Joe Kyle, MPH Kim McCoy, MPH, MS

1. The Olympic Team Trials:An Orientation to theInstitute for Healthcare Improvement Breakthrough Series* Joe Kyle, MPH Kim McCoy, MPH, MS *some adaptations for MLC collaboratives

2. Objectives By the end of this session, you should be able to— • Describe the elements of a successful Breakthrough Series collaborative • Recognize and define the phases of the Breakthrough Series model • Understand how this applies to the MLC-3 collaboratives

3. Who is IHI? The Institute for Healthcare Improvement (IHI) is an independent, not-for-profit organization whose work is to help lead the improvement of health care around the world.

4. What is the IHI Breakthrough Series? IHI’s Breakthrough Series (BTS) is an improvement method that relies on spread and adaptation of existing knowledge to multiple settings to accomplish a common aim.

5. IHI Breakthrough Series(6 to 18 months time frame) Select Topic (develop mission) Participants (10-100 teams) Prework Dissemination Publications, Congress. etc. P Develop Framework & Changes P P A D A D A D Expert Meeting S S S LS 1 LS 2 LS 3 Holding the Gains Planning Group AP1 AP2 AP3* Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports *AP3 –continue reporting data as needed to document success LS – Learning Session AP – Action Period

6. Goals for a BTS Collaborative • Achieve results • Accelerate improvement– get results faster! • Define, document, and disseminate good ideas • Develop leaders of change

7. Example of BTS Model* Applied to Public Health ISSUE 1: Implementing Clinical Practice Guidelines for Smoking Cessation in all Public Health Clinical Settings ISSUE 2: Improving capacity for Health Improvement Planning at local health departments *some adaptations for MLC collaboratives

8. BTS Phase 1 Topic Selection

9. IHI Breakthrough Series(6 to 18 months time frame) Select Topic (develop mission) Participants (10-100 teams) Prework Dissemination Publications, Congress. etc. P Develop Framework & Changes P P A D A D A D Expert Meeting S S S LS 1 LS 2 LS 3 Holding the Gains Planning Group AP1 AP2 AP3* Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports *AP3 –continue reporting data as needed to document success LS – Learning Session AP – Action Period

10. Topic Selection • There is a gap between science (evidence) and practice • Examples of better performance exist • A good “Business Case” exists for the topic

11. Topic Selection for BTS Public Health Example

12. BTS Phase 2 Developing the Technical Content

13. IHI Breakthrough Series(6 to 18 months time frame) Select Topic (develop mission) Participants (10-100 teams) Prework Dissemination Publications, Congress. etc. P Develop Framework & Changes P P A D A D A D Expert Meeting S S S LS 1 LS 2 LS 3 Holding the Gains Planning Group AP1 AP2 AP3* Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports *AP3 –continue reporting data as needed to document success LS – Learning Session AP – Action Period

14. Content Development • Collaborative Charter • Change Package • Measurement Strategy

15. Collaborative Charter • Establishes a common vision for the work • Problem statement • Gap between science and practice • Mission statement • Business case for improvement • Specific goals • Expectations

16. Change Package • The essential changes needed to accomplish the mission • Evidence-based strategies • Model practices • Credible expert opinion

17. Measurement Strategy • Key measures that will be used to track improvement • Definitions of data elements • Data collection methods

18. How is technical content developed? • Staff do initial research with one or two experts • Panel of experts broadens and deepens the content • Staff work with other experts to enhance and “package” the content for the Collaborative • During the Collaborative the content is tested and developed further; package is revised.

19. Expert Meeting- A Key Step • Invite 12-15 experts in topic area • Multidisciplinary • Mix of research and applications expertise • Practitioners necessary • Best thinkers and doers on the topic • Develop the technical content • Identify faculty for Learning Sessions

20. Development of Technical Content Public Health Examples

21. BTS Phase 3 Prework

22. IHI Breakthrough Series(6 to 18 months time frame) Select Topic (develop mission) Participants (10-100 teams) Prework Dissemination Publications, Congress. etc. P Develop Framework & Changes P P A D A D A D Expert Meeting S S S LS 1 LS 2 LS 3 Holding the Gains Planning Group AP1 AP2 AP3* Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports *AP3 –continue reporting data as needed to document success LS – Learning Session AP – Action Period

23. Why Prework? • Establish an action-oriented culture • The teams come ready to work • Engage others– lay foundation for the improvement back home

24. Prework for the Planning Group Planning Group- Collaborative staff, small group of experts • Completing first iteration of the Change Package • Selecting and enrolling teams • Creating and testing Prework materials • Preparing teams • Assessing resources

25. Prework for Collaborative Teams Collaborative Teams- Local staff, community partners, other stakeholders • Discuss aims and focus work • Engage the senior leader • Initiate measurement and other information gathering • Identify resources and develop a budget • Storyboard This is a different type of learning experience

26. BTS Phase 4 Learning Sessions and Action Periods

27. IHI Breakthrough Series(6 to 18 months time frame) Select Topic (develop mission) Participants (10-100 teams) Prework Dissemination Publications, Congress. etc. P Develop Framework & Changes P P A D A D A D Expert Meeting S S S LS 1 LS 2 LS 3 Holding the Gains Planning Group AP1 AP2 AP3* Supports Email (listserv) Phone Conferences Visits Assessments Monthly Team Reports *AP3 –continue reporting data as needed to document success LS – Learning Session AP – Action Period

28. Learning Session Objectives Learning Session 1 Get Ideas Get Methods Get Started Learning Session 2 Get More Ideas Get Better at Methods Get a “Stride” Learning Session 3 Celebrate Successes Get ready to Sustain and Spread Test all changes on small scale Test & implement all changes Action Period 1 Action Period 2

29. Opportunity for the teams to Test changes Measure results Get help from colleagues Action Periods– Where the Rubber Meets the Road

30. Action Periods Opportunity for staff to • Support teams in their improvement work • Build collaboration and shared learning • Assess collaboration and progress This is the time of maximal learning

31. Model forImprovement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Plan Act Study Do From: Associates in Process Improvement

32. Plan, Do, Study, Act • Plan – who, what, when, where • Do – implement change, collect data • Study – analyze results – if test was successful, then Act, if not, then Plan again • Act – Implement on a broad scale and move to next cycle

33. A P S D D S P A A P S D A P S D PDSA Cycle Changes That Result in Improvement DATA Implementation of Change Wide-Scale Tests Follow-up Tests Ideas Small Scale Test

34. PDSA Cycle Public Health Examples

35. BTS Phase 5 Holding the Gains and Spread

36. Holding the Gains • Continued tracking of improvements • Part of the BTS Design! Spread Definition-- Adapting change to areas or populations other than your pilot populations

37. Why Think About Spread Early in Your Collaborative Planning? • For those planning a collaborative: • Helps identify which organizations or persons to invite to collaborative • For the collaborative’s teams: • Aids in team’s selection of their pilot population • Can think about who to involve and cultivate relationships for spread

38. Examples of Spread One county clinic site to all county clinic sites One population group to multiple population groups One preventable chronic disease program to multiple chronic disease programs One neighborhood to an entire city

39. Holding the Gains and SpreadPublic Health Examples

40. Lessons Learned/Tips • Flexibility • Focus • Short-term process improvement vs. long-term outcome improvement • Incentives • Failure as valuable as success (sometimes more so)