Levels of QI

Tue, 04/05/2016 - 08:49 -- gkroberts
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Community Forum

Hi,

We are in the process of updating our QI plan and I heard from several other QI experts about distinguishing different levels of QI projects/activities that are conducted through the agency. Does anyone have a formal set of QI levels they would be willing to share? I was thinking along the lines of the following possibilities:

  • informal (individual) QI
  • formal - small (program specific) QI
  • formal - big (agency-wide, multiple programs) QI

Thanks!

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Managing QI Efforts
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Submitted by judyjh on

Hi Gurleen,

We struggled with this too.  In Washington,  we adopt a matrix  to describe the level of QI projects and to help folks figure out which level their project was.  We also create some guidance for folks about how to proceed at each level of projecct. 

Our matirx looks at 5 factors about a project:

- level of impact, number of interrelationships, ease of change, level of risk, access to resources

Based on these factors a project can be:

Small - project conducted by individual or team closest to the work

Medium - project team chartered, project facilitated by QI practitioner, may need leadership sponsor

Large - project team chartered (likely cross-agency), project facilitated by more than on QI practioner/expert,  needs executive sponsor and prioritized resources for implementation.

I'm happy to share the matrix if you want to contact me individually.

Regards,  Judy

 

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Judy Hall
Department of Health
Washington State

Submitted by bpalinski2 on

Judy,

I'd be interested in seeing your supporting documents regarding the matrix, sounds pretty interesting.

Gurleen,

Our current plan divides QI projects in the following way:

 

Little QI- represents small, limited quality improvement efforts at the program or process level

Big QI- projects that examine processes affecting the divisional level or entire health department

Giant QI- projects that encompass entire HD and at least one external agency/partner.

But I'm also interested in trying to start a YouQI (UQI for short?), for individual level projects. There are many details to work out but I think this could serve as a good brand to recognize staff QI achievements and to get staff engaged.

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Brandon Palinski, MPH-VPH, SIT
Quality Assurance & Accreditation Coordinator
Toledo-Lucas County Health Department
419.213.4136
palinskb@co.lucas.oh.us
www.lucascountyhealth.com

Submitted by copp on

Judy,

I would also be interested in your matrix.  I struggle with this same issue. Thank you.

Carla Opp

Jefferson County Public Health

Colorado

copp@jeffco.us

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Carla Opp

Submitted by gkroberts on

Thanks, Judy and Brandon! Judy, would you mind attaching your matrix in this thread now that PHQIX has this new feature? I think many of us would benefit from seeing that.

Brandon, I really like your idea for YouQI. That is so cute!

Based on your feedback and some research, I settled on the following categories:

  • Big QI - agency-wide/multi-program processes
  • Small QI - program/unit-specific processes
  • Individual QI (YouQI) - daily work, personal processes

There is no right or wrong way to do this. The main purpose was to show our staff that QI comes in many shapes and forms and it is all worthy of recognition. One thing I wanted to distinguish between was formal and informal QI, but I decided not to categorize our QI projects this way because we are encouraging everyone to formally do projects with the PDSA process.

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Gurleen Roberts, MPH
Director of Quality Management
Cobb & Douglas Public Health
Marietta, GA
gurleen.roberts@dph.ga.gov

Grace Gorenflo's picture
Submitted by Grace Gorenflo on

Great discussion and I also look forward to seeing Judy's matrix!  Individual improvement efforts make an important contribution to a culture of quality improvement and also have a positive impact on one's work.  Additionally, I encourage all QI leaders to make a distinction between individual improvement efforts and "quality improvement."   What I mean by this is that Quality Improvement involves efforts that use a defined framework (e.g., PDSA), include every person/position that touches the process that is being improved, and rely on measurable improvements.  These elements are critical for QI work but may not be embodied in an individual's improvement efforts.

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Submitted by tkane on

Hello Gurleen,

If you haven't seen this 2010 article from The Quality Management Forum, you should definitely check it out: http://www.phf.org/resourcestools/Documents/The_Continuum_of_Quality_Imp...

Chapter 9 of "Embracing Quality in Public Health, a Practitioner's Quality Improvement Guidebook" also discusses these concepts. The Guidebook is available as a free download here: https://www.mphiaccredandqi.org/qi-guidebook/

Ty

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Submitted by gkroberts on

Thanks for sharing, Ty. I really liked how this was described in the first article, and fits with how I envisioned the three levels to work together:

"Top organizational leaders address the quality of the system at a macro level (Big QI).

In the middle, professional staff attacks problems in programs or service areas by improving particular processes (Little qi).

At the individual level, staff members seek ways of improving their own behaviors and environments (Individual qi)."

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Gurleen Roberts, MPH
Director of Quality Management
Cobb & Douglas Public Health
Marietta, GA
gurleen.roberts@dph.ga.gov

Submitted by MBurke on
Does anyone have the matrix Judy Hall spoke about in the initial part of this thread? Does anyone else have a matrix they would share? I'm updating our QI plan and it would be really helpful. Thanks!
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Molly Burke | Program Specialist – Performance Management
Whatcom County Health Department
Direct: 360 778-6018 | Main: 360 778-6000

Submitted by jgoodern on
We too are looking to change this in our QI Plan. We currently use the little qi, Big QI for department vs. agency projects similar to Gurleen and Brandon. However after engaging in the process for several years now that has proven difficult to distinquish as well as minimizes the full project work the "little" teams are doing. I'm leaning toward formal (applies use of a QI model-PDSA, DMAIC, etc.) team based QI and individual QI. I'm struggling with how programs document individual and/or informal improvements?
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Submitted by gkroberts on
Hey @jgoodern, I know this doesn't address your question directly but I had been contemplating the same question in the past. We have been implementing the levels of QI for several years now as well. We found success in only documenting formal QI projects that follow a QI methodology (PDSA, etc.) and have a completed storyboard. Even these projects have levels (BIG-agency-wide, small-program/department, individual). By raising the bar and recognizing these projects, staff have gained more practice with using PDSA, tools, and creating storyboards. Informal QI is important to build a culture of quality, but it can't be the main source of QI efforts. Formal QI has to become systemic at all levels to truly spread the culture. I really liked this article by Grace Gorenflow, titled "Is the Juice Worth the Squeeze". It showed how all improvements are not QI. QI is when we make an improvement using a formal process (PDSA, etc.). https://www.phqix.org/content/juice-worth-squeeze-deciding-when-use-qi We do sometimes share individual/informal improvements in our agency-wide newsletter in the Q-Tips section to raise awareness of how we make improvements all the time.
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Gurleen Roberts, MPH
Director of Quality Management
Cobb & Douglas Public Health
Marietta, GA
gurleen.roberts@dph.ga.gov