​“What I liked most about the formal QI process was that we were able to discuss the problem without pointing fingers at anyone. That way, nobody was defensive. We all participated in coming up with ideas for improvement.”  Dr. Meister, Medical Director, Division of Family Health, Maine Center for Disease Control and Prevention (MECDC)

Dr. Meister’s sentiments capture the goal of quality improvement (QI): to identify the problem, find its roots, and solve it from the roots without blaming anyone. Rather than focus on individuals, QI focuses on the case and seeks to coalesce everybody behind the effort to move the case past its obstacle. This is what happened in the Maine Division of Family Health in a span of two months.

Started in October 2010, the Division of Family Health New Born Screening program works with hospitals to screen newborn babies for developmental abnormalities. Babies with abnormalities and those who are at high risk of developing developmental disabilities later in life are referred to the Maine Child Development Services (CDS), a program within Maine’s Department of Education, where they receive additional testing and are offered needed services.  After five months of implementation, MECDC staff observed that they were not getting accurate data on the number of neonatal intensive care unit (NICU) babies screened or the number of babies referred to CDS. Thus, they could not track how well the program was doing in ensuring that babies with or at risk of developmental disabilities were provided with the appropriate services. This is what prompted the need for a formal QI process.

With the help of the MECDC’s Office of Performance Improvement and technical assistance from Jack Moran, Senior Quality Advisor to the Public Health Foundation (PHF), the program convened a meeting for key members of staff and their hospital counterparts. The team went through the process of developing a shared understanding of the steps in the program from the time a baby is screened to the time the baby receives services from MECDC. After mapping the steps, the team developed a flowchart of the program’s referral process. During the development of the flowchart, the team identified points where problems occurred and selected goals for improving the process.

This project’s purpose was to examine and improve the processes for ensuring that pre-term newborns who may be in need of developmental service referrals receive them, and the tracking of those referrals from hospital NICUs to the state's CDS. MECDC is responsible for reporting the data, the three NICUs in the state are responsible for initiating the referral processes, and CDS approves and makes the referrals. The process developed by the team will be tested over the next three months to determine how well it is meeting this goal.

“I have gone through a formal QI process before. However, the way Jack (the consultant) does it makes it seem so simple and easy to do.” Toni Wall, Director, Maine Children with Special Health Needs, Division of Family Health, MECDC

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PHF is providing rapid cycle improvement (RCI) technical assistance to Maine, Minnesota and Wisconsin as part of the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative (NPHII).