Wednesday, March 16, 2016 - It is our pleasure to honor Susan Brace-Adkins, from the Minnesota Department of Health, as a public health QI innovator. Congratulations, Susan!
What makes Susan Brace-Adkins a QI innovator?
Susan Brace-Adkins’s role at the Minnesota Department of Health is to increase adoption of performance management and QI in local health departments by providing training, technical assistance, facilitation, and consultation. Susan possesses expert-level knowledge in performance management and QI, an ability to meet local health staff where they are and help them navigate the QI roadmap, and enthusiasm and passion for her work. She provides constructive, insightful, and thought-provoking feedback to staff. Susan has also developed and implemented many successful statewide initiatives to support local adoption of performance management and QI, including a virtual QI Community of Practice. The community is unique in that local health departments identify and share content and resources. Susan has led QI collaboratives that brought together content experts from the state health department and local program staff to increase immunization rates for young children and to increase clinical response rates to health alerts. Susan has developed and implemented QI planning and performance management workshops across Minnesota. She now leads efforts to increase the capacity of all 50 of Minnesota’s local health jurisdictions to use performance management and QI and, ultimately, to fully meet the Public Health Accreditation Board’s Standards and Measures in Domain 9.
We asked Susan to share some insights regarding challenges encountered, lessons learned, and advice about public health QI. Here's what she had to say!
Q: Describe one challenge you have encountered in conducting QI in public health and how you worked to overcome that challenge.
A: One of the current challenges that I see right now for public health is understanding the differences between data for improvement and data for research. The field of public health is steeped in the sciences and research, which is an important part of our work. However, this can get in the way of doing improvement if public health cannot accept data that do not come from a double-blind study or years of research. I was reminded of this recently, as one of our learning collaborative participants wanted to know if they needed a control group to “test” one of their possible solutions. One of the ways I have addressed this challenge is to share the table that was developed by the Institute for Healthcare Improvement that details the difference between measurement for research and measurement for improvement. I also share my personal experience with using check sheets, where one uncovered a root cause and the other identified whether improvement was sustained. I also think it is helpful to explain the scientific nature of the Plan, Do, Study, Act (PDSA) cycle; develop a hypothesis; test a solution; and study the results.
Q: What is one key lesson you have learned in your experience implementing public health QI initiatives?
A: I started my QI journey in local public health through the Multi-State Learning Collaborative. During the collaborative, we had excellent training and coaching from the Minnesota Department of Health and other national QI consultants. I spent a lot of time during those webinars and phone conference calls in a perpetual state of confusion. However, I also had some “aha” moments where I grasped a concept and successfully used a tool. So I just continued to plow through and made mistakes that I know now are common. I came up with solutions before I knew the current state, I neglected to dig deep enough to find a root cause, and I didn’t test my solutions. But I learned from my mistakes and sought out help when needed and gained more confidence. Most of us don’t learn a new skill right away and we make mistakes when we start, but it is only through continuing the work that we grow and learn.
Q: What advice would you give to public health practitioners who are new to QI?
A: I recently heard the phrase “corner of your desk work” to describe the work that we intend to get to but is forgotten because our day-to-day work keeps us busy enough. Implementing QI will take more time at the beginning. This is no different than other new practices/procedures/programs you may be learning. I don’t want to make light of what public health departments must balance these days with limited budgets and being asked to do more with less. But just like with any new skill, leaders need to attend to removing barriers to this work and honor the learning curve for QI like any other skill. Staff also need to be able to talk with leadership and negotiate time for learning this new skill. Don’t let this work be the “corner of your desk work.”
Congratulations, Susan! Thank you for sharing your insights, for your demonstrated leadership in public health QI, and for being a member of the PHQIX community!