Jim Bruckner

In recent years, the way we conduct business as local public health (PH) has been directly impacted by the downturn in and slow recovery of the economy, inadequate federal funding, reductions in state resources, losses in state and local PH infrastructure, and increases in the cost of services.  Now, local PH is faced with the uncertainty surrounding health reform, fierce competition for market share, continued waning federal and state funding, and a general lack of understanding of local PH services by many elected and appointed officials.  So, to say local PH is experiencing some extremely challenging times is an understatement.  Local PH now, more than ever, is faced with the imperative to reduce costs and improve efficiency; all while continuing to deliver the high quality services we’ve long been known for.

 

In recent years, the way we conduct business as local public health (PH) has been directly impacted by the downturn in and slow recovery of the economy, inadequate federal funding, reductions in state resources, losses in state and local PH infrastructure, and increases in the cost of services.  Now, local PH is faced with the uncertainty surrounding health reform, fierce competition for market share, continued waning federal and state funding, and a general lack of understanding of local PH services by many elected and appointed officials.  So, to say local PH is experiencing some extremely challenging times is an understatement.  Local PH now, more than ever, is faced with the imperative to reduce costs and improve efficiency; all while continuing to deliver the high quality services we’ve long been known for. 

For local PH to survive in these difficult times of diminished resources and changes in service delivery, we must continue to seek out ways to increase efficiency and utilization of available resources. Though we must operate in a business model, we in local PH cannot close our doors on our communities; therefore failure is not an option. One way local PH can accomplish this is through effective implementation and management of quality improvement (QI) programs. Many local health departments have already adopted new business planning strategies by implementing QI processes which incorporate best practices into their strategic plan.  Following the QI process can enhance planning activities, reduce service delivery costs, and improve efficiency and resource utilization; ultimately, having a positive impact on the quality of services delivered and the overall health of the community.

Why do I believe QI has an important place in public health service delivery?  Because as defined by the Institute of Medicine, it’s about assuring services we provide are safe, effective, patient centred, efficient, timely, and equitable. And, as outlined in the Macon County Public Health (MCPH) Department’s Strategic Priorities: It’s about - delivering essential public health services to the community; being accountable to our customers and stakeholders in financial reporting, monitoring internal business processes, managing organizational capacity (human, organizational, and information capital); improving communications; maximizing partnerships; and leveraging technology.  

MCPH has always focused on providing quality services to the residents of Macon County.  However, in recent years with the business impacts mentioned earlier in this article, the focus of the department’s quality program shifted with the establishment of a part-time quality program manager, implementation of a QI program, and establishment of a QI Council.

As with any large undertaking, it takes the continued commitment of the County Manager, Board of Commissioners, Board of Health, and the MCPH Leadership Team to make QI work.

In addition to leadership commitment, it takes:

  • Partnerships – we were supported by the staff from the Center for Public Health Quality, the North Carolina Institute for Public Health, the North Carolina Public Health Academy, the North Carolina State University Industrial Extension Service, and the Robert Wood Johnson Foundation’s Multistate Learning Collaborative.
  • Staff Training – we provided the following training:  The Change Process, Change Management, Introduction to Performance Improvement, Performance Improvement in the Workplace, Introduction to Lean Process Terminology, LEAN 100 and 200, the Public Health QI 101 Program, the QI Advisor Program, Traits of Highly Effective Teams, and Introduction to Triple Aim.
  • Small Wins – during the training phase, staff took part in a number of small QI initiatives to gain understanding of the process and to help cultivate buy-in.
  • Major Successes:
    • In house major projects addressing: child health visit flow, environmental health complaints, medical records flow, client feedback process, laboratory flow, men’s health, school health information technology, vaccine storage and management, and WIC work flow.
    • Regional projects: Western North Carolina (WNC) Healthy Impact Regional Community Health Assessment; WNC Health Network Triple Aim Diabetes Management Project, Senior Health Issues Project, and Healthy Kids Childhood Obesity Project; and Community Transformation Projects.
  • Ongoing engagement of stakeholders in continuous improvement and to keep them informed regarding the status of QI projects
    • MCPH has a shared computer directory for each project, which is accessible by all staff members, which includes:  Team charters/aim statements, project documents (gemba walks, process maps, and flow diagrams), team meeting notes, and other team-related communications.  In addition, MCPH has a hallway lined with bulletin boards highlighting each team’s activities and the results of their work.

I am very proud of what MCPH staff has accomplished thus far and along with staff am committed to continuing the QI/Lean/Triple Aim journey, paying close attention to improving the quality of care and the patient experience, improving efficiency throughout the agency, reducing cost for services, and ultimately improving the health of the community.

-Jim Bruckner, MSHS
Health Director, Macon County

To learn more about Macon County’s QI activities, read the recent NC Medical Journal article highlighting their QI journey by clicking here.

 

Programs supported by:

BlueCross BlueShield of NC FoundatoinThe Duke Endowment

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