Governors Sterling Award Application by nyut545e2


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Governor’s Sterling Award Application

   2009 Governor’s sterlinG AwArd ApplicAtion Form

                site listinG And descriptors Form

                           Florida Department of Health
                       Division of Medical Quality Assurance
                           4052 Bald Cypress Way, Bin C-00
                              Tallahassee, FL 32399-3250

                                                                                                                                           Division of Medical Quality Assurance

                                                                tAble oF contents
2009 Governor’s Sterling Award Application Form
Site Listing and Descriptors Form
Glossary of Terms, Abbreviations, and Acronyms

P.1 Organizational Description. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
P.2 Organizational Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

MQA’s Table of Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

CATeGOry 1: LeADerShiP
1.1 Senior Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
1.2 Governance and Social responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

CATeGOry 2: STrATeGiC PLAnninG
2.1 Strategy Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
2.2 Strategy Deployment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

3.1 Customer and Market knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
3.2 Customer Satisfaction and relationship enhancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

CATeGOry 4: MeASureMenT, AnALySiS AnD knOwLeDGe MAnAGeMenT
4.1 Measurement, Analysis, and improvement of Organizational Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
4.2 Management of information, information Technology and knowledge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

CATeGOry 5: wOrkFOrCe FOCuS
5.1 workforce engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
5.2 workforce enrichment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

6.1 work Systems Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
6.2 work Process Management and improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

CATeGOry 7: reSuLTS
7.1 Product and Service Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
7.2 Customer-Focused Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
7.3 Financial and Market Outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
7.4 workforce-Focused Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
7.5 Process effectiveness Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
7.6 Leadership Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

                                                                                                                                                                           Table of Contents
                          2009 Governor’s Sterling Award Application Form

Please update any information that has changed on the Application of Intent and type or very clearly print all information
requested. The Application Form may be duplicated and single-sided pages submitted. Applicants must submit a copy of the
Application Form with each copy of the Application. A total of sixteen (16) complete Applications are required to be
Item 1 – Applicant — Provide the official name and mailing address of the organization applying for the Award.
1.   Applicant Official Name
Organization Name: Florida Department of Health, Division of Medical Quality Assurance
Address:4052 Bald Cypress Way
           Tallahassee, Fl 32399-3250
Item 2 – Official Inquiry Point — As the examination proceeds, the Administrator may need to contact the Applicant for additional information.
Give the name, address, and telephone number of the official with authority to provide additional information or to arrange a Site Visit.
If this official contact point changes during the course of the Application process, please inform the Sterling Council.

2.   Official Inquiry Point
Name: Charlene G. Willoughby
Title: Senior Management Analyst II
Mailing Address: 4052 Bald Cypress Way, Bin C-00, Tallahassee, Florida 32399-3250
Overnight Mailing Address: same
Telephone Number: (850) 245-4689
Fax Number: (850) 412-1299                               Email Address:
Item 3 – Fees —
Application of Intent $100
Small/Med. Org       $2,500
Large Organization $4,500
Site Visit           $2,500
(Plus Examiner’s Expenses)

3.   Fee (see instructions)
Enclosed is $4,500 to cover the Application Fee. Make check or money order payable to:

Item 4 – Release Statement — Please read this section carefully. A signed Application indicates that the Applicant agrees to the terms and conditions stated

4.   Release Statement
We understand this application will be reviewed by members of the Board of Examiners. Should our organization be
selected for a Site Visit, we agree to host the Site Visit and facilitate an open and unbiased examination. We understand that
Site Visit expenses will be determined in accordance with the section: Application Fees (pages 58-59 Criteria).

Item 5 – Authorizing Official — The signature of the Applicant’s highest ranking management official or designee is required and indicates the Applicant
will comply with the terms and conditions stated in the document.

5.   Signature, Authorizing Official
Name: Lucy C. Gee, M.S.
Title: Division Director
Address: 4052 Bald Cypress Way, Bin C-00, Tallahassee, Florida 32399-3250
Date: November 6, 2008                                   Telephone Number: (850) 245-4224
                             Site Listing and Descriptors Form

                                     B. Relative Size –       C. Description of Products, Services,
       A. Address of Site
                                   Percent of Applicant’s                 or Programs
                                 Employees        Budget

     MQA Director’s Office                                        Manage division of 501.5 staff
Mailing Address:                     21        $32,409,475        responsible for regulatory
4052 Bald Cypress Way               (4%)       Includes all       activities of various health care
Tallahassee, Florida 32399                         MQA            practitioners, facilities and
                                                 salaries         businesses
Location: Building 4042                           (62%)           Serve as liaison between the
                                                                  public and the professional
                                                                  boards and councils as well as
                                                                  between licensees and their
                                                                  respective boards and councils
                                                                  Strategic Planning
                                                                  Trust Fund Management
                                                                  Personnel Management
                                                                  Correspondence Tracking

     Bureau of Health Care          181        $6,557,707         8 offices under the supervision
Practitioner Regulation (HCPR)     (36%)        (12.5%)           of Executive Directors
Mailing Address:                                                  Regulate over 40 health care
4052 Bald Cypress Way                                             professions through coordination
Tallahassee, Florida 32399                                        with 22 boards and 6 councils
                                                                  Process applications for
Location: Building 4042                                           licensure
                                                                  Credential and license
                                                                  designated health care
                                                                  practitioners and facilities
                                                                  Serve in an administrative
                                                                  liaison capacity to the
                                                                  designated boards and councils,
                                                                  whose responsibilities include
                                                                  approving or denying applicants
                                                                  for licensure and reviewing
                                                                  cases related to pending
                                                                  disciplinary action against health
                                                                  care practitioners and
  Bureau of Operations (BOO)        42.5       $7,151,937         3 units
Mailing Address:                   (8.5%)       (13.5%)           Provide support to the division
4052 Bald Cypress Way                                             Prepare and administer
Tallahassee, Florida 32399                                        examinations for health care
                                                                  practitioner applicants
Location: Building 4042                                           Collect revenue for the division
                                                                  Issue licenses to individuals
                                                                  certified eligible
                                                                  Issue practitioner licensure
                                                                  Publish health care practitioner
                                                                  Manage the division’s internet
                                                           web pages
                                                           Manage the division’s licensing
                                                           and enforcement database.

Bureau of Management Services        64       $2,622,014   4 units
              (BMS)                (13%)         (5%)      Provide support to the division
Mailing Address:                                           Report disciplinary actions to
4052 Bald Cypress Way                                      national organizations and
Tallahassee, Florida 32399                                 databanks
                                                           Coordinate facility management
Location: Building 4042                                    Manage the MQA COOP
                                                           Coordinate arrangements for
                                                           board meetings
                                                           Assist board members with
                                                           travel and reimbursement
                                                           Procure and process payment for
                                                           goods and services for the
                                                           Provide certifications of
                                                           licensure and copies of
                                                           application and licensure
                                                           Serve as Custodian of Record to
                                                           index, serve, and maintain legal
                                                           Prepare appeal records
                                                           Respond to public record
                                                           requests for board orders and
                                                           other legal documents
     Enforcement Program          193 total   $3,555,352   2 units
         (Enforcement)            (38.5%)        (7%)      Serve as central intake for
Mailing Address:                                           receipt of complaints and
4052 Bald Cypress Way                                      statutorily required reports
Tallahassee, Florida 32399                                 Analyze all complaints to
                                                           determine legal sufficiency for
Location: CSU – Building 4030        45                    investigation
Location: ISU Headquarters –        (9%)                   Investigate legally sufficient
Building 4040                         7                    complaints
               ----                (1.5%)                  Conduct inspections of facilities
          Field Offices                                    regulated by the department
                                                           Monitor probation, payment of
           Tallahassee                                     fines and costs, completion of
Koger Center Lafayette Bldg                                continuing education, and other
2551 Executive Center Drive           6                    discipline
Tallahassee, Florida 32399          (1%)

5016 North Davis Hwy.                 4
Pensacola, FL 32503-2102            (1%)

921 N. Davis St., Bldg A, Suite      12
145                               (2.5%)
Jacksonville, FL 32209

            Alachua                 7
14101 NW Hwy. 441-Suite #700      (1%)
Alachua, FL 32615-5669

            Orlando                16
400 West Robinson St., S-827      (3%)
Orlando, FL 32801

            Tampa                   17
6800 N. Dale Mabry Hwy., #220     (3.5%)
Tampa, FL 33614

          St. Petersburg           14
Sebring Bldg., 3rd Floor          (3%)
525 Mirror Lake Dr., Suite 310A
St. Petersburg, FL 33701
            Ft. Myers             (2%)
2295 Victoria Ave., Suite 319
Ft. Myers, FL 33901
       West Palm Beach            (2.5%)
1720 East Tiffany Dr., 202-A
West Palm Beach, FL 33407
         Ft. Lauderdale           (2.5%)
N. Broward Regional Service
1400 W. Commercial Blvd., 130-J
Ft. Lauderdale, FL 33309
             Miami                (4%)
Doral Center
Manchester Bldg., 1-M101
8355 NW 53rd St.
Miami, FL 33166
   Unlicensed Activity Office     (2%)
Address not published due to
criminal nature of work
Hollywood, Florida
                                                                                                Division of Medical Quality Assurance

      GlossArY oF terms, AbbreviAtions, And AcronYms
                                A                                                                     c
ADA - Americans with disabilities Act                                 CAC - consumer Advocacy council

Agenda Builder/Agenda Viewer - computer application used to           Call Center - mQA’s centralized communication unit (phone
provide board members an image of all meeting materials (confiden-    bank).
tial and public).
                                                                      CnA - certified nursing Assistant
AiM - Administrators in medicine
                                                                      CAP - corrective Action plan
Alternative Dispute resolution - mediation to resolve a complaint
against a health care practitioner alleging a minor violation.        Capital Circle Office Complex - office complex where mQA and
                                                                      other doH buildings are housed.
Annual Association Long range Planning Meeting - Yearly meet-
ing with mQA’s collaborators, facilitating two-way communication      CBA - cost benefit Analysis
and long-range planning.
                                                                      CCOC - capital circle office complex
Annual Board Chair Meeting - Yearly meeting with mQA’s
board chairs, facilitating two-way communication and long-range       CD - compact disc
                                                                      Ce - continuing education
Annual report - A statutorily required annual report detailing the
division of medical Quality Assurance’s long-range policy planning    Cease and Desist Order - An order issued to a person who is not
and monitoring process. The information provided in the report        licensed to immediately stop practicing a health care profession for
is organized around the division’s three key processes, licensure,    which they do not hold a license.
enforcement and information, with an emphasis on performance-
driven results.                                                       CFD - customer Functional directory

Ar - Annual report                                                    Chartered workgroup - workgroup with a documented purpose
                                                                      and goal (statement of work).

                                b                                     Chat with Lucy - A monthly opportunity for employees to meet
                                                                      informally with the division director to ask questions, share best
BMS - bureau of management services                                   practices, discuss ways to improve customer service, and hear about
                                                                      mQA’s plans for the future.
Board Meetings - A formally arranged public gathering of gov-
ernor-appointed members of a health care board for the purpose        ChD - county Health department
of complying with their licensure disciplinary and administrative
                                                                      Citation - An order that resolves minor offenses.
                                                                      CLeAr - council on licensure, enforcement and regulation
Board Office - support organization of department staff dedicated
to specific health care boards, who perform administrative duties.    CMiP - compas mobile inspection program
BOO - bureau of operations                                            CMu - compliance management Unit
Broadband Pay Plan System - class specifications and salary ranges    COMPAS - customer oriented medical practitioner Administra-
for the career service, selected exempt service and senior manage-    tion system
ment service classification systems.
                                                                      COOP - continuity of operations plan
BSC - balanced scorecard
                                                                      CPM - certified public manager
Bureau Chief - The head of each bureau within the division of med-
ical Quality Assurance and a direct report to the division director   CPr - cardiopulmonary resuscitation

                                                                      Critical Position - A position in which redundancy of knowledge
                                                                      is vital.

                                                                                      Glossary of Terms, Abbreviations, and Acronyms
Division of Medical Quality Assurance

CSu - consumer services Unit
Customer Functional Directory - An electronic, searchable direc-
tory located on mQA’s intranet, which is used by employees to            eeO - equal employment opportunity
obtain mQA employee and/or unit information. This directory lets
an employee search based on Unit, Job function, and name.                eiS - enterprise information system

                                                                         emergency Order - immediate action taken to protect the health,
                                 d                                       safety and welfare of the public.

                                                                         employee Covenant - An agreement signed by all mQA employees,
Data Sharing Agreement - A formal document between mQA and
                                                                         which empowers them to adhere to mQA values in the performance
suppliers and/or partners, detailing how data will be shared and used.
                                                                         of their job duties.
DBPr - department of business and professional regulation
                                                                         employee recognition Committee - An employee committee made
DDC - drugs, devices and cosmetics                                       up of representatives from all of the units or bureaus within mQA,
                                                                         which is responsible for the annual employee awards ceremony and
DeA - drug enforcement Agency                                            promotion of employee award and recognition events throughout
                                                                         the year.
Delegation of Authority - Assigning temporary responsibilities to
an employee in the absence of a manager.                                 employee recognition Program - An employee-operated program
                                                                         designed to recognize employees for meritorious achievement, years
Deputy Director - The head of the enforcement program within             of service, and customer service.
the division of medical Quality Assurance and a direct report to the
division director.                                                       eMT - executive management team

Desk Guide - written series of steps for a work system process.          enforcement - A program within mQA, responsible for the key
                                                                         process of enforcement, consisting of the consumer services Unit,
DFS - department of Financial services                                   compliance management Unit and investigative services Unit.

Director’s Thanks A Million - certificate presented to employees         enforcement Alert - electronic communication of issues, concerns
by the division director to acknowledge excellent customer service.      and suggestions from mQA enforcement personnel.
A part of the mQA employee recognition program.
                                                                         erC - employee recognition committee
District Manager - executive administrator of investigative field
offices within a region. regions are divided into north, south and       erO - emergency restriction order
central areas of the state.
                                                                         erP - employee recognition program
Division Director - The head of the division of medical Quality
Assurance                                                                eSO - emergency suspension order

DMADV - define, measure, Analyze, design, verify                         eSS - employee satisfaction survey

DMAiC - define, measure, Analyze, improve, control                       executive Director - chief administrator for the support staff, ser-
                                                                         vices, and systems needed for health care boards to carry out their
DMS - division of management services                                    mission.

DO - director’s office                                                   executive Management Team - mQA’s most senior leaders, consist-
                                                                         ing of the division director, deputy director, bureau chiefs and
DOh - department of Health                                               sps manager

DOh ethics Officer - A high-level executive employee designated
by the surgeon General to provide guidance on all ethical issues.                                        F
DPA - davis productivity Award                                           FAC - Florida Administrative code

DVD - digital video disc                                                 FArB - Federation of Associations of regulatory boards

                                                                         FBi - Federal bureau of investigation

                                                                         FDA - Florida dental Association

Glossary of Terms, Abbreviations, and Acronyms
                                                                                                         Division of Medical Quality Assurance

FDLe - Florida department of law enforcement                                 i CreATe badge - badge provided to all mQA employees, listing
                                                                             mQA’s mission, vision, purpose, focus and values.
Field Office - A unit within investigative services located in desig-
nated areas outside of headquarters.                                         iG - inspector General

Final Order - A document stating the outcome of the case. see                image APi - contracted vendor
                                                                             iPn - intervention project for nurses
FirS - Financial & information reporting system
                                                                             iSu - investigative services Unit
FLAir - Florida Accounting and information resource
                                                                             iT - bureau of information technology
FLSA - Fair labor standards Act

FMA - Florida medical Association                                                                             K
Focus - mQA’s vision to be the nation’s leader in quality health care        kSA - Knowledge, skills and abilities

FS - Florida statutes                                                                                          l
FSeCC - Florida state employees’ charitable campaign                         LASu - licensing & Auditing services Unit

FSMB - Federation of state medical boards                                    LBr - legislative budget request

FTP - File transfer protocol                                                 Legislative Budget request - A document asking the legislature to
                                                                             appropriate additional resources.
Fy - Fiscal Year
                                                                             Licensee - Any person or entity issued a permit, registration, certifi-
                                   G                                         cate, or license, including a provisional license, by the department.

                                                                             Licensure evaluation Tool - online tool for applicants to assess
GSA - Governor’s sterling Award                                              their qualifications for licensure.

                                  H                                                                           m
hCPr - bureau of Health care practitioner regulation                         Management Team - team of mQA leaders consisting of the emt,
                                                                             the executive directors, the csU manager, and the isU chief and
headquarters - The ccoc in tallahassee, Florida.                             district managers.
health care Practitioner - Any person licensed under chapter 457;            MDr - metadata repository
chapter 458; chapter 459; chapter 460; chapter 461; chapter 462;
chapter 463; chapter 464; chapter 465; chapter 466; chapter 467;             Meritorious Achievement - An award recognizing employees in the
part i, part ii, part iii, part v, part X, part Xiii, or part Xiv of chap-   areas of leadership, customer focus, quality improvement, and team-
ter 468; chapter 478; chapter 480; part iii or part iv of chapter 483;       work, who exhibit mQA’s values.
chapter 484; chapter 486; chapter 490; or chapter 491.
                                                                             Metadata - “data about data” - the data describing context, content
hiPAA - Federal Health insurance portability and Accountability              and structure of records and their management through time.
                                                                             MOu - memoranda of Understanding
hiPDB - Healthcare integrity and protection data bank
                                                                             MQA - division of medical Quality Assurance
hits - A single web-page typically consists of multiple (often dozens)
of discrete files, each of which is counted as a hit as the page is          MQAGC - mQA’s tier one Governance committee
                                                                             MT - management team

                                    i                                        MVPFV - mQA’s mission, vision, purpose, Focus and values

i CreATe - A mnemonic (theme) of mQA’s values.

                                                                                              Glossary of Terms, Abbreviations, and Acronyms
Division of Medical Quality Assurance

                                 n                                       actively assess Florida’s current and projected physician workforce

nCSBn - national council of state boards of nursing                      PiP - performance improvement plan

neO - new employee orientation                                           Platinum Odyssey - The name of mQA’s journey to sterling
nerB - northeast regional board of dental examiners
                                                                         Practitioner Profile - self-reported information (i.e., education,
nPDB - national practitioner databank                                    staff privileges, financial responsibility, etc.) from licensed medical
                                                                         physicians, osteopathic physicians, podiatric physicians, chiroprac-
                                 o                                       tic physicians, and Advanced registered nurse practitioners.

                                                                         Prn - professionals resource network
OAG - office of the Attorney General
                                                                         Probable Cause - when a panel of a board finds sufficient evidence
OGC - office of the General counsel                                      to bring formal charges against a health care practitioner.
One Stop Shopping - seamless customer service - accommodating            Project Owner - chief or executive director who sponsors a project
customer’s needs without transferring them.                              in the strategic planning services Unit.
Open Government - transparency in government operations                  PSu - prosecution services Unit
allowed by Florida statutes.
                                                                         Purpose - mQA’s mission to protect the public through health care
OPPAGA - office of program policy Analysis and Government                licensure, enforcement and information.

OPS - other personnel services                                                                            Q
OPS employee - An individual hired by the state temporarily to
                                                                         QrP - Quality review process
accomplish short term or intermittent tasks.

Order - A document stating the outcome of a case or licensure                                             r
                                                                         renewal - Health care licenses expire every two years; therefore,
OShA - occupational safety and Health Administration
                                                                         licensees must pay a fee to continue practicing.

                                 p                                       rFP - requests for proposal

                                                                         rOi - return on investment
Patient Bill of rights - Florida law promoting the interests and
well-being of the patients of health care providers and health care
facilities, as well as promoting better communication between the                                          s
patient and the health care provider.
                                                                         Safety Coordinator - The division safety coordinator coordinates
People First System - people First is the state of Florida’s self-ser-   all safety related issues and programs pertaining to the division,
vice, secure, web-based personnel system that automates the state’s      advises the division director in matters concerning safety, organizes
human resource functions, such as payroll, benefits, hiring and per-     the division safety committee meetings (at least once a quarter) to
sonnel management.                                                       oversee safety activities and reduce losses, and provides safety data,
                                                                         reports or any safety related activities to the department lead safety
Performance evaluation Form - A form provided to all employees,
which outlines the performance standards and major job duties of
their position. This form is used by an employee’s supervisor to rate
                                                                         Safety warden - A safety warden is appointed for each unit of the
the employee’s achievement of job-related competencies, job expec-
                                                                         division. safety wardens are responsible for deploying safety evacu-
tations and performance standards.
                                                                         ation plans at each location, conducting facility and office inspec-
                                                                         tions, and disseminating safety information and training to all mQA
PeST - political, environmental, social, technological
Physician workforce Survey - A questionnaire conducted at the
                                                                         SAS-70 - An auditing statement issued by the Auditing standards
time of renewal of licensed medical and osteopathic physicians to
                                                                         board of the American institute of certified public Accountants.

Glossary of Terms, Abbreviations, and Acronyms
                                                                                                     Division of Medical Quality Assurance

SharePoint - stores and catalogs policies and procedures and
other operational documents. All mQA employees have access to
                                                                          uLA - Unlicensed Activity
Sonitrol - security vendor contracted by the department.
                                                                          umbrella Division - Autonomous boards that are facilitated under
SP - strategic plan                                                       one organizational structure and trust fund.

SPP - strategic planning process                                          unit Manager - A manager of a work system office.

SPS - strategic planning services Unit                                    urL - Uniform resource locator, the global address of documents
                                                                          and other resources on the world wide web
SrC - shared resource center

SSS - system support services Unit                                                                         v
State Surgeon General - The head of the department of Health,             VCr - video cassette recorder
appointed by the Governor.

Statement of work - An executed document used by the strategic                                            w
planning services Unit, which outlines the purpose and scope of a
requested project or workgroup.                                           well Being Coordinator - As part of mQA’s well being program, a
                                                                          well being coordinator is appointed for each unit or bureau. well
Strategic Goals - mQA’s shorter-term goals (duration of 1-4 years),       being coordinators are responsible for addressing health issues and
which are in alignment with statutory and regulatory requirements.        coordinating exercise and other health programs within their areas,
                                                                          and ensuring that the health and exercise needs for each workplace
Strategic Objectives - mQA’s long-term objectives (5 years), which        environment are being met.
are aligned with the department of Health’s objectives.
                                                                          well Being Program - The well being program, implemented by
Succession Plan - provides for the redundancy of knowledge in             the mQA platinum odyssey employee safety and well being work-
mQA.                                                                      group, coordinates exercise and health programs for the division.

Sunshine Law - chapter 119 Florida statutes regulating the release        work Plan - An outline used by the strategic planning services Unit
of public documents in Florida.                                           to list the tasks and timelines for accomplishing a requested project.

SwOT - strengths, weaknesses, opportunities, Threats                      workgroup - see chartered workgroup.

Thanks A Million - certificate presented to employees by other                                             Z
employees to acknowledge excellent service. A part of the mQA
employee recognition program.                                             zzzz email - An email address for customer feedback, assigned to
                                                                          specific work units for a specified purpose.
TnAS - training needs Assessment survey

Top Talent - High quality applicants or employees.

Trak-it - An automated system that provides web-based standardized
training content, web-assisted testing, online registration, employee
(student) training histories and various reports, including reports for

TrF - training request Form

Trust Fund - A government fund administered separately from
other funds and used for a specified purpose. mQA’s trust fund is
revenue generated from licensure and enforcement fees, as opposed
to general revenue (tax-payer dollars).

                                                                                          Glossary of Terms, Abbreviations, and Acronyms
                                                                                                     Division of Medical Quality Assurance

orGAniZAtionAl proFile                                                    P.1a(2) Organizational Culture
The Florida department of Health (doH), division of medical               Through continuous improvement and team-based work systems,
Quality Assurance (mQA), was created by the Florida legislature           mQA’s culture embodies the spirit of public service to ensure quality
to preserve the health, safety, and welfare of the public. Florida is     health care services throughout Florida.
the fourth largest state in the nation and continues to grow, put-        Mission: promote, protect and improve the health of all people in
ting mQA in the top 10% nationally of regulatory agencies in terms                 Florida
of population served. Headquartered in Florida’s capital city with         Vision: A healthier future for the people of Florida
twelve field offices located throughout the state, mQA licenses and       Purpose: to protect the public through health care licensure,
regulates nearly 900,000 health care practitioners and facilities/                 enforcement and information
establishments. it is an organization defined by its values, character-     Focus: to be the nation’s leader in quality health care regulation
ized by its dedicated employees, and recognized for its innovation         Values: integrity, commitment, respect, excellence, Account-
and quality service.                                                               ability, teamwork, & empowerment

P.1 Organizational Description                                            P.1a(3) workforce Profile
                                                                          mQA maintains 501.5 positions. of this total, 4% are in the mQA
P.1a Organizational environment
                                                                          director’s office (do); 36% are in the bureau of Health care prac-
P.1a(1) Main Products and Services                                        titioner regulation (Hcpr); 38.5% are in the enforcement pro-
when the division was created in 1988, mQA identified and orga-           gram; 8.5% are in the bureau of operations (boo); and 13% are
nized its work around the key processes of licensure of health care       in the bureau of management services (bms). managers and super-
practitioners and enforcement of licensing regulations. working in        visors represent 20% of these positions and 80% are non-supervi-
conjunction with 22 regulatory boards appointed by the Governor           sory. employee education is diverse, from high school through doc-
and six advisory councils appointed by the state surgeon General,         toral-level, and includes medical doctors, nurses, pharmacists, and
mQA licenses and regulates 34 types of facilities/establishments          attorneys. employees are representative of the diverse population of
and 200-plus license types in more than 40 health care professions.       Florida and possess the language skills needed (english, spanish, &
in response to growing customer demands, in August 2006, mQA              creole) to communicate with mQA’s customers.
identified and dedicated resources to a third key process—informa-
tion. An increasing number of customers expected the division to          collective bargaining organizations representing employees include
provide easy access to licensure and disciplinary information and sta-    the American Federation of state, county, and municipal employ-
tistical data-a demand expected to continue growing into the future       ees and the Florida nurses Association. The requirements and expec-
(Figure P.1-1).                                                           tations of mQA’s employees include a safe work environment, tools
                                                                          needed to do their jobs, and the demonstration of mQA’s values by
                                                                          all employees. Key benefits include: life, health, dental, and vision
                                                                          insurance programs; competitive leave and retirement packages;
                                                                          flexible scheduling; and tuition reimbursements and waivers. Facili-

Figure: P.1-1 MQA’s Main Products and Services
 key Process      Product or Service                                                            Delivery Mechanism(s)
                                                                                                email, in person, internet, mail, phone,
                  process and approve or deny applications
                                                                                                public meetings, publications
                  renew licenses                                                                email, internet, mail, public meetings

                  Analyze and investigate complaints                                            encrypted email, in person, mail

                  inspect facilities                                                            in person

 enforcement Assist in prosecuting practice act violations                                      in person, public meetings

                  combat unlicensed activity                                                    in person, publications, internet, phone

                  impose discipline and monitor compliance with disciplinary Final orders email, in person, mail, phone

                  provide credential and discipline history about licenses to the public        in person, internet, mail, phone
                  respond to public record requests                                             email, in person, internet, mail, phone

                                                                                                             Organizational Profile – Page i
Division of Medical Quality Assurance

ties comply with all fire, safety and Americans with disabilities Act       to the Federal Health insurance portability and Accountability Act
requirements. Key employees are trained in cpr and first aid. each          (HipAA) and doH security and confidentiality requirements.
zone within mQA has an office safety warden, who is trained in
safety protocols.                                                           P.1b Organizational relationships

P.1a(4) Facilities, equipment, and Technologies                             P.1b(1) Governance
                                                                            mQA is an “umbrella” division within doH established under sec-
All mQA employees work in secured facilities. mQA headquarters
                                                                            tion 20.43, F.s., and authorized by the legislature to regulate Florida
is housed in three buildings at tallahassee’s capital circle office
                                                                            health care practitioners for the preservation of the health, safety, and
complex (ccoc). Field offices are located in either state-owned
                                                                            welfare of the public. The responsibilities of the division are specified
buildings or leased space, and investigators in the field offices use
                                                                            by chapters 401, 456, 468, and 499, F.s. revenues generated from
state-owned cars. mQA has access to conference rooms and com-
                                                                            the licensing and regulation of health care practitioners are credited
puter training laboratories in its own buildings and other doH
                                                                            to trust funds that are earmarked for regulatory activities only. The
divisions and offices throughout the state of Florida. mQA also uses
                                                                            legislature provides annual budget appropriations for mQA opera-
university classrooms and county health department (cHd) clinics
                                                                            tions. mQA’s director is lucy c. Gee, m.s. she reports to a doH
for examinations, trainings and meetings.
                                                                            deputy secretary who, in turn, reports to the doH state surgeon
                                                                            General, who reports directly to the Governor.
each employee is assigned and works with a personal computer using
microsoft software. All computers are connected to a statewide com-
                                                                            section 456.026, F.s., requires mQA to report annually to the leg-
puter network. software encryption is used to transmit confidential
                                                                            islature on finances, administrative complaints, disciplinary actions
information. secure laptops with connection to the statewide net-
                                                                            and rule guidelines, and recommendations for legislative changes
work are available for offsite meetings. printers, copiers, fax equip-
                                                                            to facilitate efficient and cost-effective regulation. mQA is sub-
ment, projectors, televisions, vcrs, dvd players, digital cameras,
                                                                            ject to reviews and audits conducted by the state Auditor General,
and scanners are available to all mQA employees. Use of microsoft
                                                                            office of program policy Analysis and Government Accountability
live meeting™ and a distance learning satellite network are tech-
                                                                            (oppAGA), and the doH inspector General.
nologies used to communicate and train with field offices.

                                                                            within its key processes, mQA has varied responsibilities, and is
email, internet websites, and specialized phone systems are used
                                                                            divided by function into work units (Figure: O-1). bureaus are
by mQA employees to communicate with both internal and exter-
                                                                            under the supervision of a chief; enforcement activities of com-
nal customers. doH and mQA intranet websites are also used for
                                                                            plaints intake, investigation, and final order compliance are under
internal communication. mQA internet websites provide informa-
                                                                            the deputy division director. mQA’s executive management team
tion, forms, and a variety of online services for licensees. The licens-
                                                                            (emt) is comprised of the director, deputy director, bureau chiefs,
ing/enforcement database, customer oriented medical practitioner
                                                                            and the strategic planning services (sps) manager. The manage-
Administration system (compAs), supports business processes,
                                                                            ment team (mt) is comprised of the emt with the addition of
maintains documentation of work information, and is a research
                                                                            eight executive directors, two enforcement unit managers, and three
resource used throughout the division. other technologies include
                                                                            field district managers. There is a two-way communication flow
an online imaging system, a data warehouse for generating reports,
                                                                            through the management system from executive management to
an online employee suggestion box, sharepoint for storing and cata-
                                                                            management to staff and back. communication is achieved through
loging policies and procedures and other operational documents,
                                                                            weekly emt meetings, monthly mt meetings, division-wide meet-
and training support through trak-it. The customer Functional
                                                                            ings, bureau- and unit-level staff meetings, quarterly management
directory (cFd) provides customized access to information for
                                                                            reports, emails and the mQA-managed intranet site.
timely response to customers.

P.1a(5) regulatory environment                                              P.1b(2) key Customers, Stakeholders and Market
mQA has regulatory responsibility and operates according to Florida
statutes (F.s.) and the Florida Administrative code (F.A.c.). chap-         mQA’s key customers, stakeholders and market segments are
ters 401, 456, 468, and 499, F.s., set forth legislative intent and rule-   licensed health care practitioners, licensure applicants, and all health
making authority for its key processes of licensure, enforcement, and       care consumers in Florida (Figure P.1-2). mQA’s services impact all
information. mQA’s regulatory program functions operate under               Florida residents and visitors.
Florida’s sunshine law, chapter 286, F.s., the public records law,
chapter 119, F.s., and the Florida Administrative procedures Act,           P.1b(3) Suppliers, Partners, and Collaborators
chapter 120, F.s. All employees and appointed members of mQA’s
                                                                            mQA’s suppliers, partners and collaborators play a significant role in
boards and councils are governed by chapter. 112, F.s., public offi-
                                                                            how well key processes are accomplished and in how value is created
cers and employees, and General provisions. employment and occu-
                                                                            for provided services. mQA’s most important suppliers are Florida’s
pational health and safety issues are regulated by the occupational
                                                                            office of the Attorney General (oAG), image Api, inc., and federal
safety and Health Administration (osHA). since employees handle
                                                                            and state law enforcement. mQA’s most important partners include
confidential information, they must also be trained in and adhere
                                                                            the Governor-appointed boards, surgeon General-appointed coun-
                                                                            cils, prosecution services Unit (psU) within the office of the Gen-

Organizational Profile – Page ii
                                                                                                     Division of Medical Quality Assurance

Figure: P.1-2 MQA’s Key Customers, Stakeholders, and Market              ability, teamwork, and empowerment. Through its contracts, mQA
Segments                                                                 establishes and enforces requirements that include meeting estab-
 Group              key requirements and expectations                    lished performance measures, maintaining data security and confi-
                                                                         dentiality, complying with relevant statutes, and providing accurate,
                    •   timely renewal of license
 licensed                                                                timely and quality products.
                    •   online access to license information
 Health care
                    •   timely resolution of investigations
 practitioners                                                           P.1b(4) key Supplier and Customer Partnering
                    •   Quality customer service
                    • timely application processing                      relationship and Communication Mechanisms
                    • timely receipt of examination scores               mQA’s key supplier and customer partnering relationship and com-
                    • Quality customer service                           munication mechanisms include purchase orders, contracts, mem-
                    • Qualified health care practitioners and            oranda of Understanding (moU), and data sharing agreements.
                      facilities/establishments                          expectations of services and deliverables are communicated during
 Health care        • online access to information about health          the competitive procurement process through a variety of mecha-
 consumers            care practitioners                                 nisms such as requests for proposal (rFp), and throughout the life of
                    • timely resolution of complaints                    the contract in the form of deliverables and performance measures.
                    • Quality customer service                           where mQA has a contractual relationship, there is a quarterly
                                                                         reporting mechanism. This includes audits of contract milestones
eral counsel (oGc), division of information technology (it), and         and site visits. mQA’s key supplier and customer communication
local, federal and state law enforcement. mQA’s most important col-      mechanisms include the internet, mail, email, phone, in-person,
laborators are the health care practitioner associations.                publications, and public meetings.

