Dan Tietz Thursday, November 29 10 am to 11:30 am RWA-0252

1. Guidance to Creating a Culture for Quality: 301 Session: Improve Your Care and Services with Consumer Input Dan Tietz Thursday, November 29 10 am to 11:30 am RWA-0252

2. NQC and Quality Workshops at 2012 AGM

3. NQC at 2012 AGM • Networking Opportunities - Interact with your peers… • Tue, Nov 27 12pm: HIVQUAL Regional Group– Thurgood Marshall Ballroom West • Wed, Nov 28 12pm: in+care Campaign - Thurgood Marshall Ballroom South • NQC Exhibit Booth - Stop by our booth… • NQC Office Hours - Meet one of our NQC coaches...

4. NQC Workshop Session 3 Agenda • Presentations: 20 minutes • Consumer Involvement Framework - Daniel Tietz, NQC Manager for Consumer Affairs • A Lesson from the Field - Al Bishop, Manger Robeson Health Care Corporation • Interactive Individual and Group Activity: 30 minutes • Consumer Involvement Organizational Assessment Scoring • Recorder Report Back and Discussion: 20 minutes • Presentation: 10 minute • Overview of Training of Consumers on Quality and Resources - Adam Thompson, NQC Peer Consultant • Q&A, Aha Moments: 10 minutes

5. Learning Objectives • Understand the importance of consumer participation in quality management (QM) programs • Learn and develop effective strategies to overcome common barriers in engaging consumers and receiving meaningful input in QM programs • Know where to access existing resources to improve participation of consumers in quality improvement efforts

6. Consumer Involvement in QM • Quality improvement (QI) models used in health care were created for the automotive industry • Critical dimension of QI is determining consumer needs as well as developing products and services that meet and exceed customer expectations. • Adapted for use in health care settings, although many medical disciplines are still grappling with how and to what extent they should involve consumers

7. Technical vs. Experiential

8. Conceptual FrameworkPLWHA Involvement in QM/QI • Defines the ways to involve PLWHA in HIV facility-wide QI activities and the mechanisms during each stage of the QI process

9. Framework for Consumer involvement in QM/QI Communicate QI activities to PLWHA Annually Assess Levels of PLWHA Involvement Routinely Solicit Input From PLWHA Engage CAB in QI Appoint PLWHA to QM teams/ committees

10. A Lesson From the Field • Robeson Health Care Corporation • Region IV Part C RW Grantee in North Carolina • Established Consumer Advisory Committee (CAC) in October 2003 initially focusing on consumer education • Main challenge: rural south east is difficult location to be open about HIV/AIDS due to stigma • Staff began involving consumers in shared healthcare decision-making leading to better health outcomes and constructive feedback to staff • Adopted “Patient Satisfaction Survey for HIV Ambulatory Care” which became annual feedback instrument for consumers

11. A Lesson From the Field • Robeson Health Care Corporation • Surveys were cumbersome and difficult to tally due to software issues • April 2010: CAC members start receiving HAB performance measure data summaries to discuss during meetings and provide feedback to staff on how improvements could be made • Examples of feedback provided on no show rates: • call client prior to appointment • give client appointment card last time in the clinic for next appointment • Send written appointment reminder via mail

12. A Lesson From the Field • Robeson Health Care Corporation • Consumers October 2011 CAC Meeting: Quality Manager introduced Oral Health HAB measure along with cause and effect diagram along with examples how it was used to 8 consumers and 2 staff members present and staff worked in collaboration to complete diagram outlining 4 main areas to focus on (environment, resources, people and processes) • Clients provided concrete input based on visually seeing how tool was used to identify problems, dissect and identify root cause

13. A Lesson From the Field • Robeson Health Care Corporation • January 2012 CAC Meeting: Cause and Effect Diagram used to address missed dental appointments (10 consumers, 6 staff present) • CAC met to prioritize solutions and viability to implement • Recommendations presented to Corporate Performance Improvement Committee (CPIC) to improve quality of care • Consumers voices were heard and they are and continue to be vital to quality improvement!

17. Individual Activity Each audience member receives, reviews, and individually scores the “Consumer Involvement Organizational Assessment Tool.” Once audience members have chosen their score, they will be asked to please stand up and go to the place on the wall that corresponds to their score The workshop moderator will ask audience members a series of questions asking for show of hands: • Type of Ryan White Grantee/Sub-grantee (Part A – F) • High or low HIV incidence geographic location • Hospital, Community Health Center, AIDS Service Organization

18. Group Activity Each group chooses a leader/facilitator and a recorder (someone to report back to the larger group) Group members will have a facilitated discussion on where each Ryan White Grantee/Sub-grantee placed their scored and why they chose the score During facilitated discussion, recorder will capture key points including challenges, barriers, successes and lessons learned with consumer involvement in QI. In addition, group members should provide recommendations to the recorder on TA/capacity building needs, resources, and strategies that will lead to improvements in the scoring that individual members chose The recorder for each group will report back to the larger group on the discussion

