2009 Model Practice Application (Public)

Quality Improvement Project

Bethlehem City Bureau of Health

The Bethlehem Health Bureau participated in a quality improvement project that addressed data collection, processing, and maintenance. Our goal was to improve accurate collection, processing, maintenance, and preliminary analysis of health data by establishing a reliable process for data collection, processing, and reporting for 100 percent of the Bethlehem Health Bureau’s program areas. Our objectives were 100 percent of program areas will complete an initial baseline assessment of data collection systems, methods, and processes by August 31, 2008; each department will have a minimum of one program area with an adequate data collection system in place by November 30, 2008; a process for producing an annual health report card for the City of Bethlehem will be established by November 30, 2008. A standard process was created for data collection. This process eliminated various forms of waste and increased the quality the Bethlehem Health Bureau’s data collection system. A standard data collection system, incorporated into all Health Bureau programs, will allow the Health Bureau to use data to improve programs, to better respond to the needs of the community, and ultimately publish an annual health report card for residents and community partners.

The Bethlehem Health Bureau is constantly striving to improve the quality and delivery of services it offers. The project focused on improving data collection, processing, and maintenance. The Health Bureau participated in a project to assess the strengths and weaknesses and areas for improvement related to the operational indicators for each essential public health service. A team of individuals completed the Local Health Department Capacity Assessment Tool and identified areas of weakness, selected one focus area on which to improve, and conducted a quality improvement initiative. A structured approach using quality improvement tools, such as the prioritization matrix, root cause analysis, affinity diagrams, and mapping, were used to improve the data collection process. This area was selected to ensure that data are driving programming needs and data are used to improve programs. Improving the Health Bureau’s data collection system will ultimately lead to the formation of a health report card for the City of Bethlehem. The report card will provide valuable information on the health of the City to community partners and community residents on annually. The report card will examine several health indicators and compare the City against county, state, and national rates. The report card will also detail several program highlights related to the health indicators. Quality improvement initiatives have been practiced for many years in the private sector, but are a fairly new concept to the public sector. The City of Bethlehem partnered with Air Products, a global company known for continuous improvement, two years ago to implement a program in the City. An individual from the Health Bureau was selected to be on the continuous improvement (CI) team and has been trained in various CI tools, such as root cause analysis, process kaizen, mapping, workplace organization and visual controls, and mistake proofing. Although the Health Bureau has participated in improvement initiatives in the past, this was the first time that many Health Bureau staff were involved in a structured quality improvement process. Each Health Bureau employee participated in at least one phase of this project, which provided the opportunity for everyone to have input into the process. This project is unique in the fact that an entire process, which has the ability to affect so many public health issues, was developed and implemented. This project also provided the impetus to institute quality improvement as part of the Health Bureau’s culture from this point forward.

The Bethlehem Health Bureau recognizes its role in the community as a lead public health agency. As a lead public health agency, it is vital that the Health Bureau has accurate, reliable data on the health issues facing the community. The first step in the process was to assure that the Health Bureau is collecting meaningful data internally so we can act as a resource to other community organizations. The next logical step will focus on working with community partners to assess other sources of data that are being collected externally. The ultimate goal is to assure that collaboration is occurring between community partners to avoid duplication of efforts and foster partnerships. The creation of an annual health report card will provide valuable information to both community partners and community members.

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Once the area of data collection was identified for improvement, the project was broken down into several phases: 1. An interview phase, in which all 26 program areas identified strengths and weaknesses in data collection, was conducted during August; 2. A root cause analysis event was held in the beginning of September to prioritize issues identified through interviews, root cause the issues, and brainstorm possible solutions; 3. A three-day mapping event was conducted during the month of September with a team of 10 Health Bureau employees to develop a process for data collection; 4. The pilot phase of the process in which four program areas environmental health, maternal and child health, chronic disease, and public health preparedness. piloted the new process during October; 5. Refinement of the process based on the findings from the pilot phase was completed in November; 6. A training phase is scheduled for the first week of December to address deficiencies identified in the interviews; 7. The process will be implemented Bureau-wide after the training phase in December; 8. A health report card template was developed and will be published and disseminated to the community in April 2009. The process was developed during the course of the grant, but trainings to address deficiencies will be ongoing. The process is implemented in four of the Health Bureau program areas and will be fully incorporated after the first round of trainings in December. The health report card for the City of Bethlehem will be released in April, in recognition of National Public Health Week.

Air Products has partnered with the City of Bethlehem on a continuous improvement initiative. Air Products has provided the City with free quality improvement tool trainings, mentoring, and recently provided some seed money to the effort. This effort is one that is supported by the Mayor of the City as well as the Health Director of the Bethlehem Health Bureau. One of the Health Bureau employees is part of the CI team and will continue to conduct quality improvement initiatives in the Health Bureau. The progress of this initiative will continue to be monitored and trainings will be ongoing with staff to sustain this specific project. The Health Bureau management team is committed to continuing to work on the weaknesses identified by the LHD Capacity Assessment Tool. Once the data collection piece is firmly in place, the Health Bureau will examine the area of data analysis because the two areas are inter-related. A quality improvement section has also been added to the yearly program plans, so from this point forward goals and objectives related to quality improvement will be established and measured each year.

The data were analyzed in ACCESS by the QI facilitator and a root cause analysis was conducted on all of the weak scoring areas with a management team. The interviews were definitely informative and allowed all employees to provide input as to how data collection can be improved. The process was modified based on some of the recommendations from the pilot. The group revisited the initial issues prioritized during the root cause analysis event to determine if the process will affect each 19. of the high impact issues identified during the staff interview phase. All but one issue was resolved or improved using the new process.

Information was not provided in 2009