The oAG provides legal counsel for the health care regulatory            P.2 Organizational Challenges
boards. image Api, inc., one of mQA’s largest vendors, collects and
deposits revenue, prints licenses and renewal notices, populates ini-    P.2a Competitive environment
tial licensure data, and processes licensure renewals. They play an      P.2a(1) Competitive Position
important role in mQA’s innovation processes, most recently devel-
oping mQA’s enterprise information system (eis) to allow staff to        As a trust-funded state agency (as opposed to general revenue-
view online images of licensure and disciplinary documents.              funded), mQA has few competitors as compared to the private sector.
                                                                         because the legislature has determined that regulation of health care
                                                                         practitioners for the safety of the public is a function most effectively
law enforcement agencies, such as the Florida department of law
                                                                         carried out by government, specifically mQA, no private competi-
enforcement (Fdle) and the Federal bureau of investigation (Fbi),
                                                                         tors exist for licensure and enforcement. The organization is highly
supply fingerprint and background search results used for licensing
                                                                         regarded in the nation for its health care regulation expertise. A few
and investigation into disciplinary complaints. in addition, mQA
                                                                         national federations have developed and offered application process-
partners with law enforcement agencies to stop the unlicensed prac-
                                                                         ing for state licensing agencies; however, they have not demonstrated
tice of health care. These agencies assist with undercover operations,
                                                                         cost efficiency or effectiveness to-date. in the area of information,
serve arrest warrants and act as witnesses in criminal trials.
                                                                         however, mQA does compete and must meet customer needs and
                                                                         expectations and provide value.
Health care practitioner associations, such as the Florida medical
Association (FmA) and the Florida dental Association (FdA), Flor-
                                                                         because Florida state government has experienced a trend toward
ida osteopathic medical Association the (FomA), the professional
                                                                         privatization and outsourcing, mQA must maintain a competitive
opticians of Florida (poF), and the Florida dietetic Association
                                                                         edge by meeting and exceeding its customers’ needs and require-
(FdA), collaborate with mQA in disseminating important licensee
                                                                         ments. Therefore, it is imperative that mQA services be provided for
information through their membership network. This information
                                                                         the lowest cost and with the highest level of quality possible.
may include renewal schedules, notification of delinquent licensees,
new licensing products and services, and changes to laws and rules.
                                                                         As the fourth largest state, in the top 10% nationally of regulatory
                                                                         agencies in terms of population served, mQA sets the benchmark in
The boards provide regulatory oversight of the health care practitio-
                                                                         various activities. For example, through comprehensive education
ners including discipline and rule-making. psU provides attorneys
                                                                         and partnership with law enforcement, mQA was one of the first
and staff for prosecution of licensees and to represent the depart-
                                                                         regulatory agencies in the nation to establish a dedicated unlicensed
ment in appellate cases. The division of it supports mQA’s network
                                                                         activity (UlA) enforcement program. mQA was the second state in
and database, providing technical assistance and operational support
                                                                         the nation to establish mandatory criminal background screenings
to ensure its stability and security. They provide technical in-house
                                                                         and published profiles of certain health care practitioners.
and contracted support of mQA’s processes such as online services
and less-paper initiatives.

mQA expects all suppliers, partners, and collaborators to adhere to
mQA’s values of integrity, commitment, respect, excellence, account-

                                                                                                             Organizational Profile – Page iii
Division of Medical Quality Assurance

P.2a(2) Principle Factors that Determine Competitive                       other entity possesses such a complete body of health care practi-
Success                                                                    tioner data that is considered primary source verified by credential-
                                                                           ing agencies and that is available at no cost to the public through
Key to its competitive position, mQA has broad legislative author-         mQA. The approximate 4.5 million “hits” a year mQA receives to
ity, a stable workforce, and a viable strategic plan (sp); therefore, it   its licensure data base reflects the public’s reliance on mQA licensing
must meet the expectations of the legislature and its constituencies       information as comprehensive, reliable, current, and important to
with greater value than that which a private contractor could pro-         making informed health care decisions.
vide. As a prime example of this requirement, mQA’s counterpart
regulatory agency for non-health care professions, the department
of business and professional regulation (dbpr), experienced what           P.2a(3) Available Sources of Comparative/
can happen when a profession challenges the effectiveness of the ser-      Competitive Data
vices provided by the agency. one of its regulated professions sought      benchmarking to compare the wide range of services and practices
and received legislative authority to privatize its regulation.            of mQA has been completed with other Florida agencies, other state
                                                                           regulatory agencies, sterling award winners, and private corporations
mQA has a stable workforce, with less than 10% annual turnover and         recognized as being among the best in their field. in addition, data
32% of employees with more than 10 years regulatory experience.            collected from professional organizations in areas such as human
Furthermore, the 2008 mQA employee satisfaction survey (ess)               resources, finance, safety, and risk management are also used. From
reflected an employee satisfaction rate of 80%. These are important        this, benchmarking strategies are developed and deployed, and mea-
success factors in the quality of the services mQA provides with a         sures are improved. in 2008, mQA provided benchmarking training
knowledgeable, competent workforce.                                        to management staff, as well as in-depth process management train-
                                                                           ing for process owners and management staff.
Another success factor is mQA’s strategic plan (sp). This sp,
which was first developed in 2000, directs and measures the work           Furthermore, mQA contacted agencies from states of similar size
accomplished by mQA. An annual swot (strengths, weaknesses,                and function from which available comparative data have been col-
opportunities, and Threats) analysis ensures the plan is flexible and      lected. These state agencies include the california department of
responsive to changing demands. it also directs needed legislative         public Health, center for Healthcare Quality; the new York state
changes.                                                                   education department, office of professions; the texas department
                                                                           of state Health services, division for regulatory services; the illi-
mQA’s licensing and enforcement information is available, in part,         nois department of Financial and professional regulation, division
for a fee in the private sector through a few vendors. However, no

Figure: P.2-1 MQA’s Key Challenges and Advantages
                Business                         Operational                     human resource                      Sustainability

                                                                                 Attracting or competing for
                                                                                                                     significant turnover in
                                                                                 top talent within a government
                A growing and diverse                                                                                leadership expected over
                                                 limited office space            compensation system that is
                population                                                                                           the next five years due to
                                                                                 low compared to the private
                                                                                                                     Attracting or competing
                                                                                 increase in workload, including
                                                 expectations to improve                                             for top talent within a
                statutory changes, especially                                    unfunded legislative mandates,
                                                 business results with limited                                       government compensa-
                those resulting in unfunded,                                     requires additional positions
                                                 resources and limited con-                                          tion system that is low
                un-staffed mandates                                              which have not been appropri-
                                                 trol over the results                                               compared to the private
                                                                                 ated by the legislature

                                                                                                                     strategic planning
                                                 compAs database and sys- comprehensive benefits                     services Unit (sps)
                emergency preparedness
                                                 tems support services (sss) package                                 facilitates continuous
                technological innovation,
                including online status          mQA is 100% trust funded
                check for applications,          (does not receive funds from employee recognition program mQA’s sp
                online renewals, and elec-       Florida’s general revenue)
                tronic fingerprinting

Organizational Profile – Page iv
                                                                                                      Division of Medical Quality Assurance

of professional regulation; and the pennsylvania department of             Figure: P.2-2 MQA’s Performance Excellence Journey
state, bureau of professional and occupational Affairs.                    years    key Tasks/Activities
                                                                                    •   established boo and bms
P.2b Strategic Context                                                              •   established employee recognition program
As a state government entity, mQA faces various strategic chal-            1997-    •   participated in doH ess
lenges; however, mQA is fortunate to have a variety of strategic           1999     •   implemented online license look-up website
advantages. Figure P.2-1 includes mQA’s key business, operational,                  •   established annual long-range planning meetings
human resource, and organizational sustainability challenges and                        with board chairs and vice-chairs
advantages.                                                                         • Adopted sterling performance excellence model
                                                                                    • established process support and improvement team
P.2c Performance improvement System                                                   and community relations office
                                                                                    • established spp
mQA employs dmAic and dmAdv methods to systematically                               • established long range planning session with health
improve performance. Adopting the sterling management system in                       care practitioner associations
2002 provided a framework for designing the improvement system                      • established Thanks A million program
that exists today (Category 6). Figure P.2-2 provides a timeline of                 • developed customer Functional directory
mQA’s performance excellence journey.                                      2000-
                                                                                    • installed imaging system, offering access to scanned
mQA uses strategic planning and systematic evaluation and                           • conducted 360 feedback surveys for all mQA
improvement methods to maintain organizational focus on perfor-                       managers
mance improvement and organizational learning. The strategic plan-                  • developed new licensee satisfaction survey
ning process (spp) described in Section 2.1a outlines the ongoing                   • participated in doH GsA assessment and feedback
evaluation of organizational objectives and opportunities to develop                  report
action plans to close gaps.                                                         • development of performance measures
                                                                                    • implemented online renewal services
mQA uses several systematic approaches to ensure the continuous                     • established strategic management services Unit
evaluation and improvement of its services, systems and processes.                  • began annually attending the sterling conference
These include the leadership evaluation process (discussed in Cat-                  • established mQA certified public manager (cpm)
egory 1), the strategic planning process (spp) and the balanced                       program
scorecard (discussed in Categories 2 and 4), process management                     • Formalized development of policies and procedures
(discussed in Category 6), employee involvement in problem-solv-                    • mapped and created desk guides for all mQA
ing workgroups (discussed throughout the application), and the sys-                   processes
tematic assessment of customer and employee feedback (discussed in         2003-    • established a process for updating desk guides
Categories 3 and 5).                                                       2005     • established workgroups based on employee satisfac-
                                                                                      tion survey data
mQA’s processes are reviewed using the dmAic (define, measure,                      • implemented an electronic continuing education
Analyze, improve, control) method (Figure 6.1-4). in addition,                        tracking system
mQA’s management system is evaluated through sterling assess-                       • implemented final and emergency order look-up
ments and feedback reports. mQA’s approach to systematic knowl-                       screen
edge and skill-sharing throughout the organization is accomplished                  • established in-house consultants (cpm graduates) to
through its team-based employee involvement structure and sharing                     assist with special division-wide projects
at all levels, through regular staff and leadership meetings, as well as            •   established sps
the wide availability of data and information (mQA intranet, cus-                   •   participated in sterling navigator process
tomer Functional directory, eis, compAs, sharepoint, etc.).                         •   established mQA ess
                                                                                    •   established sterling navigator workgroups
                                                                                    •   established complaint tracking system
                                                                                    •   began conducting quarterly “chat with lucy” infor-
                                                                                        mal meetings with division director
                                                                                    •   established state’s first physician workforce practitio-
                                                                                        ner practice survey
                                                                                    •   established davis productivity team to assist indi-
                                                                                        vidual units with completing and submitting davis
                                                                                        productivity Award (dpA) applications
                                                                                    •   implemented online nursing application process
                                                                                    •   conducted first and second annual division-wide
                                                                                        mQA update for all employees

                                                                                                               Organizational Profile – Page v
Division of Medical Quality Assurance

Figure: O-1 MQA’s Table of Organization

                                                        State of Florida

                       orGAniZAtionAl diAGrAm
                       MQA’s Table of Organization
                                                     State Surgeon General
                                                 Florida Department of Health

                                                       Deputy Secretary
                                                 Florida Department of Health

                                          Division of Medical Quality Assurance (MQA)

              Bureau of Health Care                                                       Deputy Director/
          Practitioner Regulation (HCPR)                                                    Enforcement
                  (See Figure 0-2)                                                        (See Figure 0-5)

                                                      Strategic Planning
                                                      Services Unit (SPS)

                             Bureau of                                               Bureau of
                     Management Services (BMS)                                   Operations (BOO)
                          (See Figure 0-3)                                        (See Figure 0-4)

Table of Organization – Page vi
                                                                                       Division of Medical Quality Assurance

Figure: O-2 HCPR’s Table of Organization

                                           Division of Medical Quality Assurance

                                                  Bureau of Health Care
                                              Practitioner Regulation (HCPR)

                     Chiropractic Board Office                                 Medicine Board Office

                     Dentistry/491 Board Office                                Nursing Board Office

                    EMT/Rad. Tech. Board Office                             Osteopathic Board Office

                  Medical Therapies Board Office                               Pharmacy Board Office

                                                                                             Table of Organization – Page vii
Division of Medical Quality Assurance

Figure: O-3 BMS’ Table of Organization

                                          Division of Medical Quality Assurance

                                         Bureau of Management Services (BMS)

                Client Services Unit                                                  Central Records Unit

                     Communication Services Unit                            Internal Services Unit

Table of Organization – Page viii
                                                                                  Division of Medical Quality Assurance

Figure: O-4 BOO’s Table of Organization

                                          Division of Medical Quality Assurance

                                              Bureau of Operations (BOO)

             Licensure and Auditing
                                                                                  Testing Services Unit
                  Services Unit

                                              System Support Services Unit

                                                                                        Table of Organization – Page ix
Division of Medical Quality Assurance

Figure: O-5 Enforcement’s Table of Organization

                                             Division of Medical Quality Assurance


              Consumer Services Unit              Investigative Services Unit        Compliance Management Unit

                   North District                       Central District                    South District

                  Alachua                            Jacksonville                         Ft. Myers
                Field Office                         Field Office                        Field Office

                 Pensacola                             Orlando                          Ft. Lauderdale
                Field Office                         Field Office                        Field Office

                Tallahassee                         St. Petersburg                          Miami
                Field Office                         Field Office                        Field Office

                                                       Tampa                           West Palm Beach
                                                     Field Office                        Field Office

                                                                                      Unlicensed Activity
                                                                                          Field Office

Table of Organization – Page x
                                                                                                 Division of Medical Quality Assurance

cAteGorY 1: leAdersHip                                                    Figure 1.1-1 MQA’s Mission and Vision Timeline

1.1 Senior Leadership
                                                                                         Prior to 2006, MQA’s Mission reflected
1.1a Vision and Values                                                                   both its key processes and DOH’s Mission.
1.1a (1) Setting and Deploying Vision and Values                                         MQA shared DOH’s Vision.
The executive management team (emt) sets and reviews the orga-                           Mission
nization’s mission, vision, and values in step 1 of the strategic plan-                  Protect and promote the health of all
ning process. The mission, vision, and values evolved over several                       persons in Florida by diligently regulat-
years and resulted in statements that were short and easy to remem-         1997-        ing health care practitioners and facilities.
ber, written in plain language, were inspirational, realistic, and          2005
achievable, easily measured, and contributed to the organization’s                        Vision
long-term sustainability. Until 2007, the division’s vision was to be                      By providing quality services and
the nation’s leader in quality health care regulation, and its mission                     promoting healthy communities, we are
was to protect the public through health care licensure, enforce-                          valued by those we serve and our partners
ment, and information. That year, the department, in an effort to                          as the leading public health organization
establish a marketing “brand,” requested all work units to adopt the                       in the nation.
department’s mission and vision. because mQA’s mission and vision
had been so effectively deployed throughout the workforce and with
its key suppliers and partners, the decision was made to retain and                        rough a division wide SWOT analysis,
adopt them as mQA’s purpose and focus (Figure 1.1-1).                                    MQA updated its Mission and Vision to be
                                                                                         current and measurable.
mQA’s mt deploys mQA’s mission, vision, purpose, focus and
values (mvpFv) to employees through:
                                                                            2006         To protect the public through health care
•   mQA’s intranet and internet site                                                     licensure, enforcement and information
•   strategically located posters
•   training                                                                              Vision
•   email signature lines                                                                  To be the nation’s leader in quality
•   i.d. badges                                                                            healthcare regulation.
•   mQA employee covenant
•   employee performance standards and goals
•   “i creAte” buttons and badges
•   mQA’s annual division-wide mvpFv meetings                                            To create a unifying brand, DOH revised
•   mQA’s reward and recognition programs                                                its Mission and Vision and decided that all
•   staff meetings                                                                       divisions should adopt the new DOH
•   monthly chat with lucy to check organizational climate                               Mission and Vision as their own.
•   recruitment and selection process of new employees                                   Mission
•   new employee orientation (neo) and 6-month follow-up with               2007         Promote, protect and improve the health
    emt                                                                                  of all people in Florida.
•   ethics policy and training
•   role modeling                                                                         Vision
•   strategic and business plans                                                           A healthier future for the people
•   individual work unit staff meeting videos on values                                    of Florida.
•   mQA open House showcase
•   bureau newsletters
•   employee surveys
                                                                                         To better define MQA’s role within DOH,
mQA systematically deploys its mvpFv to its key suppliers, part-                         MQA adopted its 2006 Mission and Vision
ners, and stakeholders through memorandums of agreement, con-                            as its Purpose and Focus.
tracts, annual reports, annual meetings, internet site under “who is
mQA,” division publications, and attendance at board meetings or                         Purpose
other presentations. For suppliers, leadership deploys the mvpFv            2008          To protect the public through health care
though established contract performance measures. deployment is                           licensure, enforcement and information
measured through contract compliance monitoring.
to further deploy mQA’s values, the emt requested that a work-                            To be the nation’s leader in quality
group review and clearly define mQA’s values in terms of specific                         healthcare regulation.
behaviors. The result is the mQA employee covenant, signed by
all employees and posted prominently throughout the division.

                                                                                                         Category 1: Leadership – Page 1
Division of Medical Quality Assurance

Another workgroup was charged by the emt with developing a               when Governor crist made changes to the state’s ethics policy in
campaign to deploy the values. The theme, “i creAte,” (using the         2007, all employees were required to familiarize themselves with the
first letter of each value) was deployed with buttons and laminated      changes. The emt ensured mQA was a compliance leader within
badges. Games and contests challenged employees to complete the          doH by designing a training course for its employees to complete
statement “i creAte mQA by ________.”                                    prior to the deadline.

The emt’s personal actions reflect a commitment to mQA’s mvpFv           As a final example of how the emt promotes legal and ethical
starting with the director who conducts monthly open-invitation          behavior, when the 2006 sterling navigator survey identified ethi-
informal meetings (chats with lucy) with local and field staff.          cal and legal behavior as an organizational strength, emt members
The emt holds annual division-wide meetings to promote mQA’s             chartered a workgroup. This legal and ethical behavior workgroup,
mvpFv. At mQA’s neo, new employees meet the emt where                    comprised of leaders, has been charged with defining contributing
the mvpFv are communicated and reinforced through powerpoint             factors to this strength and developing action plans to reinforce and
presentations, games, and a self-evaluation that asks employees how      sustain them.
their job fits into the division’s mvpFv. This is reinforced at the 6-
month follow-up. emt and mt members perform skits portraying             1.1a (3) Creating a Sustainable Organization
the mvpFv at the annual employee recognition ceremony.
                                                                         one of mQA’s core competencies is leadership. The emt is com-
                                                                         prised of leaders recruited for their problem solving skills, financial
The mvpFv is deployed so effectively that in a recent employee
                                                                         management acumen, ability to manage and standardize work pro-
survey 99% of employees agreed that they are acquainted with
                                                                         cesses, and ability to manage by data. They create a sustainable orga-
                                                                         nization through financial management, strategic planning, swot
                                                                         analysis, legislative planning, innovation, succession planning, train-
1.1a (2) Promoting Legal and ethical Behavior                            ing, and a balanced scorecard (Figure 2.1-3). The emt also creates
The emt promotes an organizational environment that fosters,             a sustainable organization by: (1) ensuring the solvency of the mQA
requires, and results in legal and ethical behavior through formal       trust fund—the emt conducts a quarterly analysis of cash balances
and informal means. legal and ethical behavior is formally discussed     and an annual analysis of the adequacy of fees and its five year cash
with employees at the neo and the neo six-month follow-up.               balance projections; and (2) ensuring continuous operations through
chats with lucy, annual meetings, and staff meetings provide infor-      mQA’s continuity of operations plan (coop) (Section 6.1c) in
mal settings to reinforce legal and ethical behavior. The doH ethics     the event the division has to suspend normal operations and/or relo-
policy, which is signed by all new employees, provides explicit guide-   cate. business improvements that are implemented as a result of the
lines for ethical behavior. The doH ethics officer is assigned to        spp, customer feedback, and other means also create sustainability.
monitor ethics compliance and to serve as a resource to the depart-      They are shown in Figure 1.1-2.
ment when ethical questions arise. employee compliance with
mandatory annual ethics training is monitored by all managers. All The emt created and maintains an environment for organizational
mQA managers have performance standards that set forth legal and performance improvement through the following models, tools, and
ethical behavior. Furthermore, the emt and executive directors work systems:
must complete annual financial and gift disclosure forms, compli-
ance with which is tracked by the division director.
  Figure 1.1-2 examples of improvements that enhance MQA’s Sustainability
                 improvement                          Sustains MQA by:
                 created an online initial            creating a competitive advantage by encouraging practitioners to practice in Florida
                 application for nursing              by making the application more accessible.
                 created an online renewal            creating value by providing licensees 24/7 access to timely renew their license and
                 application                          ensuring that fees are paid at time of renewal.
                 developed the compAs mobile          - creating a competitive advantage by encouraging facilities to practice in Florida by
                 inspection program (cmip)            providing a faster inspection process.
                                                      - providing real-time information about inspection results of regulated facilities
 enforcement                                          resulting in better protection of the public.
                 created the enforcement issue        providing better communication between headquarters and field office investigators
                 Alert system                         regarding immediate actions and best practices.
                 enhanced tracking of legislation     providing agility to respond to proposed legislation, to develop implementation
                 (lbt application)                    plans, and to adjust strategic plan and prioritization of projects accordingly.
 information     developed compAs licensinig          - standardizing processes.
                 system                               - creating a centralized location for performance monitoring and the maintenance
                                                      of data.
                                                      - providing fiscal reliability.

Category 1: Leadership – Page 2
                                                                                                 Division of Medical Quality Assurance

• Adoption of the sterling model for organizational performance         Figure 1.1-3 role Model Performance Leadership
• strategic plan and strategic planning process                         Method: COOP leadership roles
• balanced scorecard                                                    examples: • mQA division director serves as doH incident
• Action plans                                                                      commander
• chartered workgroups                                                            • mQA leaders serve as planning and operations
• systematic management reports                                                     chiefs
• Annual reports                                                        Method: Disaster response leadership roles
• innovation and achievement awards                                     examples: • mQA division director served as doH incident
• training                                                                          commander during 2004 hurricane season
• shared best practices (mQA open House showcase and intranet)                    • mQA leaders serve as chiefs and liaisons to doH
• employee recognition program (erp)                                                incident command team
• customer service system (section 3.2a(3))
• enforcement Alerts                                                    Method: Pilot projects
• employee intranet suggestion box                                      examples: • mQA piloted Governor’s plain language initiative
                                                                                    for doH
each of the above contributes to the creation of an environment                   • mQA piloted doH training management
that supports the achievement of mQA’s mission and strategic objec-                 program, trak-it
tives and ensures organizational agility. to promote an environment     Method: national federation and association leadership
that achieves strategic objectives and innovation, the emt mem-         positions
bers serve as owners of workgroups formed to address improve-
                                                                        example:   • 2006-2007 Annual report provides detailed list of
ment opportunities for the work systems identified above. They are
                                                                                     more than 25 positions held by mQA leaders
responsible for action plans and business results tied to work system
improvements. The environment for the accomplishment of strate-         Method: Speaking engagements (subject matter experts)
gic objectives is also enhanced because the emt adopted the use of      example:   • mQA leaders routinely speak to schools,
the dmAdv and dmAic methods for process design and process                           associations, consumer groups, and other
improvement. examples of a few workgroups owned by the emt                           stakeholder groups
are public records, legal and ethical behavior, patient notification,   Method: Serve on Governor and department-appointed task
ess “Question 27”, duplicate license, and compliance monitor-           forces
ing. emt members report to the division director quarterly on the
                                                                        examples: division director serves on:
progress of their workgroups.
                                                                                  • office of drug control task Force
                                                                                  • patient safety workgroup
The emt creates an environment that encourages innovation                         • electronic prescribing Advisory panel
through a number of means. employees can submit suggestions and                   • department of children and Families Advisory
best practices through the mQA intranet site (employee suggestion                   panel
box), enforcement Alerts, chats with lucy, annual division-wide                   • other mQA leaders serve on:
meetings, mQA open House showcase, and cross-functional process                   • women’s Health Advisory workgroup
improvement chartered workgroups. The erp empowers employees                      • Florida Health information privacy workgroup
to be innovative by recognizing employees for quality improvement                 • state office of drug control diversion response
through the meritorious Achievement Awards and the davis pro-                       team
ductivity Awards (dpA).
                                                                        Method: inter-agency task forces
The emt creates an environment that supports and provides role-         example:   • mQA leaders serve on medicaid Fraud inter-
model performance leadership (Figure 1.1-3).                                         Agency Advisory workgroup with Attorney
                                                                                     General’s office and Agency for Health care
 Figure 1.1-3 role Model Performance Leadership                                      Administration
 Method: Training                                                       Method: Certifications
 examples: • mQA-sponsored cpm training with more than                  examples: mQA leaders are certified in:
             50 graduates                                                         • project management
           • sterling examiner training                                           • contract management
 Method: Cross-functional department workgroups                                   • Administrative law
                                                                                  • Fraud investigation
 examples: mQA leaders serve on:
           • doH central office performance improvement                 Method: Community
             Advisory council                                           examples: mQA leaders serve in leadership capacities on:
           • doH public records workgroup                                         • United way
           • doH legislative bill tracking system design                          • community Human services partnership

                                                                                                       Category 1: Leadership – Page 3
Division of Medical Quality Assurance

mQA’s emt creates an environment of organizational agility by pri-          1.1b Communication and Organizational
oritizing mQA’s strategic plan, engaging in quarterly reviews, and          Performance
adjusting action plans and performance targets to adapt to changes
in the environment, resources, customer needs, and improvement              1.1b(1) Communication and engagement of
opportunities. The annual swot analysis is engaged in by the emt            workforce
and mt and serves as a key contributor to the organization’s agility.
                                                                            The emt and mt communicate with and engage the entire work-
The division’s strategic plan, bsc, and action plans are accessible to
                                                                            force through a variety of means including face-to-face meetings,
all employees on the mQA intranet site and ensures deployment.
                                                                            surveys and survey results, mQA intranet, email, neo, neo 6-
new legislative mandates, such as the physician workforce survey
                                                                            month follow-up, mQA employee Appreciation day, employee
(Section 4.2a(4)), provide an excellent example of mQA’s ability to
                                                                            recognition ceremony, and mQA’s open House showcase. mQA’s
quickly adjust strategic plans, action plans, and strategic priorities to
                                                                            director emphasizes communication and provides the model for
implement their requirements.
                                                                            communication throughout the division with monthly division-
                                                                            wide chats with lucy, weekly emt meetings, monthly emt and
to create an environment for continuous organizational and work-            mt meetings, quarterly emt, mt and mid-manager meetings, and
force learning and development, the emt approves and promotes:              annual division-wide mQA meeting. All meetings are accessible to
•   sterling criteria and examiner training                                 field staff by telephone conference and live meeting™.
•   tuition waivers and reimbursements
•   Flex schedules to accommodate class schedules                           Although meetings are an important communication tool for mQA,
•   required leadership training (benchmarking, process manage-             the bsc, the intranet, emails, desk guides, process maps, surveys,
    ment, the dmAic method, and recruitment and retention)                  training, and recognition are also valuable methods for communi-
•   performance planning for all employees                                  cating work information and performance. The bsc communicates
•   paid national and state educational conferences                         how well the division and individual work units are performing. The
•   cpm                                                                     intranet provides information and links to topics such as policies,
•   office retreats (includes teambuilding exercises)                       training, personnel, and employee recognition. desk guides and
•   mentoring                                                               process maps are also essential communication tools for training and
•   Formal assessments (ess, training needs assessment (tnA))               cross-training. surveys provide staff and management feedback to
•   succession planning                                                     implement improvements. training helps ensure standardized pro-
•   structured training management system(trak-it)                          cesses and business results.
•   “lunch-n-learns”
•   mid-managers forum and steering committee meetings                      Although face-to-face meetings and other means of communica-
•   specialized training (communication, quality customer service,          tion outlined above encourage two-way communication through-
    time management, plain language, resume writing, interviewing           out the organization, the emt replaced physical “comment” boxes
    skills)                                                                 in the various units with an anonymous intranet “suggestion box”
All of these are also offered to field offices through a variety of dis-    that provides another means to ensure frank two-way communica-
tance learning methods.                                                     tion with leadership. The electronic suggestion box has resulted in
                                                                            a number of improvements, including revision of the sps service
The emt personally participates in succession planning (Section             request Form and the mQA intranet.
5.1b (4)) and the development of future organization leaders. The
emt owns the division’s succession plan. The division director is           Finally, in 2007, the emt chartered a communications workgroup
responsible for tracking action plans and associated timeframes to          to identify communication improvement opportunities. A number
ensure achievement of action steps. to create the plan, each emt            of action plans have been developed and include such improvements
member completed a succession planning and bench strength analy-            as:
sis, identifying employees who might retire within the next five
years, as well as those in critical positions. in addition to the emt,      • development of comprehensive communication plan
all managers and identified employees were interviewed to evalu-            • promotion of redesigned intranet as main internal communica-
ate position descriptions and their required core competencies. The           tion tool
succession plan, which is updated annually, ensures the systematic          • creation of a division-wide calendar of scheduled events and
collection and transfer of all relevant organizational knowledge. The         meetings
emt ensures that mQA’s bench strength meets current and future              • creation of a policy on email communications
needs by informing employees of required competencies to fill future
leadership roles.                                                           Key decisions are primarily distributed to the workforce through
                                                                            email and face-to-face meetings. The manner in which they are com-
                                                                            municated depends upon the message to be conveyed. new and
                                                                            updated policies and procedures, for example, are communicated by
                                                                            email with a link to the sharepoint directory. other key decisions,
                                                                            such as the decision to apply for the 2009 GsA or the adoption
                                                                            of the new mvpFv, are communicated with face-to-face, division-
                                                                            wide meetings so leaders can answer questions, address concerns,
                                                                            and engage the workforce in the decision.

