The Iowa Department of Public Health Uses Quality Improvement Tools to Improve Programs

June 20, 2017|6:24 a.m.| Leah Silva

Health agencies regularly engage in quality improvement (QI) activities by using QI tools and methodologies to improve processes and make programs and operations more efficient. QI tools turn performance data from health agency programs and operations into useful information about health agency successes and opportunities for improvement. QI tools also make problems and solutions more apparent and provide an objective way of making decisions that will ultimately improve programs, processes, and policies within health agencies. QI tools can be used at each step of the Plan-Do-Study-Act (PDSA) cycle (also called the Plan-Do-Check-Act or PDCA cycle); a four-step problem-solving model organizations utilize to improve a process or carry out a change. QI tools can be used within the PDSA cycle to understand an identified problem, to plan for successful implementation of a particular improvement, to monitor progress of the improvement, and to determine if an improvement has been made.

PDSA Cycle for Learning and Improving  

Figure 1. The Plan-Do-Study-Act Cycle (PDSA), is a four-step problem-solving model commonly used in many different private and public organizations to improve a process or carry out change.

One QI tool that can be used in the different stages of the PDSA cycle is the Process Decision Program Chart (PDPC).The Iowa Department of Public Health (IDPH) uses the PDPC tool in many of its quality improvement (QI) efforts and new employee orientation trainings. PDPC is a QI tool used to identify what could go wrong when doing a QI project or implementing new processes and helps to develop countermeasures to prevent or offset potential problems. PDPC can be used to proactively avoid potential challenges that may arise during a QI project or implementation of a new process, allowing the user to better-prepare to respond to potential challenges. IDPH has incorporated the use of this tool over time, but has used the tool more strategically in the last six months with success. ASTHO spoke with Joy Harris, modernization coordinator at IDPH’s Bureau of Planning Services, about how IDPH uses the PDPC tool and how it benefits quality improvement efforts. Joy leads IDPH’s quality improvement, performance management and accreditation efforts, and in this role supports staff in the use of quality improvement tools and implementation of methodologies.

How does PDPC work?

Using the PDPC tool, health agency staff first identify the major steps in a policy or plan under development and brainstorm what could go wrong at each step. Staff then develop countermeasures to prevent or offset those potential problems. For example, IDPH first identifies the major steps in implementing a process or plan. Identified steps should not be too small to avoid duplicative problems and countermeasures to address problems. If steps are too small, it will take longer to complete the QI activity. IDPH then brainstorms what could go wrong at each step. IDPH brainstorms possible countermeasures for each step to address potential problems or challenges. Finally, IDPH determines which countermeasures are practical. Countermeasures are practical if the health agency has control or influence over them. These countermeasures are then incorporated into the process or plan. IDPH also identifies the staff responsible for and when they are responsible for implementing the countermeasures.

IDPH uses the process of baking a cake to break down the steps of the PDPC tool and demonstrate to employees how it can be used to improve a process or plan (See Figure 2).

Visual breakdown of how one uses the PDPC tool  

Figure 2. Visual breakdown of how one uses the PDPC tool to improve the process of baking a cake. Blue represents the major steps in the process, red represents the potential problems, and green represents countermeasures used to address identified problems.

When is PDPC Used?

IDPH uses PDPC to supplement planning efforts across the organization. Much time and effort goes into developing activities, grant applications, and new policies. Often, teams put forth their best ideas but have not taken the time to think about what could go wrong as they undertake their work. At the point where a team or individual feels their plan is in place, the PDPC is used to help uncover additional items the team should consider including in their work plan. PDPC works with both operational and programmatic work. IDPH has used PDPC to strengthen work plans in areas like implementation of the department quality improvement plan, cleaning up and reorganizing files in a move from outlook to google, and rolling out a new employee recognition policy.

What are benefits of using the PDPC?

The use of PDPC as a QI tool ensures that stronger plans and programs are put in place. PDPC requires IDPH staff to think proactively about potential problems or challenges in implementation and helps avoid the need for reactive adjustments and solutions when the implementation process is underway. Staff engaged in QI efforts are encouraged to ask “what could go wrong?” Although this is a new perspective and approach for many staff members, it can also be empowering. Both individual staff and teams can use PDPC to shape and improve programs or processes already in place or to shape new programs and processes that are being developed. IDPH found that PDPC is an efficient tool and does not take too much time to learn and use.

Health agencies that want to start using PDPC should familiarize staff at all levels with this QI tool. At IDPH, the QI coordinator, members of the QI Council, and the modernization coordinator lead usage of this tool and provide training to staff at multiple levels of the organization, including the executive team, program staff, new employees, and administrative assistants. This is not an intuitive way of approaching process or programmatic improvements, so it may require training and on-going conversations among staff and leadership. IDPH notes that once staff embrace this new approach, they readily accept the PDPC tool. It is important to emphasize that taking the time the time to ask what could go wrong does not prevent the organization from doing work that moves a process or program forward. In fact, the PDPC strengthens and facilitates this work. Health agencies should also identify those processes or programs where this tool would be most effective: programs or processes where there are often reactive responses to challenges or roadblocks.

For more information about IDPH’s use of the PDPC tool, please contact Joy Harris, Modernization Coordinator in the Bureau of Planning Services at IDPH.

Leah Silva

Leah Silva, JD, is director of state and territorial performance improvement at ASTHO. She supports initiatives and projects related to state, territorial, and freely associated state health agency quality and performance improvement and coordinates ASTHO’s work in the territories and freely associated states.