, weather alerts, coordination of shelters • Infectious disease: hand washing, social isolation, stay at home, cleaning, cough and sneeze etiquette • Environmental health: food safety for holiday and summer picnics (Labor Day, etc.) • Immunizations: back to school, adult immunization, travel immunizations • Clinical services: laboratory tests, family planning (FP), intraconception health (child spacing), folic acid 2. Reach out to subject matter experts (SMEs) in each field and work with them to develop this content. 3. Review recent health needs assessment to determine areas of concern or interest within the community to ensure information of interest is being provided. Increase visibility through the use of a variety of digital communications. 1. Use GovDelivery, an organization that assists governmental agencies with connecting to their communities via digital communications. (http://www.govdelivery.com/) Increase engagement through effective information dissemination strategies. 1. Increase interaction with local media. 2. Increase interaction with other governmental agencies. 3. Develop targeted, strategically implemented advertising and other promotional activities. 4. Develop newsletters.

Lessons Learned, Observations and Insights:

Many lessons learned were discussed in previous sections. Some of the main ones were as follows: 1. Any information released by the health department should be timely and locally relevant. 2. Sometimes the root cause will be incorrectly identified, which is OK. As the project progresses, the true root cause will become evident. 3. It is OK to change the aim statement. 4. No project is too small (or too big) to benefit from QI. If the project seems too big, break it down into manageable pieces. If it seems too small, it is not. The benefits of running a QI rapid-cycle PDSA and seeing results in real time can encourage a team. 5. Get input from those outside the normal channels. Ask someone unfamiliar with the information to be shared to review it for relevancy, readability, and comprehension.

Future Plans:

The concepts and change strategies developed during the QI process have become the method of operating in the communications department. Every project begins with an assessment of where GNR Health is, where it wants to go, what it needs to do to get there, and most importantly, why it is doing this. What area is it looking to affect and how will it know if it did? The model for improvement PSDA cycle ensures that every project has a plan and a measure. Other divisions within the health department are seeking the experience of those who have worked with this project. GNR Health will be providing technical assistance to several upcoming projects in other areas. This assistance will help to ensure that (1) the team’s QI skills remain sharp and (2) a culture of QI is created organically.

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Submission Status:

Completed

Comments

Web tracking

As my background is in marketing, I thoroughly enjoyed reading about your QI project. What system do you use to monitor the data and trends of your digital efforts? Have you done any user testing with your site to see how your population may respond to the placement of finding your materials? It could be beneficial to run a small "focus group" for this effort. Also, I was not familiar with govdelivery.com and will be researching this in more detail to determine how I may use it in our digital communication efforts. Thank you for sharing!

Thanks, Lisa! We enjoyed

Thanks, Lisa! We enjoyed working on the project. We use Google Analytics to monitor our web site data/trends. Facebook has some analytics, and for Twitter we track follows and look at retweets and other activity.

We did receive solicited input for our emergency preparedness messaging, as well as our Environmental Health pages redesign. We have not done community/user testing on our website - that's a great idea.

Very interesting project!

Very interesting project! Have you set up dashboards within Google Analytics to track your indicators? We also use Analytics but haven't customized it for specific projects. Any good resources to learn about how to best use the data available in Analytics?

Thanks for sharing your

Thanks for sharing your project. I agree that public health has been lacking in using social media outlets to the best our advantage for reaching clients and our targeted populations. We have been increasing our social media efforts recently and I think it has been great. Thanks for sharing your experiences.

Thanks so much for this

Thanks so much for this submission. Our LHJ is exploring the uses of social media, including putting into place socially responsible guidelines BEFORE taking the full plunge. At the same time, our county web pages will be undergoing a complete revision in 2014. Your journey will help to guide our own.

I have shared your project

I have shared your project with our communications staff. We face a challenge in that our County maintains control of the web page and its design so we are not always able to easily make the changes we would like to make. This project may help us show the potential impact of making improvements in the website.

Margy Robinson MPH
HIV Care Services Mgr.
Multnomah County Health Dept.
Portland, OR

Using Quality Improvement to Increase Community Connections Through Digital Communications

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

Contact Information of the Submitter

Comments

Web tracking

Thanks, Lisa! We enjoyed

Very interesting project!

Thanks for sharing your

Thanks so much for this

I have shared your project

QI Spotlight

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Using Quality Improvement to Increase Community Connections Through Digital Communications

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

Contact Information of the Submitter

Comments

QI Spotlight