Category 1: Leadership – Page 4
                                                                                                    Division of Medical Quality Assurance

The emt and mt take an active role in the reward and recognition         • long-range plan measures reported to the legislature and internal
of the workforce through the erp, which includes employee Appre-           performance measures reported in the bsc
ciation day, Thanks A million, and the employee recognition cer-         • doH and mQA ess results
emony (erc). managers provide more than $2,000 out-of-pocket             • legislative implementation plans and associated target dates
annually to fund these activities. The erp is described in greater       • individual performance appraisals of the emt
detail in section 5.1a(3). The Thanks A million program provides         • corrective action plans for oppAGA and Auditor General audits
an inexpensive and immediate means for all employees to recognize
each other for excellent customer service. Thanks A millions elevated    Fiscal accountability is mandated by statute and achieved through:
to the division director level are reserved for extraordinary acts of    • Quarterly expenditure and revenue board reports
customer service and are handed out during emt and mt monthly            • Annual report to the legislature detailing revenues, expenditures,
meetings. two hundred and sixty-four Thanks A millions were given          cash balances, and a review of the adequacy of existing fees
out by the division director alone in 2007-2008. individual Thanks       • Annual, updated 5-year cash projections
A millions, although not tracked, number in the thousands. individ-      • Annual legislative budget requests
ual offices also celebrate high performance, innovation, excellence,     • monthly cash balance reports
and customer service with their own recognition events.                  • independent audits
                                                                         • department-managed budget, finance, and accounting offices
1.1b(2) Focus on Objectives, Performance                                 • internal audit controls over revenues and expenditures
improvement, and Vision                                                  • policies and procedures governing the handling of money
                                                                         • balanced scorecard measures related to fiscal soundness
The emt creates a focus on action to accomplish the organization’s
objectives, improve performance, and attain its vision through its       independent internal and external audits are conducted by the office
strategic plan, bsc, and associated action plans. performance mea-       of policy performance and Government Accountability (oppAGA),
sures in the bsc and action plan status reports are reviewed quarterly   the office of the inspector General, the state Auditor General, and
by the emt to inform them of needed actions. The emt, mt, and            non-state auditors hired by mQA.
mid-managers meet annually to review and adjust mQA’s strate-
                                                                         mQA is not governed by a board nor are there stockholder interests.
gic plan goals and objectives using an environmental scan (swot)
                                                                         However, governance accountability is established by the legislature
and mQA’s mission and vision as guides. performance issues and
                                                                         and agency policies. transparency of operations is ensured by adher-
opportunities for improvement are discussed weekly at emt meet-
                                                                         ence of all leaders to the Florida sunshine law and to the Governor’s
ings. Key decisions are communicated back to appropriate work
                                                                         open Government executive order 07-01. The bsc and strategic
units for development of action plans and measures. Although the
                                                                         plan are linked to the Governor’s executive order, further ensuring
emt reviews the measures weekly, unit managers responsible for
                                                                         transparency of operations.
particular measures review results as frequently as daily. to further
create a focus on action, the bsc is posted on mQA’s intranet for all
employees to review. The bsc measures can be seen in their entirety      mQA’s purpose is to protect the public, its stakeholders, through
in Figure 2.1-3.                                                         health care licensure, enforcement and information. mQA’s strategic
                                                                         plan identifies goals and strategies to achieve that purpose. protec-
                                                                         tion of stakeholders’ interests is achieved in a number of ways. For
The emt uses mQA’s strategic goals and mvpFv to focus on cre-
                                                                         example, all public meetings conducted by mQA are advertised and
ating and balancing value for customers and other stakeholders in
                                                                         operate under sunshine laws. All administrative rules promulgated
their organizational performance expectations. Also used to develop
                                                                         by mQA’s boards are governed by the Administrative procedures
and implement process improvements that create value for custom-
                                                                         Act and are subject to hearings, workshops and challenges and must
ers and other stakeholders are: customer feedback from surveys and
                                                                         contain explicit estimates of cost and impact on private sector com-
focus groups; input from annual long-range association and board
                                                                         petition. Finally, consumer complaints against health care practitio-
chair planning meetings; measurements of customer satisfaction cap-
                                                                         ners are handled within legislated timeframes under confidentiality
tured in the bsc; and the dmAic method to develop and imple-
ment process improvements. mQA knows what its customers and
stakeholders expect in its performance because it actively solicits,
measures and acts upon their input. mQA’s well-deployed mvpFv            1.2a(2) Performance evaluation of Senior Leaders
provides a framework for ensuring balance and value for mQA’s cus-       The performance of mQA’s emt, including the division director, is
tomers and other stakeholders.                                           evaluated through annual performance reviews conducted by their
                                                                         immediate supervisor, and through the annual mQA ess and bien-
1.2 Governance and Social responsibility                                 nial doH ess. (in the case of the division director, the performance
                                                                         review is conducted by the deputy secretary of doH with concur-
1.2a Organizational Governance                                           rence by the state surgeon General.) The 2006 navigator survey
1.2a(1) Governance System                                                results also provided feedback that was used by the emt to capi-
                                                                         talize on its strength in the leadership category of legal and ethical
management action accountability is achieved through:                    behavior.
• mQA’s annual report, which is distributed to the speaker of the
  House and the president of the senate and leaders within doH
• Action plans, results of which are reported in the strategic plan

                                                                                                           Category 1: Leadership – Page 5
Division of Medical Quality Assurance

in recent years, mQA leadership has also utilized leadership feed-       believe their emt and mt demonstrate ethical behavior as com-
back tools, including “360°” and “20/20 insight Gold” for senior         pared to the 2006 GsA winner with 74% and 63% for doH overall.
leader competency assessment. leadership used the feedback from          ethical behavior is introduced and promoted to all new employees
the competency assessment surveys to develop plans to improve their      in the doH and mQA neo and six-month neo follow-up, the
own leadership effectiveness and the leadership system. The sp con-      signed employee covenant, required code of ethics training, and
tains a action step to redeploy “20/20 insight Gold” in 2009.            the signed employee Handbook and ethics policy. ethical behavior
                                                                         is sustained through annual required ethics training, staff meetings,
1.2 b. Legal and ethical Behavior                                        and the annual division-wide meeting. mQA workforce is currently
                                                                         at 100% compliance with required ethics training.
1.2b. (1) Addressing Adverse impacts
to the greatest extent possible, mQA’s emt and mt anticipate and         to ensure suppliers comply with legal and ethical requirements,
prevent adverse impacts on stakeholders that may result from its key     contracts set forth requirements and prohibitions and compliance
process products, services, and operations. They do this through the     is closely monitored. The standard doH contract language sets
spp; by using the dmAic method for process improvement; by uti-          forth a wide variety of prohibited unethical acts and is included in
lizing action plans; by developing and enforcing policies and proce-     all contracts. contract violations can result in financial penalties up
dures; by communicating key decisions; and through customer and          to and including contract cancellation. mQA board members (part-
stakeholder engagement in business process changes. However, in          ners) must comply with state ethics laws governing their behavior.
the event an unanticipated adverse impact occurs, the emt and mt         new board members also receive ethics training and sign conflict of
are responsive and accountable. Figure 1.2-1 shows how potential         interest forms. Annually, all board members must file financial dis-
adverse impacts are prevented and how they are responded to if they      closure statements. if a board member engages in unethical behavior,
occur, along with the strategic goal to which they are aligned. mea-     mQA submits a complaint to the Governor. violations may result
sures associated with strategic goals are in the bsc (Figure 2.1-3).     in suspension.

An example of how the emt and mt anticipated and responded               1.2c. Support of key Communities
to an adverse impact on consumers is when the drugs, devices and
                                                                         All mQA-sponsored fundraising activities that support and
cosmetics program (ddc) handled the imminent loss of a drug
                                                                         strengthen the community are limited to the Florida state employ-
source to a number of Florida hospitals. After the Federal govern-
                                                                         ees’ charitable campaign (Fsecc) set forth in chapter 60l-39,
ment suspended a Florida drug wholesaler’s license, mQA expedited
                                                                         F.A.c. The Fsecc-identified charitable organizations comprise
the issuance of a license to an out-of-state company within 24 hours
                                                                         some of mQA’s key communities. The emt models the importance
to ensure an uninterrupted drug supply.
                                                                         of community support and involvement by having Fsecc leader-
                                                                         ship category givers ($1,000 and above). mQA leaders and employ-
in addition to the examples in Figure 1.2-1, some resource-sustain-      ees organize and chair fundraising activities to support the Fsecc.
ing processes upon which the emt and mt also rely to achieve or          Administrative leave is granted to mQA employees to participate
surpass regulatory and legal requirements include mandatory secu-        in doH-sponsored programs, such as school mentoring and meals
rity and information training for all employees; signed confidential-    on wheels. mQA has been recognized by doH because more than
ity affidavits; detailed polices and procedures; budget proposals (new   73 mQA employees served as mentors from 2004-2008 as com-
and recurring); legislative amendment requests; and it governance.       pared to a similar-sized doH division with 36 employee mentors.
Key compliance business process measures, goals, and risks are cap-      mQA’s emt and employees also support the community during
tured in the division bsc. Unit-specific bsc measures also identify      their personal time. They coach youth sports teams, serve as judges
associated risks and mitigations for each action plan and steps.         for school science fairs, and serve as leaders in local churches and
                                                                         civic organizations.
1.2b(2) ensuring ethical Behavior
The emt and mt promote and ensure ethical behavior in all the            mQA’s key communities outside of the Fsecc are those served by
division’s interactions with customers, partners, and other stakehold-   its mission to promote, protect and improve the health of all people
ers. mQA’s performance indicators and results of ethical behavior are    in Florida. improvements in key communities are achieved through
derived from the ess, compliance rate for ethics training, the office    mQA’s strategic objectives, goals, and strategies and their related
of the inspector General (iG) investigations and findings, and inter-    measures that are developed and monitored by the emt.
nal and external audits. suspected breaches are immediately reported
to the iG according to department policies and procedures and sub-       For example, promoting public awareness of the dangers of crimi-
stantiated ethics violations are corrected through action plans, the     nal unlicensed health care practice is a strategic action step that
results of which are reported to the deputy secretary and the state      has resulted in numerous billboard campaigns, radio and television
surgeon General. The doH ethics officer serves as a resource to          public service announcements, and printed brochures and promo-
mQA to answer questions on ethics and to provide guidance.               tional items that are distributed at health care fairs, community civic
                                                                         groups, and law enforcement agencies. The UlA television campaign
The division director, emt and mt ensure ethical behavior is sus-        in 2006 about the danger of unlicensed pharmacies resulted in an
tained in the governance structure and throughout the organization       increase in the number of complaints, and an increase in the number
by modeling mQA’s values. more than 80% of mQA employees                 of cease and desist orders issued. today very few unlicensed cana-
                                                                         dian storefront pharmacies exist.

Category 1: Leadership – Page 6
                                                                                                   Division of Medical Quality Assurance

Figure 1.2-1 Prevention and response to Adverse Action impact
 key       Potential    Potential Adverse                                                       response in the event          Strategic
                                          Steps to Prevent Adverse impact
Process Adverse Actions  Action impact                                                          of an Adverse impact             Goal
                Fees              • economic          • notice of rule-making            not Applicable
                                                      • rule workshops
                                                      • engagement of partners and                                             1.1, 3.1
                                                      • communication on website
                work systems      • system Failure    • extensive User testing           • 24-Hour Alert and repair response
                (online services) • security breach   • sophisticated security Firewalls • Alert messages
                                  • not User            and notification systems         • immediate system shutdown capa-
                                    Friendly          • stakeholder involvement            bility and a Full-time dedicated
                                                                                                                             1.1, 3.1
                                                        (Focus Groups in design)           response team
                                                                                         • online continuous customer
                                                                                           satisfaction surveys

                                                                                         • deadline extensions
                license status    • delinquent       • notification through col-         not Applicable
                                    license status     laborators Four weeks prior to
                                                                                                                               1.1, 1.3,
                                    equals inability   license Going delinquent
                                    to practice      • online capability for licensee
                                                       to print temporary license
                rule-making       • economic          • detailed calculation and state- • legal Appeal
                                  • private sector      ment of economic and private • repeal rule
                                    competition         sector impact
                                  • Uninformed        • notice of rule-making, public                                          1.1, 1.2,
                                    Affected            Hearings, and workshops;                                               1.3, 3.1
                                    stakeholders        communication to stakehold-
                                                        ers via website, mailings, legal
                                                        notices, etc.
                emergency         • public safety     • due process laws                 • immediate rescission of emergency
                Actions           • Abandoned         • election of Appellate rights       Action
                                    patient records   • education of licensee on laws    • Assist in locating custodian for
                                  • Access to           regarding patient records          Abandoned patient records
                                                                                                                             1.1, 1.2,
                                    Health care;      • immediate notification on        • immediate rescission of erroneous
                                                                                                                             1.3, 3.1
                                    property loss       website and to Hospitals and       data from website

                                  • economic loss       other entities and providers
                                  • licensee          • daily system error reports
                drug seizure      • drug supply       • education and training of        • Assist in rehabilitation
                and stop sale     • economic loss       licensee                         • notification to the public
                                  • private sector    • training of inspectors           • identify Alternative drug sources
                                                                                                                               1.1, 1.2,
                                    competition       • inspections
                                                                                                                               1.3, 3.1
                                                      • legal due process
                                                      • Application process (notifica-
                                                        tion of deficiency)
                derogatory         • licensee         • specialized Unit dedicated to    • immediate rescission of erroneous
                information          reputation         data integrity                     data from website
                (discipline,       • economic         • Quality control processes        • Acknowledge Accountability
                criminal             impact           • data system controls to pre-       (letters)

                background,                             vent errors                      • root cause Analysis and prevention
                medical                               • data comparisons Against           methods implemented                1.1, 1.2,
                malpractice, etc.)                      Alternative data systems         • process improvements               1.3, 3.1
                                                                                         • modification of policies and
                                                                                         • opportunity to request criminal
                                                                                           information be reviewed and pos-
                                                                                           sibly deleted

                                                                                                          Category 1: Leadership – Page 7
Division of Medical Quality Assurance

cAteGorY 2: strAteGic                                                   Figure 2.1-1 Strategic Planning Process

plAnninG                                                                   Who:
                                                                                        Leaders            Staff         Stakeholders
2.1 Strategy Development
                                                                                    1. Set/review &
2.1a Strategy Deployment Process                                                     communicate
2.1a(1) how Strategic Planning is Conducted                                          the mission,
                                                                                     vision and
mQA conducts strategic planning using 10 key process steps (Figure                   values
2.1-1). Key participants in the process are the emt and mt. needs,
expectations, and recommendations of various customer and stake-
holder groups, such as members of various health care practitioner
                                                                                    2. Review and understand customer and
boards and health care practitioner associations are also systemati-                   partner requirements
cally solicited at annual long-range planning meetings. The spp is
based upon a one-year planning cycle and is designed to align mQA’s
strategic objectives with those of doH. The spp also ensures that
services, resources, and capabilities are aligned with the division’s               3. Conduct an environmental scan, including
mission and vision. A more detailed description of the spp follows.                    SWOT analysis; set/review core competencies,
                                                                                       challenges and advantages
Annually the emt reviews the division’s mission, vision, and values.
Any changes are communicated to the workforce. input from the
entire mt is used to confirm or revise mQA’s purpose and focus.                     4. Validate/
Through a swot analysis, the mt also gathers and analyzes exter-                       determine
nal and internal information to determine current issues and oppor-                    strategic
tunities to consider during the strategic planning cycle. core com-
petencies developed from swot analyses in prior planning years

are reviewed, and strategic objectives are validated or determined
along with corresponding strategic goals, strategies, and measures.                 5. Develop strategic goals
Action plans are developed throughout all levels of mQA, includ-                       and strategies
ing bureaus and units, and are aligned with division strategic objec-
tives. resources are allocated or shifted to accomplish these action
plans. Action plans are implemented and progress on action plans is
tracked through data and status reports. Finally, the strategic plan-               6. Develop action plans
ning cycle is evaluated and the process is improved as needed.                         • Plans include Bureaus, Board
                                                                                         Offices, and Units within
                                                                                         MQA and are aligned with
strategic objectives, in compliance with a statutory requirement for                     overall strategic objectives
a 5-year long range plan, provide a working framework for managing
mQA’s key business processes and meeting key customer needs and
expectations. mQA’s associated strategic goals are shorter-term (1-4
years) and are reviewed quarterly and annually by the emt and mt                    7. Allocate/shift
to adjust timeframes if needed, reprioritize action steps, and adjust                  resources
                                                                                       • Budget
resource allocations. short and long-term planning horizons are set
                                                                                       • Human
during steps 4 and 5 of the spp.                                                       • Training

All employees participate in the spp through swot analysis inter-
views conducted by each member of the mt with his or her employ-
ees prior to the annual strategic planning retreat. Key stakeholders,               8. Implement action plans and
such as image Api, health care practitioner associations, and pros-                    track progress on action plans
ecution services Unit (psU), are actively solicited for input.

improvements in the spp (step 10, Figure 2.1-1) have been made                      9. Modify activities/strategies
to include reviewing and revising the mvpFv and core competen-                        based on data (as applicable)
cies in 2000; seeking additional key stakeholder input in 2000; and
conducting swot analysis interviews of all staff in 2006. The emt
meets weekly and the mt meets monthly to discuss emerging issues
                                                                                    10. Evaluate strategic planning
and their impact on the sp, as well as to review program performance                    cycle and improve process
as it aligns with the strategic objectives.

Category 2: Strategic Planning – Page 8
                                                                                                                                               Division of Medical Quality Assurance

                                                                                                                   phase of the spp. information from the scan is translated into action-
 Figure 2.1-2 key Factors in Determining MQA’s                                                                     able ideas by conducting a swot analysis. environmental scan-
 Strategic Plan
                                                                                                                   ning gives mQA the agility to alter its strategies and plans because
 key Factor                                                      Source of input                                   it anticipates factors such as new (funded or unfunded) legislative
                                                                 • customer satisfaction and complaint data
                                                                 • comparative data                                2.1a(2) how Strategic Planning Addresses key
                                                                 • Focus Groups                                    Factors
             strengths, weaknesses, opportunities, and Threats

                                                                 • compAs database                                 Key factors used in establishing mQA’s sp and methods of collect-
                                                                 employees                                         ing data and information pertaining to these factors are illustrated in
                                                                 • employee satisfaction and engagement data       Figure 2.1-2. These key factors are evaluated in steps 2 and 3 of the
                                                                 • turnover rate
                                                                                                                   spp. As part of mQA’s swot analysis, the emt examines data and
                                                                 • division, bureau, and Unit meetings
                                                                                                                   feedback from a variety of stakeholders to determine how strategic
                                                                 • Focus Groups
                                                                                                                   priorities may shift, where resources may need to be reassigned, and
                                                                 • dpA submissions
                                                                 • mQA customer service, leadership & Quality      how performance measures may need to be created or adjusted. An
                                                                   improvement Award submissions                   example of how the spp enabled mQA to address a major shift in
                                                                 • comparative data                                the regulatory environment occurred when the legislature mandated
                                                                 • sterling navigator Feedback report              that mQA determine 100% compliance with continuing education
                                                                 Suppliers                                         (ce) requirements through an electronic tracking system. prior to
                                                                 • Audits of contract milestones                   this, manual random audits were used to determine compliance.
                                                                 • site visits                                     The shift required use of the dmAdv method, a reallocation of it
                                                                 Partners                                          resources, design of system requirements and competitive bid pro-
                                                                 • board chair meetings and surveys                curement, creation of a business unit, and comprehensive marketing
                                                                 • meetings with oGc, psU, and it                  to all stakeholders. more than 20 focus groups and workshops were
                                                                 Collaborators                                     conducted with key stakeholders (ce providers, licensed health care
                                                                 • Health care practitioner Association meetings   practitioners, etc.) to determine needs, requirements, expectations,
                                                                 • ce broker meetings                              and to ultimately get stakeholder buy-in. The legislative implemen-
                                                                                                                   tation plan and action steps demonstrated mQA’s agility and its abil-
                                                                 Technology                                        ity to execute its strategic plan to accommodate this major shift in
 early indicators of major shifts in
  technology, markets, customer

                                                                 • meetings with it                                regulatory requirements.
   preferences, competition, or
      regulatory environment

                                                                 • sss
                                                                 Markets                                           mQA’s 10-step strategic planning process ensures long-term organi-
                                                                 • Analysis of data from customer Feedback         zational sustainability because it is a continuous process, it is system-
                                                                 • swot                                            atically measured and monitored, it is agile, and it considers partners’
                                                                 Competition                                       and other stakeholders’ needs and requirements within the unique
                                                                 • comparative data
                                                                                                                   regulatory environment in which it must operate.
                                                                 regulatory environment
                                                                 • legislative tracking
                                                                 • Attendance at various conferences and Health    2.1b(1) Strategic Objectives
                                                                   care practitioner Association meetings          mQA’s key strategic objectives and their most important correspond-
                                                                                                                   ing goals are shown in Figure 2.1-3. (note that mQA used doH’s
                                                                 •   succession planning                           strategic objectives for organizational alignment.) The timetable for

                                                                 •   bsc
          long term

                                                                                                                   accomplishing each strategic objective is 5 years, while the timetable
                                                                 •   sps                                           for accomplishing the corresponding goals is 1-4 years. These time-
                                                                 •   benchmarking                                  tables are set during steps 4 and 5 of the spp.
                                                                 •   redundancy of Knowledge via process map-
                                                                     ping, desk Guides, and cross-training
                                                                                                                   2.1b(2) how Objectives Address Challenges and
                                                                 • emt and mt budget ownership                     Advantages
         execute plans
           Ability to

                                                                 • budget tracked and Analyzed                     mQA’s strategic challenges and advantages are determined through
                                                                 • cost effective operations ensure budget         swot analysis in steps 2 and 3 of the spp and are addressed in
                                                                   stability                                       strategic objectives. Through consensus, challenges and advantages
                                                                 • legislative tracking
                                                                                                                   gathered from the swot analysis are condensed into like-groups
                                                                                                                   from which strategic objectives and goals are developed and priori-
The spp identifies potential blind spots through an environmental
                                                                                                                   tized. Figure 2.1-4 shows how the challenges and advantages are
scan or pest (political, environmental, social, and technological)
                                                                                                                   aligned with mQA’s current strategic objectives and goals. during
analysis to systematically analyze and evaluate internal conditions
                                                                                                                   step 6 of the spp, strategic goals and objectives are operationalized
and external data and factors that affect mQA. while environmental
                                                                                                                   through action plans.
scanning is a continuous process, it also serves as the exploratory

                                                                                                                                              Category 2: Strategic Planning – Page 9
Division of Medical Quality Assurance

 Figure 2.1-3 Strategic Objectives, Goals, and Strategies from MQA’s BSC (continued on next page)
 DOh/MQA Strategic Objective: 1. public Health, wellness, Access, prevention & protection
 MQA Strategic Goals: 1.1 expeditiously licensed health care practitioners who meet statutorily mandated minimum standards of
 MQA Strategies: 1.1.1 provide an efficient licensure process that meets statutory requirements
                                                         Projected Projected
 Measures                                                                    Selected Action Plans
                                                         Fy 08-09 Fy 12–13 Average # of days to issue an initial license          60         50 monitor performance weekly by profession;
                                                                              develop online licensure tools that allows applicants to
                                                                              check the status of their application for licensure; % of complete initial licensure applications        95%        100% develop online licensure applications
 approved or denied within 90 days number of days to process an initial            30        19.7
 licensure application of licensees renewing online                       50%         95% implement mandatory online renewal or a business
                                                                             process that would reduce the number of manual

 DOh/MQA Strategic Objective: 1. public Health, wellness, Access, prevention & protection
 MQA Strategic Goals: 1.2 Health care standards are enforced through timely discipline, education, and remediation of health care
 practitioners found in violation of the law
 MQA Strategies: 1.2.1 provide an efficient enforcement process that meets statutory requirements
                                                         Projected Projected
 Measures                                                                    Selected Action Plans
                                                         Fy 08-09 Fy 12–13 # of cease and desist orders issued                  200         225 educational campaign % of UlA cases referred for criminal                1.5%        35% Foster relationship with law enforcement
 prosecution # of UlA cases investigated                          700         700 monitor timeframes for investigations % of initial investigations and                     90%         93% develop an online report to monitor monthly
 recommendations as to the existence of probable                             performance
 cause completed % of cases offered for Alternative dispute         90%         90% develop a report to monitor success of Adr
 resolution (Adr) resulting in successful resolution

 DOh/MQA Strategic Objective: 1. public Health, wellness, Access, prevention & protection
 MQA Strategic Goals: 1.3 timely and accurate information for stakeholders and consumers that will enable informed health care
 decisions and promote equitable and accessible health care for all persons in Florida.
 MQA Strategies: 1.3.1 improve accuracy and compliance with reporting requirements and accuracy of information received from
 internal and external sources
                                                         Projected Projected
 Measures                                                                    Selected Action Plans
                                                         Fy 08-09 Fy 12–13 Average # of days to fulfill a public record           10          10 develop centralized database for tracking public records
 request for license application file                                          requests Average time (in seconds) customers are                45          30 review information system (cFd) used by the call
 waiting in the queue                                                          center staff for pertinent and accurate information

Category 2: Strategic Planning – Page 10
                                                                                                     Division of Medical Quality Assurance

 Figure 2.1-3 Strategic Objectives, Goals, and Strategies from MQA’s BSC (continued from previous page)
 DOh/MQA Strategic Objective: 3. organizational development
 MQA Strategic Goals: 3.1 customers are informed of, have confidence in, and value mQA services
 MQA Strategies: 3.1.1 increase knowledge of customer expectations regarding quality, cost, effectiveness, and timeliness of products
 and services
                                                           Projected Projected
 Measures                                                                      Selected Action Plans
                                                           Fy 08-09 Fy 12–13 % of external customers satisfied with services        90%         95% report overall customer satisfaction rate quarterly
 provided by mQA % of loyal customers                                   65%         75% Quarterly review ongoing customer satisfaction survey
                                                                                for improvement opportunities

 DOh/MQA Strategic Objective: 3. organizational development
 MQA Strategic Goals: 3.2 A motivated workforce committed to excellence
 MQA Strategies: 3.2.1 recruit, hire and retain skilled and motivated employees who will exemplify mQA’s mission, vision, and values
                                                           Projected Projected
 Selected Measures                                                             Selected Action Plans
                                                           Fy 08-09 Fy 12–13 % of employee satisfaction                             85%         85% conduct annual ess of employee turnover                                  10%           7% compare the doH ess survey results with mQA
                                                                                 results; analyze differences and modify action plans as
                                                                                 necessary Average # of training hours per employee                 40          45 implement additional in-house training % of employees satisfied with mQA-                     90%         90% conduct training satisfaction survey after each training
 sponsored training

 DOh/MQA Strategic Objective: 3. organizational development
 MQA Strategic Goals: 3.3 A fiscally sound organization
 MQA Strategies: 3.3.1 All regulated professions have a positive cash balance
                                                           Projected Projected
 Selected Measures                                                             Selected Action Plans
                                                           Fy 08-09 Fy 12–13 % of professions operating with a positive or          71%         78% provide methods of correcting negative cash balances to
 neutral cash balance                                                           board executive directors % of professions with adequate renewal fees            70%         70% review application and renewal fees

mQA’s strategic objectives and goals address opportunities for inno-     2.2 Strategy Deployment
vation because, as with challenges and advantages, opportunities
are identified in the swot analysis. strategic objectives and goals      2.2a Action Plan Development and Deployment
also address opportunities for innovation because they are modified      2.2a(1) Action Plan Development and Deployment
as needed to respond to customer requirements and expectations.
Gaps between targets and actual performance in action plans are          Following the development of key strategic objectives, goals, and
reviewed during quarterly mt meetings and may result in modifica-        strategies, measures and targets are established (step 5 of spp). each
tions that address opportunities for innovation in products, services,   strategy has action plans, and each step in a plan is assigned an owner
and operations.                                                          who becomes the lead person for developing the action plan step,
                                                                         identifying financial and other risks, and quantifying resource needs.
                                                                         owners are responsible for ensuring that action steps are achievable
mQA ensures that its strategic objectives and goals balance short-
                                                                         and will have the desired outcome. Action steps often include estab-
and longer-term challenges and opportunities, as well as a balance of
                                                                         lishment of chartered workgroups, an effective means of deploying
all key stakeholder needs, through steps 2 and 3 of the spp (Section
                                                                         action plans throughout the organization and an excellent leadership
                                                                         development tool. Action plans also include communication action
                                                                         steps to ensure that they are deployed throughout the workforce and
                                                                         to all key stakeholders. in addition, each bureau and unit develops
                                                                         its own strategies, action plans, and expected outcomes for those
                                                                         strategies that are bureau or unit-specific. This is achieved through
                                                                         step 6 of the spp. Figure 2.1-3 shows mQA’s strategic objectives,

                                                                                                  Category 2: Strategic Planning – Page 11
Division of Medical Quality Assurance

 Figure 2.1-4 how Strategic Objectives, Goals, and Strategies Address Challenges and Advantages
                      Business                    Operational                      human resource                          Sustainability

                                                                          Attracting or competing for top
             A growing and diverse                                                                               significant turnover in leader-
                                                                          talent within a government com-
             population (1.1.1, 1.2.1,    limited office space (3.3.1)                                           ship expected over the next five
                                                                          pensation system that is low com-
             3.1.1, 3.3.1)*                                                                                      years due to retirement (3.2.1)
                                                                          pared to the private sector (3.2.1)

             statutory changes,           expectations to improve         increase in workload, including        Attracting or competing for
             especially those resulting   business results with limited   unfunded legislative mandates,         top talent within a government
             in unfunded, un-staffed      resources and limited con-      requires additional positions which    compensation system that is low
             mandates (1.1.1, 1.2.1,      trol over the results (1.1.1,   have not been appropriated by the      compared to the private sector
             3.1.1, 3.3.1)                1.2.1, 3.1.1)                   legislature (3.2.1)                    (3.2.1)

                                          compAs database and                                                    strategic planning services
             emergency preparedness       systems support services        comprehensive benefits package         Unit (sps) facilitates continu-
             (1.1.1, 3.3.1)               (sss) (1.1.1, 1.2.1, 1.3.1,     (3.2.1)                                ous improvement (1.1.1, 1.2.1,
                                          3.1.1)                                                                 3.1.1)

             technological innovation,
             including online status
                                          mQA is 100% trust funded
             check for applications,
                                          (does not receive funds         employee recognition program
             online renewals, and                                                                                mQA’s sp (1.1.1, 1.2.1, 3.1.1)
                                          from Florida’s general rev-     (3.2.1)
             electronic fingerprint-
                                          enue) (1.1.1, 1.2.1)
             ing (1.1.1, 1.2.1, 1.3.1,
 *indicates strategy(ies) that addresses challenge or advantage. strategies align with corresponding strategic Goal and objective.

goals, and strategies, the related measures, and selected targets and         lative authority is required to expend funds. to be approved by the
action plans from mQA’s bsc.                                                  department, legislative budget requests must show alignment to the
                                                                              department’s mission.
in addition to workgroups and through methods identified in com-
munication action steps, strategies and related action plans are              The budget process is flexible to ensure adjustments can be made
deployed to the workforce and stakeholders through neo, weekly                to accommodate changing needs and directions. in addition, mQA
and monthly emt and mt meetings, staff meetings, annual divi-                 incorporates cbA and roi into its planning process to ensure
sion-wide meetings, annual board chair and association meetings,              resources are balanced and adequate to meet current obligations.
the published annual report (Ar) and the mQA intranet and inter-              This also allows the emt to assess financial risks and evaluate the
net site, and they are referenced in legislative budget requests and          benefit of each action plan (strategy) to the organization. examples
legislative bill analyses. deployment ensures familiarity with key            of projects to which resources were allocated based upon cbAs and/
objectives and opportunities for improvement and that employees               or rois include:
and stakeholders are invested in the organization’s goals.                    • nursing digital Fingerprinting project: conversion of paper
                                                                                card submission to digital submission of fingerprints (Section
mQA ensures that the most important outcomes of its strategies and              4.1a(1));
related action plans are sustained by using a bsc. outcomes of all            • testing item bank project: implementation of a new item bank-
action plans, from the unit level to bureau level, roll-up into the divi-       ing system to maintain licensure examination questions; and
sion-wide action plans. The bsc includes strategic objectives, goals,         • central records database: development of a new central records
strategies, action plans and the related measures, targets, owners,             database to track licensure and disciplinary orders (conversion of
baseline measures, current fiscal year (FY) measures, and projected             old ms Access database).
measures for the next five FYs.
                                                                              2.2a(3) establishing and Deploying Modified Action
2.2a(2) resource Allocation                                                   Plans
each member of the mt is responsible for the development and                  mQA reviews objectives and action plans during weekly emt and
management of his/her unit or bureau’s annual spending plan.                  monthly mt meetings. As identified in step 9 of the spp and as
mQA’s annual budget planning includes the determination and                   part of the continuous review process, action plans are reviewed to
allocation of resources needed to accomplish action plans. The                determine if plans should be added, deleted, revised, or re-prioritized
annual budget request submitted through the department to the                 as needs or requirements change. The physician’s workforce survey
legislature is arrived at through consensus of the emt. individual            (Section 4.2a(4)) legislated in 2006 provides an example of mQA’s
spending plans are reviewed to determine alignment with mQA’s                 ability to rapidly modify and re-prioritize its action plans. mQA’s
strategic goals and objectives. Although mQA is trust-funded, legis-          knowledge and engagement of its customers and stakeholders, as

Category 2: Strategic Planning – Page 12
                                                                                                        Division of Medical Quality Assurance

well as its ability to shift action plans, allowed it to rapidly and suc-   The following is an example of mQA’s human resource planning.
cessfully deploy and execute this new plan.                                 A 2002 law was passed allowing the division to mediate consumer
                                                                            complaints against health care practitioners. An action plan was
2.2a(4) key Short- and Longer-term Action Plans                             developed that identified the number of staff and the type of train-
                                                                            ing needed to meet anticipated demand. As a result, field investiga-
mQA’s key short- and longer-term strategies, which have corre-              tive staff capacity has been enhanced because cases resolved through
sponding key short- and longer-term action plans (Figure 2.1-3),            mediation do not require investigation.
• provide an efficient licensure process that meets statutory               2.2a(6) Performance Measures
  requirements (short-term)
• improve accuracy and compliance with reporting requirements               Key performance measures for tracking progress on mQA’s objec-
  and accuracy of information received from internal and external           tives and action plans are reviewed monthly by the mt using a bsc
  sources (long-term)                                                       approach (Figure 2.1-3). mQA’s bsc measurement system covers
• increase knowledge of customer expectations regarding qual-               all key deployment areas and key stakeholders because it encom-
  ity, cost, effectiveness, and timeliness of products and services         passes key strategies and stakeholder feedback results. Unit-and
  (short-term)                                                              bureau-level scorecards are rolled up to the division-level scorecard,
• recruit, hire and retain skilled and motivated employees that will        ensuring organizational alignment.
  exemplify mQA’s mission, vision and values (long-term)
• All regulated professions have a positive cash balance                    in addition, mQA achieves organizational alignment by deploying
  (short-term)                                                              the sp with workforce and stakeholders through the neo, weekly
bureau- and unit-level action plans align with the key mQA action           and monthly emt and mt meetings, staff meetings, annual divi-
plans (Figure 2.1-3).                                                       sion-wide meetings, annual board chair and association meetings,
                                                                            the mQA intranet and internet site. Furthermore, legislative budget
Key planned changes to products and services include technology             requests and legislative bill analyses are aligned to the sp.
changes to accommodate changing customer needs and expectations
(online application status check (Sections 3.2a(2) and 4.1a(1)),            one final method mQA uses to ensure that the measurement system
establishment of work units to accomplish new and changing                  reflected in the bsc is deployed to all key stakeholders, is to include
work processes (licensing and Auditing Unit (Section 2.1a(2)),              them in the Ar that is published, mailed, and made available on the
and enhanced marketing of the UlA program (Section 1.2c). Key               internet.
changes to customers and markets occur when new professions
are created by the legislature (pharmacy technicians, orthotic and          2.2b Performance Projection
prosthetic residents, etc.). Key changes in how mQA operates are
addressed in its action plans.                                              mQA’s key performance projections are determined through cus-
                                                                            tomer requirements, benchmarking, or statutory requirements.
                                                                            A selection is shown in Figure 2.1-3. mQA’s bsc includes all of
2.2a(5) human resource Plans                                                mQA’s key performance projections through FY 12-13. perfor-
mQA’s strategic goal 3.2 (Figure 2.1-3), a motivated workforce              mance projections compare favorably with key benchmarks, goals
committed to excellence, resulted in the development of a number            and past performance of mQA’s competitors and comparable orga-
of strategies and related action plans that include succession plan-        nizations. progress to meet projections is ensured through action
ning, recruitment and retention training, leadership development,           plans reviewed quarterly by the emt.
employee satisfaction surveys, and employee turnover data studies.
                                                                            mQA’s focus is to be the nation’s leader in quality health care regu-
As a part of the spp, annually the emt, with input from the mt,             lation. when gaps in performance against mQA’s competitors and
identifies human resource requirements that have arisen from chang-         comparable organizations are identified, they are addressed by per-
ing or increased customer and other stakeholder requirements. These         formance improvement workgroups who conduct research into best
workforce needs are translated into legislative budget requests that        practices and develop process improvements. Although mQA has
require cbA and articulation of alignment to the department and             identified meaningful comparative data, leaders continue to search
the Governor’s strategic priorities.                                        for benchmarks against which to compare its performance. exam-
                                                                            ples of new comparative data and potential benchmarks for the UlA
Human resource capacity and capability requirements are identi-             program include information from the state of new York and from
fied for every action plan step. mQA addresses potential changes to         the Florida department of Financial services.
workforce capability and capacity needs through succession plan-
ning, training assessments, training plans, and work system improve-
ments. Action plans are the tools owners use to determine the need
to assign additional human resources or to adjust completion dates if
workforce capacity or capability are not sufficient to attain them.

