“

Jacy Weems

HSMP-4850 Field Experience

Tennessee Department of

Health

Mission: To protect, promote, and improve the health and prosperity of people in Tennessee

1998 Tobacco Master Settlement Agreement

$206 billion paid to states over the first twenty-five years of the agreement

Costs of treating smoking-related illness Funding educational programs to reduce underage

smoking2013 – Tennessee General Assembly and Gov. Bill Haslam appropriated $15 million to the Tennessee Department of Health to mitigate tobacco use and related costs.

2014-2016 – $5 million is dispersed annually to all 95 health departments to fund tobacco prevention programs.

Tobacco Settleme

nt Training

Year 1 Plan

Year 1 Report

Year 2 Plan

My Task

Tennessee Tobacco Settlement Program Planning Presentations

PDCA Training – Director of the Office of Performance Management

December 2013 – Year 1 Program Plan due via SurveyGizmo Problem

Statements

Best Practices

January 2014 – Year One Program Progress Report and PDCA form due via SurveyGizmo

February 8, 2015 - Program Plans for Year Two due via SurveyGizmo Problem

Statements

Best Practices

Compose a report for legislators regarding Program progress

Perform a qualitative study on PDCA cycle to measure appropriate utilization of PDCA

Tennessee Tobacco Settlement Program Process

Statewide Report of Year 1 Progress

Financial InvestmentMap of Participating CountiesGoals for ChangeStandard Measures of Success

Experiences “From the Field”Common Improvements Identified by the Plan-Do-Check-Act Cycles of Learning

Project Progress Gauge

Use of the Plan-Do-Check-Act Cycle for Project Improvement: 2014-2015 Tennessee

Tobacco Settlement

Quantitative Scoring – PDCA Cycle of Learning

[Step 1]: Compare Top Five/ Bottom Five

[Step 2]: Created an index score

[Step 3]: Identify inclusion and exclusion

criteria[Step 4]: Convenience &

Random SampleOverall Score Range: 0-

12

ResultsTennessee Tobacco Settlement Utilization of the Plan-Do-Check-Act Cycle

TDH Geograp

hic Region

Plan (0-2)

Do (0-2)

Check (0-2)

Act (0-2)

Understanding of the PDCA Cycle

(0-2)

PDCA Implementation Score

(0-2)

PDCA Total Scor

e

Region A 1.87 1.60 1.22 0.91 1.41 1.19 8.19

Region B 1.33 1.50 1.00 1.17 1.00 1.33 7.17

Region C 1.67 1.92 1.42 2.00 1.83 1.58 10.42

Region D 1.69 1.56 1.31 1.14 1.42 0.83 7.94

Region E 1.38 1.69 1.08 1.24 1.43 0.92 7.75

Region F 1.19 1.44 0.88 1.75 1.56 0.88 7.69

Region G 1.38 1.58 0.79 1.43 1.04 0.90 7.13

Region H 1.42 2.00 1.25 1.50 1.67 1.33 9.17

Strong Example of PDCA Implementation

Implementing Changes from Year 1 PDCA into Year 2 Plan – “What Would You Do Differently?”

Plan Do Check Act Year 2 Changes

From the beginning, create different PowerPoints with different additional focuses. For instance, one could have detailed 5As, plus detailed e-cigarette usage, while another could have detailed 5As, plus detailed general tobacco use to have in place based on audience need.

Understand beforehand the difficulty in collecting offices/addresses for all obstetricians in [X] County to be able to get out the packets quicker.

Bring together a focus group of healthcare providers for a brief time to discuss best approaches to provide training in the offices since many times, healthcare providers are on a busy/tight schedule, so it makes it hard to provide a one hour training and request feedback and surveys from all attendees.

Better anticipated the number of questions received at many of the locations. Since they are already on a tight timeframe, time did not permit to go into detail on all the answers to their questions, especially their interest in e-cigarettes and how it relates to the intervention.

Based on feedback and separate training information, questions were updated for the 3-month and 6-month surveys to include more information such as implementing 5As components into electronic records. The training presentation was modified to include more time for questions and more information on e-cigarettes. In year two, the 5As Training will be expanded to include pediatrician offices in addition to the current OB/GYN offices. Training in the pediatrician offices will allow for program expansion to address secondhand smoke exposure.

"Use of PDCA Cycle in Year 2 Plan"

TDH Geographic

Area

Pregnancy Smoking

Secondhand Smoke

Exposure

Helping Children Not to Begin

Tobacco Use

Region A 0.75 1.64 1.17

Region B 1.67

Region C 0.75

Region D 1.33 0.5 0.67

Region E 0.75 1 1

Region F 1.25

Region G 0.83 0.88

Region H 0.67

Overall Average 0.88 1.10 0.99

  No projects were selected

 Less than two projects were selectedResults

Left: PDCA Index Scores by ProjectRight: Use of the PDCA Cycle in Developing the Year 2 Plan

• Highest Scoring Section: “Do”• Lowest Scoring Section: “Act”• Low variation by region with

exception of one outlier• Highest Scoring Project: Teens

Against Tobacco Use (TATU)• Lowest Scoring Project:

Supportive Media and Messaging

• Best PDCA Examples By Project• Peer-Reviewed Report

Results and Analysis

What can we gain from these

findings?

Plan

DoCheck

Act

1 2 3 4 5