What is the slowest step in the QI process?

Fri, 08/15/2014 - 10:54 -- markobrien233

I tend to consider the QI process to work in a cycle of evaluation, planning, implementation, and review. Based on your experience, which step in this process is the slowest? I find it interesting to see the process in this way, because if we can speed up the rate limiting step, we can dramatically improve the pace at which public health improves.

I'm a recent graduate, so my experience is very limited. However, from my perspective I think the evaluation part is the slowest. It takes so long to get IRB approval (if required), recruit the people you want to study, collect the data (for long cohort studies this can take decades), analyze the data, and so on. That's not to mention the resources spent in this whole process! I'd say the implementation process is the second slowest, just because policy takes so long to draft and actually make it through to implementation (if it makes it at all).

As a follow up question for those of you who don't see the QI process in this manner, how do you conceptualize it? How would you going about improving the speed at which public health improves?

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Submitted by lcmcintosh on

Hi Mark. Our Health Department has been doing QI for just under 2 years, so I am no expert, however my immediate reaction to your question was the "plan" phase. That's why it was so interesting to read about your experience as your evaluations are clearly very thorough. I am at the local health department level, and the type of projects we have done to date have focused on administrative processes, and therefore haven't required human subjects or IRB approval.

The QI process we have been trained in is outlined well in an article available at the Public Health Foundation's website "The ABC's of PDCA" - http://www.phf.org/resourcestools/documents/ABCs_of_PDCA.pdf. The final page of the report is the step by step process we follow for each QI project, and you can see the the plan phase is the most intensive. Hope this is helpful!

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Submitted by 4Sloan on

I agree with icmintosh about the "planning" phase taking a great deal of time. However, what I've found to be the most time-consuming and sometimes the most frustrating and resource-consuming phase is the "change management" phase. Ideas are great but when it comes to implementing them there will always be some resistance coming from somewhere! Talking about change management in the planning stage is a good start to anticipating implementation resistance and being proactive--including perhaps developing a communication plan.

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Submitted by jerober on

I also agree with what lcmcintosh said. Similar to his/her situation, our local health department has been doing QI for a couple of years and we've been trained in the PDSA model. In my experience thus far, planning is definitely the slowest and most intensive part of the process. Several staff have made this observation as well, usually not positively! It's helped to talk about why it's so critical to spend time in the planning phase. When the project is planned well up front, I think you're more likely to be successful in the end.

Working through the plan phase in detail also helps you figure out what's truly feasible. Had one of our teams not focused as much time as they did in this phase, they may have charged ahead on a project that was highly complex without examining true root causes or how to get the results they desired. It helped determine that this project needed to be adapted and more thoroughly planned out.

To improve the speed of the process, I think a lot of that comes down to training, experience and familiarity--the more we're involved in QI projects, the easier and faster it will become. Having leadership fully commit and prioritize the project certainly helps to move it forward faster because we're able to devote our time to it. On the other end (bottom-up), engaging and motivating team members also helps keep the process moving forward as fast as it can. It's awesome when team members are excited to work on a project and invested in the outcome!

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Jenny Robertson, MSPH
Salt Lake County Health Department

Submitted by Jne310 on

PLANNING! PHF does a nice powerpoint that explains this, but I agree with others. It's the most frustrating bc your team is ready and wanting to dive right in, however if you don't take a step back and really plan, then you can set your team up for failure. Evaluation is hard and planning for this is even harder! But you do need data. I think evaluation is definitely a hard sell for QI, especially to those that aren't used to it. However, if you have a good team planning session (many of them usually) on the front end, you can set this up in the early stages and move forward. Just my two cents for what it is worth! Just the fact that you are thinking about evaluation should count for a LOT!

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C. Janie Cambron, RS, BS, MPH
Program Manager, EnviroHealthLink, Kentucky's Environmental PH Tracking Network
Kentucky Department for Public Health
Phone: 502-564-4537 ext. 4088; janie.cambron@ky.gov

Submitted by tlsmith on

Any steps which are outside the direct control of your team. Your team's priorities might not be the priorities of people outside the team, so things can really slow down. Choosing your team carefully can help you handle some of the potential road blocks from the beginning, but sometimes these issues can't be avoided.

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Submitted by margyrob on

Agree that planning takes the most time, and as a part of planning, I think identify what the real problem is the most time consuming. It is often tempting to move to solutions before adequately identifying the root problem.

Also challenging is figuring out a good metric for some of the longer term public health/prevention issues we may want to tackle. Identifying a smaller project within the larger goal can sometimes work and be indicative of the larger change. So thinking about evaluation from the beginning is really helpful!

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