Improving Planning Processes in
Public Health
MARLENE (MARNI) MASON
M A R M A S O N C O N S U LT I N G , L L C
M I N N E S O TA M L C - 3 C O L L A B O R AT I V E
APRIL 4, 2011
Today’s Agenda
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Welcome and Revised Format (Kim)
Method to Improve Planning Processes and how it
applies to building capacity in public health
Individual or Group discussion and report out (15 min.)
The Quality Trilogy; Quality Planning, Quality Control and
Quality Improvement
Individual or Group discussion and report out (15 min.)
Q&A and Next Steps
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Projects to Conduct Planning
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 Some projects to plan services to address new or
emerging issues aren’t a good fit for “traditional”
quality improvement methods and tools, such as
Rapid Cycle Improvement (RCI)
 Excellent for the Collaborative or Breakthrough
Method from Institute of Healthcare Improvement
(IHI)
 Do benefit from AIM statements and from using the
Plan-Do-Study-Act cycle
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When is Quality Planning project appropriate?
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 Service/process has never existed before
 Customer requirements are not known
 Existing service/process performance is not capable of
meeting customer requirements
 Service/process is ad hoc; extremely variable; never been
well defined or worked on before as a whole
 Unstable environment – major market, technology,
organizational change
 No performance data exists or would take excessive
time/expense to collect data
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Quality Planning
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 J. Juran* described the three basic managerial
processes to manage quality as interrelated:
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Quality planning (QP)
Quality control (QC) and
Quality improvement (QI)
 Purpose for QP is to provide the organization with
the means to provide services that can meet client
and stakeholder needs.
 Quality control is needed to stabilize a process and
to hold the gains made through QI efforts.
*Juran on Planning for Quality, pg. 11
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QP compared with QI
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 How does quality planning differ from project-by-
project quality improvement?
Juran uses example of an alligator infested swamp and
the difference between removing alligators individually
(QI) or draining the swamp to remove all the alligators at
once (QP).*
 Another description is the difference between improving
an existing work activity, action or intervention and the
method used to design a new program or activity.

*Juran on Planning For Quality
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Application in PH
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 PH already has expertise in parts of the quality planning
process
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MAPP, Sector Mapping, Partner Tool, Program Development, many others
 Strengthen QP step of optimizing program to meet HD and
stakeholder needs

Force Field Analysis, Meeting Effectiveness, Interrelationship Digraph,
Failure Mode Analysis, many others
 Strengthen step of optimizing the work processes to achieve
desired results

