Implementing Successful QI: Lessons Learned featuring RiverStone Health

1. Implementing Successful QI: Lessons Learned featuring RiverStone Health December 12, 2013 Hannah Silveus – RiverStone Health Lea Ayers LaFave, RN, PhD – Community Health Institute/JSI Grace Gorenflo, MPH, RN – Public Health Consultant Moderated by Deborah Porterfield, MD, MPH – PHQIX Evaluations Welcome! Thank you for joining! Sound for the webinar will come through your computer speakers. Please feel free to submit your questions throughout the webinar through the chat feature. We will start momentarily.

2. Agenda • Welcome and webinar overview • Presentation from Hannah Silveus (QI Champion at RiverStone Health) • Presentation from Lea LaFave (QI Consultant at Community Health Institute/JSI) • Discussion with Grace Gorenflo, PHQIX Expert Panel Member • Q&A

3. Quality Improvement in Public Health Successes and Lessons Learned from Women, Infants, and Children (WIC) Quality Improvement Project Hannah Silveus – RiverStone Health Public Health Associate for the Centers for Disease Control and Prevention December 12, 2013 PHQIX Webinar

4. Two Goals

5. Six Questions to Answer • What tools were used? • Who participated in the QI team? • What data/measures were used? • How did we come up with solutions? • How did we test the solutions? • How were the improvements sustained?

6. Assembling a QI Team

8. Team members in many places… Home visiting nurse WIC clinic nutrition educator

9. Front WIC Desk

10. QI Goal • The initial aim statement was: By August 1, 2013, RiverStone Health will increase the percentage of participants ages 1-5 who meet the WIC definition for active participation from 85% to 90%.

11. Our Timeline

12. Our Timeline • 50% of the project time spent in the “Plan” phase • 25% of the time spent in the “Do” Phase • The remaining 25% divided between the “Study” and the “Act” phases

14. Meeting Evaluations Meeting Evaluation • Did we address the agenda? • Did we meet the goals for our meeting? • After this meeting, how do you feel about the project’s progress?  • Rate today’s meeting from 1-10. (10= best possible meeting).

15. Group Brainstorming Group brainstorming builds trust, promotes participation of all team members, and is time-efficient. One idea: “Pass the Paper”

17. What does the data say?

18. Keepin’ Motivated

19. Maintaining Progress

20. Maintaining Progress

21. Project Evaluation • On a scale of 1-10, how would you rate the success of the WIC QI project? Why? • In your opinion, what were the positive aspects of the project? • Is there anything that could be improved for future QI projects? This could include QI tools used, meeting times and frequency, etc. • Did you learn anything new about QI projects from your participation on the QI team? • Are there any parts of the QI process, tools, or other parts that you are confused about or wish you could have learned more about? • Was there anything you expected to do as part of the team that didn’t happen? • Do you have any additional comments, suggestions, or feedback to improve future projects?

22. Project Evaluation (cont.) Honestly, it felt a little intimidating being the only non-supervisor staff. Data tells a whole new story. When done properly, people really can like QI. I have appreciated the blended effort between public health divisions and the expertise. The improvement may include the addition of additional WIC staff in the project.

23. QI in Accreditation PHAB Standards:  • Domain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community Standard 1.4 Provide and Use the Results of Health Data Analysis to Develop Recommendations Regarding Public Health Policy, Processes, Programs, or Interventions Measure 1.4.1 A Use data to recommend and inform public health policy, processes, programs, and/or interventions • Domain 9: Evaluate and continuously improve health department processes, programs, and interventions Standard 9.2 Develop and Implement Quality Improvement Processes Integrated Into Organizational Practice, Programs, Processes, and Interventions Measure 9.2.2 A Implement quality improvement activities

24. Storyboards for Accreditation Documentation

25. Was it a “success”? • YES! Because…. • Successfully standardized a procedure • Increased excitement surrounding QI • Fostered a working relationship with the Montana State WIC epidemiology department • Tools and data for future projects

26. Did we answer the questions? • What tools were used? Meeting evaluations, flowcharts, brainstorming, group multi-voting. • Who participated in the QI team? A blend of staff, as well as supporting QI coach and the state dept. • What data/measures were used? Used data from state WIC office to track appointments made. • How did we come up with solutions? We used brainstorming tools and multi-voting to decide. • How did we test the solutions? Over a three month time period, we changed the way we scheduled appointments. • How were the improvements sustained? We made arrangements with state office to continue receiving data, and staff are updated on a monthly basis.

27. Need a place to start? Start here: Presenter Information: • Hannah Silveus, Prevention Health Specialist: hannah.sil@riverstonehealth.org General Resources: • “Embracing Quality In Public Health: A Practitioner’s Quality Improvement Guidebook” is a downloadable document that contains great information about identifying customers, clients and stakeholders, drafting valid surveys and interview questions, and developing flowcharts. It can be accessed by following this link: http://mphiaccredandqi.org/Guidebook.aspx. • “The Public Health Memory Jogger II” provides detailed information on how to use tools such as the Nominal Group Technique (NGT), or multi-voting. • For any documents used during RiverStone’s WIC QI project, contact Hannah at the email above or by phone at (406) 651-6537.

28. A COACH’S PERSPECTIVE Lea Ayers LaFave, PhD, RN Community Health Institute/JSI Research & Training, Inc. www.nhchi.org PHQIX Webinar December 12, 2014

29. Coaching Framework… • Four categories of coaching actions: • explore the context • build relationships • offer support to the improvement process, • reinforce the QI process by providing TA. • Godfrey, M. M., B. Andersson-Gare, et al. (2013). "Coaching interprofessional health care improvement teams: the coachee, the coach and the leader perspectives." Journal of Nursing Management: Available at http://onlinelibrary.wiley.com/doi/10.1111/jonm.12068/full

30. The Coach Explores the Context… • Context was the unique system of the Montana Department of Health and RiverStone, • roles of team members (providers, consumers, directors, etc.),   • gaps in staffing and implications for the project, • challenges for engaging team members (busy schedules, competing priorities, geography).

31. The Coach Builds Relationships… • Good communication helps build relationships • established regular phone meetings, • provided template questions to guide each call, • supported development of strategies to foster team member engagement in the QI process, • assured team member time was well-spent, • strategized ways to engage the group in building their team, • used Skype.

32. The Coach Supports QI Process … • Facilitated team function, learning, leading, capacity building • helped when teams got “stuck” • encouraged teams, clarified process and tasks • kept teams on track • developed strategies for meetings that maximized use of time & fostered maximum engagement of stakeholders • reviewed and provided feedback on qualitative data collection (questions & process), • tracked timeline and deliverables (PHQIX submission).

33. The Coach Provides TA… • TA to reinforce the QI process and team learning • provided tools for meeting skills (roles, evaluation) • supported/provided feedback in developing NNPHI/QI Award Presentation • provided input/feedback on PHQIX submission, • reinforced bigger picture positive outcomes.

34. Thank you! Lea Ayers LaFave llafave@jsi.com 603.573.3335

35. Questions

36. Thank you! The date of our January webinar will be announced on our home page.