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Harnessing the Power of a QI Mini-Collaborative

Harnessing the Power of a QI Mini-Collaborative. Applying the Lessons from the Interim MLC-3 Evaluation and the Institute for Healthcare Improvement Breakthrough Series Marlene Mason MCPP Healthcare Consulting, Inc. February 4, 2010 . Muskie Interim Evaluation.

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Harnessing the Power of a QI Mini-Collaborative

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  1. Harnessing the Power of a QI Mini-Collaborative Applying the Lessons from the Interim MLC-3 Evaluation and the Institute for Healthcare Improvement Breakthrough Series Marlene Mason MCPP Healthcare Consulting, Inc. February 4, 2010

  2. Muskie Interim Evaluation • Good progress has been made AND improvements are needed in how we prepare for and manage Collaboratives • Preparing for our Collaboratives: • Target Selection • Advance Planning and Work • Goals and Expectations • Composition and Membership • Sponsorship/Sustainability (Marni’s addition) MCPP Healthcare Consulting, Inc.

  3. Muskie Interim Evaluation • Managing Collaboratives • Level of Effort • QI Tools and Methods • Use of Evidence and Resources • QI Training and Technical Assistance • Marni’s Additions: • Establishing the AIM, Measures and Changes to Test • 1st Learning Session (content & QI expertise) MCPP Healthcare Consulting, Inc.

  4. Applying the Lessons • MLC Case Studies (Preliminary Findings) -11/09 – Muskie Evaluation Team • MLC Mini-Collaborative Results - 11/09 Muskie Evaluation Team AND • IHI’s 2003 Breakthrough White Paper - Collaborative Model for Achieving Breakthrough Improvement MCPP Healthcare Consulting, Inc.

  5. Collaborative Model for Achieving Breakthrough Improvement Systems are perfectly designed to produce the results they achieve MCPP Healthcare Consulting, Inc.

  6. IHI’s* Breakthrough Series • Also known as the Collaborative Learning Method – to easily learn from each other and experts • It is a structured method for learning and action to engage organizations in real system-wide improvements • Short-term (6-18 mo.) teams seek improvement in a specific target area *Institute for Healthcare Improvement www.ihi.org MCPP Healthcare Consulting, Inc.

  7. Proven Model that Works • Developed in 1995 by Paul Batalden, MD and Don Berwick, MD (founders of IHI) • By 2003 had conducted > 50 Collaboratives with > 2000 QI teams • Examples of Results: •  wait times by 50% •  worker absenteeism by 25% •  costs by 25% •  hospitalizations for CHF by 50% MCPP Healthcare Consulting, Inc.

  8. Breakthrough Method (IHI) Participants Select Topic Prework P P Identify Change Concepts P A D A D A D S S S Learning Congress and Publications Experts & Planning Group LS 1 LS 2 LS 3 Supports E-mail Visits Web-site Phone Assessments Senior Leader Reports MCPP Healthcare Consulting, Inc.

  9. IHI Key Elements • Topic Selection • Faculty Recruitment • Enrollment of Participants and Teams • Learning Sessions • Action Periods • Model for Improvement • Summative Congress and Publications • Measurement and Evaluation MCPP Healthcare Consulting, Inc.

  10. Conclusions-Successes • Consistent success and we have learned a lot about “promoting the application of QI methods and tools” (MLC-3 goal #1) • Use of QI Tools: • Fishbone – 11 (36%) to 39 (75%) • Root Cause Analysis – 12 (39%) to 30 (59%) • PDSA cycle – 22 (65%) to 47 (84%) • Affinity Diagrams – 5 (16%) to 14 (28%) MCPP Healthcare Consulting, Inc.

  11. Conclusions – Opportunities • Opportunity to increase consistency in using: • Content expertise (faculty recruitment), • Developing and testing “change packages” • Developing measurement strategies • Individual target area teams have been successful in these areas and we need to harness their learning MCPP Healthcare Consulting, Inc.

  12. MLC-3 Levels of Collaboratives MCPP Healthcare Consulting, Inc.

  13. Well Done Key Elements • Enrollment of Organizations and Teams • LHD (used open solicitation or selective) and faculty recruitment (from limited to state to external academic, consultant & community) • Use of Improvement Model (RCI & PDSA) • Emphasized when and how to use tools • Immediate application and feedback on use MCPP Healthcare Consulting, Inc.

  14. Mixed Success – Key Elements • States’ 1st Learning Session (extent of pre-work and change packages) • Action Periods (frequency/productivity of group calls & webinars, 1-1 consults, site visits) • 2nd Learning Session (how consistent and productive??) • Measurement – tracking and reporting of measures for improvement (IHI requires run charts) MCPP Healthcare Consulting, Inc.

  15. Opportunities for Improvement* – Key Elements • Advance Planning/Pre-work including: • Panel of content and QI experts, • Clarity of expectations and deliverables, • establishing AIM, measures and list of changes to test • Extent of evidence to support interventions • Learning curriculum and work plan • Sponsorship, support and resources for sustainability *Same issues IHI needed to refine between 1995 & 2003 MCPP Healthcare Consulting, Inc.