Common QI tools-work flows, fishbone diagrams, PDSA cycles
 Implement only after program and work processes have been
optimized to deliver results
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QP Roadmap*
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 In broad terms, QP consists of developing services and
processes required to meet stakeholders’ needs.
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Identify stakeholders and their needs
Develop an activity or program to address the needs (establish
stakeholder related measures)
Optimize the program or service activities to meet health
department needs
Develop a work process to conduct the services and
interventions
Optimize the work process, prove that it delivers the results
needed
Implement the program or service in the health department
*Juran on Planning For Quality
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Quality Planning Cycle
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Define Opportunity &
Stakeholder Needs
Take Action
•Fully implement if expected
outcomes achieved
•Initiate QI if outcomes not
achieved
•Problem/Opportunity to Address
•Identify clients/stakeholders and needs
•Translate stakeholders needs
•Establish performance measures based on
needs
Design & Pilot
Service/Process
•Develop activity to meet needs
•Establish outcome measures
•Implement service/process
Monitor Impact/Results of
Service
•Measure Outputs and Outcomes
•Compare actual results to expected
results
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Application of QP:
Consultation for City Planners
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 Original concept: Hire a temporary, part-time health
educator to provide consultation services to city planners
to include built environment concepts into next round of
plans.
 QP tools used: customer interviews
 Results: Customers didn’t need the services; program not
implemented.
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Application of QP:
Healthy School Grants Program
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 Original concept: Offer mini-grants to school districts to
choose from a menu of “best practice” policies and
systems-level interventions
 QP tools to be used: customer needs analysis,
benchmarking, process controls, performance measures
 Results: TBD
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Discussion and Comments
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 Each group/individual take 10 minutes to discuss current
program planning and how they might benefit from
quality planning efforts
 Report out from 2-3 groups
 Comments and Questions
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Adapted from Juran on Planning for Quality, Joseph
Juran
Optimize the design of the
activities and services
Identify clients and
stakeholders
(List of Stakeholders)
Establish activity/service
goals., objectives and
performance measures
Identify stakeholder needs
(List of Needs in client language)
Implement the service and
measure outputs & outcomes
Translate client needs
(in our language)
Compare actual outcomes
to expected outcomes
Establish performance
measures based on needs
Initiate QI, if not meeting
expected outcomes or
fully implement program,
if meeting outcomes
Develop activities and
services to meet
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Examples of Tools for Quality Planning
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 Sector Mapping to identify Key Stakeholders and their
needs
 Force Field Analysis to identify driving forces and
restraining forces
 Meeting Effectiveness Tool to improve the participation
and contribution of community partners
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Sector Maps for Planning –
Example of Public Sector
Health & Human Services
•Center for Disease
Control & Prev.
•Center-Medicaid
&Medicare Srvcs
•Fed. Drug
•Administration
Dept. of Social & Human
Services
Office of the Insurance
Commissioner
Governor / Legislature
Employment Security
Department
Department of Health
Tribal Government
•Community & Family
Health
•Women, Infants &
Children
•Licensing Boards
Health Care Authority
School Boards
•Public Schools (K-12)
•Private Schools (K-12)
Local Health Jurisdictions
Rural & Community Health
Centers
Local Government
Public Library System
Indian Health Service
State Board of Health
Bullets refer to examples of organizations and are not a comprehensive listing.
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Example of Community-Based Sector
Service Organizations
•Thousands of
community-based
agencies: specific partners
will be identified in each
community
Communities of Color
Organizations
United Way
Community Centers
Senior Centers
Faith-based Community
Organizations
Youth Associations
•YMCA / YWCA
•Boys & Girls Club
•Boy & Girl Scouts of
America
•Campfire Girls and Boys
American Association
of Retired Persons
Community Health
Alliances
Youth Sports Associations
Churches, Temples &
Mosques
•Little League
•Pop Warner
•Soccer, etc
Community Health
Centers
•Federally Qualified
Health Centers
•Migrant Health Centers
Community-based
Daycare Sites
•All ages
•Birth to 3 childcare
Bullets refer to examples of organizations and is not a comprehensive listing.
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Example of Target Populations
CONDITION
Diagnosed
Public:
Private:
Community:
Academic:
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Age
Racial/ethnic
Communities
Socio-economic/low literacy
General Population
 Center for Medicaid &
Medicare Services (CMS)
 DOH -- CDRRP/DPCP
 Public Hospital Districts
 Tribal Associations
 Veteran’s Admin.
 Dept. of Defense
 Medicaid
 Qualis Health
 Health plans
 Media
 Inland NW Business Coal.
 Alternative health providers
 Home health
 Student health centers
 DOH-Chronic Disease Risk
Reduction (CDRRP)
 DOH- Diabetes Prevention
& Control Program (DPCP)
 Tribal Assns.
 Indian Health Services
 DOH-Chronic Disease Risk
Reduction (CDRRP)
 DOH- Diabetes Prevention
& Control Program (DPCP)
 Dept. of Veterans Affairs
 Maternal Support Services
 Community Health Plans of
WA – (CHPW)
 Association of Black Health
Care Professionals
 Association of American
Indian Physicians “Move It”
program
 Amer. Diabetes Assoc.
 Juvenile Diabetes Research
Foundation (JDRF)
 Senior centers
 Service organizations
 Community Aging Service
Providers
 WSU Extension
 Focused research programs,
e.g. SEARCH for Diabetes
in Youth
 Communities of color
organizations
 Amer. Diabetes Assoc.
(ADA)
 CHOICE Health
 Commu. Health Centers
(CHCs)
 WSU Extension
 Focused research programs,
e.g. SEARCH for Diabetes
in Youth
 Molina health plan
 Community Health Plans of
WA (CHPW)
 Disease management
vendors
 Critical access hospitals
 Home Health
 Washington Health
Foundation
 CHOICE Health
 Commu. Health Centers
(CHCs)
 Centers for Disease Control
& Prevention (CDC)
 Office of Insurance
 Governor/Legislature
 Dept. of Corrections
 Public Employees Benefit
Board
 Local Health Jurisdictions
 Professional orgs
 Pharmaceutical. Co
 Medical Supply Co.
 Purchasers
 Disease mgt
 Hospitals
 Critical access hospitals
 Primary/specialty groups
 WA StateUniv. Extension
 Commu. Health Centers
 Amer. Diabetes Assoc.
(ADA)
 Nutrition & Cultures
 Disease Management
Education Centers
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Allied health training
UW Med school
Bastyr University
Nursing Schools
Private Universities
Pharmacology Schools
Community Colleges
Tribal Colleges
Force Field Analysis
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 Why use it?
 To identify the forces and factors in place that support or work
against the solution of an issue or problem so that the positives
can be reinforced and/or the negatives eliminated or reduced.
 What does sit do?
 Presents the positives and negatives of a situation so that they
can be compared
 Forces people to think about all aspects of making a desired
change a permanent one
 Encourages honest reflection and that people to agree about the
relative priority of factors on each side of the “balance sheet”
PH Memory Jogger pg. 63
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How to Build a Force Field Analysis
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 Draw a large letter “T” on a flip chart
 Above the top of the T write the issue or problem
 To the far right of the top of the T, write a description of the ideal
situation the team would like to achieve
 Brainstorm the forces that are driving toward the ideal
situation.

