Joining PHMC in March 2013 to implement Total Quality Management, Nina Boffa had enjoyed a long and successful career in quality and resource management at Thomas Jefferson University Hospitals. A licensed social worker who is certified in Six Sigma methodology, Boffa earned an MSW degree from Temple University and an MBA in healthcare administration from Eastern University. Public Health Directions asked Boffa about her new role, the current healthcare environment and what inspires her to carry out her work.

You worked in the Methodist Hospital division of Thomas Jefferson University Hospitals for 24 years.
What attracted you to PHMC?

I saw the job posting and was excited right away because I like to engage and motivate people. I was also excited because of the all-round diversity at PHMC, from the services and programs to the personnel.

You’ve been working here since October 2012.
What impresses you about PHMC’s behavioral health network?

Its diversity. PHMC’s behavioral health network has such a diverse range of programming. We have a lot of expertise and knowledge in a lot of areas, ranging from addiction services to sexual abuse.

How do you define Total Quality Management (TQM)?

[TQM is a comprehensive, structured approach to organizational management. It seeks to improve the quality of services through ongoing enhancements in response to continuous feedback from customers. At PHMC, our customers include the senior management team and employees at our headquarters, staff at our programs and affiliates, participants in our services and regulatory agencies.

I recently introduced a new way to do TQM for our behavioral health division that I want to roll out accross the enterprise. It involves four sequential categories: Plan, Do, Study and Act (the PDSA cycle). In the last phase, Act, we document the results, inform others about changes to the process and determine the effectiveness of those changes. We make recommendations for addressing the problem in the next PDSA cycle by achieving the goal, adapting the plan or abandoning the plan and starting again.

We understand that different programs have different regulation requirements. We're now introducing universal performance indicators for all programs and affiliates. Our goal is to include TQM in PHMC's daily activities.


How has the Affordable Care Act affected what you're doing?

The Affordable Care Act has made my job a little easier, as everyone now has a renewed interest in quality. Many insurers have incorporated pay for performance into their contracts, so PHMC needs to prove that, as a large public health institute, one of its priorities is quality. We want to be at the forefront of the quality initiatives that are being launched nationwide.

In 2014, the expansion of Medicaid under the Affordable Care Act could potentially extend coverage to 17 million low-income individuals nationwide, depending on whether or not each state accepts the federal Medicaid subsidy. Pennsylvania has not yet accepted the federal Medicaid subsidy.

Beginning October 1, 2013, individuals, families, and owners of small businesses (those with 50 or fewer employees) will be able to shop for health insurance in online marketplaces, similar to travel websites, which means that access to quality health care is very important. Making our processes as efficient as possible will help to ensure that the most vulnerable populations we serve have access to our primary and behavioral health services.

You developed a TQM plan for FY 2014 that uses the Lean methodology.
Wasn't the Lean methodology first used for manufacturing by Toyota?
How do cars relate to health care?

[Laughs] Actually, many healthcare agencies have implemented Lean methodology. It's been used effectively in manufacturing companies for years, particularly in Japan, where it started. Lean thinking begins with driving out waste so that all work adds value and serves customers' needs. If we can identify waste, we can offer more value to our customers.

Let me give you an example. Say the wait time at a clinic is two hours. We'd examine all the steps from the time the person checks in to the time he or she is seen by a clinician. We'd examine which steps add value and which ones don't, and identify the services that have a positive impact on the customer.

Although health care differs in many ways from manufacturing, there are surprising similarities. Whether building a car or providing services to patients, service providers must rely on multiple, complex processes to accomplish their tasks and create value. Waste—of money, time, supplies or good will—decreases value, no matter what the industry.

The commitment to Lean principles has to be embraced not only by those at the very top of the organization, but also by all staff who should be involved in helping to redesign processes to improve flow and reduce waste. Thankfully we have this at PHMC.

I should also mention that my team consists of three full-time employees and one part-time employee, including me—we are a lean department!

What are the barriers to TQM implementation at PHMC?

I feel very fortunate in that I haven't come across any barriers, except time. There's much to do and not enough hours in the day. Employees at all levels—from the direct line person to the senior team—have been extremely welcoming and supportive.

What inspires you to carry out this work?

I really enjoy empowering people and seeing the changes they make to achieve the desired results. Employees usually have the answers needed to improve a process, increase efficiency and decrease redundancy because they're the ones who are closest to the work. The problem is that until very recently, we weren't leveraging their insight in the best way possible.

What do you do in your spare time?

I love to laugh, especially those deep, belly laughs. It's a great way to reduce stress. I spend time with my husband, my extended family and great friends; I like to surround myself with people who enjoy life. And my husband and I love to travel. Last year we went to Italy and Puerto Rico. This year we've planned a trip to Mexico. I'm also a member of a book club and I like to read novels, most recently The Twelve Tribes of Hattie by Ayana Mathis and Fifty Shades of Grey by E. L. James.