                                                                                                     Category 2: Strategic Planning – Page 13
Division of Medical Quality Assurance

cAteGorY 3: cUstomer                                                      professionally-facilitated focus groups. Feedback on the usefulness of
                                                                          the profiling product is achieved through a customer online survey.
And mArKet FocUs
                                                                          beginning in 2001, the division began conducting an annual strate-
3.1 Customer and Market knowledge                                         gic planning meeting with health care practitioner associations who
3.1a(1) Customer Groups and Market Segments                               serve as collaborators and who represent one of mQA’s key custom-
                                                                          ers, its licensed health care practitioners. The associations possess
mQA is established under Florida statutes to regulate health care         a unique perspective on licensees’ needs and through this meeting
practitioners as necessary for the preservation of the health, safety,    (and ongoing dialogue) have provided feedback on such services and
and welfare of the public. Through the spp, which includes a swot         service delivery methods as online services, postcard renewals, con-
analysis, mQA identified three key customer groups—licensed               tinuing education tracking and audits.
health care practitioners, licensure applicants, and health care con-
sumers. Their key requirements are identified in Figure P.1-2. mQA
markets and promotes its products and services through its web-           mQA leaders speak at and participate in industry conventions and
site, press releases, brochures, and a host of other communication        meetings as an opportunity to market its products and services and
technologies.                                                             to gain customer feedback and loyalty. For example, staff annually
                                                                          provides the keynote address for the Florida Association of medical
                                                                          staff specialists, the organization that represents the credentialing
overall, mQA has minimal direct competition with other service            staff of hospitals and managed care organizations (a unique customer
providers. since the products and services mQA provides are dic-          segment). These professionals were once highly critical of the value
tated by Florida laws and rules regulating health care practitioners,     of mQA’s services. They found the division and its employees to be
with few exceptions, such as data reports, mQA does not compete           unresponsive and the service they provided unreliable. Using their
for the same customers as private sector providers.                       feedback to improve its services, mQA established them as a loyal
                                                                          customer base. They increasingly rely upon mQA’s web services to
over the years mQA has reviewed and redefined its customers and           make critical hiring/business decisions for their employers. modi-
their needs and expectations. As a result, key processes of licensure     fication to the mQA’s web-based services were made based upon
and enforcement were expanded to include information in 2006.             their feedback, specifically, the ability to select and sort disciplinary
Historically, mQA provided information tangentially to its primary        final orders, and the ability to print license verifications that meet
duties of licensing health care practitioners and enforcing the laws      national accrediting standards. mQA is now a competitive provider
governing their practice. when demands for information exceeded           of credentials verification. Through voice-of-the customer informa-
resource capabilities and negatively affected customer satisfaction       tion, mQA’s services provide value, because they are reliable, timely,
with mQA’s services, the sp was modified to include information as        and accessible, and most importantly, they are free.
a key process and its value and reliability as a strategic goal.
                                                                          The mQA call center provides immediate feedback on problems
3.1a(2&3) using Voice of the Customer Feedback to                         with services. For example, when an error occurred in the amount of
Determine requirements, Become More Customer-                             renewal fees being charged to nurses, it was identified through con-
focused, and identify Opportunities for innovation                        sumer complaints to the call center, elevated to the licensure services
                                                                          unit, and immediate corrective action was taken. Furthermore, a
mQA’s leaders have determined key customer requirements and               systematic process improvement occurred to prevent future renewal
design and modify products and services to meet them through a            errors: managers of the appropriate program office are now required
variety of methods (Figure P.1-2). timeliness, access and quality that    to attend all pre-renewal planning meetings and there is systematic
customers have demanded have not only been reflected in products          notification of renewal fee changes.
and services offered by the division, but the legislature also directed
them by law. For example, in 1997 the legislature directed the divi-
                                                                          while mQA constantly uses voice-of-the customer information
sion to process all consumer complaints against health care practi-
                                                                          to modify all its services, it is most evident in the division’s cus-
tioners within 180 days. in another example, they directed that all
                                                                          tomer-focused technology. when customer input indicates a need
applications for licensure must be reviewed for completeness within
                                                                          for change in products or services, the division accomplishes change
30 days and acted upon within 90 days. in addition, the Florida
                                                                          by developing a strategic business plan that includes a variety of
open Government commission in 2007 directed all state agencies
                                                                          performance measures and cost-savings data. major modifications
to timely respond to public records requests. results to these and
                                                                          are piloted through user-acceptance testing and the application/tool
other key customer requirements are captured in mQA’s bsc.
                                                                          is systematically reevaluated to determine that it is delivering its
                                                                          intended functionality.
The division develops strategies and action plans for improved prod-
ucts and services, marketing initiatives, and business processes and
                                                                          The mQA profiling website which receives millions of “hits” per year
systems. The division involves customers throughout this process
                                                                          has presented numerous opportunities for innovation that resulted
through surveys, focus groups, and analysis of complaints. different
                                                                          from customer feedback. The website provides information on edu-
methods are employed depending on the particular customer seg-
                                                                          cation, discipline, medical malpractice claims, criminal history, and
ment. For example, design of the web-based application for gather-
                                                                          other data, to assist consumers in making health care decisions.
ing and updating physician profile data was best achieved through
                                                                          based upon user feedback obtained through emails, phone calls,

Category 3: Customer and Market Focus – Page 14
                                                                                                        Division of Medical Quality Assurance

and media coverage, in 2003 the division conducted focus groups             two examples of how mQA acquires customers and increases loyalty
in six cities around the state. The objective was to design meaning-        in one of its key customer groups—applicants—are (1) how it builds
ful modifications to the profile based upon customer needs. mQA             relationships with schools and universities throughout Florida and
learned customers could not easily find the website. once in the site,      (2) how it has given graduates (future applicants) a variety of tools to
it was difficult to navigate. terminology was confusing. colors and         simplify the licensing process. to accomplish the former:
display of information were not AdA compliant. As a result, the             1. board members and staff give lectures and provide presentations
Url was changed to a recognizable name identified by its custom-               on school campuses and include school leaders in its interested
ers, subject tabs were added, font size and color were modified, and a         parties list to receive news, updates, and board meeting agendas.
glossary of terms was added. The information was also segmented by          2. training videos on licensing have been developed and distributed
customer-use requirements: licensees needed a user-friendly portal             to schools.
to modify their information; consumers needed an entry point to             3. As a result of mQA’s efforts, some school curriculums have been
review data and to contact the state if they had questions or needed           modified to include requirements for senior students to attend
to file a complaint. Through customer feedback mQA continues to                board meetings.
improve this site. A user survey on the website allows customers to         4. some boards have modified continuing education rules to
provide immediate feedback. mQA also included in its 2008-2009                 require first-year licensees to attend board meetings.
sp, a follow-up series of focus groups to continue customer-driven
improvements. currently, a chartered workgroup—mQA’s internet               to accomplish the latter:
redesign workgroup—is redesigning mQA’s website based on cus-
tomer feedback and best practices from other regulatory websites to         1. mQA markets an online assessment tool for students and poten-
make the site easier to navigate and information more accessible.              tial applicants to determine their readiness for licensure.
                                                                            2. while in school, students are invited to and accommodated at
                                                                               board meetings.
3.1a (4) keeping Current
mQA keeps its customer and market listening and learning meth-              to meet and exceed customer expectations, customer service train-
ods current with business needs and directions. The spp includes a          ing is provided to all mQA employees. employees must meet uni-
review of customer and partner requirements and a swot analysis             formly applied performance standards of customer service—such as
(steps 2 and 3). data-driven strategic performance objectives in the        returning all phone calls and emails within 24 hours. letters from
division’s sp and bsc require a systematic gathering and analysis           application processors to applicants and letters from enforcement
of data from a large customer population. steps 2 and 3 in the spp          staff to complainants all include direct phone numbers. All mQA
provide information that is then compiled into online surveys of            employees attach their contact information to the signature block of
new licensees, exam candidates, public records requesters, and inter-       their email. mQA uses its new licensee survey as a means of measur-
nal customers. This guarantees that large amounts of data can be            ing the timeliness of return calls.
compiled and objectively analyzed to improve business processes and
services.                                                                   For its key customers—consumers and health care practitioners—
                                                                            mQA relies upon systematic feedback tools such as surveys to build
in addition to web-based and other modern survey methods, mQA               products and services that meet and exceed their expectations.
leaders participate in federation meetings with other national indus-       mQA’s online services and website are a simple, accurate, and acces-
try leaders where best practices are shared. For example, licensee          sible method for health care practitioners to fulfill their licensure
mobility across state lines means that employers and licensees need         requirements, including license renewal, updating their address, and
timely response to their requests for license verifications. A best-prac-   learning about legislative changes effecting their profession. For con-
tice adopted from other states is the “license verification” screen that    sumers, the online services and website provide vital information
allows these customers to receive immediate verification at no cost.        about their practitioners to help them make health care decisions.
                                                                            mQA’s website is “hit” more than 15 million times a year, a testa-
                                                                            ment to its value and customer loyalty. mQA markets its website
3.2 Customer Satisfaction and relationship                                  through press releases, brochures, commercials, promotional items,
enhancement                                                                 and participation in community events and health fairs. mQA
3.2a(1) Building relationships                                              also partners with cHds to distribute brochures and promotional
                                                                            items to community outreach programs. An example of the result
mQA builds relationships to acquire customers in its three key              of mQA’s efforts to build relationships to acquire and retain loyal
groups—applicants, health care practitioners, and consumers. mQA            customers is the mutually beneficial relationship fostered with health
is able to be responsive to their key requirements expectations of          care practitioner associations. by defining their needs through the
timeliness, quality and accessibility, because they have been both          spp, mQA determined associations need information to provide
defined and met. to meet and exceed their expectations, increase            value to its members; conversely, mQA needs associations to help
loyalty, and gain positive referrals with its various partners and          distribute and market its information.
stakeholders, mQA uses the methods outlined previously, as well
as surveys, federation memberships, meetings, outreach to schools
and law enforcement agencies, and in-service training to other              3.2a(2) key Access Mechanisms
state-agencies.                                                             mQA’s key customers—applicants, health care practitioners, and
                                                                            consumers—access key services of licensure, enforcement and infor-
                                                                            mation, through the website, online services, email, licensee walk-up

                                                                                          Category 3: Customer and Market Focus – Page 15
Division of Medical Quality Assurance

window, centralized call center, and a toll-free complaints hotline.      3.2a(4) keeping Current
Through these mechanisms, customers are able to conduct business
                                                                          mQA keeps its approaches to building relationships and provid-
(download applications, renew licenses, update licensing informa-
                                                                          ing customer access current through strategic planning and process
tion); seek information (to make health care provider choices and
                                                                          improvement, by benchmarking and networking with other state
evaluate credentials for employment purposes); and lodge com-
                                                                          regulatory authorities and researching best practices. An example of
plaints against licensees for enforcement purposes. The website pro-
                                                                          an improvement in providing customer access is the online renewal
vides a contact link for customers to complain about products and
                                                                          system. This system allows health care practitioners to renew their
services. surveys do the same.
                                                                          license online 24/7.

to determine key customer contact requirements while also satisfy-
ing statutory requirements for each access mechanism, mQA uses            3.2b(1) Customer Satisfaction/Dissatisfaction
surveys, focus groups, and other user data. As demonstrated in the        Determination
earlier example of the practitioner profiling website, two methods,       mQA determines customer satisfaction, dissatisfaction and loyalty
survey and focus groups, were used to determine how customers             for its three key customer groups through survey instruments and
could locate the information, and how to use it once it was found. in     focus groups. different survey instruments are used for different
another example of how customer contact requirements were defined         customer segments. survey questions are tailored to the services pro-
and used to meet customer needs, analysis of phone call data in the       vided to each customer group. Three surveys comprise the division’s
board of medicine showed that most callers were inquiring about the       overall satisfaction rate—new licensees; public records requests; and
status of their license application. Using the dmAic method and           candidates.
linking to the division’s sp, that data analysis was used to design and
deploy an online application status check service. modifications to
                                                                          A recent improvement was the development of the online customer
the system, such as this, are marketed to consumers through media
                                                                          service system (Section 3.2a(3)). data will be analyzed to identify
releases and mQA’s partners, and deployed to mQA staff through
                                                                          opportunities for improvement in processes and customer service
its intranet, email communications, policies and procedures, desk
                                                                          (Figure 3.2-1)
guides, neo, customer service training, and staff meetings.

                                                                          mQA ensures that surveys are capturing actionable information by
3.2a(3) Customer Complaint Process                                        using a workgroup of subject matter experts to design the survey
mQA manages customer complaints, ensuring that they are resolved          around customer expectations and needs. each group is also assigned
effectively and promptly, through its correspondence tracking             a specialist in survey design. For example, survey items for the new
system, iG management reports and action plans, zzzz email track-         licensee survey were crafted using a workgroup from the licensure
ing, and the customer service system (Figure 3.2-1) correspon-            and Auditing services Unit who are familiar with licensees’ needs
dence received through the tracking system is monitored to insure all     and expectations.
complaints are responded to in a timely fashion. All forms and form
letters have been modified as part of the division’s plain language       survey information from the new licensee surveys, candidates and
initiative and all correspondence is written according to correspon-      public records requestors is compiled into reports quarterly and are
dence guidelines to ensure they are understandable, professional and      presented to the unit managers. The reports contain recommenda-
compassionate. customer dissatisfaction is minimized through staff        tions for improvements. Unit managers develop action plans based
training, written performance standards, customer satisfaction sur-       upon the reports and recommendations. overall results are captured
veys, and input of customers into the design and delivery of products     in the sp and in the bsc and are reported quarterly to the emt. An
and services.                                                             example of an improvement to customer service that was made as a
                                                                          result of survey data is the expansion of operating hours to evenings
in 2008, to better define customer requirements and identify              and weekends in the board of nursing during renewal times when
improvement opportunities, mQA developed a customer service               phone usage is heaviest.
system. customers can submit complaints or suggestions online.
employees can submit suggestions or concerns on behalf of a cus-          3.2b(2) Follow-up on Services
tomer through the online employee suggestion box. This system
provides data for analysis and identification of systematic improve-      mQA follows up with customers on the quality of products, services,
ments needed in mQA to minimize customer dissatisfaction and to           and transactions to receive prompt and actionable feedback using
prevent reoccurrence of similar issues. (Figure 3.2-1). All concerns      online surveys. These surveys ask customers questions that are tai-
are reviewed to determine if the issue is an isolated incident or is      lored to their particular customer segment needs (Section 7.2).
broader in scope. The process provides a means for aggregating con-
cerns and/or complaints and identifying opportunities for improve-        3.2b(3) Comparative Customer Satisfaction
ment and needed corrective action plans, including, but not limited
                                                                          mQA obtains and uses information on customer satisfaction from
to, processes and policies and procedures.
                                                                          other organizations providing similar products or services, sterling
                                                                          award winners, and private corporations recognized as being among
                                                                          the best in their field. The division also contacted agencies from
                                                                          states of similar size and function from which available comparative
                                                                          data have been collected. comparative data obtained thus far indi-

Category 3: Customer and Market Focus – Page 16
                                                                                                     Division of Medical Quality Assurance

 Figure 3.2-1 Customer Service System

                   Customer concern received
                                                                                     Customer Ombudsman reviews concern
                      in zzzz Feedback SPS

        Ombudsman acknowledges receipt of concern                                    Ombudsman enters concern in database

                              Is the
                                                                                          Ombudsman refers concern to
                         concern an MQA                  Yes
                                                                                          appropriate manager for action


           Ombudsman responds to customer and                                            Manager responds to consumer
         refers concern to appropriate Agency/O ce                                    and copies Ombudsman with response

                      Ombudsman analyzes customer concerns
                                                                                      Ombudsman updates database with response
                      received for improvement opportunities

                                                           Ombudsman refers to                               Manager completes
                    Opportunities           Yes          appropriate manager and                            action plan and copies
                     identi ed?                             updates database                                     Ombudsman


                                                      Ombudsman updates database

                        Ombudsman provides quarterly reports to SPS manager on customer concerns
                 received and handled and identi ed opportunities for improvement and action plan statuses

cates the division meets or exceeds the level of satisfaction customers   veys which were once collected and compiled manually are now col-
have with the services they receive from agencies providing similar       lected and compiled electronically through online surveys. surveys
services. if gaps are identified as more comparative data is obtained,    are pilot-tested before they are deployed to insure the measures are
it will be used to develop strategies and action plans to improve the     valid, that they function as expected, and that the data collected can
measure.                                                                  be used to develop improvement action plans.

3.2b(4) keeping Current                                                   As services change to reflect business enhancements and improve-
                                                                          ments such as with health care practitioner online services, measures
mQA keeps its approaches to determining satisfaction current
                                                                          of customer satisfaction are also modified.
with business needs and directions by systematically evaluating and
improving methods for gathering customer satisfaction data. sur-

                                                                                        Category 3: Customer and Market Focus – Page 17
Division of Medical Quality Assurance

cAteGorY 4: meAsUrement,                                                   Figure 4.1-1 Example of the Drilldown of the Scorecard
                                                                           from Division to Bureau to Unit
AnAlYsis And KnowledGe
                                                                            DOH Strategy         Organizational Development.
4.1 Measurement, Analysis, and improvement of
Organizational Performance                                                    MQA Goal
                                                                                                 Customers are informed of, have
                                                                                                 con dence in, and value MQA services.
4.1a Performance Measurement
4.1a(1) Selection, Collection, Alignment and
integration of Data and information                                                              Develop and administer a survey
                                                                             Bureau Goal
                                                                                                 that assesses customer satisfaction.
mQA collects data and information to monitor organizational
performance in conducting mQA’s key processes and achieving its
mvpFv and strategic goals. selection of data is driven by legislative
                                                                                                 % of satis ed examination candidates
mandates and requirements of mQA’s key customers, stakehold-                   Sub-Unit
ers, and market segments. The emt develops performance mea-
sures based on legislative mandates, process requirements, benefits
to customers and stakeholders, workforce improvements, and fiscal
                                                                                                 Develop and implement customer
responsibilities. These performance measures are directly aligned with
                                                                                                 survey(s) to actively seek customers’
mQA’s key and support processes and sp using a bsc approach.
                                                                                                 feedback and suggestions regarding
strategic goal and action plan measures are incorporated into mQA’s
                                                                                                 organizational performance.
bsc and are reviewed and tracked for progress as a part of its sp             Individual
                                                                                                 Use customer feedback and
and emt meetings. during these reviews, key measures are evalu-
                                                                                                 suggestions to enhance organizational
ated to determine the need for continued tracking or amendments
                                                                                                 e ectiveness. Share information and
based on changing requirements. The bsc includes both short- and
                                                                                                 ideas with customers.
longer-term financial measures. in addition to the key performance
measures reflected in mQA’s bsc (Figure 2.1-3), each bureau has a
scorecard aligned with mQA’s bsc. bureau scorecards include addi-         collection sources includes the inter-tel taske monitoring system
tional measures that support mQA’s performance measures, some             which provides statistical data on the number of calls received by
of which are reviewed daily (e.g., % of health care practitioner com-     mQA’s centralized call center, the average wait time, the number of
plaints reviewed within 10 days from receipt) in tracking day-to-         calls abandoned, and the number of calls answered per employee.
day operations. each bureau’s scorecard contains data and measures
aligned to the division’s scorecard and sp in support of the division’s   information, collection, and analysis drive mQA’s decision making
strategic objectives. each unit within mQA’s bureaus has a scorecard      process for both strategic and day-to-day operations. wait times,
aligned with their respective bureau scorecard (Figure 4.1-1). divi-      cycle times, and error rates are used daily to determine workload
sion, bureau, and unit scorecards can be seen in their entirety on-       distribution, training, and workforce needs. For example, Florida
site. performance is reviewed daily and/or weekly through internal        statutes mandate the analysis, investigation and recommendation of
online data management reports.                                           probable cause of a complaint against health care practitioners are
                                                                          complete within 180-days from receipt of a complaint. to ensure
data are collected using various methods, depending on the key pro-       compliance with this mandate, the process is segmented to 10 days
cess and customer or stakeholder group (Figure 4.1-2). collected          for analysis, 90 days for investigation and 80 days for recommen-
data are analyzed during weekly emt and staff meetings, monthly           dation of probable cause. The consumer services Unit reviews
mt meetings, and annual strategic planning meetings to monitor            data daily to ensure all complaints against health care practitioners
progress in achieving mQA’s objectives, assessing trends or patterns,     received are analyzed within 10 days from receipt. Another example
and determining action plans for improvement. data are analyzed           is the data collected from a customer satisfaction survey regarding
daily and/or weekly by program staff to determine if statutory man-       the external mQA website which is reviewed weekly and used to
dates and performance measures are being met. prior to the develop-       determine revisions needed to the external mQA website.
ment of mQA’s centralized database, compAs, data was collected
and maintained in numerous free standing databases by each pro-           data and information are used to support innovation and decisions in
gram. compAs is the database for data collection for mQA’s key            determining priorities for both strategic and day-to-day operations.
processes, including revenue collection which allows for a check and      The process to use data for innovation includes periodic review and
balance with the state revenue system, FlAir. An example of data          analysis of management reports, quarterly and annual performance
collected is on applicants for licensure. data are collected from an      reviews comparing actual to expected performance, and benchmark-
application and stored in the compAs database. Key data elements          ing. As an example of using data for innovation, nursing managers
are used to measure the number of applications received, the average      reviewed their performance measure, average number of days to issue
time to determine an application complete, and other performance          a nursing license. Florida law requires nursing applicants to submit a
indicators of the application process. Another example of key data        set of fingerprints for a criminal background check. The process took

Category 4: Measurement, Analysis and knowledge Management – Page 18
                                                                                                       Division of Medical Quality Assurance

 Figure 4.1-2 examples of Main Types of Data and Collection Methods
   Type of Data         Application                                        examples of Measures                                     SP impact
                                         % of initial investigations and recommendations as to the existence of probable
  internal Process       compAs                                                                                                       1.2; 3.1
                                         cause completed within 180 days of receipt
                        virginia tech    % of new licensees satisfied with the services received from the division                    1.1, 3.1
         Customer         inter-tel
                                         Average time customers are waiting in the queue when placing a call to the
                        taske moni-                                                                                                     3.1
                                         centralized call center (in seconds)
 human resource         virginia tech    % of employee satisfaction                                                                     3.2
          Financial     FlAir/Firs       % error of budget expenditures from projected expenditures                                     3.3

an average of 6-8 weeks. mQA implemented an innovation, the use             to mQA. These agencies contacted include the california depart-
of scanned fingerprints, as the method for submitting fingerprints.         ment of public Health, center for Healthcare Quality; new York
background results are now received within 3 days.                          state education department, office of professions; texas depart-
                                                                            ment of state Health services, division of regulatory services; illi-
in another example of data-driven innovation, a workgroup reviewed          nois department of Financial and professional regulation, division
the number of applicant contacts (telephone calls, correspondence,          of professional regulation; and pennsylvania department of state,
emails, etc.) and staff time responding to queries about license            bureau of professional and occupational Affairs. Florida state agen-
application status. The solution, an online status check application,       cies such as department of Financial services and department of
resulted in a 55% reduction in applicant contacts and a 67% reduc-          business and professional regulation are also contacted. in addition,
tion in staff time.                                                         mQA’s centralized call center routinely collects and compares data
                                                                            from other call centers on customer queue wait times to determine
                                                                            wait time goals. employee satisfaction rates are compared to other
4.1a(2) Selection and use of Comparative Data and                           divisions within doH as well as to other state regulatory agencies.
information                                                                 comparative data are included in the bsc. The data are used in the
priorities and needs for comparative data are set by the emt and are        spp and by the emt and mt for benchmarking, identifying areas
based on mQA’s strategic goals and performance measures that focus          of innovation and best practices, and setting targets for performance
on indicators related to legislative mandates and the requirements of       measures.
mQA’s customers and stakeholders. processes identified as drivers of
these goals or targets are mapped by the appropriate process owners.        4.1a(3) keeping the Performance Measurement
outcome indicators are established to measure performance. These
                                                                            System Current
indicators are reviewed to determine the adequacy of current perfor-
mance against a comparison, a recognized standard or best-in-class          The emt systematically reviews performance to identify opportuni-
performer.                                                                  ties for improvement during weekly and sp meetings. As a part of
                                                                            the spp, the emt reviews customer and stakeholder feedback and
comparative data are collected for performance measures included            data to update mQA’s measures to align with changing needs and
in mQA’s bsc. national organizations such as the Federation of              requirements. The mt participates in national associations and con-
state medical boards and the national council of state boards of            ferences which provide process and measurement updates through
nursing collect data and report on activities specific to the regula-       tracking of regulatory trends and best practices. These reviews and
tion of their respective professions. The health care regulatory boards     national trending provide for expeditious modification of mQA’s
within mQA are participating members in national health care orga-          measures in response to unexpected organizational or external
nizations and routinely attend conferences which provide a forum            changes, such as legislative mandates. workgroups are chartered to
for state regulatory agencies to meet in a collegial environment to         develop and improve processes, create measures and solve problems.
discuss regulatory issues and common regulatory challenges unique           These workgroups use the dmAic method improvement method.
to individual states that may have an impact on a national level.           For example, as a result of an executive order issued by the Gover-
members partner to share aggregate data, enforcement information,           nor pertaining to open Government and the handling of requests
and other public information between states to improve the protec-          for public records, a workgroup was created to review, improve, and
tion of health care consumers. mQA assesses data and information            standardize processes and determine measures for handling requests
received at these conferences and reports provided by national orga-        for public records. implementation of approved recommendations is
nizations to identify opportunities for improvement.                        ongoing. Another example is that in 2006 mQA added information
                                                                            as a key process as a result of changing customer requirements. A
                                                                            workgroup was created to improve the reliability, validity, and acces-
mQA identifies organizations to compare performance based on the            sibility of mQA’s data and to identify more effective and efficient
following criteria: 1) top performers 2) health care regulatory func-       methods to use data to measure and improve services. As a result of
tions, 3) other professional regulatory functions, 4) similar functions,    this workgroup, key data fields were identified and defined, valid-
and 5) similar size. For example, available data are compared with          ity and reliability documentation was developed and error reports
other state’s regulatory agencies that are similar in size and function     were created. mQA’s data collection system has undergone signifi-

                                                               Category 4: Measurement, Analysis and knowledge Management – Page 19
Division of Medical Quality Assurance

cant improvement to help it keep current with mQA’s measurement           compliance with this measure. Another example is analysis of mQA’s
needs (Figure 4.1-3).                                                     employee satisfaction rate. workgroups review specific survey items
                                                                          that receive a 75% or below satisfaction rate and improve related
Figure 4.1-3 examples of Measurement Analysis improvements                processes using the dmAic method. An indicator of the success of
   years                          improvement                             these workgroups is the improvement in overall employee satisfac-
             • established enforcement performance measures               tion from 54% in 1999 to 80% in 2008.
             • established enforcement performance improve-
               ment workgroups                                            Action plans are developed for indicators that are not meeting targets
 1996-00     • enforcement performance indicators tracked and             to facilitate improvement. during the spp, key measures and out-
               reported                                                   comes from the past year are reviewed and analyzed. A gap analysis
                                                                          from the end of the year performance and past year’s goals aids in
             • converted to new database
                                                                          setting targets and evaluating mQA’s performance. This allows the
             • developed enforcement data management reports
                                                                          emt to identify measures and data to focus on in the next year
             • established licensure performance measures                 as priorities for strategic goals and to identify or assign projects for
             • established licensure performance improvement              workgroups. As part of ongoing management of operations, mQA’s
               workgroups                                                 budget and operating cash balances are monitored to ensure mQA
             • converted to new database                                  remains fiscally solvent. Five-year cash balance projections of the
             • established key processes                                  mQA trust Fund are conducted annually. mQA’s fiscal status is
             • created sps Unit (designated for developing data           reviewed using FlAir, which provides a detailed level of analysis of
               reports, tracking performance indicators and data          monthly financial reports. during the spp, key performance indi-
               integrity issues)                                          cators related to historical costs are reviewed to project anticipated
                                                                          costs, allocate resources, and set priorities.
             • established performance measures for all key
             • developed data dictionary
                                                                          4.1b(2) Translation of review Findings for
             • developed validity and reliability documentation           improvement
               for all performance indicators                             mQA translates organizational performance review findings into pri-
             • created Access and Analysis of data workgroup              orities for improvement and opportunities for innovation. improve-
             • developed data validations                                 ment opportunities are systematically identified, defined, reviewed
             • developed internal and external online reports             and prioritized in alignment with strategic priorities and customer
                                                                          requirements. They are systematically identified and defined through
                                                                          the sps statements of work, the governance system requirements
4.1b Performance Analysis, review and improvement                         documentation, and through quarterly review of action plans and
                                                                          performance measures. improvement and innovation priorities are
4.1b(1) Performance review and Analysis                                   determined through swot analysis and sp sessions in which emt
because mQA systematically reviews and analyzes what it does,             and mt brainstorm, and consensus is achieved through the nominal
the division improves access to health care, protects the public          group technique. priorities for technology projects are established by
from unsafe practitioners, and helps consumers make informed              consensus of the emt during the governance process. such criteria
decisions.                                                                as resource demands and mission criticality are considered. on a day-
                                                                          to-day basis, work priorities are established or modified based upon
Analysis of key indicator performance measures occurs as part of the      management performance reports. in the call center, for example,
spp; during the development of improvement projects by assigned           real-time data determines how many call center agents are assigned
workgroups; as part of weekly emt and monthly management                  to answer the phones. in another example, daily license printing
meetings; as part of the quarterly review of mQA’s bsc data; and as       error reports are reviewed and corrective actions assigned.
part of annual analysis of data for legislative planning. These reviews
include trend, comparative performance, work volume, gap and              priorities and improvement opportunities are deployed to work-
root cause analyses. These reviews allow mQA to respond rapidly to        groups, suppliers, partners, and collaborators to ensure organiza-
changing needs and challenges. Additionally, bureaus analyze data         tional alignment. They are deployed through face-to-face meetings,
daily to determine if statutory mandates and performance measures         contract modifications, targeted email communications, and policy
are being met and develop action plans as needed. For example,            and procedure and desk guide modifications. improvement action
Florida law requires all complaints against health care practitioners     plans are accessible to the workforce on the mQA intranet. Finally,
be analyzed, investigated and a recommendation of probable cause          because work system improvements use input from collaborators,
made within 180-days from receipt of a complaint. The investigative       suppliers, and the workforce, ownership and, consequently, deploy-
services Unit (isU) has an internal performance measure of com-           ment occurs throughout the process.
pleting an investigation within 90 days from receipt to ensure com-
pliance with the 180-day mandate. isU runs and analyzes reports           suppliers, partners, and collaborators are often asked to engage in
weekly on cases that are 75 days or older to ensure that the isU          improvement efforts. For example, the professionals resource net-
internal performance measure of completing an investigation within        work (prn) and the intervention project for nurses (ipn), vendors
90 days is met. Action plans are developed as appropriate to ensure       with whom the department contracts to administer mQA’s required