Forces may be internal or external and should be listed on the left
side of the vertical line below the T.
 Brainstorm the forces that are restraining movement
toward the ideal situation.

Forces may be internal or external and should be listed on the right
side of the vertical line below the T.
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Fear of Public Speaking
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+ Driving Forces
Ideal state: To speak confidently
in any situation
Restraining Forces –
Increases Self Esteem
Past
Embarrassments
Helps Career
Afraid to Make
Mistakes
Communicates Ideas
Lack of Knowledge
on the topic
Contributes to a
plan/solution
Afraid People will be
Indifferent
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Optimizing the Chance of Success
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 Once the Force Field Analysis has been constructed:
Prioritize the driving forces that can be strengthened
 Identify restraining forces that would allow the most
movement toward the ideal state if they were removed
 Achieve consensus through discussion or by using ranking
methods like Multivoting or Nominal Group Process
 Remember that it is often more helpful to remove barriers
than to push the positive forces to create positive change
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Example- AIM for Meeting Effectiveness
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 What are We Trying to Accomplish? Increase the
effectiveness of Community Health Improvement Plan
(CHIP) coalition meetings and maximize stakeholder
participation. We do this in order to increase member
engagement and contribution to the implementation of
the CHIP.
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How Will We Know When We Get There?
Measurements
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 Increase in meeting attendance (% of members that
regularly attend)
 Increase in effectiveness (% of members rating
meetings as effective or valuable)
 Increase in engagement (% of members rating their
commitment as high)
 Increase in participation (% of members that contribute
resources to CHIP activities)
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Evaluating Meeting Effectiveness
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How Will We Know When We Get There?
Measurements
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 Increase in meeting attendance (% of members that
regularly attend)
 Increase in effectiveness (% of members rating meetings
as effective or valuable)
 Increase in engagement (% of members rating their
commitment as high)
 Increase in participation (% of members that contribute
resources to CHIP activities)
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Effectiveness Ratings – Adams Co., IL
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5.00
4.50
4.00
3.50
3.00
2.50
2.00
5/11/2009
1.50
7/13/309
1.00
9/14/2009
0.50
11/9/2009
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Value of
meeting goals
Effectiveness
Participation
Communication
Clear goals
Commitment
to the group
0.00
The Quality Trilogy
(adapted from Juran)
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Quality Planning
Quality Control & Improvement (During Operations)
Model for Improvement
Sporadic
Spike
Define
Opportunity
&
Stakeholder
Needs
Take
Action
What are we trying
to acc omplish?
How will we know that a
change is an improvement?
Original Zone
of Quality Control
Design & Pilot
Service or Process
Ac t
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Begin
Monitor
Impact /
Results of
Service
Opeartions
Study
Process not Achieving
Desired Results
(An Opportunity
for Improvement)
Plan
Do
New Zone
of Quality Control
Quality
Improvement
Time
Important Leadership Activities
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 Be intentional about determining whether the
improvement effort in the agency is appropriate for QI or
if it would be more successful with QP.
 Train the team in QP methods and tools
 Support the implementation of the team’s design and
results
 Recognize and celebrate QP team accomplishments
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Discussion and Comments
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 Each group/individual take 10 minutes to discuss how the
methods and tools for improving planning processes
could be used in your agency
 Report out from 2-3 groups
 Comments and Questions
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In Summary…
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 Using Quality Planning methods and tools can improve
public health planning processes
 Build on proven practices from other health departments
 Be intentional about which methods and tools to use for
improvement based on the topic and needs
 Remember to plan for holding the gains and sustaining
improvement (quality control)
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What questions do you have?
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