19. Consumer Capacity Building Resource

20. Training of Consumers on Quality (TCQ) To build capacity of consumers to be equal partners in the planning, implementation, and evaluation of quality improvement efforts at both clinical and regional levels To increase the number of people living with HIV/AIDS (PLWHA) formally engaged in ongoing quality management committees, quality improvement teams, and regional quality improvement activities

21. TCQ Learning Objectives Increased understanding of the Ryan White Program and its quality requirements and expectations Increased understanding of basic vocabulary for quality improvement tools, methodologies, activities, and processes Increased competency to be a consumer champion in local or regional quality management committee activities Increased confidence in participating in quality improvement teams through an understanding of team decision-making processes, team roles, and processes to address specific aspects of HIV care Increased understanding of the various forms of individual and systematic consumer involvement, and identification of appropriate methods of involvement

22. TCQ Learning Objectives Increased awareness of basic HIV care and treatment terminologies so that participants better understand basic indicator definitions and performance data reports Increased knowledge related to health numeracy and health literacy, and understanding of performance measurement, including indicator development, data collection methodologies, and data reporting Exposure to other patients, consumer quality leaders, and peer experts in patient involvement who can provide community support and leadership

23. TCQ Expectations for Participants Complete an online application and submit documentations (2 hour) Complete a standardized survey to assess basic QI competencies (1 hour) Actively participate in all 3 pre-work webinars (3 hours) Overview of Ryan White quality expectations Reading of two essays on different methods of involvement (agitation, activism, advocacy) Provider/patient relationship and peer mentoring (3rd webinar will be in-person on June 20) Completion of all pre-work assignments (6 hours) Attend and actively participate in a 2-day face-to-face TCQ session (2 days) Get further involved in quality improvement activities by the supporting organization Attend and actively participate in post-TCQ conference calls and complete post TCQ assessment tool (4 hours)

24. Expectations for Supporting Ryan White Grantees Commitment to further engage the TCB participant in ongoing quality improvement activities Actively supporting the TCQ participant in the application process Submission of written letter of support agreeing to accept applicant as member of organizations QM committee, team or other QI efforts and describing roles, responsibilities and organization’s expectations Assist the TCQ participant in making travel arrangements, if needed Review and offer feedback to consumer on personalized action plan Coach/mentor consumer to support active engagement in QI activities for continued capacity development Participate in post-training evaluation activities via webinars, focus groups or interviews to assess program impact

25. TCQ Application/Selection Process Interested applicants must apply on-line submit a resume or bio-sketch submit letter of reference submit a letter of support from a Ryan White grantee Incomplete applications will not be considered

26. Application/Selection Process Approximately 30 individuals will be selected to participate in the pilot Location, dates and times yet to be determined for second pilot (first held in Philadelphia) Need to ensure diverse pool of training participants (demographics/geography/funding stream) Applications need to have a strong commitment from supporting organization Applicants should successfully demonstrate previous experience(s) in HIV quality improvement activities Applicants should have the ability to communicate and disseminate information with existing consumer networks in their local jurisdictions

27. Post-TCQ Session Activities Upon completion of the TCQ program, participants are expected to: Return to local supporting organization on implementing personalized action plans Establish and sustain a collaborative relationship with a TCQ peer mentor Once the pool of TCQ graduates is established, these individuals may go on to be mentors themselves Complete a post-TCQ skills assessment

28. Post-TCQ Session Activities Participation in TCQ webinars to sustain the “community of learners” Sharing of lessons learned for consumer involvement in QI activities Identification of emerging barriers to consumer involvement Development of strategies for increased consumer involvement Testimonials by TCQ graduates and supporting organizations regarding consumer engagement in QI activities

29. Aha Moments and Action Planning • What have you learned from this workshop? • What will you do differently in response to this workshop?

30. NQC Offerings NQC WebsiteQuality Academy HIVQUAL Regional GroupsOn-Site TA in+care CampaignNQC Trainings

31. NQC Resources

32. Other Consumer Capacity Building Resources http://www.hivguidelines.org/ordering-publications/

33. Other Consumer Capacity Building Resources

34. Other Consumer Capacity Building Resources

35. Other Consumer Capacity Building Resources

36. Daniel TietzNQC Program Manager for Consumer Affairsdet01@health.state.ny.usAdam ThompsonNQC Peer Consultantadamtthompson@gmail.comAl BishopRobeson Health Care Corporational_bishop@rhcc1.com

37. National Quality Center • 212-417-4730NationalQualityCenter.orgInfo@NationalQualityCenter.org