Category 4: Measurement, Analysis and knowledge Management – Page 20
                                                                                                      Division of Medical Quality Assurance

impaired practitioners program, are critical partners in ensuring the     ers have access to data and information through the internet and
public is protected from untreated impaired practitioners. They pos-      through public record requests. because data is collected consistently
sess the skills and expertise to determine the need for a practitioner    (metadata) it can be shared with other doH programs.
to volunteer to withdraw from practice for the purpose of undergo-
ing intensive treatment and to enforce that withdrawal. As a result       it is responsible for setting data standards, collection of metadata,
of contract performance reviews, the doH surgeon General and              management of the metadata repository and the information data
mQA engaged the prn and ipn programs in devising a solution to            store and providing technical support for the agency. established
address the problem of frequent relapses by practitioners that con-       data standards facilitate doH in monitoring data quality. it devel-
tinued to practice their profession. As a result, their contracts were    oped a metadata repository (mdr) and is collecting information
modified to establish relapse protocols. in another example, c.e.         about the data tracked by all systems in use by doH. As this infor-
broker, a vendor with whom mQA contracts to provide statutorily           mation is collected it is made available across the agency through the
required electronic tracking of continuing education compliance           mdr web application. Additionally, it facilitates system integra-
by licensees, regularly engages with the division in customer service     tion, data reuse, secure, efficient data sharing, and HipAA compliant
improvements. to help achieve the strategic goal, 1.1, expeditiously      billing. by using cloverleaf integration broker and associated File
licensed health care practitioners who meet statutorily mandated          mover processes, coupled with metadata, program areas can share
minimum standards of competency, the vendor developed an inno-            information regardless of the system in which the data is collected or
vative electronic solution to the division’s need for an efficient way    its format. As the information is collected, it is made available across
to randomly audit licensees. This solution reduced manual work-           the agency through the mdr web application.
load significantly while satisfying expectations of the legislature and
others for mQA to ensure all practitioners are compliant with their       data for mQA’s key processes, licensure, enforcement and
continuing education requirements.                                        information, are collected and maintained in the compAs
                                                                          database. compAs is maintained by a dedicated mQA Application
to support continuous improvement and its deployment, sps facili-         development team in it. compAs is a customizable, off-the-
tates employee improvement workgroups. service request forms              shelf licensing and enforcement system. data is backed up to a
are accessible to all employees through the mQA intranet. when            disaster recovery database in a separate county using the oracle
a request is received from a process owner, a statement of work is        dataGuard utility which provides for real-time updates to the
created and signed. The project manager in conjunction with the           disaster recovery database. security is handled through the system
process owner defines the purpose of the workgroup, selects partici-      administrators in sss. supervisors are required to submit a signed
pants, maps and analyzes processes, develops performance and suc-         security form specifying the access needed for each employee. Users
cess measures, and presents formal recommendations for approval.          are granted access only to the modules within compAs that they
implementation plans are also developed and include policies and          are authorized to view. enforcement information has a public or
procedures, desk guides, and training for mQA employees, partners         private indicator that is used to determine when it is publishable on
and suppliers as appropriate.                                             the web. compAs requires a unique login and password for each
                                                                          user that follows doH security standards. confidential information
4.1b(3) incorporating results of Performance                              is provided to suppliers and partners with a secure connection to
reviews into improvements of key Processes                                the doH network through data sharing Agreements. suppliers
                                                                          and partners are assigned unique user ids to ensure all activity
The results of organizational performance reviews are incorporated        is auditable. compAs data is made available on the web using
into the environmental scan as a part of the spp and the develop-         a sQl oracle server database. it maintains the doH public
ment of initiatives, which include action plans for process improve-      website that averages over 11 million visits per year. The website,
ments. The performance improvement system used by mQA to        , provides access 24 hours a day, seven days
measure, analyze, and improve organizational performance includes         a week to mQA’s customers’ most requested services. information
statements of work and project plans that are aligned and linked          is segmented into citizen/consumer and licensee/provider needs.
to mQA’s sp and key or support processes. The dmAic method is             customers can access licensure and disciplinary information as well
used for improvement projects.                                            as download commonly requested data reports, make requests for
                                                                          copies of public records and make online payments. This website
4.2 Management of information, information                                also provides access to webpages for individual health care regulatory
Technology and knowledge                                                  boards. practitioners can access, update their data and renew licenses
                                                                          online by logging in with a secure user id and password provided
4.2a Management of information resources                                  to them by mQA. A new feature of the mQA internet is the ability
                                                                          for applicants to submit applications and fees online. The board of
4.2a(1) Data Availability and Accessibility                               nursing application was the pilot profession for this new service. A
mQA data and information are governed by Florida statute (public          press release was issued on June 30, 2008 and the board of nursing
and government information requirements), it security policy (pro-        began accepting online applications on July 1, 2008. All professions
tection of confidential data), and HipAA requirements (protection of      will be provided this service within the next 5 years. Applicants who
medical data). data and information are made available to suppliers,      do not have internet access will still be able to request an application
partners, and collaborators through a secure network (metropolitan        by calling the mQA call center.
Area network). The workforce has access to data and information
through the compAs licensing and enforcement system. custom-

                                                              Category 4: Measurement, Analysis and knowledge Management – Page 21
Division of Medical Quality Assurance

mQA’s intranet, through which information is made available to the       4.2a(3) Continued Availability of hardware and
workforce, is windows-based and is used as a source of communica-        Software Systems, Data and information During an
tion with employees. This intranet contains announcements; policies
and procedures; the mQA sp, Action plan and bsc; coop; the
employee suggestion/comment box; best practices; personnel hand-         to ensure the continued availability of hardware and software sys-
book; access to the doH/mQA training management tool (trak-it)           tems and data and information in the event of an emergency, the
that announces available training; information on the erp; as well       department and division have a detailed coop that is compliant
as commonly used forms and links.                                        with the state of Florida Administrative rule for it security. in an
                                                                         emergency, compAs is identified in the doH and mQA coop
                                                                         as a level 2 system that is restored within 48 hours. This is tested
4.2a(2) hardware and Software, reliability, Security                     in quarterly disaster recovery simulations performed by it and
and user Friendliness                                                    mQA. since the oracle dataGuard utility has been implemented,
doH’s technology standards, standard purchasing procedures and           it ensures that the restore contains the most recent data. previously,
the information systems development methodology, which defines           compAs was restored from tape backups which were on a three
systematic methods for design, control, configuration of hardware        week rotation, thus the restore could possibly be up to three weeks
and software systems, assure that mQA’s hardware and software are        old. with dataGuard, the disaster recovery database is current within
secure, reliable and user-friendly. technology standards include basic   seconds of the production database. it provides disaster recovery for
desktop operating systems and office automation software, email          all doH applications running at the shared resource center (src)
software, and pc hardware standards. They also address servers and       for which it is responsible for production backups. Additionally, the
applications development platforms. These standards ensure effec-        it coop provides for hardware at alternate sites.
tive electronic communication and data sharing and are regularly
updated as technology improves. standards are adopted by recom-          4.2a(4) keeping Current
mendations of the doH it standards workgroup. The workgroup
consists of state and local system and network administrators who        data and information mechanisms such as the license verification
test hardware and off-the-shelf software products in the department’s    website, compAs licensing and enforcement system, and the prac-
technology environment. workgroup members compare similar                titioner profiling website, and their corresponding hardware and
products by price and function, review the literature and industry       software are kept current with business needs and directions with a
standards, and test performance. in addition, software applications      variety of tools. strategic planning (swot), legislative implemen-
and interfaces developed by the agency employ a set of application       tation plans, and customer feedback are among the tools used. For
development standards with the objective of providing industry stan-     example, when mQA transitioned its licensure and enforcement
dard functionality, consistency, reliability, and security. standards    database to a new operating platform, it relied upon a thorough
are published, provided through the intranet to doH employees,           business analysis that included gap identification, software sup-
and are included in the criteria for approving purchase requests. The    port availability, and future business needs. As other technological
state chief information officer must approve purchases that are          changes occur, the division of it notifies mQA when operating
exceptions to standards. The doH has a tier Governance process           environments should change to reflect the new technology.
for governing the development, acquisition, and use of information
technology resources within doH. All projects must comply with           mQA’s spp also provides a systematic mechanism for keeping
the department’s information technology standards, including those       information and data current. process owners, as they are looking
related to platform, security, equipment, and software.                  at their processes and identifying improvement opportunities, also
                                                                         identify needed data and information mechanism enhancements.
User-friendliness is ensured in several ways. All new applications are   For example, under customer focus, a measure of success is timely
web-based to ensure ease of access and use. when new applications        response to public records requests. to improve this measure, pro-
are under development, statewide user groups are formed to ensure        cess owners identified standardized information adaptable to online
that the finished product meets the end user requirements and can        access—final order and emergency action search application. This
be easily accessed and used by staff. For example, to keep current       new system enhancement, as with others, is subject to the gover-
with technology standards, mQA’s database was converted in 2004.         nance process described in Section 4.2a(2).
to ensure the hardware and software met user needs and adequately
supported business processes, users provided process maps, were          technology replacement and upgrade schedules (hardware and soft-
interviewed prior to the conversion, and were involved in post-          ware enhancements) are established by the division of it and built
conversion acceptance testing. Finally, user-friendliness is ensured     into the mQA budget. Additionally, input from both internal and
through the tier 1 Governance process. Users submit business needs       external customers, as well as staff, may identify emerging hardware
for approval by the tier 1 governing body (Section 6.1a(2)).             and software needs. For example, the medical malpractice issues in
                                                                         the Florida legislature required physician workforce data.
sss provides “train-the-trainer” training to key employees, when-
ever hardware or software modifications are made, who then provide       Historically, physician workforce data in Florida has been unavail-
training to employees in their respective work units. Additionally,      able. because existing mQA software was current (the oracle plat-
sss staff and it help desk staff are available to quickly respond to     form), it enabled the division to meet a new customer demand for
user issues through a tracking and ticketing system.                     critical information using existing resources. The physician work-
                                                                         force survey was developed to meet this need and provides workforce

Category 4: Measurement, Analysis and knowledge Management – Page 22
                                                                                                     Division of Medical Quality Assurance

data instrumental in shaping Florida’s health care and physician          ing the doH it security policy which includes controls for separa-
workforce policies. The data is available to research entities.           tion of access by role, limiting access to the minimum necessary for
                                                                          business need-to-know functionality, strong authentication of users,
4.2b Data, information and knowledge Management                           encryption of data, and audit trails for usage. security for compAs
                                                                          is provided through sss. supervisors determine security levels and
4.2b(1) ensuring Accuracy, integrity, reliability,                        submit a signed security form specifying the access needed for each
Timeliness, Security and Confidentiality                                  employee. compAs requires a unique login and password for each
                                                                          user that follows doH security standards. All new mQA employees
mQA ensures the accuracy, integrity and reliability, timeliness, and
                                                                          receive orientation training on security and confidentiality and all
security and confidentiality of its data, information and knowledge.
                                                                          employees must complete annual training. sonitrol security ensures
                                                                          that no unauthorized individual has physical access to electronic and
Accuracy: Accuracy of data, information and knowledge is ensured          physical data. For example, applicant test questions, copies of pre-
by several different methods. procedures are mapped and docu-             vious examinations, and confidential exhibits are maintained in a
mented in desk guides to standardize processes and data entry. when       secure vault in the testing services Unit where only employees of
improvements or changes in processes or policies occur, correspond-       that unit have access.
ing desk guides and process maps are updated. A notice is sent to
all mQA staff when a new or updated policy is posted to the mQA
policy and procedure share point site which is accessible through         4.2b(2) knowledge Management
the mQA intranet. Additionally, pertinent announcements and best          mQA manages organizational knowledge through an electronic net-
practices are posted and shared on the mQA intranet.                      work infrastructure that allows the sharing of knowledge within the
                                                                          organization. All mQA employees have access to the internet and
data validations are set in compAs. For example, compAs will              the doH and mQA intranet. The mQA intranet publishes impor-
not accept a future date as the receipt date of a complaint. error and    tant information and announcements on current events as well as
data management reports with back-up data are reviewed weekly by          policies and procedures. Additionally, the mQA intranet provides
supervisors to determine compliance with performance measures.            employees access to the mQA sp, bsc and strategic Action plans
supervisors conduct periodic audits of data. errors are identified        and the coop. employees share best practices through a best
and corrected using error reports that pinpoint data outside as well      practices share point link on the mQA intranet and through the
as within the defined parameters. Ar and performance measure data         enforcement Alert.
are reviewed quarterly. error and missing data reports are distributed
as a part of the quarterly review for data integrity.                     mQA ensures the systematic transfer of workforce and organiza-
                                                                          tional knowledge and accumulated intellectual resources through its
integrity and reliability: data elements are defined in the mQA           workforce succession plan. The plan is analyzed by the emt and
data dictionary. validity and reliability forms are established for       mt and updated annually to identify key and critical positions in
each performance measure and Ar requirement. The validity and             which no knowledge redundancy exists. to eliminate these potential
reliability document includes a definition of the measure or data;        knowledge gaps, the plan establishes mentoring, leadership, and core
data sources and methodology used in the query; and information           competency development guidelines. The succession plan includes
as to what makes the data reliable and valid, including any limita-       employee turnover data as a measure of the success of knowledge
tions or issues that may impact the validity and reliability of the       transfer. ideas, learning, and understanding of the division’s work
data. Additionally, compAs is backed up daily. Antivirus systems          systems and key processes is also transferred among mQA employ-
are used to perform automatic scanning of network servers and             ees through policies and procedures, desk guides and process maps,
exchange (email) servers to detect and deny the intrusion of virus        critical information in shared drives, cross-training, and workshops.
attacks. policies and procedures with corresponding desk guides and
process maps ensure uniformity, thus integrity and reliability, in per-   mQA transfers knowledge in the form of information to customers,
forming mQA’s key processes.                                              suppliers, partners, and collaborators through press releases, public
                                                                          meetings, contracts, and memoranda of understanding. For exam-
timeliness: compAs has system-initiated date and time stamps              ple, a press release is issued when emergency action is taken against
for all data entries. compAs updates are reflected on a real time         a licensee or when an arrest is made against an unlicensed person.
basis. mQA has several performance measures pertaining to timeli-         mQA communicates information to customers using the customer-
ness. For example, to ensure compliance with statutory mandates in        designed internet website, examples of
approval of licensure applications, mQA measures the percentage           information available to mQA’s customers are licensure and disci-
of complete initial licensure applications approved or denied within      plinary information on health care practitioners, information specific
90 days. data management reports are analyzed weekly to ensure            to individual regulatory boards, and Ars. customers also have direct
compliance with performance timeframes.                                   access to commonly requested public licensure information free of
                                                                          charge through this website. customers can download information
security and confidentiality: The infrastructure of the doH inter-        at their convenience into a variety of word processing, database, and
net and database systems are secured through firewalls and up-to-         spreadsheet programs, circumventing the need to request assistance
date security standards that are monitored by a dedicated team in         from mQA. examples of data available are licensee mailing labels
it. Alerts are received when attempts are made to hack into doH           and lists of licensees by profession and city or county.
systems. security and confidentiality of data is ensured by follow-

                                                              Category 4: Measurement, Analysis and knowledge Management – Page 23
Division of Medical Quality Assurance

Additional methods of systematically transferring knowledge to and      tices and the other health care regulatory boards within mQA are
from mQA’s customers, stakeholders and collaborators are through        in the process of implementing this practice. Additionally, the board
annual strategic planning meetings with health care associations and    meetings are recorded on cds and uploaded to the Ftp site where
chairs of the health care regulatory boards, focus groups, and cus-     customers can listen to the meeting in part or in its entirety. other
tomer satisfaction surveys.                                             boards have implemented the practice of providing recordings of the
                                                                        meetings online.
mQA identifies and shares best practices in several ways. externally,
the mt participates in national associations and conferences where      The assembly and transfer of knowledge for use in mQA’s spp are
information and best practices are shared. internally, best prac-       achieved through annual meetings with mQA stakeholders, for
tices and information are shared during mt and staff meetings as        example, the Annual Association meeting and the board chair
well as through the best practices share point link on the mQA          meeting. All levels of staff participate in the spp through swot
intranet. improvement opportunities and best practices are imple-       analysis interviews conducted by each member of the mt with his or
mented through workgroups and resulting action plans. An example        her staff prior to the annual strategic planning retreat. The sp, bsc
of an internally shared best practice is the board of medicine’s File   and strategic action plans are accessible through the mQA intranet.
transfer protocol (Ftp) page. in 1999, the board of medicine staff      employees are involved in implementation of strategic action plans.
began using a program, Agenda builder/Agenda viewer, in which
all materials for board meetings were scanned and provided to board
members on cds/dvds. This resulted in a cost savings for copying
and mailing the agenda materials to board members. The boards of
nursing and osteopathic medicine have adopted these best prac-

cAteGorY 5: worKForce                                                   sures for workforce satisfaction and others as measures for workforce
                                                                        engagement (Figure 7.4-4). in 2007, mQA developed its own ess
FocUs                                                                   from the doH ess as a means of extracting even more usable data.
                                                                        This was done because the emt decided that workforce satisfaction
5.1 workforce engagement                                                and engagement should be evaluated yearly and be segmented by
                                                                        years of service, supervisor/non-supervisory employees, and bureaus.
5.1a workforce enrichment
                                                                        They also wanted to ensure continued trend data since the 2008
5.1a(1) key Factors Affecting workforce engagement                      doH ess was going to change significantly.
and Satisfaction
one of mQA’s strategic goals is to have a motivated workforce com-      5.1a(2) Fostering a high Performance
mitted to excellence (Figure 2.1-3). This strategic goal is attained    Organizational Culture and a Motivated workforce
by focusing on workforce satisfaction and engagement. mQA deter-        Figure 5.1-1 shows how mQA fosters an organizational culture con-
mines the key factors affecting its workforce engagement and sat-       ducive to high performance and a motivated workforce to accom-
isfaction through employee feedback and employee turnover data.         plish the following:
These methods are used systematically throughout mQA’s different
workgroups and segments.                                                1. cooperation, effective communication, skill sharing
                                                                        2. effective information Flow, two-way communication with
                                                                           supervisors and managers
mQA obtains measurable feedback from its employees through the
                                                                        3. individual Goal setting, empowerment, and initiative
annual mQA ess as well as the biannual doH ess. both of these
                                                                        4. innovation in the work environment
surveys contain questions addressing workforce satisfaction and
                                                                        5. The Ability to benefit from the diverse ideas, cultures, and
engagement. mQA’s employees also give feedback through regular
                                                                           Thinking of Your workforce.
staff meetings, retreats, and an electronic suggestion box on mQA’s
intranet homepage.
                                                                        5.1a(3) workforce Performance Management System
mQA’s emt reviews employee turnover data on a quarterly basis.          mQA’s workforce performance management system supports high-
This data consists of both employee turnover rates and results from     performance work and engagement using systematic strategies that
the survey for separating mQA employees. This survey gives depart-      provide recognition and incentives. when beginning a new posi-
ing employees (excluding dismissals and retirees) an opportunity to     tion within mQA, employees are immediately informed of the per-
provide both specific and general information about their reasons       formance expectations and major job duties of their position and
for leaving mQA.                                                        mQA values (mQA employee covenant) by their supervisor. They
                                                                        are also provided with a copy of their performance evaluation Form
in 1999, the department conducted its first biennial satisfaction       listing this information. employees and their supervisors conduct
survey in which mQA participated. At that time, mQA’s focus was         an evaluation session at the end of their probation and, thereafter,
on workforce satisfaction, while workforce engagement was mea-          on a yearly basis. This evaluation session is based on a combination
sured solely on employee turnover rates. in 2006, mQA reevaluated       of achieving job-related competencies, and meeting job expecta-
the doH ess questions and identified specific questions as mea-         tions and performance standards, all of which are developed to drive

Category 5: workforce Focus – Page 24
                                                                                                Division of Medical Quality Assurance

Figure 5.1-1 Fostering MQA’s Organizational Culture                     D = Bureau Deployment            A = Accomplishment (1-5)
Method                D          A   Description
emt meeting        Across    2       The emt meets weekly to discuss strategic challenges; share information, two-way, from doH
                                     management and each bureau; perform an environmental scan and determine if any action is
                                     necessary; discuss budget issues.
mt meeting         Across    2, 5    The mt meets monthly to discuss current issues affecting mQA and strategic challenges; share
                                     information, two-way, from emt and each bureau/unit; receive status updates regarding the
                                     bsc, action plans and technological or process improvements.
mid-manager        Across    2, 5    The mid-managers meet quarterly with the mt to discuss current issues affecting mQA and stra-
meeting                              tegic challenges; share information, two-way, from mt and each unit/workgroup; receive status
                                     updates regarding action plans and workgroups.
mid-manager        Across    1, 2,   The mid-managers meet quarterly to discuss best practices and issues effecting mQA and its
Forum                        5       business processes, as well as to receive leadership training through guest speakers, powerpoint
                                     presentations and instruction videos.
management         within    2       bureau chiefs regularly meet with direct reports to share information, two-way, regarding the
meetings                             division, bureau, and individual units.
Unit staff meetings within   1       Unit managers regularly meet with unit staff to share information, two-way, regarding the divi-
                                     sion, bureau, and the unit. These meetings are also used to highlight best practices and train
employee           within    1, 3    employee mentoring is utilized as needed within each bureau to help employees manage career
mentoring                            development and for personal growth. it is also used to transfer skills and knowledge as well as to
                                     raise employee morale and increase job satisfaction.
cross-training     within    1       Units within each bureau cross-train their employees to perform other job duties/functions to
                                     support their unit, as well as other units, in times of high volume or crisis. For example, employees
                                     from other units within bms are cross-trained in the functions of the call center. This allows
                                     other units within bms to assist the call center in times of high volume, such as during the
                                     certified nursing Assistant (cnA) renewal event. in addition, the call center can conduct staff
                                     training and meetings without a disruption in service to mQA’s customers.
process mapping    Across    1, 5    process maps and desk guides are used at mQA to communicate business processes to all employ-
& desk Guides      &                 ees, ensuring consistent, reliable, and measurable services and results. All business processes are
                   within            mapped by workgroups made up of employees from each unit or bureau involved in the business
                                     process. For example, when new legislation was passed requiring a new regulatory process within
                                     the enforcement program, a workgroup was created consisting of employees and managers from
                                     each unit affected by the new legislation to create, map and implement the process.
policies           Across    1       policies are used within mQA to communicate official standards and rules to all employees, ensur-
                   &                 ing that fairness and consistency is an integral part of mQA’s culture.
communication      Across    1, 2    mQA’s communication plan gives guidance to all employees regarding the most appropriate way
plan                                 of relaying different types of information to different groups both internal and external to mQA.
sharing best       Across    1, 3,   best practices are shared in a variety of ways at mQA, including through the mQA intranet and at
practices          &         4, 5    meetings. because mQA’s employees are encouraged to share their skills and ideas, they are empow-
                   within            ered to take initiative and be innovative in their jobs. The sharing of best practices also allows
                                     mQA employees to benefit from the skills, innovations and experiences of their coworkers.
performance        within    1, 3    performance standards are used within mQA to communicate the job duties and responsibilities
standards and                        required of each employee. regular employee evaluations allow supervisors and employees an
employee                             opportunity to review the employee’s job performance; review performance standards and modify
evaluations                          them as necessary; and discuss and develop career goals.
training           Across    1, 3    The variety of training provided to mQA’s employees helps them excel in their job duties and to
                   &                 meet career goals. training needs are determined through the annual training needs Assessment
                   within            survey.
process improve-   Across    1, 3,   All mQA employees are empowered to participate in and cooperate with process improvement
ment workgroups    &         4, 5    workgroups, giving them an opportunity to share their innovative ideas and diverse cultures.

                                                                                               Category 5: workforce Focus – Page 25
Division of Medical Quality Assurance

 Figure 5.1-1 Fostering MQA’s Organizational Culture                        D = Bureau Deployment           A = Accomplishment (1-5)
 Method                    D          A   Description
 mQA employee          Across     1, 3    mQA’s employee covenant, which is signed by all employees, communicates mQA’s mission,
 covenant                                 vision and values to coworkers and customers. it empowers employees to adhere to the mQA
                                          values in the performance of their job duties.
 strategic planning    Across     1, 2,   strategic planning allows mQA to plan for the future while considering ideas from all employees.
                       &          4, 5    For the swot analysis, mQA management obtains input from all employees to represent the
                       within             diversity within the division.
 employee sugges-      Across     1, 3,   mQA’s employee suggestion box, located on mQA’s intranet, allows employees to communicate
 tion box                         5       their suggestions, questions, and comments to mQA’s emt. Feedback is reviewed daily.
 employee satisfac-    Across     1, 5    employee satisfaction surveys allow employees to provide feedback about their job satisfac-
 tion surveys          &                  tion and engagement. some of these surveys also allow employees to offer suggestions for
                       within             improvement.
 continuity of         Across     1, 2    establishes policy and guidance to ensure execution of mission essential functions, including
 operations plan       &                  relocation of personnel and resources to alternate facilities capable of supporting operations
 (coop)                within             during emergency events that disrupt business operations.
 employee recogni- Across         3, 4    The mQA erp is designed to recognize employees for meritorious achievement, years of service,
 tion program                             employee and board member retirement, customer service, productivity, and innovation
 chat with lucy        Across     1       chat with lucy is a monthly opportunity for employees to meet informally with the division
                                          director to ask questions, share best practices, discuss ways to improve customer service, and
                                          hear about mQA’s plans for the future.

high performance. during employee evaluations, each employee is          The Thanks A million program, started in 2001, allows an employee
rated on a one-to-five scale, with those being rated a five showing      to quickly recognize and thank their coworker for excellent customer
outstanding performance. supervisors and employees then review           service by presenting him or her with a Thanks A million certificate
and update performance standards as necessary to better reflect the      and providing the employee’s supervisor with a description of the
employee’s current work and career goals. employees scoring high on      excellent customer service provided. exceptional customer service
their evaluation may receive a superior performance merit increase       is recognized with a director’s Thanks A million. supervisors and
based on their performance appraisal. conversely, employees scoring      managers submit their employee nominations for this award to the
low on their evaluation receive coaching, which can include a perfor-    division director. The director then reviews these submissions and
mance improvement plan (pip). to ensure uniformity, all supervi-         determines those deserving of a director’s Thanks A million. These
sors are required to take basic supervisory training, which includes     awards are presented to the employees at the monthly manager’s
instruction on conducting and scoring performance evaluations and        meeting and a letter is placed in their personnel file.

to reward, recognize, and encourage employees beyond a standard-          Figure 5.1-2 Compensation and recognition Programs
ized pay system, mQA deploys an array of team and individual com-         Program Type      Approach                      Award
pensation, reward and recognition, and incentive programs described                         merit salary increases        individual
in Figure 5.1-2. All of mQA’s permanent positions fall under the          Compensation
state’s broadband pay plan system. As such, limited flexibility exists                      promotional increases         individual
to increase employees’ salaries. However, within these limitations,                         Thanks A million              individual/team
mQA makes every effort to properly compensate employees for their                           director’s level
work, in the form of promotions, reclassifications, and special salary                                                    individual/team
                                                                                            Thanks A million
increases. As an additional incentive to employees, mQA offers flex-
                                                                          employee          meritorious Achievement
ible work schedules, telecommuting, and tuition reimbursement/                                                            individual/team
                                                                          recognition       Awards
waiver programs for employees wishing to further their education.
                                                                          Program           davis productivity Awards     individual/team
mQA recognizes employees in numerous ways through its erp,                                  Years of service Awards       individual
which is run by employees for employees. The erc is made up of                              mQA employee Apprecia-
representatives from all of the units or bureaus within mQA and                             tion day
is responsible for the annual ceremony and promotion of events                              Flexible work schedule        individual
throughout the year. since 1992, this program has evolved from
an informal program that included the “big banana” award, to the                            tuition reimbursement/
                                                                          incentive                                       individual
mature, sustainable, and comprehensive program it is today (Figure                          waiver
5.1-2).                                                                                     training                      individual/team

Category 5: workforce Focus – Page 26
                                                                                                    Division of Medical Quality Assurance

The erc hosts an annual, formal awards ceremony to highlight the         mQA’s training plan was first developed in 2006 after conducting
meritorious achievements of employees as well as years of service,       training focus groups. Using the lessons learned from these focus
which recognizes an employee every five years for service to the state   groups, the tnAs was developed and distributed to managers in
of Florida. The meritorious Achievement Awards recognize five dif-       2007 and to all employees in 2008. to provide mQA employees
ferent employee classifications (managers, supervisors, professionals,   with another tool for expressing their training needs, the trF was
paraprofessionals and staff support employees) in the areas of leader-   created in the second half of 2008. This form allows all employees to
ship, customer focus, quality improvement, and teamwork. employ-         submit their training ideas and desires at anytime during the year.
ees are nominated for these awards by their coworkers, supervisors,
or managers based on their exemplification of mQA’s values. These        mQA’s workforce development and learning system addresses its
nominations are then presented to a judging panel made up of             core competencies, strategic challenges, and accomplishment of
employees, who review and score the nominations. winners in each         both short- and long-term action plans through formal and informal
area and classification are determined by the highest score. As many     trainings and tools. Formal trainings include mQA neo, code of
as 90 or more nominations are submitted each year by employees.          ethics, information security and privacy Awareness training, cul-
                                                                         tural diversity Awareness, office safety, violence in the workplace,
mQA employees and teams also participate yearly in the dpA by            computer application trainings, cpm training, new investigator
submitting nominations. The dpA recognizes individuals and teams         training, Annual investigator training, Annual inspector training,
whose work significantly and measurably increases productivity and       plain language training, Keys to Quality customer service, Keys
promotes innovation to improve the delivery of state services and save   to effective time management, and Keys to effective communica-
money for Florida taxpayers and businesses. For example, in 2006,        tion. informal training is received by mQA employees through tools
mQA’s nursing management team won a notable team Award for               such as the mQA employee covenant, i creAte badge, chats
streamlining the nursing licensure application process. The team cre-    with lucy, annual division-wide meetings, staff meetings, email,
ated an internet-based licensure application that resulted in a reduc-   intranet, desk guides, delegation of authority, on-the-job training,
tion in application processing time over a four year period, despite     mentoring, coaching, and participation in workgroups. Addition-
an increase in applications.                                             ally, all workgroups facilitated by sps receive informal training on
                                                                         developing and implementing action plans.
beginning in 2006, the mQA managers began hosting an annual
mQA employee Appreciation day in multiple locations throughout           whenever there are organizational performance improvements,
the state to thank employees for their hard work and dedication.         technological changes, and innovations within mQA, chartered
These events include food provided by the mt and games for all           workgroups are created. A result of these workgroups is the devel-
mQA employees.                                                           opment and deployment of an action plan that includes a training
                                                                         component for the employees affected by the new or improved busi-
mQA’s workforce performance management system reinforces a cus-          ness process. in addition, workgroup facilitators provide the tools
tomer and business focus and achievement of action plans by:             and training needed for developing and deploying action plans to
                                                                         the employees and leaders involved in the process.
• promoting mQA’s mvpFv through the mQA employee
  covenant, mQA’s platinum odyssey campaign and calendars,
  business email and correspondence, doH and mQA neo, and                process improvement workgroups create action plans as part of the
  i creAte badges;                                                       dmAic method; while workgroups addressing technological change
• recognizing excellent customer service, teamwork and quality           or innovation create action plans as part of the dmAdv method.
  improvement through the erp;                                           All action plans and workgroup objectives are aligned with the goals
• systematically training employees on excellent customer service;       and objectives of the sp.
• encouraging all employees to participate in chartered workgroups
  where they receive the training and skills to create and imple-        mQA educates its employees about the breadth of development
  ment action plans; and                                                 opportunities through doH and mQA neos, emails and flyers
• communicating business and workgroup/action plan results and           announcing trainings, trak-it—an online system listing both
  their impact through email, meetings and the mQA intranet.             required and optional training for each employee—performance
                                                                         evaluations (coaching and mentoring), and cross-training. when
5.1b workforce and Leader Development                                    employees begin their careers with mQA, they are required to attend
                                                                         the doH and mQA neos as well as a six-month follow-up to
5.1b(1) workforce Development and Learning                               the mQA neo (Figure 5.1-3). At these orientations, employees
in the area of workforce development and learning, mQA identi-           are welcomed to the department, meet with the emt, and learn
fies the training needs for its employees through feedback obtained      about the department and division. in addition, existing employees
from the annual training needs Assessment survey (tnAs), the             are offered a wide range of both internal and external educational
training request Form (trF) located on mQA’s intranet, train-            opportunities, such as the cpm program and the college tuition
ing evaluations completed by participants after each training, and       waiver and reimbursement programs, to help them meet their per-
process development and improvement workgroups. mQA uses this            sonal and career goals.
feedback to improve current trainings and to create mQA’s yearly
training plan.

