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Working on QI in communities poses unique challenges.
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Population Health in Communities: Common Pitfalls (and How to Avoid Them)

By Joseph Mauti | Thursday, August 8, 2019
Population Health in Communities: Common Pitfalls (and How to Avoid Them)

Photo by Michael Podger | Unsplash

For the past 20 years, I have been working as a Quality Improvement (QI) Advisor coaching teams and individuals to apply improvement science to their work. Typically, those I work with care for patients of traditional health care organizations where the work occurs within four walls. Lately, however, I have been challenged with a series of projects working to improve population health in specific communities.

My employer partners with communities to deliver a program for health care providers and administrators to learn about QI. These community QI teams face some unique challenges. They are trying to do things like improve the health of people living in a specific park and prevent caregiver distress for elderly couples living alone in a specific apartment building. One of my roles is to ensure teams attend the first day of class with a draft of their project charter. This includes a problem statement, an aim statement, a set of measures, and team member roles (like “Team Lead” and “Process Owner”).

While doing QI work with communities, I’ve learned some lessons that I’m happy to share with others to help them challenges that often arise:

  • Bring key stakeholders together at the start — Since no one organization owns the mandate to serve a specific population, those assembled to work on a given QI project have different perspectives on the problem they’re trying to address. (This means drafting a joint problem statement is more challenging and will take more time than a typical improvement project.) People representing different organizations must demonstrate leadership as they define their shared purpose. This means either addressing the needs of their target population or stepping aside to support others to do so.
  • Prioritize building trusting relationships — Since the participants in community population health initiatives lack a common CEO, they must deal with turf issues and confusion about shared purpose. All QI projects, regardless of setting, require individuals and groups to come together and better understand their current state. This leads to a better appreciation of each other’s perspectives. These insights then help the group identify change ideas that stand a better chance of eventual adoption.  
  • The project funder should designate the organization with primary project responsibility — Funders should facilitate an accountability agreement that outlines roles and responsibilities. For example, they should appoint an executive sponsor from among the community agencies involved to take lead responsibility for the project. This is important because one of the first challenges community population health projects face is identifying roles and responsibilities for both individuals and organizations. Unlike, say, a primary care clinic trying to improve wait times, identifying all the process owners is more difficult because it’s less obvious who is responsible for each part of the process.
  • Agree to at least one objective measure to track progress — Collecting and analyzing objective measure data is always a challenge in population health. There are seldom defined processes that can be observed and measured. This makes it difficult to obtain valid and reliable information to serve as baseline data. You may have to use proxy measures. For example, how do we answer the question, “Are the people living in that park healthy?” We can use data on ER visits or crime statistics. Teams I have coached collected self-reported survey data gathered in face-to-face interviews with the target population.

Improving population health is challenging. It is important for organizations to come together not with the goal of winning the debate, but to learn more about how they can help improve the health of a population.

Joseph Mauti is a Quality Improvement Advisor for the Ontario Health Quality Council.

You may also be interested in:

The Population Health track of the IHI National Forum on Quality Improvement in Health Care

IHI Quality Improvement Essentials Toolkit

How Do You Measure Health?

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