  16. Take Time to Assess Status • Stop for a moment and evaluate how your collaborative is meeting the Muskie Evaluation categories and Breakthrough Model’s Key Elements • Identify 1 or 2 specific improvements for next 12 months • Get help where needed MCPP Healthcare Consulting, Inc.

  17. Harnessing the Power • Mini-Collaboratives are at different stages, can learn together and help each other • Areas that are “Well Done” in Muskie Evaluation and Breakthrough Model Key Elements are ready to Hold the Gains in current sites and to spread to other sites MCPP Healthcare Consulting, Inc.

  18. Harnessing the Power • Areas that have “Mixed Success” are where TAGs can help each other • Measurement – review current measures and revise, as needed; report progress • Action Periods – Alternate webinars with content expertise one month and QI expertise on alternate month • Future Learning Sessions – provide content or QI expertise; share process and materials MCPP Healthcare Consulting, Inc.

  19. Harnessing the Power • Opportunities for improvement: • Clarity of expectations and deliverables – what are current needs? anything that MLC-3 can provide for last year of grant? • Further Planning – such as proven, EBP changes to test in next 10-12 months • Revision of TAG work plans • New learning opportunity – find faculty that colleagues have used and been successful MCPP Healthcare Consulting, Inc.

  20. Harnessing the Power • Areas that need improvement: • Sustainability – resources, plan for standardizing improved practice and for spreading improvements/success • Actively engage senior leaders in monitoring progress, providing necessary resources, celebrating and communicating the success, and developing plans for spread MCPP Healthcare Consulting, Inc.

  21. Addressing “Impeding” Factors • Team Composition/Faculty Recruitment – • Acquire content expertise through state program staff or national experts in topic • Acquire QI expertise – internal experts or academic or consultant experts • Revise goals and expectations, make them feasible for next year • Share strategies to address competing work priorities and staff turnover/layoffs MCPP Healthcare Consulting, Inc.

  22. Adopting Success in Other States • Formal academic knowledge is bolstered by the practical voices of peers who can say “I had the same problem; let me tell you how I solved it.” IHI Breakthrough Series White Paper- 2003 MCPP Healthcare Consulting, Inc.

  23. Table Groups Strategize • Table groups discuss most successful part of collaborative process and most successful intervention in each state represented at table, then • Discuss which success or intervention to test in another state represented at table • Report Out – how can we help each other MCPP Healthcare Consulting, Inc.

  24. Final Comments Measurement, Improvements to Breakthrough Model, References and Resources, and Change versus Improvement MCPP Healthcare Consulting, Inc.

  25. Measurement Tips • Establish quantifiable measures that address: • Outcome (how is the system performing and what is the result) • Process (Are the parts/steps in the system performing as planned) • Balancing (changes designed in one part causing problems in another part of the system) • Establish measurement strategy MCPP Healthcare Consulting, Inc.

  26. Measurement Tips • Make measurement more effective*: • Plot data over time – “Tracking a few key measures over time is the single most powerful tool a team can use”* • Seek usefulness, not perfection – measurement is not the goal, improvement is the goal • Use sampling – a total of 30 is usually enough • Integrate measurement into daily routine • Use qualitative and quantitative data *IHI website: Improvement Methods/Measures MCPP Healthcare Consulting, Inc.

  27. Improvements to BTS by IHI • Enhance collaborative prework – participants do more before the 1st Learning Session • Prioritize the “Change Package” according to interventions that were most effective in producing results. • Senior leaders more engaged in removing barriers • Teach teams better communication skills, especially with senior leaders MCPP Healthcare Consulting, Inc.

  28. Some QI References - Handout • Embracing Quality in Local Public Health: Michigan’s Quality Improvement Guidebook, 2008, www.accreditation.localhealth.net • Public Health Memory Jogger, GOAL/QPC, 2007, www.goalqpc.com • Breakthrough Method and Rapid Cycle Improvement www.ihi.org • Bialek R, Duffy DL, Moran JW. The Public Health Quality Improvement Handbook. Milwaukee, WI: ASQ Quality Press; 2009 • Guidebook for Performance Measurement, Turning Point Performance Management National Excellence Collaborative, 2004, http://www.phf.org/pmc_guidebook.pdf • Mason M, Schmidt R, Gizzi C, Ramsey S. Taking Improvement Action Based on Performance Results: Washington State’s Experience. Journal of Public Health Management and Practice. Jan/Feb 2010; 16(1): 24-31 MCPP Healthcare Consulting, Inc.

  29. Change versus Improvement • W. Edwards Deming stated “Of all changes I’ve observed, about 5% were improvements, the rest, at best, were illusions of progress.” • We must become masters of improvement • We must learn how to improve rapidly • We must learn to discern the difference between improvement and illusions of progress MCPP Healthcare Consulting, Inc.

  30. Contact Marni Mason at Marni@mcpp.net or 206-613-3339 THANK YOU!What questions do you have? MCPP Healthcare Consulting, Inc.

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