Implementing and Evaluating a Community Health Improvement Initiative Part III

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Implementing and Evaluating a Community Health
Improvement InitiativePart III

• Dorothy A. Bazos, PhD
• Associate Director
• Veteran Rural Health Initiatives
• White River Junction VA

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Monitor Process and Outcomes

• Tips for Measurements
• Seek usefulness, not perfection
• Balanced measures
• Use sampling
• Plot data over time - run charts

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Monitor Process and Outcomes
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Monitor Process and Outcomes
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A Model for Improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in
improvement?
PLAN
ACT
DO
STUDY
Langley et al. , The Improvement Guide, 1996
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The PDSA Cycle
Act
Plan

• Objective
• Questions and
• predictions (why)
• Plan to carry out
• the cycle (who,
• what, where, when)

• What changes
• are to be made?
• Next cycle?

Study
Do

• Complete the
• analysis of the data
• Compare data to
• predictions
• Summarize what
• was learned

• Carry out the plan
• Document problems
• and unexpected
• observations
• Begin analysis
• of the data

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Testing on a Small Scale
Monitor Process and Outcomes

• Try out new ideas before implementing them
• Break-down new ideas into a series of small tests
  
• Modify ideas if needed
• Work out the bugs in the new change before you
  implement it

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Repeated Use of the Cycle
Changes That Result in Improvement
DATA
Hunches Theories Ideas
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Dyersville Initiative Based on Small Tests of
Change
Monitor Process and Outcomes

• This was a step by step process
• First step was community survey
• Canvassed community for causes and change ideas
• ISOLATION
• Developed and tested the idea of teams
• A way for people to get together with friends,
  or make new friends, who could help them in their
  struggle........

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Use Data to Track Your Changes
Monitor Process and Outcomes

• Keep track of your efforts as you do them
• Diaries were helpful for community
• Share results
• Use a Standard Template
• Excel is an easy program for creating run charts
• Monitor change idea is it working?

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Monitor Process and Outcomes
Started Running
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Celebrate Success

• One other person is enough to start the team
  reaction. Its like mixing two colors. Put red
  and blue together and you get purple. Its
  synergy!!!! The two of you pool your
  energy.....................
• From the Meltaway Mommas, Millennium Grannies,
  and Slim Pickens teams...keep it fun and move
  whenever you can!!!

Clemen, Kirkwook, Schell, Myerson, The Town that
Lost a Ton, 2002.
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Why use the Quality Improvement Process?

• To validate your work
• To improve the health of the public
• To evaluate programs
• To obtain grant dollars for new initiatives

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Primary References
Clemen, J., Kirkwood, D., Schell, B., Myerson,
D. 2002. The Town that Lost a Ton. Illinois,
Sourcebooks Inc. Langley G., Nolan K., Nolan
T., Norman C. , Provost L. 1996. The Improvement
Guide A Practical Approach to Enhancing
Organizational Performance. San Francisco,
Jossey-Bass Publishers. IOM (Institute of
Medicine). 1997. Improving Health in the
Community A Role for Performance Monitoring.
National Academy Press, Washington, D.C. Nelson
E, Batalden P, Ryer J (Editors). The Clinical
Improvement Action Guide. Oakbrook Terrace, IL.
1998. Joint Commission on Accreditation of
Healthcare Organizations. New Hampshire
Department of Health and Human Services. 2001.
Healthy New Hampshire 2010. NHDHHS.
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Questions?