Implement Performance What?

The Los Angeles County Department of Public Health (LAC DPH) established a department-wide, interdisciplinary Performance Improvement (PI) Team to implement continuous quality improvement methodologies. The Office of Women's Health (OWH) is one of thirty-eight programs that participate in PI Team activities. We describe the challenges and lessons learned on preparing senior staff to successfully implement performance measurement and rapid-cycle PDSA projects. Objectives: Integrate the OWH strategic plan with performance measurement, better assess opportunities for improvement, increase accountability, and better evaluate program effectiveness. Methods: A PI Coordinator was selected by the OWH director to attend PI Team meetings. To increase senior staff support, PI Team activities were implemented in 3 phases: 1) dissemination and review of PI concepts and terminology at senior staff meetings, 2) discussions on applicability of PI to each person's work area through one-on-one conversations, and 3) selecting performance measures aligned with the OWH strategic plan. Challenges: Major implementation challenges included limited prior exposure to PI concepts, fear of increased workload, and lack of experience in data collection, monitoring, and management. As a result, the PI Coordinator workload initially tripled. Lesson Learned: Encouragement and support from the PI Team and high level administrators influenced the inclusion of PI activities at OWH senior staff meetings. Repeated review of PI concepts in group and individual settings helped increased awareness. In our experience, one- on-one discussions and demonstrations of PI applicability to individual work functions were most effective. New data collection templates and databases facilitated easier data collection.