                                                                                                   Category 5: workforce Focus – Page 27
Division of Medical Quality Assurance

 Figure 5.1-3 new employee Orientation Curriculum                         ship skills, mQA managers attend department legislative training,
                                                                          sterling criteria training, and contract management and project
 Class          Curriculum                                                management training.
 DOh neO        overview of doH’s organizational structure,
                culture and its executive leadership; “public             ethical and legal behavior remains a top priority for mQA and is
                Health: A continuing legacy of essential                  reflected in three of the core values: integrity, respect, and account-
                services” video; plain language concepts; service         ability. ethics training is required for all mQA employees and is
                excellence concepts                                       reinforced through the signing of the mQA employee covenant,
 MQA neO        introductions; mvpFv; budget; sp; platinum                performance standards, and department policies. The sterling nav-
                odyssey; values; bureaus and enforcement                  igator survey identified ethical and legal behavior as an organiza-
                program; workforce Focus; sps; personnel                  tional strength. to sustain that strength, mQA established a work-
                (including benefits); closing & evaluation                group comprised of leaders who have been charged with identifying
 Six-Month      division director and employees discuss how their         the underlying contributing factors to that strength and reinforcing
 Follow-up      perception of mQA’s core processes, mvpFv, and            them.
                strategic goals have evolved and changed since
                their initial orientation.                                mQA’s leadership development and learning system addresses core
                                                                          competencies, strategic challenges, and accomplishment of action
Knowledge from departing and retiring workers is retained by mQA          plans through management meetings and training:
in a variety of ways:
                                                                          • mQA’s regularly scheduled management meetings (Figure
• mQA’s succession plan (segmented by bureaus) is reviewed and              5.1-1),
  updated annually.                                                       • mQA’s annual division-wide meetings,
• exit reviews are conducted upon separation to promote continu-          • mQA’s long range planning meetings (Annual board chair
  ous quality improvement.                                                  meeting and Association meeting),
• desk guides for all mQA business processes are created and              • The cpm program, and
  updated regularly.                                                      • on-the-job training, mentoring, and coaching.
• Job overlapping is used when possible so a new employee can
                                                                          Through these meetings and training, mQA’s leaders acquire the
  work alongside the departing employee.
                                                                          KsAs to build and enhance mQA’s core competencies: leadership;
• cross-training is used to create redundant workforce knowledge
                                                                          identifying and meeting customers’ needs; and health care regula-
  for a business process.
                                                                          tion. leaders are responsible for developing, implementing and
• delegations of authority are used by managers to develop leader-
                                                                          monitoring both short- and long-term action plans, as well as com-
  ship skills.
                                                                          pleting action steps within these plans.
mQA reinforces new knowledge and skills on the job through the
six-month follow-up to neo; annual training in the areas of ethics,       mQA leaders develop their organizational improvement, change
security and confidentiality; desk guides; yearly performance evalua-     and innovation skills by:
tions; job-specific training, such as investigator training; and coach-   •   participating in process creation and improvement workgroups,
ing and mentoring. supervisors also evaluate training effectiveness       •   developing and implementing action plans,
on an individual basis through the performance evaluation process.        •   attending the cpm program,
Furthermore, mQA is currently piloting a training program in the          •   attending conferences, and
licensure and Auditing services Unit (lAsU). The objective of this        •   sharing and learning about best practices at management
program is to systematically train and evaluate employees using               meetings.
lesson plans and performance tests specific to their job functions.
The lesson plans and performance tests are based upon each job’s          mQA informs its leaders about the breadth of leadership develop-
expectations, standards and competencies.                                 ment opportunities through succession planning and management
                                                                          meetings. mQA’s succession plan lists the skills, attributes and
5.1b(2) Leader Development and Learning                                   knowledge needed to fulfill critical positions within mQA, provid-
                                                                          ing future leaders with the information necessary to attain career
comprehensive leadership development in mQA includes the divi-            goals. leaders also learn about development opportunities by partic-
sion-sponsored cpm program, tuition waivers and reimbursement             ipating in management meetings, as well as practitioner association
at state colleges, active recruitment for mQA and department work-        meetings, federation meetings, and annual conferences.
groups and special projects, succession planning, and mentoring. in
addition, mQA provides leadership training and experience through         5.1b(3) effectiveness of Development and Learning
delegation of authority, the basic supervisor training program, and
regular participation in a wide range of management meetings.
                                                                          mQA evaluates the effectiveness of its workforce and leadership
organizational knowledge development begins with mQA’s neo                development and learning systems by (1) testing employees upon
for all employees. continued organizational knowledge is developed        completion of any required training conducted in-house, to assess
through the spp, management meetings, organizational publications         their comprehension of the material; (2) asking employees to com-
such as mQA’s Ar and the intranet, the customer Functional direc-         plete a training evaluation to determine their level of satisfaction
tory (cFd), and mQA’s annual meetings. to broaden their leader-           with the training content and presentation, as well as its usefulness

Category 5: workforce Focus – Page 28
                                                                                                      Division of Medical Quality Assurance

in the fulfillment of their job duties; and (3) reviewing the doH            a. KsAs,
and mQA employee satisfaction survey results, as well as employee            b. key tasks,
performance evaluations. results from the training evaluations, sur-         c. competencies, and
veys, and performance evaluations are used by managers and other             d. personal characteristics.
training personnel to develop and improve training. For example,          3. publishing the information gathered for each position so that
based on feedback obtained from training evaluations, in 2007,               employees can determine what skills, experience, and education
sps revised their customer service training to include a component           they will need to successfully advance their career.
addressing language barriers—providing tips and guidance on how           Although mQA cannot pre-select job candidates, it can establish its
to communicate with customers who have difficulty speaking, hear-         bench strength by identifying those employees with the qualifica-
ing, or understanding english.                                            tions to directly step into management positions through its succes-
                                                                          sion plan.
5.1b(4) Career Progression and Succession Planning
mQA manages effective career progression for its workforce                5.1c Assessment of workforce engagement
through:                                                                  5.1c(1) Assessment Methods and Segmentation
•   succession planning                                                   mQA systematically assesses workforce engagement and satisfaction
•   performance evaluations (career and personal development)             using both formal and informal methods. Formal methods and mea-
•   mentoring                                                             sures include the electronic employee suggestion box, exit reviews
•   training                                                              and surveys, employee turnover rates, and employee satisfaction
•   cross-training                                                        surveys. informal methods and measures include employee com-
•   delegation of authority                                               ments, questions and suggestions gathered at regular staff meetings
•   tuition reimbursement and waiver programs                             and retreats, chats with lucy, absenteeism data, as well as grievances
•   division-sponsored cpm program                                        filed with the inspector General’s office (iG). All of these meth-
As part of their performance evaluations, employees discuss personal      ods and measures are used consistently throughout mQA’s different
and career goals with their supervisors. From these discussions, super-   workgroups and segments. For the formal methods and measures,
visors help their employees to meet their goals by recommending           corrective action plans are required that include the creation of pro-
and implementing career progression tools such as mentoring, train-       cess improvement steps (and workgroups), in-progress reviews and
ing, cross-training, and workgroup participation. For example, if an      outcome reports. informal methods and measures may include the
investigator in csU is interested in becoming a medical malpractice       same and may also include training plans. see Figure 5.1-4 for a
investigator in the field, the csU supervisor recommends that the         description of how these methods and measures are reviewed.
csU investigator contact the tallahassee Field office to schedule
cross-training (i.e., ride-along with a field investigator when he/she    As a result of mQA’s 2006 sterling navigator survey, six work-
is conducting interviews or inspections). in addition, in 2008, sps       groups were formed to address the three identified opportunities
implemented new training in the areas of interviewing and resume          for improvement, as well as to enhance and sustain the three iden-
writing based on feedback received from employees and leaders in          tified strengths. working with the Florida sterling council, these
the 2007-2008 and 2008-2009 training Assessment surveys.                  workgroups identified objectives, and developed action plans to
                                                                          meet these objectives. As a result of these workgroups, numerous
supervisors also encourage employees wishing to advance their careers     improvements have already been implemented within mQA. For
to participate in the department’s tuition reimbursement or waiver        example, in 2008, the communication workgroup developed and
programs. The tuition reimbursement program allows employees to           implemented an information sharing plan to improve internal com-
be reimbursed for work-related classes, up to six credit hours per        munication throughout the division.
term at state universities and colleges, while the tuition waiver pro-
gram waives the tuition at these schools (up to six credit hours per
term) for degree seeking employees. supervisors also accommodate          5.1c(2) key results and employee engagement
degree-seeking employees with flexible work schedules.                    employee engagement assessment findings from ess and turnover
                                                                          data are stratified at the division, bureau and unit levels and incorpo-
Anticipating and planning for a change of leadership is critical in       rated into mQA’s sp as measures of its strategic goal of a motivated
mQA, where managers tend to be long-term employees with sub-              workforce committed to excellence. Assessment findings are related
stantial institutional and job knowledge. to do this, mQA has devel-      to the key business result of percentage of external customers satis-
oped a comprehensive succession plan. This succession plan includes       fied with services provided by mQA and percent of loyal customers.
the following steps:                                                      because these data are key measures, they are systematically moni-
                                                                          tored and negative trends can be immediately addressed through
1. identifying:
                                                                          improvement action plans. Furthermore, comparisons between
   a. leaders that are retiring within 5 years; and
                                                                          turnover data and employee satisfaction data show a correlation
   b. positions critical to the continuation of mQA’s business
                                                                          between length of service and employee satisfaction—the longer the
                                                                          service, the more satisfied the employee. Thus, assessment findings
2. interviewing the employees identified in step one (and their
                                                                          are related to key business results.
   supervisors or managers) to determine the following regarding
   their position:

                                                                                                     Category 5: workforce Focus – Page 29
Division of Medical Quality Assurance

5.2 workforce enrichment                                                ing needs, mQA may hire ops employees, contract with manpower
                                                                        services, or utilize cross-trained employees from other areas.
5.2a workforce Capability and Capacity
5.2a(1) workforce Capability and Capacity needs                         5.2a(2) recruitment, hiring and retention
mQA’s leaders assess workforce capability and capacity through a        employees are recruited internally and externally through the state
systematic workforce planning and development process as shown          of Florida’s people First system. when a position becomes vacant
in Figure 5.2-1. in direct response to business needs, the workforce    it is advertised through the people First website, as well as through
characteristics and skills required to meet those needs are analyzed    select newspapers. All job advertisements include both a job descrip-
and clearly identified through the development of competency-           tion and the necessary KsAs and core competencies. within the
based job descriptions in alignment with mQA’s core competencies        department, both the Human resource management and office of
and the state broadbanding classification system. mQA prepares for      performance improvement provide classification, recruitment and
long-term workforce capability and capacity needs through the spp       selection training, as well as coaching, technical assistance and infor-
(Section 2.1a).                                                         mation to any individual or group in relation to the hiring process.

The number of employees needed to meet a specific business need is      The hiring manager uses the desired KsAs and core competencies to
determined by analyzing performance measures and process maps,          rate the applications and identify the top candidates for interview-
conducting time studies, reviewing statutorily mandated timeframes,     ing. A set of interview questions are developed based on the KsAs,
and preparing for scheduled events such as renewals and continuing      core competencies, and behaviors required in the vacant position.
education (ce) audits. once a need for additional permanent posi-       A diverse panel of employees and managers uses these questions to
tions has been identified, mQA must submit a legislative budget         conduct the interviews and score the interviewees, determining who
request that has been reviewed and approved by the emt to the           is most likely to be motivated and engaged in the mission of the
department to acquire approval for new positions from the legis-        division and succeed in the position. Using the interview panel’s rec-
lature. The legislative budget request shows justification for the      ommendations, the hiring manager selects the best candidate for the
new positions, using the data and measures gathered during mQA’s        job.
initial assessment of the business need, and alignment to the depart-
ment’s and Governor’s strategic priorities. to meet temporary staff-

 Figure 5.1-4. Assessment Methods and how They Are reviewed
 Method/Measure          how it is reviewed
 electronic employee • The suggestion box is reviewed daily by the sps manager.
 Suggestion Box      • The sps manager forwards suggestions to the manager of the area impacted for review and appropriate action.
                         • An exit review Form is provided to the departing employee prior to separation. The employee submits the
                           completed form via inner-office mail to doH Human resource management (Hr).
 exit review
                         • Hr reviews the form and informs the immediate supervisor of any issues that need to be addressed. The form
                           is then placed in the employee’s personnel file.
 Departing               • data from this survey is compiled and analyzed on a quarterly basis by sps.
 employee                • A report of the survey results are then forwarded to the emt for review and discussion and their next
 Survey results            scheduled emt meeting, at which time they determine what action is appropriate, if any.
                         • employee turnover data (a performance measure on mQA’s bsc) are compiled annually by the Human
 employee                  resource consultant within the director’s office.
 Turnover rates          • The results are then viewed by the emt and mt annually as part of the spp and action plans developed as
                         • data from doH and mQA employee satisfaction surveys are compiled on a quarterly, annual or bi-annual
                           basis by sps.
                         • The results from the surveys are forwarded to mQA’s emt, mt and mid-managers for review and discussion
                           at their next scheduled meeting, at which time they will determine what action is appropriate.
 Staff Meetings/         • This feedback is obtained during and after the meeting or retreat by the unit or bureau manager.
 retreats                • Action is taken as necessary.
                         • Absenteeism data is compiled and reviewed by the supervisor or manager of each bureau, unit or office.
 Absenteeism Data
                         • Action is taken on an individual or group basis by the supervisor or manager as appropriate
                         • mQA employees may file a grievance with the iG’s office. The iG’s office notifies mQA’s division director of
                           the grievance. The grievance is then entered into a secure database by the director’s office and forwarded to
 Grievances                the appropriate manager for review and response.
                         • Action may be taken as a result of recommendations made by the iG’s office and/or as deemed appropriate by
                           the director, bureau chief or manager

Category 5: workforce Focus – Page 30
                                                                                                   Division of Medical Quality Assurance

 Figure 5.2-1 Workforce Planning/Development Process                    5.2a(3) Managing and Organizing the workforce to
                                                                        Accomplish work
                           Business                                     mQA organizes and manages its workforce by bureau according to
                                                                        its three key processes (Figure O-1). each bureau capitalizes on core
                                                                        competencies through its recruitment, hiring and retention pro-
                Determine Skills, Scope, and                            cesses as described in Sections 5.2a(1) and 5.2a(2). customer and
               Number of Staff to Fulfull Need                           business focus is reinforced through training, division-wide recogni-
                                                                        tion of outstanding customer service, and performance targets and
                                                                        measures. customer focus is also reinforced in policies and proce-
                                   Develop Job Description              dures and through customer service training. For example, mQA’s
     and Retention                                                      policy on answering customer phone calls emphasizes “one stop
                                Advertise Postion on People
                               First and in Select Newspapers
                                                                        The management of mQA’s workforce to exceed performance
      Compensate                                                        expectations and to address strategic challenges and action plans
      and Reward                                      Interview         is achieved through performance evaluations and workgroups as
                                 Hire                 Applicants
                                                                        described in Section 5.1a(3), through mQA’s bsc, and through
                                                                        the annual, quarterly, monthly and weekly management meetings
                                                                        with the division director as described in Section 5.1b(2). These
      Performance                                          NEO
                                 Input                                  management meetings also help mQA achieve organizational agility
       Evaluation                                                       by facilitating frequent communication (Figure 5.1-1) on current
       and Results           • MVPFV                                    events and emerging issues that may impact mQA’s business needs
                             • Strategic Objectives
                               and Goals                                and strategic goals.
                             • Key Processes
      Training and           • Organizational Chart
      Performance                                                       5.2a(4) Preparation for Changing Capability/
        Standards                                                       Capacity needs and workforce reduction
                                                                        mQA prepares its workforce for changing capability and capacity
once hired, all new mQA employees receive organizational train-         needs through:
ing through the doH and mQA neos and participation in other
                                                                        •   strategic planning,
mQA meetings and workgroups. They receive job-specific training
                                                                        •   succession planning,
and coaching from their supervisors and co-workers. during the
                                                                        •   cross-training, and
first-year probationary period, the hiring manager continuously
                                                                        •   performance measurement.
evaluates whether or not the employee has received sufficient train-
ing and is a good match for both the position and the division.         mQA prepares and plans for changes in workforce capability and
                                                                        capacity needs as part of its spp and succession planning process.
to retain employees, mQA’s leaders create a culture that nurtures       These are active, five-year plans that are reviewed during weekly emt
personal and professional growth. This culture is supported by pro-     and monthly mt meetings. Actions taken as a result of changes or
moting cross-training, career development opportunities, the abil-      identified gaps in workforce capability or capacity may include pro-
ity to work flex schedules to accommodate educational or personal       viding new training to employees, cross-training, and deploying
needs, continuous participation in process improvement workgroups       employees to other work units, or recruiting new employees. mQA
and other activities, as well as consistent sharing of information in   also ensures continuity and prevents and/or prepares for workforce
all directions. As state employees, mQA employees receive a broad       reduction by measuring and reporting workforce performance to
range of benefits and services designed to support employees.           justify current and future job positions. in spite of a tight budget
                                                                        environment, mQA has been able to receive legislative approval for
                                                                        new positions and avoided workforce reductions based upon its abil-
to ensure that mQA new employees represent the diverse ideas, cul-      ity to demonstrate data-driven workforce needs.
tures and thinking of the community, mQA recruits through the
people First website as well as through local and/or minority news-
paper advertising. mQA may also include special skills in their job
                                                                        5.2b workforce Climate
criteria when necessary. For example, mQA’s miami and tampa field       5.2b(1) workforce health, Safety and Security
offices may include bilingual language skills in the job criteria for
                                                                        mQA ensures and improves workforce health, safety and security
their inspector and investigator positions to meet the needs of the
                                                                        systematically through the doH employee wellness program, the
Hispanic and creole communities in their areas.
                                                                        doH safety committee, the mQA platinum odyssey employee
                                                                        safety and well being workgroup, the mQA wellness coordina-
                                                                        tors, and mQA’s coop. The doH employee wellness program

                                                                                                  Category 5: workforce Focus – Page 31
Division of Medical Quality Assurance

• weekly Garden market: provides fresh organic fruits, vegetables           the health and exercise needs for each workplace environment are
  and flowers from local farmers                                            being met. mQA also provides accommodation to ensure ergonom-
• lunch & learn seminars: a one-hour informational session                  ics by providing such things as glare-free computer screens, adjust-
  during lunch                                                              able chairs and hands-free phone sets.
• pedometer loan program: 6-week challenge for employees to
  track and increase their steps and overall wellness.                      mQA’s coop, which is discussed fully in Section 6.1(c), establishes
• take the stairs campaign: Uses stairway artwork to encourage              policy and guidance to ensure execution of mission essential func-
  stairway use.                                                             tions, including relocation of personnel and resources to alternate
• Healthy meetings: promotes healthful eating at worksite                   facilities capable of supporting operations.
• Group Fitness: offers weekly fitness classes to employees.                performance measures for workplace health, security and safety for
• A mother’s place: An intimate room set aside for nursing                  all employee groups include worker’s compensation claims, safety
  mothers.                                                                  inspections and percentage of employees who agree that their office
The doH safety committee, made up of all division safety coor-              supports their efforts to engage in healthy behavior.
dinators, meets on a quarterly basis and is responsible for preventing
and reducing on-the-job accidents and injuries by focusing on edu-
                                                                            5.2b(2) workforce Policies, Services and Benefits
cation and training, analysis of worker’s compensation incidents and
recommendations for a safer environment. They are also trained in           mQA supports its workforce through a wide array of policies, ser-
cpr, First Aid, and blood pathogen Awareness and are responsible            vices and benefits. These are illustrated in Figure 5.2-2. The benefits
for deploying safety evacuation plans at each location, as well con-        listed in the table are provided to all full-time employees. The ben-
ducting facility and office inspections.                                    efits are broad and extensive to appeal to all categories and types of
                                                                            employees in the workforce.
safety violations are identified and corrective actions are taken as
appropriate. mQA’s safety coordinator meets with and contacts                Figure 5.2-2 employee Benefits and Services
mQA’s safety wardens (one for each unit) on a regular basis to share         Category         Services
the latest health and safety information and improvement goals.
                                                                                              • low-cost comprehensive health insurance
mQA safety wardens are also responsible for disseminating safety
information and training to all mQA employees. enforcement field
                                                                                              • dental plan
personnel also receive additional safety and security training as part
                                                                                              • vision plan
of their annual training conferences.                                        health
                                                                                              • employee Assistance plan (eAp)
                                                                                              • sick leave
All mQA employees work in secure buildings and are required to                                • doH wellness program & mQA well being
wear id badges. in addition, security guards are contracted for most                            program
mQA facilities. to ensure doH security performance measures
and improvement goals, security companies are contracted to per-                              •   basic and optional life insurance
form annual preventative maintenance inspections and to repair and                            •   long-term disability insurance
upgrade security equipment as needed. For example, in 2005, all                               •   state retirement
mQA employees were required to obtain new id badges as a result of                            •   deferred compensation plan (457)
security system upgrades. Additionally, in 2006, isU hired an inde-                           •   pre-tax premium plan and flexible spending
pendent consultant to evaluate the safety of all field offices and inves-                         accounts (125)
tigative practices. isU subsequently formed a workgroup to review            Financial        •   medicare supplement and life insurance plans
and implement the consultant’s recommended supplemental safety                                    for retirees
and security measures. examples of recommendations implemented                                •   direct deposit
are: encouraging partnering up when conducting inspections or field                           •   payroll deductions
interviews and adding security cameras to specified office locations.                         •   credit union and discounted banking services
                                                                                              •   Florida prepaid college plan
                                                                                              •   Florida college investment plan
The mQA platinum odyssey employee safety and well being work-
group, which meets on a quarterly basis, addresses health and safety                     •      Flexible work schedules
issues and improvement goals; recommends and implements pro-                             •      telecommuting options
cess improvements; and coordinates and promotes health and safety                        •      Generous annual leave plan
training. For example, the safety subcommittee of this workgroup             work        •      sick leave pool and donations
revised and updated all safety and security related policies and forms,      environment •      compensatory time plans for FlsA exempt
requested additional funds for providing first-aid kits and storage                             employees
clipboards to all safety wardens, and coordinated security and per-                           • doH safety committee & mQA safety
sonal safety training with the Fdle capitol police. in addition, the                            subcommittee
employee well being subcommittee implemented the well being                                   • tuition waiver and reimbursement plan
program. each bureau and unit now has a well being coordina-                                  • cpm program
tor who is responsible for addressing health issues and coordinating
exercise and other health programs within their areas, ensuring that

Category 5: workforce Focus – Page 32
                                                                                                                   Division of Medical Quality Assurance

cAteGorY 6: process                                                      Figure 6.1-1 MQA’s Core Competencies
                                                                           Core     example of a related Action Plan
mAnAGement                                                               Competency
6.1 work Systems Design                                                                                  research efficient ways to close cases prior to
                                                                                                         probable cause.
6.1a Core Competencies                                                                                   study cost effectiveness of Adr to determine

                                                                                health Care regulation
6.1a(1) Determining Core Competencies                                                                    future course of action.
mQA’s core competencies are determined, reviewed, and revised                                            perform study to determine if citations are being
through the swot analyses during steps 2 and 3 of the spp (Figure                                        utilized whenever rule allows.
2.1-1). The field of health care regulation is complex. mQA’s core                                       develop a process for substantiating violations of
competencies represent its areas of greatest expertise and drive the                                     statute before presentation to the probable cause
success of the organization. mQA knows its business and maintains                                        panel.
its competitive advantage through:                                                                       develop training program for probable cause
1) leadership;                                                                                           panel members to educate on disciplinary
2) identifying and meeting customers’ needs; and                                                         options.
3) Health care regulation.                                                                               eliminate renewal notices and move to generic
each of these core competencies is aligned to mQA’s mvpFv, key                                           renewal postcard.
processes and strategic objectives through its spp. mQA recruits                                         develop process for centralized processing of

leaders and managers that possess the leadership core competency by                                      public records requests to include quality review.
assessing their problem solving skills, financial management acumen,
                                                                                                         monitor performance weekly by profession.
ability to manage and standardize work processes, and manage by
data. All core competencies are reflected in job announcements,                                          develop division succession plan.
position descriptions, training, division-wide meetings, and in the
                                                                                                         determine if fees are at an acceptable rate.
succession plan.
                                                                                                         develop online licensure tools that allow appli-
mQA is considered a national leader in health care regulation as                                         cants to check the status of their application for
demonstrated by numerous national awards and leadership roles in                                         licensure.
various health care regulation federations. in the competitive envi-                                     develop online licensure applications.
                                                                            identify and Meet
                                                                            Customers’ needs

ronment, mQA’s core competencies ensure its three key customer
groups’ needs are met. Health care licensure applicants are expedi-                                      place pre-populated renewal notice online under
tiously licensed because the workforce has standardized processes                                        practitioner login for those licensees that may
and manage by data. Health care practitioners are regulated effi-                                        want to print and mail in.
ciently and cost effectively because of the regulatory knowledge pos-
                                                                                                         develop centralized database for tracking public
sessed by mQA’s leaders and workforce. Health care consumers are
                                                                                                         records requests.
able to make informed decisions using mQA’s wealth of health care
practitioner data because mQA is adept at determining and meeting                                        expand online services to allow practitioners to
their needs.                                                                                             renew their delinquent license online.
                                                                        and systems and how they are to be accomplished. This process is
when developing and implementing strategic action plans, mQA            available to leaders and managers on the mQA intranet.
relies upon its core competencies. mQA’s core competencies and
examples of related action plans are shown in Figure 6.1-1.             mQA’s tier 1 Governance committee (mQAGc), comprised of the
                                                                        emt and business manager, provides a formal voting structure to
6.1a(2) work System Design                                              ensure alignment of all the division’s work system technology needs
                                                                        to it strategic goals and resources. The committee meets the second
mQA systematically designs and innovates its work systems through
                                                                        and fourth Thursday of each month to review, prioritize, and approve
its spp. mQA’s suppliers, partners and collaborators are critical to
                                                                        it work system projects. The committee relies upon the division’s
how well its key processes are accomplished and in how it creates
                                                                        sp and thoroughly defined systems requirements to make decisions.
value for the services it provides. The work of mQA is accomplished
                                                                        The systems requirements documents require definition of customer
through its workforce, key partners, suppliers, contractors and col-
                                                                        needs and include input of stakeholders, and follow established it
laborators, such as its contracted vendors and it. internal work
                                                                        standards and enterprise-level perspectives.
processes and external resources are coordinated through policies
and procedures and desk guides, process mapping and analysis, pre-
governance systems requirements definitions, project management         trained project managers use project management tools, such as ms
tools, implementation plans, and contract monitoring.                   project and visio, to create work plans, map and analyze processes,
                                                                        and develop implementation plans to design, improve, and innovate
                                                                        work systems.
mQA has a clear and concise process for creating and revising poli-
cies and procedures that document and standardize work processes

                                                                                                              Category 6: Process Management – Page 33
Division of Medical Quality Assurance

contract monitoring by mQA’s certified contract managers ensures           online surveys. it has been ranked nationally as one of the best in the
suppliers and collaborators are helping mQA succeed in deliver-            nation – user-friendly and informative.
ing its products and services to its customers. For example, image
Api, a key supplier, helps mQA achieve its key process of licensure.       profitability in mQA equates to reasonable cash balance to operate.
Through daily, monthly, quarterly, and annual monitoring and plan-         All costs of regulating health care practitioners are financed solely by
ning, errors are mitigated and avoided, costs are managed and in           licensees and licensure applicants in the form of licensure fees and
some cases reduced, and customer needs are met.                            fines. work systems, such as the database that manages practitioner
                                                                           profiling, are designed to support key processes within budget con-
The decision to use internal systems versus external resources involves    straints and with the strategic goal of fiscal soundness in mind.
a systematic cost-benefit evaluation. is the work system being evalu-
ated a key or support process? Has the process been mapped? can            mQA establishes sustainability and, consequently accountability
a cost per delivery unit be determined? does the law allow the divi-       to the legislature, through its sp and with pre-governance systems
sion to delegate the authority or responsibility for the work system?      requirements definitions, implementation plans, process mapping
Finally and most importantly, what are the customer’s needs and            and analysis, policies and procedures, desk guides, chartered work-
expectations? Using this process, mQA has had no failed external           groups, project management, statements of work, and needs-assess-
resource initiatives.                                                      ments surveys.

external resources may support key processes and work systems more         to further promote sustainability, sps was created by the emt to
efficiently or less expensively. A series of questions, however, must be   provide infrastructure support to the division’s key processes. sps’
answered before the decision is made to use external resources. is         charter sets forth its reason for existence: management of the mQA
the business process standardized? Are there established performance       sp; project management; process mapping and analysis; training and
measures and standards? can a real cost savings be identified? is the      staff development; development and management of performance
transition seamless to mQA’s customers? An outsourcing decision            measures; sterling development; customer survey development and
in which the answers to the questions were “yes”, was the contract-        analysis; and oversight of marketing campaigns.
ing of the administration of the clinical dental hygiene examination
with the northeast regional board of dental examiners (nerb),              by aligning key processes, core competencies and the sp, mQA’s suc-
effective January 2008. nerb demonstrated a real cost savings to           cess is defined, measured and continuously improved. The practitio-
the candidate over time, consistency and congruency between both           ner profile receives over 1.5 million hits per year—a measure of its
examinations, and that customer service standards would be met.            value to customers and an indicator of mQA’s success in implement-
                                                                           ing one of its many programs. mQA’s measures of its performance,
6.1b work Process Design                                                   continuous improvement, and responsiveness to customer needs,
                                                                           ensures organizational success through legislative support of mQA
6.1b(1) key work Processes                                                 programs and innovations.
mQA’s key work processes, licensure, enforcement, and informa-
tion, and the corresponding support processes were identified
                                                                           6.1b(2) work Process requirements
through swot analyses. samples of related customer requirements
and measures are shown in Figure 6.1-2. mQA’s core competencies            mQA’s key work process requirements are identified through the
ensure the key work processes are competitive. For example, mQA’s          spp and derived from incorporating customer, supplier, partner,
core competency of leadership provides the ability to manage and           and collaborator feedback using the listening and learning methods
standardize process results in expedient licensure and reliable data       previously described in category 3. simply stated, licensure requires
for more than 40 professions.                                              timeliness, convenience, and quality; enforcement requires timely
                                                                           resolution and alternative methods for resolving complaints; and
The key work processes deliver customer value because mQA is the           information requires timeliness, accessibility, and quality. mQA key
primary source of health care licensure, enforcement, and informa-         processes are designed to meet these requirements.
tion in Florida. mQA’s key work processes are designed to meet the
needs and expectations of its customers gathered through the learn-        mQA’s website provides a specific example of how customer input
ing and listening methods previously described in Category 3. The          was used to determine key work process requirements. A gap was
information is used to review and improve products and services to         identified between what customers need and what mQA provides
increase customer value and ensures the sp is sustainable and agile.       with online licensure services. Through customer feedback, mQA
For example, practitioner profiling uses all core competencies, repre-     learned licensees need a temporary license to show proof to their
sents a work system designed around mQA’s three key processes that         employer of a timely renewal. with customer input into design, the
delivers a product that customers value, and incorporates input from       online services were expanded to include the capability to print a
customers and partners. The sp incorporates goals and action plans         temporary license.
specific to providing timely and accurate information (strategic goal
1.3 on the bsc, Figure 2.1-3).                                             customers, suppliers, partners, and collaborators participate in
                                                                           meetings and/or workgroups to determine if modifications in on-
The practitioner profile has evolved into a more accessible and cus-       going processes are warranted. This input is systematically solicited
tomer-friendly tool using customer feedback from focus groups and          in different ways for different processes. For example, mQA surveys

Category 6: Process Management – Page 34
                                                                                                                                Division of Medical Quality Assurance

 Figure 6.1-2 MQA’s key work Processes and Sample Support Processes
 Bureau/                     Core         key work                                                              Sample Support
                                                                                  requirements                                               Sample Measures
  Office                  Competencies    Processes                                                                Processes
                          • leadership                                 • engaged and satisfied employees       workforce              % of employee satisfaction
      Director’s Office

                          • identifying                                                                        management

                            and meeting                                                                                               % of employee turnover
                            needs                                                                              strategic planning     % of action plans complete
                          • Health care
                          • leadership                                 • timely application processing       license Health care      Average # of days to issue an
regulation (hCPr)
 Bureau of health
 Care Practitioner

                          • identifying                                • Qualified health care practitioners practitioners            initial license
                            and meeting      licensure                 • Quality customer service
                            needs                                                                                                     % of complete initial licensure
                          • Health care                                                                                               applications approved or denied
                            regulation                                                                                                within 90 days

                          • leadership                                 • timely resolution of complaints     compliance               % of cases offered for Adr
                          • identifying                                • timely resolution of                monitoring               resulting in successful resolution


                            and meeting                                  investigations
                            customers’                                 • Qualified health care practitioners investigations           % of initial investigations and
                            needs                                      • Quality customer service                                     recommendations as to the
                          • Health care                                                                                               existence of probable cause
                            regulation                                                                                                completed within 180 days of
                          • leadership                                 • online access to information          call center            Average time (in seconds)
Services (BMS)

                          • identifying                                  about health care practitioners                              customers are waiting in the

  Bureau of

                            and meeting                                • Quality customer service                                     queue
                            customers’                                                                         public records         Average # of days to fulfill a
                            needs                                                                              requests               public record request for license
                          • Health care                                                                                               application file
                          • leadership                                 • timely renewal of license             renewals, supplier     % of licensees renewing online;
                                             licensure & information
  Bureau of Operations

                          • identifying                                • online access to license              (contract vendor)      image Api accuracy rate
                            and meeting                                  information                           monitoring and
                            customers’                                 • timely receipt of examination         management

                            needs                                        scores                                online services     % of external customers satisfied
                          • Health care                                • Qualified health care practitioners   development         with services provided by mQA
                            regulation                                 • online access to information          and maintenance
                                                                         about health care practitioners       (information system
                                                                       • Quality customer service              management)

association members, board executive directors, board chairs and                                   testing and revision involving customers and workforce occur. This
members, and psU staff at the board chairs Annual meeting. mQA                                     ensures the product or service meets identified needs and aligns
also surveys association members and board executive directors at its                              with strategic goals. mQA develops innovations and addresses gaps
annual Association long range planning meeting.                                                    through the dmAic method (Figure 6.1-4) when opportunities
                                                                                                   for improvement are identified, when requirements change, or when
communication with stakeholders allows mQA to determine                                            research identifies best practices. see Section 4.2a(4), physician
needed improvements, implement feasible changes with the current                                   workforce survey, for an example of dmAdv method in action.
technology, and prepare for future improvements through its spp.                                   new technology, organizational knowledge, and agility are all incor-
mQA’s key work process requirements are listed in Figure 6.1-2.                                    porated into the design of mQA’s products, processes, and services.

