QI in Action: Streamlined Operations Get Funding Out Faster to Local & Tribal Communities in Nevada
Success StoriesThe Nevada Division of Public and Behavioral Health is using the Public Health Infrastructure Grant (PHIG) to achieve public health accreditation and build a culture of quality improvement across the agency. Mitch DeValliere, Agency Manager, explains that his agency used PHIG to initiate the accreditation process, which helped them properly document ongoing quality improvement (QI) efforts and create QI templates, such as Plan-Do-Study-Act (PDSA) cycles, for all programs to use. These tools help teams continuously track outcomes and improve processes accordingly. Nevada also used PHIG to train 14 staff members, from administrative assistants to section managers, in Lean Six Sigma.
These QI practices have led to major efficiency gains: contracts that once took up to a year to process are now completed in 5–6 months, and other processes have been reduced by 3–4 weeks. Faster contracting means funding reaches local health authorities, tribal communities, and cities sooner, allowing them to address community needs more quickly. For example, local and Tribal health authorities have used this flexible funding to take action: one county purchased a four-wheel-drive vehicle to reach remote residents, another improved water quality, and others hired staff to tackle pressing, community-specific needs. By streamlining their operations and disbursing flexible funding efficiently, Nevada is delivering services and resources faster and more effectively across the state.
Video Transcript
This transcript has been lightly edited for clarity.
How did you use PHIG to support quality improvement?
Through the A2 segment of PHIG, we were able to initiate the accreditation process. We used several methods to do this, but one key thing we found with the accreditation process was that while our quality improvement efforts had been ongoing, they were not documented properly.
The accreditation process brought about a better way of documenting and solidifying all the quality improvement efforts happening across the state. We were able to formulate templates that others could use when starting their own quality improvement efforts. We established what we call a culture of quality improvement. That was kicked off by our administrator in a large town hall-style meeting, which was filmed and is now used in our onboarding process for new employees so they understand we’re trying to build a culture of quality improvement. The accreditation process supported all of this, and the documentation that we use has helped many sections initiate their quality improvement efforts. Many segments are now using what’s called a “Plan, Do, Study, Act” cycle, and that’s used to measure improvement – then they continually check it so that they’re continually improving their processes.
How did you use PHIG to support efficiency?
We also used A2 funding to help upskill our staff. One of the areas that we used was Lean Six Sigma certification. We were able to have 14 staff members, from administrative assistants all the way up to section managers, undergo the Lean Six Sigma training. We also use Lean Six Sigma techniques to improve our contract unit processing. We were able to bring some contracts that were taking up to a year down to five to six months. Other contract processes we were able to reduce by three to four weeks throughout the entire process.
Those were very beneficial for us because last year, we were able to provide our local health authorities, and the city of Carson City, and the county health departments their own funding. Previously, that process took quite a bit of time to actually bring the funding to the local health authorities and to the counties. That created delays in service provision. This time, after we went through the quality improvement process with the contracting unit and we reduced processing time, we were able to bring the funding to the local health authorities, the tribal community, and the cities and counties at a much faster rate. This allowed them to prioritize the needs that their citizens have in using public health funding.
How has PHIG funding impacted the community?
The flexible funding that was allocated to different entities allowed them to do many things. One county, for example, needed access to its citizens in a rather remote area, so they used the funding to purchase a new four-wheel drive vehicle. Other counties were able to use the funding to help with the water quality in their area. Some were able to hire staff to work on public health issues. Larger counties like the Southern Nevada Health District in Clark County, Nevada, had a lot of different priorities that they were able to facilitate for their citizens using the state public health funding.
In Nevada, if you’ve gone to one county, you’ve gone to one county. Every county in Nevada is different. Some of them are very rural or frontier, some of them are very urban. And the flexibility that PHIG offered – we had the infrastructure so that when we received funding, we could help each of those counties, or the cities, or the tribal communities use the funding for what they needed in their particular area. So whatever their needs were, they could utilize the funding to benefit their citizens because they knew best how the public health funding would help their citizens of their counties, their city, or their tribal community.
What has PHIG meant to Nevada?
What we’ve seen with PHIG in all aspects of it, whether it’s data modernization or workforce development or these foundational capabilities, is that it has improved the quality and the efficiency of our state being able to deliver public health programs to our citizens. It has also allowed us to bring in the other health districts so that they can see what types of quality improvement they’re capable of doing. If we have ongoing funding, it’s basically building the infrastructure of workforce, data, but also quality improvement. And quality improvement is something that most people don’t recognize that a state can provide. We want to change that model. We want to be able to make sure that people see how quality improvement in state government can help the citizens of the state overall.