Quality Improvement in Strategic Planning

Summary

Impact Statement:

Saginaw County Department of Public Health (SCDPH) conducts strategic planning every 2 years. After noting that not all staff were engaged, the four previous strategic planning groups conducted a PDSA cycle on the strategic planning process. As a result, staff are now more committed to setting and monitoring agency strategic priorities. Because of this success, SCDPH is using its performance management system as the platform for measuring progress toward strategic priorities and how well the priorities advance the health department.

Summary:

Since 2004, SCDPH has undertaken a comprehensive strategic planning process every 2 years. The process is led by a group of staff dubbed the MOD (Moving in One Direction) Squad, a multidisciplinary team comprising representatives of front-line staff, managers, and the governing body. Each strategic planning cycle is steered by MOD Squad facilitators who learn strategic planning skills and lead the team in reviewing and updating the SCDPH vision, mission, and priorities, in addition to developing goals to support them. Over time, it became evident that despite cross-agency staff involvement in the effort, staff were not truly engaged and did not perceive any benefit from participating in the process or having a thoughtfully developed strategic plan. The SCDPH management team decided to apply a PDSA cycle to the strategic planning process and pulled together a quality improvement (QI) team comprising the team facilitators from the four MOD Squads to date, as well as the health officer. The PDSA cycle spanned an entire strategic planning cycle and resulted in improved staff connectivity to the strategic planning process.

Organization that conducted the QI initiative:

SCDPH

Citation:

Harrington, C. Public Health Quality Improvement Exchange. Quality Improvement in Strategic Planning . Mon, 10/26/2015 - 16:50. Available at https://phqix.org/content/quality-improvement-strategic-planning. Accessed March 26, 2023.

Background and Aim

Aim statement:

By the conclusion of MOD Squad 5, staff will feel more connected to the strategic planning process, as evidenced by the following survey results: (1) an increase in staff’s understanding of the time commitment and duties expected of MOD Squad members by 20%, (2) an increase in staff’s understanding of how they fit in with the MOD Squad strategic planning process by 17%, (3) an increase in staff’s understanding of how the community-based strategic planning processes fit in with the MOD Squad process by 14%, and (4) an increase in sharing MOD Squad information at monthly divisional staff meetings by 14%.

Need For The QI Initiative:

Evaluations were performed at the end of each strategic planning cycle, when the MOD Squad was disbanded. After the fourth cycle, leadership reviewed the data. Prominent concerns were staff frustration with the process, which was viewed as lengthy and not connected to daily work. Leadership within each division also noticed that staff were reluctant to participate in the planning process and resentment of co-workers who were “being pulled from clinics” to participate. At that point, leadership determined that improvements were needed if strategic planning was to be a meaningful process to guide high-priority actions throughout SCDPH.

Area for Improvement:

The SCDPH leadership established the MOD Squads as way to ensure that agency staff, leaders, and governors all had a voice in the strategic planning process. The underlying philosophy to this approach was that the result would be a continually updated strategic plan that would be meaningful to all. After 8 years and four cycles of strategic planning, it became evident that this process was not yielding the desired result. SCDPH’s leadership was passionate about the planning process and viewed it as a framework for building and maintaining a high-functioning health department and having a clear direction, a means for which to achieve a shared vision, and mechanisms to hold themselves accountable. The governing body representatives were always enthusiastic and appreciated the opportunity to participate. Staff members, on the other hand, were not, so leadership decided to embark on a QI effort to increase staff buy-in and perception of the strategic plan’s value.

Root Cause:

The root cause of the disconnect staff felt from the strategic planning process was determined to be that SCDPH had not customized the process in a way that demonstrated value to staff.

Planning and Execution Details

QI Implementation:

The strategic process for MOD Squads 1–4 entailed at least a year-long (and sometimes longer) commitment from each member to complete the planning phase, unclear monitoring processes that included only semiannual progress reporting, and an unstandardized approach for staff input into the planning process. The following new strategies were incorporated into the MOD Squad 5 strategic planning process, based on the improvement theory developed by the MOD Squad PDSA team members: • Membership for MOD Squad 5 will consist of a 9-month planning phase in which the members will meet monthly for approximately 5.5 hours. A second phase for plan implementation will last 1 year and will immediately follow the planning phase. The second phase will consist of quarterly meetings (four meetings during that year) to discuss plan implementation progress. • All staff will participate in an exercise to develop the agency’s vision priorities, goals, and actions for the department. This exercise may occur as an all-staff event (off-site meeting) or as focus groups, depending on the available budget. • Each division will write its own goals and actions based on the agency’s plan. A minimum requirement for each division will be to write at least one goal and its action steps. • A community-based strategic planning representative will be a member of each MOD Squad and active in the strategic planning process. • All division staff meetings will have a standing agenda item: MOD Squad.