6.1b(3) work Processes Design                                                                      strategic planning (swot), legislative implementation plans, and
                                                                                                   customer feedback are among the tools used to keep technology
new or radically redesigned products, processes, or services are                                   current. new technology identified as the solution for work process
designed to meet all key requirements through the dmAdv method                                     needs through the governance process (Sections 4.1b(2), 4.2a(2)
(Figure 6.1-3). before a process is implemented, multiple phases of

                                                                                                                         Category 6: Process Management – Page 35
Division of Medical Quality Assurance

 Figure 6.1-3 DMADV Method                                                is available on what part of the process is causing delays. process
                                                                          improvements are focused on the process segment that accounts for
 D define the project Goals and customer deliverables                     the problem and the design is reengineered.
      measure and determine customer expectations and
      specifications                                                      two examples of work process design that met key requirements,
   Analyze the process options to meet customer                           incorporated new technology, organizational knowledge, cost sav-
   expectations                                                           ings, efficiency, agility and cycle time were the nursing license crimi-
      design the new product, service, or process to meet                 nal background screening project and the board meeting electronic
 D                                                                        agenda (Sections 4.1a(1) and 4.2b(2)).
      customer expectations
      verify the design performance and Ability to meet
 V                                                                        with the former, the process owner identified a gap between the
      customer expectations
                                                                          performance standard, average number of days to issue a nursing
 Figure 6.1-4 DMAiC Method                                                license, and actual cycle time. Through process mapping, criminal
 D define the project Goals and customer deliverables                     background screens were identified as a significant factor in the gap.
                                                                          staff with organizational knowledge defined the problem, measured
 M measure the process to determine current performance                   the cycle time for each step in the licensing process, researched best
 A Analyze the specific problem for root causes                           practices and new technologies, and implemented a new technology
  i   improve the process with lasting solutions                          solution that achieved desired results. criminal background screens
                                                                          that had taken 6-8 weeks now take 48 hours.
 C control Future process performance
and 6.1a(2)) is tested and implemented through sss. Their relation-       with the latter, the process owners defined a problem. The board
ships with contracted vendors and with other agencies and organiza-       offices were copying and mailing massive numbers of documents to
tions help them keep current on technological developments. The           each board member prior to a board meeting. Through research into
design process requires benchmarking and research into best prac-         best practices and technology innovation, a vendor now performs
tices. For example, sss learned that web-based business solutions         the function by scanning the case documents onto one dvd at a
(online services) are a major focus of regulatory agencies across the     cost of $20 per board member versus $100 per board member. The
nation. This affords many opportunities to share technology expe-         agility of this innovation was ensured by systematic feedback (board
riences. As a result of benchmarking and research, mQA recently           member surveys) and through diligent contract monitoring. The
piloted an online licensure evaluation tool for applicants to verify      innovation has served as a best practice nationally.
qualification for a Florida license. The expected results defined
during the governance process is more timely licensure.
                                                                          6.1c emergency readiness
organizational knowledge is incorporated into the design of pro-          mQA adopted a coop that establishes operational procedures to
cesses by systematically soliciting input from process owners at emt      sustain priority services and critical business applications if normal
meetings, management retreats, and through chartered workgroups           operations are suspended due to actual or threatened emergen-
representing a cross-section of employees with the needed competen-       cies, disasters, or hazards. The priority services are developed and
cies and expertise. The statements of work used by sps to establish       prioritized by the emt based on the need to provide vital services
and track projects are the critical tool used to ensure organizational    and exercise mQA’s statutory mandates. Applications, equipment,
knowledge is incorporated into the design of work processes.              systems, vital records and data required to accomplish each prior-
                                                                          ity service are also identified. services that are not deemed mission
The need for agility is acknowledged and incorporated into pro-           critical are deferred until additional personnel and resources become
cess design by requiring that processes have a means of monitoring        available. The following emergencies, disasters, or hazards are identi-
changes in customer requirements. The primary sources of on-going         fied as those with the highest probability of impacting or occurring
feedback are through online customer satisfaction surveys that are        in mQA offices: fires; tornados/severe weather; hurricanes; gunfire/
continuously tracked for trends by sps. if comments, requests, or         armed assaults; barricades/hostage situations; bomb threats/explo-
complaints indicate changing requirements or if in-process or out-        sive devices; biological hazards; acts of terrorism; and suspicious
come measures move in the wrong direction, sps will analyze the           packages.
data and a process improvement initiative will occur. Agility is also
incorporated into process design through the development of desk          coop also provides for the relocation of selected personnel and
guides that make it easy to cross-train staff and manage increased        functions and guides the restoration of a building’s full functions.
workflows.                                                                The determination of the alternate relocation point will be made at
                                                                          the time of activation and based on the incident, threat, risk assess-
design quality, including the ability to meet cycle-time standards,       ment, and execution timeframe. to ensure the adequacy of assigned
efficiency, and cost, are addressed through the development of mea-       space and other resources, potential relocation offices are pre-deter-
surable specifications, not only for the entire process cycle, but also   mined and reviewed annually. The alternate locations are all mQA-
for sub-processes. monitoring these performance measures enables          leased facilities and are equipped with connectivity to the doH
design refinements if cycle-time performance is not up to standard.       network, which provides access to the intranet, internet, licensee
if the system design does not perform to specification, detailed data     database and other essential applications. each operating unit within
                                                                          mQA has a coop liaison, who is responsible for managing the

Category 6: Process Management – Page 36
                                                                                                        Division of Medical Quality Assurance

unit’s plan of continuity and drive-away kit. each kit includes sup-        saving days off the processing time. A focus group will provide nec-
plies, equipment and other logistical support currently being used in       essary feedback to refine the process before expanding the service to
the primary facility that would need to be relocated to an alternate        all licensure applicants. This project is aligned with mQA’s strategic
site in the event of inaccessibility of the primary site. This listing is   goal to expeditiously license health care practitioners while ensuring
included in the individual unit’s coop.                                     they meet legal requirements.

in the event of a disaster or emergency that affects one or more of         day-to-day operation of work processes is managed by monitor-
the field offices, staff will telecommute from their homes. The essen-      ing and oversight of performance measures relative to key process
tial duties of the field staff are conducted outside of the office. each    requirements. For example, bms uses inter-tel tAsKe monitoring
investigator is equipped with a laptop computer that is configured to       system software to monitor process performance in the call center.
connect to the doH network.                                                 The software monitors wait times, length of calls, and operator avail-
                                                                            ability to ensure customer service targets related to queue times are
in 2006, doH also established a permanent toll-free automated               met. when necessary, additional staff members from other areas are
message line for its employees to report general building and area          called in to assist.
information or post instructions during emergency or coop
events. The mQA coop is available to all employees on the mQA               customer, supplier, partner and collaborator input is used in man-
intranet and is flexible and subject to modifications whenever pro-         aging processes through various means, such as survey results, cus-
grammatic changes (facilities, human resources, technology, fund-           tomer feedback, data analysis, meetings, contract monitoring, regular
ing, etc.) occur.                                                           reviews of business processes, internal audits, and daily interaction.
                                                                            The input is reviewed to identify any gaps and/or opportunities for
pre-disaster planning, managed by doH and the office of emer-               improvement. For example, mQA employees are regularly encour-
gency operations, is continuously updated, evaluated, and exercised         aged to provide feedback on the organization’s operations through
through a series of workshops to ensure operational readiness. train-       various sources, such as the mQA neo six-month follow-up, chats
ing and exercise activities include performing fire drills and activat-     with lucy, and an anonymous online suggestion box. Also, the
ing call tree lists. mQA also encourages its employees to establish a       miami isU is currently piloting a bilingual survey to assess customer
personal/family preparedness plan prior to the start of and during          satisfaction with routine pharmacy and dispensing practitioner
hurricane season through division-wide emails. doH General ser-             inspections in the miami-dade area.
vices and the division of management services (dms) conduct
routine inspections at the doH/capital circle office complex                mQA’s key performance measures, including in-process measures,
(ccoc) facilities to ensure security, intrusion and fire alarms are         used for control and improvement of key work processes, are listed
in place and surveillance measures are operational. mQA ccoc                in the bsc (Figure 2.1-3). All key process measures are reviewed
safety wardens also perform unofficial random office inspections.           during emt meetings to ensure the organization is achieving its
offices with reported deficiencies are required to immediately cor-         strategic objectives. Additionally, managers and their units review
rect the problem. Generators are tested by it on a regular schedule         unit-specific measures during monthly meetings to ensure perfor-
to prepare for emergencies. mQA satellite offices located outside of        mance targets are met and to identify gaps. process owners can then
ccoc, and not maintained by dms, conduct their own facility                 analyze the identified process or review new and improved processes
inspections. The appointed facility manager in the satellite office         for effectiveness in design. Also, monitoring and oversight of some
usually performs the inspection while the isU safety warden assists.        performance measures through daily productivity reports, such as
                                                                            the licensure error report, ensure key process requirements are met.
6.2 work Process Management and improvement
                                                                            6.2a(2) Minimization of Process and Performance
6.2a work Process Management
                                                                            Audit Costs
6.2a(1) work Process implementation                                         mQA minimizes costs associated with process and performance
mQA implements work processes to ensure they meet design require-           audits by utilizing internal (doH and mQA) resources to the
ments through the use of the dmAdv method (Figure 6.1-3). As                extent possible to review processes, assist in standardizing proce-
part of this process, design requirements are tested and measured           dures, identify and eliminate duplicative and/or non-value added
prior to full deployment via a pilot phase tested by users, which           steps, and ensure quality. For example, the enforcement managers
allows for feedback and improvements to be made prior to orga-              utilize a Quality review process (Qrp) that specifically audits inves-
nization-wide implementation. The process also includes identifica-         tigative reports to ensure consistency with report writing standards.
tion and assignment of ownership for key processes, determination           boo utilizes electronic surveys created by sps to solicit feedback
of key requirements, mapping, measuring and monitoring perfor-              from health care practitioners on the online renewal process. mQA
mance and identifying and acting upon improvement opportunities.            requested the iG’s office to audit the organization’s licensure system
For example, the online initial Application project has been an 18-         to test for potential error and redundancy, to improve security and
month effort to automate and streamline the application process for         eliminate identity theft, and to audit the organization’s trust fund to
registered nurses and licensed practical nurses applying for licensure      look at various management tools and recommend opportunities for
in the state of Florida. This new tool, effective July 1, 2008, gath-       improvement.
ers all of the application information online and uploads it to the
licensing system for processing, eliminating manual data entry and

                                                                                                  Category 6: Process Management – Page 37
Division of Medical Quality Assurance

mQA prevents errors, rework, and productivity losses in several           earlier. The workgroups define and analyze the problem, establish
ways. employees are involved in the development of processes and          measures, and develop implementation plans and feedback mecha-
the monitoring of in-process measures. many manual processes              nisms. two examples of dmAic-driven key and support process
have checklists and sign-off documents to ensure compliance. desk         improvements follow.
guides are updated and processes are mapped whenever new pro-
cesses are designed or existing processes are updated and are used        mQA identified and defined a problem with one of its key pro-
as training tools. internal and external audits help to identify errors   cesses—licensure renewals. legislatively-mandated budget reduc-
and the potential need for process improvements based on results.         tions and the inability to achieve performance targets for online
certain restrictions have been placed in compAs to eliminate              renewals necessitated a process improvement. The measures for
some manual errors, such as entering future and past dates for when       determining gaps and successes were a 4% reduction in contracted
a licensure application is received. employees use the sss ticket-        services expenses and a 20% increase in practitioner online renewal.
ing system to report issues with data integrity, system operation         The solution that was approved and implemented was to substitute
and to request needed enhancements. customers can submit com-             a postcard with instructions for online renewal for the more costly
plaints, concerns or suggestions through the online customer ser-         mail-in renewal application. control of the process improvement
vice system. employees can submit suggestions or concerns through         was achieved through weekly statistical reports comparing prior
the employee suggestion box. These are all methods used to identify       years’ renewal rates to current and customer and collaborator feed-
issues that negatively impact the efficiency, validity, and reliability   back. mQA demonstrated agility in meeting customer needs when
of mQA’s key work processes. information received through these           one customer group, dentists, was showing a slow rate of renewal.
methods is tracked by sps in a centralized database. The sps man-         The website was modified and additional notifications were sent out
ager coordinates any necessary corrective action plans to identify the    by mQA’s collaborator, the Florida dental Association.
issue, determine the scope, and fix the problem. A final report is
presented to the division director. Also, to centralize tracking and      A problem identified in the key support process of workforce man-
reporting of image Api processing errors, mQA worked with its             agement lent itself to the dmAic method. The 2006 doH ess
supplier to implement an online error tracking system. The system         showed an unsatisfactory rating of the question “i observe fair treat-
allows mQA staff to report processing errors made by image Api,           ment of each employee in my work unit.” A workgroup was formed
who in turn provide mQA with processing error summary reports             to determine the cause and identify measures and improvement
that can be used to ensure that image Api is meeting its contracted       action plans that addressed hiring, performance standards, employee
98% accuracy rate requirement.                                            recognition, and discipline. As a result, employee satisfaction in this
                                                                          category improved from 55% to 71%.
6.2b work Process improvement
mQA improves work processes by creating work systems that solicit         work processes are improved and kept current with business needs
process improvement ideas and suggestions; that reduce variability        and directions through a variety of systematic methods described
through standardized work processes; and that measure the success         in category 3, through the dmAic improvement process, bench-
of its products and services. improvement suggestions are systemati-      marking, sharing of best practices, and from information from key
cally solicited through the mQA intranet suggestion box, chats with       vendors.
lucy, the enforcement Alert, the erp, sps service request form, and
customer feedback surveys.                                                improvements and lessons learned are shared via weekly and monthly
                                                                          bureau and division meetings, the mQA intranet page, the erp,
dmAic-structured improvement projects have been instrumental in           and promotion of the dpA. mQA facilitates sharing by creating a
helping the organization achieve key and support process improve-         culture that celebrates innovation (erp) and encourages employee
ments. mQA used pdcA (plan-do-check-Act) through 2005 until               involvement. The mQA intranet, email system, chats with lucy,
dmAic (Figure 6.1-4) was adopted as a more systematic model to            sharepoint, and newsletters make it easy for employees to share les-
improve process performance, reduce variability, improve products         sons learned and drive organizational improvement and innovation
and services, and keep processes current. mQA charters workgroups         throughout all levels of mQA.
to address areas of improvement generated from sources identified

Category 6: Process Management – Page 38
                                                                                                         Division of Medical Quality Assurance

cAteGorY 7: resUlts                                                       Figure 7.1-4 shows the percentage of licensed health care practi-
                                                                          tioners and regulated facilities that renewed their license by using
7.1 Product and Service Outcomes                                          mQA’s online system. The performance of this measure has been
                                                                          targeted because online renewals cost less to process and the service
7.1a Product and Service results                                          improves accessibility and convenience for health care practitioners,
mQA examines its performance levels relative to competitors and           one of mQA’s key customers. This is bsc measure
other organizations who: 1) are top performers; 2) perform health
                                                                                          Percentage of Licensees Renewing Online
care regulatory functions; 3) perform other regulatory functions;
4) perform similar functions; and 5) are of a similar size (Section                 80
                                                                                    60                                                     70
                                                                                                                            65                  Target

Figure 7.1-1 shows the percent of complete initial health care prac-                40                                                           50%
                                                                                           49                    59
titioner and regulated facility licensure applications approved or                                  43
denied within the 90 day statutorily mandated timeframe. prior to                   20
FY 07/08 when compAs was modified to capture the data, indi-                                                                                    Good
vidual board offices manually monitored applications to ensure they                                                              16
did not exceed the 90-day timeframe. This is bsc measure                         FY        FY         FY            FY   Projected
  Licensure Applications Approved or Denied Within 90 Days                               04-05     05-06      06-07         07-08 FY 08-09
                                                        Target                              MQA          Similar Function Within State
     80    99.7      99.8     99.8 99.8 97         100 100%

     40                                                                   Figure 7.1-5 shows the average number of days to issue a Florida
     20                                                                   nursing license. This measure was created in 2003 to address the
      0                                                                   statewide nursing shortage. data collected from 2003 through 2007
        Quarter 3 Quarter 4 Quarter 1 FY 07-08 Projected
                                                                          reflect the timeframe to issue a temporary nursing license while wait-
        FY 07-08 FY 07-08 FY 08-09               FY 08-09
                                                                          ing for a criminal background check. in 2007-2008, mQA initiated
                MQA                  Best in State
                                                                          the digital fingerprint background check, resulting in much quicker
Figure 7.1-2 shows the average number of days to process initial          background results thus eliminating the need for temporary nursing
licensure applications from receipt to approval or denial. compAs         licenses. targets for this measure were set based on the temporary
was modified in FY 07/08 to begin capturing this measure. This is         license process. This is a measure that is reported annually to the
bsc measure                                                      legislature for which targets are set at least two years in advance
                                                                          and cannot be changed. Future targets will be set based on the new
Average Number of Days to Process an Initial Licensure Application        process.
  50                                                       Target                    Average Number of Days to Issue a Nursing License
  40                                         47           30 Days
  30                                                                           100                                                    92

  20                                                  30
  10      20       18         19        19                                          80
   0                                                                                60                                                          Good
      Quarter 3 Quarter 4 Quarter 1       FY      Projected

       FY 07-08 FY 07-08 FY 08-09 07-08 FY 08-09                                    40                                           31             Target
    MQA         Out-of-State Regulatory Agency of Similar Size                                              24
                                                                                    20    15      12                   15                   15 15 Days
Figure 7.1-3 shows the average number of days to issue an initial                   0
license. data includes all professions and the measure starts from                        FY      FY        FY         FY         FY Projected
the time an application is received until the license is issued. some                    03-04   04-05     05-06      06-07      07-08 FY 08-09
professions require more information be included with the applica-
                                                                                     MQA          Out-of-State Nursing Agency of Similar Size
tion, i.e. school transcripts. This may increase the average since the
measure is dependent upon the responsiveness of the applicant or
school. This is bsc measure                                      Figures 7.1-6, 7.1-7, and 7.1-8 show the timeliness of the enforce-
                                                                          ment process from the time a complaint is received through a recom-
               Average Number of Days to Issue an Initial License         mendation of probable cause. by law, the process must be complete
          80                                                              within 180 days. to manage the work, the performance targets are
                                                                Target    set for 3 key sub-processes: analysis, investigation, and recommenda-
                  57.3      61.5     66.2                 60   60 Days    tion of probable cause.

          40                                   52.2
          20                                                       Good   Figure 7.1-6 shows the percentage of complaints against health care
          0                                                               practitioners and regulated facilities that were analyzed for legal suf-
                Quarter 3 Quarter 4 Quarter 1 FY       Projected          ficiency within 10 days.
                FY 07-08 FY 07-08 FY 08-09 07-08       FY 08-09

                                                                                                                      Category 7: results – Page 39
Division of Medical Quality Assurance

                   Complaints Analyzed Within 10 Days                              Figure 7.1-10 shows the percentage of legally sufficient complaints
      100                                                                          that meet the guidelines designated by rule as minor violations for
       90                                                                 Target
                                                                                   which mediation was attempted and the complaint was successfully
                                   94          91             95           90%
                                                                                   resolved. This is bsc measure

       80          85
       70                                                                                      Percentage of Successfully Resolved Mediation Cases
       60                                                                                    100
                FY          FY          FY       Projected                                   80                                         91              90
              05-06       06-07        07-08       08-09                                             72                      76                               75%

Figure 7.1-7 shows the percentage of investigations of legally suf-                                            63
ficient complaints against health care practitioners and regulated                           40                                               52
facilities that were completed within 90 days.                                               20                                                              Good
                 Investigations Completed Within 90 Days
          100                                                                                 0
                                                                          Target                    FY        FY         FY              FY       Projected
                      97           93        95     92            95       90%                     04-05     05-06      06-07          07-08 FY 08-09

           70                                                                                              MQA                       Best in State
           60                                                             Good
            0                                                                      Figure 7.1-11 shows the number of complaints of the unlicensed
                   FY       FY                 FY        Projected                 practice of health care that were investigated. Unlicensed practice is a
                  05-06    06-07              07-08      FY 08-09                  criminal offense and poses a danger to the health, safety and welfare
                       MQA                     Best in State                       of the public. This is bsc measure

Figure 7.1-8 shows the percentage of legally sufficient complaints                                   Unlicensed Activity Cases Investigated
against health care practitioners and regulated facilities that were                         800                                  769
analyzed, investigated and received recommendations as to the exis-
                                                                                                                                          700 700 700 Target
tence of probable cause within 180 days of receipt. This is a measure
that is reported annually to the legislature for which targets are set                                               610                               676
                                                                                             600            572
at least two years in advance and cannot be changed. This is bsc

  Percent of Initial Investigations and Recommendations as to                                400   391
          the Existence of Probable Cause Completed
    90                                                                                       200
                                      93    93 92   95 90%

                      83      82
          70                                                                                  0
                                                                          Good                      FY      FY        FY           FY         FY Projected
                                                                                                   03-04   04-05     05-06        06-07      07-08 FY 08-09
                 FY         FY       FY      FY         FY Projected                               MQA               Similar Size Regulatory Agency
                03-04      04-05    05-06   06-07      07-08 FY 08-09
                           MQA                    Best in State                    Figure 7.1-12 shows the number of complaints of unlicensed activ-
                                                                                   ity in which an order to cease and desist practice was issued. This is
Figure 7.1-9 shows the percentage of legally sufficient complaints                 bsc measure
that meet the board and department rules setting forth minor viola-
tions for which mediation can be attempted. mediation is a cost-                                   Number of Cease and Desist Orders Issued
effective and timely way to resolve complaints to the satisfaction of                        250                          243
                                                                                                                                225        225 Target
both the licensee and the complainant.                                                                            195                           225
                      Percentage of Complaints Mediated

                                                         24               Target             150            134
          20                                                                                        109
                                             20                    22      20%

                                                                                             100                                                             Good
          10                13      14                                                        50                                                   33
                 10                                                       Good
           5                                                                                   0
           0                                                                                        FY    FY           FY      FY      FY Projected
                 FY         FY      FY       FY        FY          FY                              03-04 04-05       05-06 06-07 07-08 FY 08-09
                02-03      03-04   04-05    05-06     06-07       07-08                             MQA               Similar Function Within State

Category 7: results – Page 40
                                                                                                             Division of Medical Quality Assurance

Figure 7.1-13 shows the percentage of complaints of unlicensed             Figure 7.1-16 shows the total number of calls answered by the
activity in which an order to cease and desist practice was issued.        mQA call center to be used as a reference for Figures 7.1-17 and
             Percent of Cease and Desist Orders Issued                     7.1-18.
     40                                                                                     MQA Call Center Volume
                                                              Target                 Fy 04-05          Fy 05-06       Fy 06-07             Fy 07-08
     30                                                        32%
                                 32        32          32                            254,708           349,670         305,766             399,441

     20      28
                                                              Good         Figure 7.1-17 shows the average time (in seconds) customers spend
                                                                           in queue waiting to speak to a call center agent. This is bsc measure
                 FY         FY           FY        FY      Projected              Average Time Customers are Waiting in the Queue
                04-05      05-06        06-07     07-08    FY 08-09            1,000                                          896
Figure 7.1-14 shows the percentage of investigations of unlicensed               800                                      750

practice that were referred to law enforcement. because the unli-                600                                                     Good
censed practice of a health care profession is a criminal offense, com-               400
                                                                                                                                201             Target
plaints must be referred to law enforcement for criminal prosecu-                     200                  168
tion. This is a measure that is reported annually to the legislature                            39                   41                       45 45
for which targets are set at least two years in advance and cannot be                           FY          FY       FY           FY       Projected
changed. Future targets will be set based on trend data. This is bsc                           04-05       05-06    06-07        07-08     FY 08-09
                                                                                          MQA              Similar Size               2007 GSA
           Percent of ULA Cases Referred for Criminal Prosecution                                          Regulatory Agency          Winner
           50                      49
                                                                           Figure 7.1-18 shows the abandoned call rate for the mQA call
           40                                34              34   Good     center.

           20                                                                               MQA Call Center's Abandoned Call Rate
                                                                  Target             10
           10                                      6
                   2                                               1.5                                                                10       Target
            0                                                                         8
                FY 05-06     FY 06-07        FY 07-08     Projected                                          8                               9 8%
                                                          FY 08-09                    6

                 MQA                Similar Size Regulatory Agency                    4
Figure 7.1-15 shows the average number of days to fill public record                  2         3                           3
requests for license application files. This is an important measure of               0
mQA’s compliance with the Governor’s open Government initia-                                 FY             FY          FY             FY
tive. This is bsc measure                                                          04-05          05-06       06-07         07-08
                                                                                                     MQA                 Best in State
                Average Number of Days to Fulfill a Public
                Record Request for License Application File
                                   19.7                                    7.2 Customer-Focused Outcomes
                15.2                                        Good           7.2a Customer-Focused results
                         10.5                          10 Target           From 2002 – 2003 through 2006 – 2007, mQA determined cus-

                                             5.8             10            tomer satisfaction for its key customers using two surveys: new
           5                                                Days           licensee satisfaction (for licensed health care practitioners) and
           0                                                               candidate satisfaction (for licensure applicants). in 2007-08, when
                 FY         FY           FY        FY    Projected         information was identified as a third key process, another customer
                05-06      06-07        07-08    08-09 FY 08-09            satisfaction measure was added: public records request satisfaction
                                             through August                (for health care consumers).
Figures 7.1-16, 7.1-17 and 7.1-18 show call volume, wait times,
and abandoned call rate for the mQA call center. services pro-             in 2007-2008, mQA began calculating the overall customer satis-
vided by the call center are directly impacted by the volume of            faction rate using satisfaction data for new licensees, candidates,
calls. volume varies primarily with license renewal cycles. when a         and public records requests. For 2007-08, new licensee satisfac-
large profession is renewing, such as in 05/06 and 07/08, the volume       tion = 91%; candidate satisfaction = 95%; public records request
of calls and corresponding wait time increase. volume of calls can         satisfaction = 87%; overall customer satisfaction = 93% (bsc mea-
also increase when a new business process is implemented or when           sure mQA’s overall customer satisfaction rate of 93% for
a new law goes into effect. in 05/06 certified nursing assistants were     2007-08 exceeds its target of 90% and compares favorably with a
required to renew for the first time. in 07/08, postcard renewals were     2007 malcolm baldrige national Quality Award winner’s customer
first introduced.                                                          satisfaction rate of 94%. Figures 7.2-1 and 7.2-2:

                                                                                                                     Category 7: results – Page 41
Division of Medical Quality Assurance

    100                    New Licensee Satisfaction                                                 Candidate Satisfaction Segmented by Profession
                                                                   Target                                               Fy 06-07               Fy 07-08
                                 92        89         91 94     90 90%
          80                                                                  Profession                               Q3     Q4         Q1    Q2     Q3      Q4

                  85      83
          70                                                                  chiropractic                             n/a    89%        n/a   90%    n/a    92%
          60                                    67                            dental                                   91% 94%           n/a   n/a   95% 97%
          0                                                                   dental Hygiene                           n/a    93%        n/a   95%    n/a    95%
                FY         FY      FY       FY   FY Projected                 Hearing Aid specialist                   n/a    n/a    92%       n/a    n/a     n/a
               03-04     04-05 05-06 06-07 07-08 FY 08-09
                                                                              opticianry                               n/a    91%        n/a   91%    n/a    92%
              MQA         Out-of-State Similar     2007 Baldrige
                          Size Regulatory Agency   Award Winner               optometry                                n/a    n/a    95%       n/a    n/a     n/a
                                                                              OVerALL                                  91% 92% 94% 93% 95% 95%
     100                    Candidate Satisfaction                                                   n/a = examination not administered that quarter
          90                                                       Target
                                                                            mQA determines customer loyalty by the percent of “top box”
                  90      89     90        92         95 94     95 90%      responses to its new licensee satisfaction and candidate satisfac-

                                                                            tion surveys. in 2007-08, mQA added another customer loyalty
                                                                            measure, for public records requests, which had a “top box” percent
          60                          64        67                  Good    of 62%. An overall customer loyalty rate was calculated using
           0                                                                the loyalty data for new licensees, candidates, and public records
                FY         FY      FY       FY   FY Projected               requests. For 2007-2008, new licensee loyalty = 70%, candidate
               03-04     04-05 05-06 06-07 07-08 FY 08-09                   loyalty = 64%; public records requests loyalty = 62%; overall
              MQA         Out-of-State Similar     2007 Baldrige            customer loyalty = 67% (bsc measure mQA’s overall
                          Size Regulatory Agency   Award Winner             customer loyalty rate of 67% for 2007-08 exceeds the benchmark
                                                                            of 65%, which was set with a national corporation rated number one
new licensee satisfaction data segmented by profession is repre-            in its industry in customer loyalty. Figures 7.2-5 and 7.2-6:
sented in Figure 7.2-3. This figure displays segmentation by the
professions with the largest number of responses (10 or more). All                                                  New Licensee Loyalty
other professions with fewer than 10 responses are combined and                                                                                              Target
                                                                            "Top Box" Percent

labeled as “other”.                                                                             50       72             68          70    65         70       65%
               new Licensee Satisfaction Segmented by Profession
                                                                                                25                                                           Good
                          Fy 06-07                    Fy 07-08
 Profession              Q3      Q4        Q1        Q2       Q3     Q4                         0
                                                                                                         FY            FY            FY          Projected
 clinical lab                                                                                           05-06         06-07         07-08        FY 08-09
                         88%    100%       88%       100% 100%      92%
                                                                                                              MQA                   Industry Leader
 medicine                77%    84%        90%       82%      100% 100%
                                                                                                                     Candidate Loyalty
 nursing                 86%    95%        100%      93%      91%   86%                     75
                                                                            "Top Box" Percent

 occupational                                                                                                          60           64 65            65       65%
                         86%    92%        93%       82%      83%   90%                     50           57
                                                                                            25                                                               Good
 pharmacy               100%    86%        89%       100%     91%   100%
 physical                                                                                       0
                         97%    100% 100%            90%      96%   94%                                 FY             FY            FY        Projected
                                                                                                       05-06          06-07         07-08      FY 08-09
 psychology             100% 100%          90%       100% 100% 100%                                        MQA                      Industry Leader

 other                   93%    86%        85%       93%      89%   94%     mQA’s method of determining customer dissatisfaction is through
                                                                            customer complaints. customer complaints are tracked by the
 OVerALL                 88%    93%        90%       90%      91%   93%     number of “buckslips” received through the doH surgeon Gen-
                                                                            eral’s office. buckslips are generated regarding an outcome of a ser-
There are six professions for which mQA provides examinations               vice. The number of complaints received has steadily decreased from
for licensure applicants (candidates): chiropractic, dental, dental         2004 through 2007. beginning in 2008, mQA also began tracking
Hygiene, Hearing Aid specialists, opticianry, and optometry.                customer complaints through its new customer service system. As
Figure 7.2-4 displays segmentation by these six professions. (note          of september 30, 2008, no complaints have been received through
that examinations are not administered every quarter.)                      this system. Figures 7.2-7 and 7.2-8:

Category 7: results – Page 42
                                                                                                                           Division of Medical Quality Assurance

                                        number of Buckslips                             Figure 7.3-3 – because license renewals are biennial, the percent of
                                                                                        professions with an adequate renewal fee varies from one fiscal year
                                      2004     2005        2006     2007       2008*    to another.
  number of                                                                                     Percent of Professions with Adequate Renewal Fee
                                      354      338         296         282      228
  Buckslips                                                                                 100
                                                                                             80        77 74 77            82
  *through september 30, 2008                                                                                                        71         70
                                                                                             60 59                      59

                                      Customer Complaint rate                                      40                                                                Good
                                        2008       2008           2008       2008 GSA              20
                                         Q1         Q2             Q3         winner                0
  Customer                                                                                                 FY           FY          FY        FY    Projected
                                        0%            0%          0%          .019%                       04-05        05-06      06-07      07-08 FY 08-09
  Complaint rate
                                                                                                        MQA           Best in State (Trust-funded Organization)
Figure 7.2-9 shows the percent of partner and collaborator satisfac-
tion at mQA’s Annual Association long range planning meeting.                           Figure 7.3-4 – because license renewals are biennial, the revenue-
           Partner and Collaborator Satisfaction Rate                                   expenditure ratio varies from one fiscal year to another.
   100                                                     Target
            100          100       100 100          100 100%                                                        Revenue-Expenditure Ratio

                                                                                Good                                                                     126
                                                                                                   100                    115                  113                   Good

                      0                                                                                                         102
                               FY         FY         FY     Projected                                         89                          91
                              05-06      06-07      07-08   FY 08-09                               50
                                      MQA      2008 GSA Winner
                                                                                                            FY              FY             FY              FY
7.3 Financial and Market Outcomes                                                                          04-05           05-06          06-07           07-08
7.3a Financial and Market results                                                                       MQA           Best in State (Trust-funded Organization)
mQA monitors and maintains fiscal soundness with reports that
                                                                                        Figures 7.3-5, 7.3-6, and 7.3-7 are indicators of mQA’s market
include: cash balances; percent of professions operating with a
                                                                                        performance, including market share and growth.
positive or neutral cash balance (bsc measure; percent
of professions with Adequate renewal Fees (bsc measure;                                                   Actively Licensed Practitioners
and revenue-expenditure ratios. These are presented in Figures                           Fy                                    04-05     05-06*      06-07        07-08
7.3-1, 7.3-2, 7.3-3 and 7.3-4.
                                                                                         Actively Licensed
                                  Licensed Account Cash Balances                         Practitioners in                  827,349 723,821 762,652 767,680
                                                             49.9                        Florida
                      50                                             44.5
Millions of Dollars

                      40 37.5              39.6                                          % of population                       4.8%       4.0%       4.1%            4.2%
                                  31.5             34.3
                      30                                                                 Actively Licensed
                             20.9  18.9                                                  Practitioners in
                      20                     16.9      14.3               Good                                                  -      358,782 431,412 388,892
                                                                                         Similar Size State
                      10                                                                 with Same Function
                           FY     FY        FY       FY       FY Projected               % of population                        -         2.9%       3.5%            3.1%
                          03-04 04-05 05-06 06-07 07-08 FY 08-09                         *decrease from 04-05 to 05-06 due to change in CnA renewal
                         MQA       Best in State (Trust-funded Organization)             requirements

                                  Percent of Professions Operating                                            number of Licensed establishments
                      100      with a Positive or Neutral Cash Balance                     Fy 03-04           Fy 04-05         Fy 05-06        Fy 06-07        Fy 07-08
                       80        77         77        82                                     16,952            18,503           18,304          24,776          24,359
                              68       66         66         70        71

                                                                                                                    MQA external website hits
                       40                                                       Good     Fy                             hits                      Comparison*
                       20                                                                05-06                          2,846,221                 596,218
                          0                                                              06-07                          3,092,519                 3,962,556
                              FY         FY          FY        FY    Projected
                             04-05      05-06      06-07      07-08 FY 08-09             07-08                          3,444,138                 3,315,568
                           MQA         Best in State (Trust-funded Organization)         * best in state (trust-funded organization)

                                                                                                                                       Category 7: results – Page 43
Division of Medical Quality Assurance

7.4 workforce-Focused Outcomes                                            Figure 7.4-3 shows mQA’s overall employee satisfaction rate of
                                                                          headquarters versus the field (investigative services).
7.4a workforce results
                                                                          Employee Overall Satisfaction Segmented by Headquarters/Field
Figure 7.4-1 shows mQA’s overall employee satisfaction rate (bsc            100
measure The division’s overall employee satisfaction rate for
2007 and 2008 meets the target of 80% and exceeds the 2006 GsA                                         84 77 84           85

                                                                             60 72          70 66                   71        75
winner’s employee satisfaction rate of 75%.
                                                                             40       55
                 Employee Overall Satisfaction                               20
                                                      Target                  0
        80                                                                         2004      2006       2007     2008 Projected
                              83                   85 80%
        60 69 74 69 74 77        75 80 72 70                                                                               2009

             63                                                                          Headquarters                Field
        20                                                                Figure 7.4-4 shows mQA’s overall employee satisfaction rate for 2007
         0                                                                and 2008, the two years for which the survey was newly segmented by
            2004      2006    2007       2008 Projected
                                                                          years of service and supervisor/non-supervisory employees.
        MQA     Best DOH Division Peer      2006 GSA Winner                    MQA’s employee Satisfaction rate Segmented by years of
                                                                                Service and Supervisor/non-Supervisory employees
Figure 7.4-2 shows mQA’s overall employee satisfaction rate seg-
mented by bureaus and program offices.                                                                    Segment             2007    2008
                                                                                                     less than 1 year           84        89
                  employee Satisfaction rate Segmented
                    by Bureaus and Program Offices                                                        1–3 years             74        79
     Bureau/                                                                years of Service              4–6 years             79        71
                          2004       2006          2007        2008
  Program Office                                                                                          7–9 years             80        77
           BMS             81         71            82          78                                   10 years or more           92        82
           BOO             63         68            89          89           Supervisor/                  supervisor            89        90
 Director’s Office         63         70            95          100        non-Supervisory
                                                                              employee          non-supervisory employee        80        76
    enforcement            73         70            81          73
           hCPr            72         69            89          81
                                                                          Figure 7.4-5 shows employee responses to survey items that measure
                                                                          the overall level of workforce engagement.
                                            Figure 7.4-5 employee Overall Level of engagement
                                                                                         2004             2006         2007        2008
                                    Question                                        MQA    *    ** MQA       *   ** MQA MQA          *     **
                                                         Training and Career Development
 i am provided with sufficient work-related training.                               77     64 78     74     82 85       73    76     77 86
 Attending work-related training is supported.                                      80     68 78     77     83 84       83    86     68 72
 my Unit manager or executive director allows team building exercises to
                                                                                    65     60 60     61     69 67       73    79     61 61
 take place during the scheduled work day.
 my direct supervisor works with me to take on more responsibility.                 68     58 65     64     61 69       74    76     58 65
 i’ve had a chance to meet with my direct supervisor to establish reasonable
                                                                                    75     75 77     72     81 77       81    81     77 74
 objectives and goals for my work.
                                                             recognition and reward
 my direct supervisor shows appreciation for what i do.                             79     81 75     77     83 77       83    85     84 79
 my Unit manager or executive director shows appreciation for what i do.            61     56 64     55     65 68       81    80     62 67
 recognition is typically presented to employees who offer excellent
                                                                                    66     66 57     68     66 67       71    76     62 62
 customer service.
                                                    equal Opportunity and Fair Treatment
 people in my unit or office are treated fairly.                                    63     67 63     55     72 60       71    67      -        -
 my unit or office is made up of employees who are responsive to customers’
                                                                                    75     75 83     79     83 88       82    84      -        -
 cultural differences.

                                             *Best DOh Division Peer            **2006 GSA winner

Category 7: results – Page 44
                                                                                                                   Division of Medical Quality Assurance

Figure 7.4-6 shows mQA’s overall rate of employee engagement.                       Figure 7.4-10 shows the number of workgroups chartered within
This has continued to improve since 1999, exceeding the best doH                    mQA, the number of new and improved processes implemented,
division peer and a 2006 GsA winner.                                                and the number of action plans completed. many of the action plans
                  Employee Overall Engagement                                       developed in fiscal year 2007-08 are still in-progress; therefore, the
                                                           Target                   number of action plans shown is not a representation of the actual
     60 71 67 70 68 75 74        77      79            80 80%                       number of action plans developed that year. The number of work-
                                            69 71

     40                                                                             group participants typically ranges from 5 to 20 individuals.
     20                                                    Good
      0                                                                              Chartered workgroups, improved Processes, and Action Plans
           2004       2006      2007       2008 Projected
                                                                                       Fiscal year         Fy 05-06             Fy 06-07            Fy 07-08
      MQA        Best DOH Division Peer       2006 GSA Winner                          chartered
                                                                                                               26                    20                  22
Figure 7.4-7 shows the percentage of employees who were given
the chance to be a part of improvements made in mQA based on                                                   26                    18                  21
the results of the previous ess, reflecting workforce engagement.
between 2006 and 2007, the percentage increased dramatically from                    new processes             4                     5                    6
41% to 80%.                                                                           Action plans
                                                                                                               80                    56               24*
           Percentage of Employees Given the Chance                                   completed
            to be Part of Improvements Made in MQA                                                                  *35 in process
                                            80     76
    60                                                                              Figure 7.4-11 shows the number of leaders and employees who

                     52                            57                               are currently enrolled in cpm, have graduated, and have been pro-
           40                          51                                48 Good
                43        45 41 39          4141                                    moted following graduation. This shows the results of one of mQA’s
           20                                                       34              leadership development tools.
            0                                                                                       Certified Public Managers Program
                 2002             2004       2006       2007       2008
                                                                                                                       # Promoted            # of employees
            MQA            Best DOH Division Peer             2006 GSA Winner                          # of
                                                                                                                        Following               Currently
Figure 7.4-8 shows the percentage of employees who are acquainted                                                      Graduation               enrolled
with mQA’s mission, a measure of mission deployment.                                   Leaders            21                   3                     9
                                  Mission Deployment                                 employees            12                   7                     20
      100                                                                  Target
       90                                                98         99      95%     Figure 7.4-12 shows the percentage of new employees who attended
                     93           96          95

       80                                                                           mQA’s new employee orientation and 6-month Follow-Up, as well
       70                                                                  Good     as their percentage of satisfaction. As illustrated, new mQA employ-
       60                                                                           ees are fully compliant with this requirement. in addition, continued
                 2002             2004       2006       2007       2008             improvements made to new employee orientation in 2006 and 2007
                                                                                    resulted in 100% satisfaction for fiscal year 2007-08.
Figure 7.4-9 shows the number of employees or teams recognized
for leadership, excellent customer service, quality improvements
                                                                                         new employee Training Participation and Satisfaction
and/or cost savings within mQA. The number of awards given goes
up or down based on the number of nominations submitted.                                                               Fy 05-06          Fy 06-07    Fy 07-08

                                  employee recognition                                MQA’s new employee
                                                                                                                          100              100            100
                                                Fy    Fy    Fy    Fy
            Type of Award earned                                                        6-month Follow-up
                                               04-05 05-06 06-07 07-08                                                     -               100            100
          director’s Thanks A million               -    53       86       264
            meritorious Achievement                                                     Percentage Satisfied               95              96             100
                                                    8     4        7        3
              Award - leadership
                                                                                                 Target                   100              100            100
       meritorious Achievement
                                                    6     5        4        5
     Award - Quality improvement                                                    Figure 7.4-13 shows the average number of hours of training per
            meritorious Achievement                                                 mQA employee. Historically, mQA has been committed to train-
                                                    9     5        6        4
            Award - customer Focus                                                  ing its employees. This commitment has become more evident
            meritorious Achievement                                                 since FY 06-07, with the establishment of training focus groups,
                                                    4     2        3        2       followed by training needs assessment surveys in FY 06-07 and
                 Award - team
           davis productivity Awards                4     6        3        5       FY 07-08. This resulted in the creation of a division-wide training
                                                                                    plan that includes training from both outside vendors and in-house
                          Total                    31    75       109      283      personnel.

                                                                                                                               Category 7: results – Page 45
Division of Medical Quality Assurance

                         Training Hours Per Employee                            Figures 7.4-16 shows mQA’s employee turnover rate (bsc measure
          40                                                           Although almost half of mQA’s employees occupy entry-
                                                                  Target        level positions, mQA’s overall turnover rates still compare favorably
          30                   38        37                  40    35           with the department as a whole. in addition, when looking at non-
                  30                              32
                                                                                entry level position turnover rates only, mQA also compares favor-

                                                                                ably with the best in state organization.
          10           17                                            Good                                 Turnover rates
          0                                                                                                           Fy          Fy            Fy
                   FY            FY               FY      Projected                                                  05-06       06-07         07-08
                  05-06         06-07           07-08*    FY 08-09               Overall Turnover rates               10           13           10
                         MQA                  2007 GSA Winner                    Comparison - Overall
                                                                                                                      12           11           10
*due to state budget cuts, training hours were reduced during                    Turnover rates*
FY 07-08.                                                                        non-entry Level Position
                                                                                                                       8           9             8
                                                                                 Turnover rates
Figure 7.4-14 shows mQA’s overall employee satisfaction rate with
internal training. These satisfaction rates were calculated from evalu-          Comparison - non-entry
ations completed by employees immediately following each train-                  Level Position Turnover              10           10            7
ing event. The overall employee training satisfaction rate of 97% for            rates**
2006-07 and 2007-08 exceeds mQA’s target of 90%.                                            *department of Health          **best in state

     100                 Employee Training Satisfaction
                                                                                Figure 7.4-17 shows the top three responses to three of the survey
                                    97           97         98         Target   items contained in mQA’s separating employee survey. This survey
                    88                                                  90%     was implemented in november 2007 as part of an action plan to

                                                                                recruit and retain a workforce committed to excellence. note: per-
          70                                                                    centages do not add to 100 because only the top three responses are
                                                                       Good     shown.
                                                                                         Separating employee Survey results (Percent)
          0                                                                                                          Fy 07-08                Fy 08-09
                   FY            FY              FY      Projected
                  05-06         06-07           07-08    FY 08-09                                               Q2         Q3     Q4           Q1
                                                                                                       why are you leaving?
Figure 7.4-15 shows the percentage of employees satisfied with
training access, sufficiency and support; work-related training; and             Opportunities for
                                                                                                                20         22     27           21
career development opportunities.                                                Advancement
                                                                                 Personal reasons               20         56      -            -
                   Training Access, Sufficiency and Support
                             Percent                                             Personal Development           40         -       9           16
           year                               Comparison* Comparison**
                                                                                 Volume of work                  -         11      9            -
           i have Access to Career Development Opportunities.
           2004                73                 71              64             Other Benefits                  -         -       -           11
           2006                71                 71              77
                                                                                                      where are you going?
           2007                 -                  -              -
           2008                78                 68              72             To the Private Sector           -         71     50           33
           i Am Provided with Sufficient work-related Training.                  To Another State Agency         -         -      50           67
           2004                77                 64              78
                                                                                 To Another Division of
           2006                74                 82              85                                             -         29      -            -
                                                                                 the DOh
           2007                73                  -              -
                                                                                       what advantages does your new employer offer…?
           2008                76                 77              86
                Attending work-related Training is Supported.                    higher Salary                   -         29     13           17
           2004                80                 68              78             More Challenging
                                                                                                                 -         29     38           22
           2006                77                 83              84             Position
           2007                83                  -              -              Better Chance for
                                                                                                                 -         14     38           28
           2008                86                  -              -
               *best doH division peer           **2006 GsA winner               Different Type of work          -         -       -            -

Category 7: results – Page 46
                                                                                                                           Division of Medical Quality Assurance

Figure 7.4-18 shows the ratio of workers compensation claims to                           Figure 7.4-21 shows the number of internal and collective bargain-
total number of mQA employees, a measure of workforce safety.                             ing grievances filed by mQA employees.
mQA’s ratio remains steady at 5% and is lower than the department
                                                                                                                     employee Grievances
as a whole. in addition, no corrective action plans were warranted as
a result of these claims.                                                                                    number of internal or
                                                                                               Fiscal                                    number of Collective
                                                                                                              “Customer Service”
                        Worker’s Compensation Claims Ratio                                      year                                     Bargaining Grievances
                                                                                                                       1                            2
           8                                         9                                         03-04
           6                                                               7                                           0                            2

                                                                                   Good         Fy
           4             5               5                      5                                                      0                            1
           2                                                                                    Fy
                                                                                                                       0                            0
           0                                                                                    Fy
                         FY                   FY                  FY                                                   1                            0
                        05-06                06-07               07-08
                                MQA                        DOH
                                                                                          7.5 Process effectiveness Outcomes
Figure 7.4-19 shows the percentage of mQA employees who agreed
                                                                                          7.5a Process effectiveness results
that their office supports their efforts to engage in healthy behaviors
(diet, smoking cessation, exercise, nutrition). mQA’s rate of 83%                         Figure 7.5-1 shows how an external resource supports a key process
exceeds the best doH division peer and a 2006 GsA winner.                                 less expensively as reflected in cost savings to exam candidates and
                                                                                          mQA as a result of outsourcing the administration of two exams in
          Percentage of Employees Who Agreed at eir Office
                                                                                          2005 and 2008. The 07/08 results are a combined cost savings of
           Supports eir Efforts to Engage in Healthy Behavior
                                                                                          outsourcing both examinations. A cost savings per candidate and to
                                                                                          mQA were not calculated in 06/07 because mQA’s contract with the
           80                                                                             vendor was renegotiated.
                                         81                79       83        82
                                                                         74                          Cost Savings from Outsourcing a key Support Process
           60                                    69 72

                   71            68 69                                             Good                                      Fy           Fy              Fy
                        60 58
           40                                                                                                               04-05        05-06           07-08
                                                                                           Cost Savings per
           20                                                                                                                $5            $5               $135
                                                                                           Annual Cost Savings
               0                                                                                                        $111,661        $43,286         $500,000*
               2002      2004         2006      2008                                       to MQA
           MQA    Best DOH Division Peer   2006 GSA Winner                                                            * = estimated cost
Figure 7.4-20 shows the percent of compliance with mandatory
office and facility inspections for all mQA facilities, conducted by                      Figure 7.5-2 shows image Api’s, a key supplier, accuracy rate. This
mQA’s safety coordinator and/or wardens. minor safety violations                          contracted accuracy requirement is one way mQA ensures its exter-
are addressed on-the-spot. no corrective action plans were reported                       nal resources minimize errors, rework, and productivity losses. prior
as a result of these inspections.                                                         to June 2006, the main source of error tracking was done through
                                                                                          email. in June 2006, mQA consolidated all error reporting into a
                   Mandatory Office and Facility Inspections                                central web-based repository.
     100                                                                       Target
                                                                               100%                               Image API Accuracy Rate
                    100           100                100             100                            100                                                       Target
                                                                                                             99.95             99.87               99          98%

          50                                                                   Good

                                                                                                    70                                                        Good
           0                                                                                         0
                                                                                                              FY                FY              Projected
                    FY            FY              FY            Projected
                                                                                                             06-07             07-08            FY08-09
                   05-06         06-07           07-08          FY 08-09

                                                                                                                                    Category 7: results – Page 47
Division of Medical Quality Assurance

Figure 7.5-3 shows the number of internal and external statistical                                                                  Percentage of Timely Renewals
data requests received and processed. it provides key information                                                 80                                                           Target
for analysis and process improvements related to mQA’s key pro-                                                                                                                 75%
                                                                                                                  60                         74            74         75
cess of information—a new key process as of 2006. it is also a good
indicator of customer loyalty – requests increase as customers have

                                                                                                                  40         48
confidence in mQA data.
                                                                                                                  20                                                            Good
                     Statistical Data Requests Received and Processed
                                                                         1,250                                    0
            1,250                               1,186                                                                        FY            FY              FY      Projected
                                                                                 Target                                     05-06         06-07           07-08    FY 08-09
                                       831                                       1000
Data Requests

                                                             767                           Figure 7.5-7 shows the percentage of online renewals and manual
                 750            628                                                        renewals. in FY 06/07, mQA substituted a postcard with instruc-
                                                                                           tions for online renewal for the more costly mail-in renewal appli-
                                                                                           cation. This new process resulted in an increase in the number of
                 250                                                                Good   online renewals for FY 06/07 and 07/08.
                                                                                                                  80                 Percent of Online Renewals
                                   FY                   FY              Projected                                                                                             Target
                                  06-07                07-08            FY 08-09                                                                     59     67           70    60%

                                  MQA                      Best in State                                          40         49
                                                                                                                  20                                                           Good
Figure 7.5-4 shows the number of davis productivity Award (dpA)                                                    0                                          14
nomination submissions and total cost savings to the organization                                                            FY         FY       FY         FY    Projected
since 2005. dpA nominations are based on performance improve-                                                               04-05      05-06    06-07     07-08 FY 08-09
ment or innovative work processes.                                                                                           MQA             Similar Function Within State
                                                                                           Figure 7.5-8 shows the cost savings of processing online renewals
                DPA nomination Submissions and Total Cost Savings
                                                                                           compared to manually processing those same renewals. mQA’s pro-
                         year                Submissions                Cost Savings       motion of online renewals resulted in a significant cost savings to the
                     2005                          6                     $9,115,975        division for FY 06/07 and 07/08.

                     2006                          3                    $10,984,147                                           Cost Savings from Online Renewals
                                                                                             ousands of Dollars

                     2007                          5                     $2,193,265                                   800
                                                                                                                                                  837              800
                                                                                                                      600                                   752
Figure 7.5-5 shows the number of business days to release candi-                                                      400                                                $500,000
dates’ examination grades. The number has improved as a result of                                                     200                324
                                                                                                                              270                                             Good
process efficiency—online exam scores.
                                                                                                                              FY         FY        FY       FY Projected
                     Average Number of Days to Release Exam Grades
                                                                                                                             04-05      05-06     06-07    07-08 FY 08-09
                          14                                            14                 Figure 7.5-9 shows the number of workforce requests (tickets) to the
                                                                                 Target    sss Unit that involve data integrity and system operation issues and
                                                                                12 Days    needed enhancements. These “tickets” represent an internal resource
                10                    11      11                   11
                                                        10                    10           that mQA uses to ensure quality and to prevent errors and produc-

                                                                                           tivity losses. The 296% increase in the number of tickets since 2005
                5                                                                   Good   is a measure of workforce commitment to performance excellence.
                                                                                                              Number of Workforce Requests Submitted to SSS
                0                                                                                                                                   8,000
                          FY       FY         FY        FY       FY Projected                              6,000                                            Target
                         03-04    04-05      05-06     06-07 07-08 FY 08-09                                                             6,857               6000

                                  MQA                     Best in State                                    4,000             4,682
                                                                                                           2,000                                                                Good
Figure 7.5-6 shows the percentage of timely health care practitioner                                                          1,731
licensure renewals. The percentage has improved as a result of a work                                                  0
                                                                                                                               FY             FY           FY       Projected
system improvement: postcard renewal notices.                                                                                 05-06          06-07        07-08     FY 08-09

Category 7: results – Page 48
                                                                                                                      Division of Medical Quality Assurance

Figure 7.5-10 shows the number of enhancements performed as a                                       Average Number of Staff Hours Responding to
result of requests submitted to sss.                                                                       Status Checks of an Application
                   Number of Enhancements Performed as                                     50
                   a Result of a Request Submitted to SSS                                  30                    42                                       Good

           160                                                                             20
                                                                   151                      0                                          14
                                                                                                                     Reporting Period

           80                                                                                               February 15, 2008 - August 31, 2008
                            74                                                                  Pre Online Application               Post Online Application
            0                                                                      7.6 Leadership Outcomes
                          FY                    FY                  FY
                                                                                   7.6a Leadership and Social responsibility results
                         05-06                 06-07               07-08
                                                                                   Figure 7.6-1 shows the percent of mQA strategic action plans com-
Figure 7.5-11 shows the number of incidents during mQA’s semi-
                                                                                   pleted by the due date from its balanced scorecard.
annual fire drills. it indicates mQA’s workforce is well prepared for
disasters or emergencies.                                                                            Timely Completion of Strategic Action Plans
                      incidents During Semiannual Fire Drills                                                                                             Target
                                                                                              80                                     87                    85%
                  Fy                          Fy                     Fy                                     80    85 80                             85

                 05-06                       06-07                  07-08                             65
                  0                           0                       0                                                                                   Good
Figures 7.5-12 and 7.5-13 show the percent of compliance with
maintaining coop drive-away kits and the number of coop call                                            FY          FY              FY      Projected
tree exercise incidents.                                                                               05-06       06-07           07-08    FY 08-09
                   Percent of Compliance with Maintaining                                                MQA                      2007 GSA Winner
                            COOP Drive-away Kits
           100                                                            Target   Figure 7.6-2 shows the percent of mQA performance indicators
            80        100            100     100100        100        100 100%     meeting the target from its balanced scorecard.

            60                                                                                         Performance Indicators Meeting Target
            40                                                              Good
            20                                                                                100                                                         Target
             0                                                                                 80           88           94           91             90    90%
                    FY                FY       FY          FY      Projected                   60                  71

                   04-05             05-06    06-07       07-08    FY 08-09                           62
                                                                                               40                                                         Good
                         MQA                         2007 GSA Winner                           20
                           number of incidents During                                                   FY          FY               FY           Projected
                      Activation of COOP Call Tree exercise                                            05-06       06-07            07-08         FY08-09
          Fy                 Fy               Fy            Fy        Projected                            MQA                    2007 GSA Winner
         04-05              05-06            06-07         07-08      Fy 08-09
                                                                                   Figure 7.6-3 shows mQA’s employee ethical conduct compliance
            0                    0            0              0              0      as measured by the number of ethical violations that have been
Figures 7.5-14 and 7.5-15 indicate the number of physician con-                    substantiated.
tacts (telephone calls, correspondence, emails, etc.) and staff time
                                                                                                             ethical Conduct Compliance
responding to queries about physician license application status. The
solution, online status check application, resulted in a 55% reduc-                                                                                   Projected
                                                                                                                 2004     2005       2006   2007
tion in applicant contacts and a 67% reduction in staff time.                                                                                           2008
              Average Number of Contacts Per Day to                                 ethical Violations
                                                                                                                  0           0       0       0           0
               Check Status of a Physician Application                              for MQA
     60                                                                             ethical Violations

     40                                                     Good                    for 2007 GSA                  0           0       1       0               -
           20                                                                       winner
            0                                                                      Figure 7.6-4 shows staff responses on mQA’s and doH’s ess ques-
                                     Reporting Period                              tion about how well managers demonstrate integrity, an indicator of
                            February 15, 2008 - August 31, 2008                    ethical behavior. comparisons in 2007 and 2008 are unavailable as
             Pre Online Application                    Post Online Application     this question was removed from doH’s ess.

                                                                                                                                  Category 7: results – Page 49
Division of Medical Quality Assurance

                         Leadership integrity                              Figure 7.6-7 shows the number of investigations doH’s iG has
  employee Survey Question: My *** Demonstrates integrity                  conducted regarding mQA for the past five years.

                    MQA/                        Percent Agreed                                              Completed iG investigations regarding MQA
                  Comparison             2004 2006 2007 2008                                                     number of
           MQA                            69      64      81        83                                      recommendations per                      recommendations

           Similar size DOh Division      60      54          -     -                                           investigation                            Corrected
           DOh Overall                    63      63          -     -                                       0 1 2 3 4 6                  7
           2006 GSA winner                74      74          -     -                                                                              All corrected except for 1
                                                                               05-06 4                                1        1 1       1
                                                                                                                                                    which did not concur
           MQA                            66      67      84        83
                                                                               06-07                                        1 1                          All corrected

           Similar size DOh Division      61      54          -     -

                                                                               07-08 6 1                                                                All corrected*
           DOh Overall                    64      64          -     -
                                                                                                                          *one investigation is still open.
           2006 GSA winner                69      75          -     -
           MQA                            66      67      81        83     Figure 7.6-8 shows the percent of mQA employees who completed

           Similar size DOh Division      61      54          -     -      the mandatory ethics training.

           DOh Overall                    64      64          -     -                                            Employee Ethics Training Compliance
           2006 GSA winner                69      75          -     -                            100                                                                     Target
                                                                                                                           100               100                100      100%
Figure 7.6-5 shows the dates and purpose for audits conducted by                                       80        93
the state’s Auditor General. mQA’s key indicators of fiscal account-                                   60
ability are corroborated through audits some of which are conducted
by state’s Auditor General, oppAGA, and by independent staff of                                        40                                                                Good
doH’s inspector General (iG). mQA also conducts internal audits.                                       20
Through the audit findings and recommendations and mQA’s                                               0
accompanying corrective action plans to fulfill the recommenda-                                                       FY                    FY          Projected
tions, fiscal accountability is ensured. At this time all but one, which                                             06-07                 07-08        FY 08-09
is on-going, of the action plans are complete.                                                                       MQA                       2007 GSA Winner
                  Auditor General Audits on MQA
                                                                           Figures 7.6-9 and 7.6-10 show mQA’s employee’s citizenship in
                                                  Action Plans             support, both financially and functionally, of mQA’s key commu-
   Date                Purpose
                                               Completed On Time           nities such as the Florida state employees’ charitable campaign
 11-30-00 MQA – Operations                              yes                (Fsecc) and the department’s mentoring program.
               Core Credentialing &                                                           Charitable Contributions Made by MQA Employees
               reporting (COreSTAT)                                                         50,000                             48,421
  9-13-01                                               yes                                                               41,384
               System – information                                                                            39,305
                                                                                            40,000 33,914                             34,874
                                                                                            30,000       27,656      28,526

               MQA Audit Prior Audit
  1-18-02                                               yes
               Follow up – Operational                                                      20,000                                                                        Good
               MQA Trust Fund &                                                             10,000
               Continuing education
  5-4-04                                       yes (1 is on-going)                                          0
               System – Prior Audit                                                                                  2005              2006           2007 Projected
               Follow-up                                                                                                                                     2008
               hCPr Disciplinary                                                                                     MQA                       2007 GSA Winner
  10-8-04                                               yes
               Process – Operational
                                                                                                                     Number of Employees Participating
Figure 7.6-6 shows the dates and purpose of the inspector General’s                                                   in the DOH Mentoring Program 24
                                                                              Number of Participants

internal audits of mQA. The iG’s office focuses on evaluating the
internal controls necessary to ensure fiscal accountability. All cor-                                  20
                                                                                                                16                17               16                     Good
rective Action plans for these audits are closed.                                                      15              13                                                12
             inspector General’s internal Audits of MQA                                                10                                9
                                                       Action Plans                                    5                                                 3
  Date              Purpose            Findings         Completed
                                                         On Time                                       0
                                                                                                                 FY                 FY           FY           FY
 6-13-06 COMPAS Application                6                  yes                                               04-05              05-06        06-07        07-08
 10-5-06         MQA Trust Fund            5                  yes                                                MQA                          DOH Division Peer

Category 7: results – Page 50

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