Focus activities

Administration:

Policies / internal procedures and processes

Other QI Focus Activities:

Strategic planning

QI Methods:

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

QI Tools:

QI Tool Documentation:

Root cause analysis

The team conducted an affinity diagram exercise to categorize potential solutions to the identified root cause.

Cause and effect

IF... THEN theories were developed to determine the appropriate improvement strategy.

Initiative Dates:

3/1/10 to 5/1/13

Initiative Duration:

Greater than 24 months

Methods of evaluation:

Surveys were performed with all staff before and after the improvement (i.e., before and after MOD Squad 5) and asked them to rate the following: 1. If they clearly understood the commitment of time and duties of MOD Squad members 2. If they have been able to provide input into the department strategic plan 3. If they understood how the community health improvement plan fits into the MOD Squad planning process 4. If MOD Squad information was shared as a regular part of the division's monthly staff meetings 5. If they understood how they fit in with the strategic planning process

Supplemental Materials:

Report

Supplemental Files:

Attachment	Size
2013_Survey_Results.ppt	486.5 KB

Results

Measurable QI Outcomes:

Post–MOD Squad 5 survey results were as follows: 1. Staff increased their understanding of the time commitment and duties of MOD Squad members by 9%, thus not meeting the goal in the aim statement. 2. More staff believed that they had an opportunity to provide input on the strategic plan, exceeding the aim statement goal by increasing their responses by 26%. 3. Staff had a better understanding of how the community health improvement planning fit in with the MOD Squad, exceeding the aim statement goal by increasing their responses by 19%. 4. MOD Squad information sharing increased in monthly divisional meetings, exceeding the aim statement goal by increasing their responses by 21%. 5. Staff had a better understanding of how they fit into the strategic planning process, exceeding the aim statement goal by increasing their responses by 47%.

Other QI Outcomes:

A significant outcome of this improvement process was the acceptance of staff being pulled from clinic duties to perform MOD Squad duties. Previously, staff who were "left behind" in clinics to cover for staff attending MOD Squad meetings were resentful, feeling that clinic duties were a higher priority. This staff sentiment has now changed: Staff realize the true importance of strategic planning. Moreover, the new strategies provide for ongoing engagement of staff in monitoring progress toward the strategic priorities throughout the entire strategic planning cycle. Finally, perhaps the most important result is the use of the strategic plan as the basis for developing the new performance management system, as described in the next section.

Future Plans:

One facilitator created a local health department strategic planning guide, and all team facilitators updated MOD Squad meeting agendas to reflect the improved process. In 2015, the team is also implementing a 4-month rapid-cycle improvement strategy to include performance management as an integral part of the planning process. The MOD Squad will use the current framework to develop strategic goals, as they have always done, but instead of implementing an action plan that is focused on strategies to fulfill the vision, the new process will focus on standards and measures to improve the current performance of SCDPH that will better align with the department’s vision. SCDPH will move from “hit it and quit it” objectives to more meaningful and ongoing measurement of operations by incorporating performance management. The entire performance management system will be driven by the strategic plan, QI, workforce development, community health assessment, and community health improvement planning. This is perhaps the most exciting and relevant movement in recent years for this longstanding planning process for the department. Should the data support the effective inclusion of performance management into the strategic planning process by January 2016, the department anticipates that it will be considered a model practice and will work to share it with health departments across the nation.

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

Thanks so much for sharing

Thanks so much for sharing this initiative, Christina! Your process effectively addressed two issues that many health departments are working to improve: engaging staff at all levels in strategic planning and aligning plans. Keep us posted on the inclusion of performance management into the SCDPH strategic planning process!

Rachel Melody, MPH, ASQ-CQPA, CQIA
Michigan Department of Health and Human Services

Link to the resource where this submission is also published:

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Quality Improvement in Strategic Planning

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

Thanks so much for sharing

QI Spotlight

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Quality Improvement in Strategic Planning

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