Transcript South Carolina MLC-3 Experiences Opinionated Lessons Learned

South Carolina
MLC-3 Experiences
Opinions*
*Subject to change after 2nd collaborative experience
Select
Topic
(develop
mission)
IHI Breakthrough Series
(10 month time frame)
Modified for SC
Participants: (4 county teams from Region 8, and 3 county
teams from Region 4 selected by regions)
Prework
June 2008
Expert
Meeting
P
Develop
Framework
& Changes
Planning
Group
A
P
D
S
LS 1
A
P
D
A
S
LS 2
NOTE: Evidence is known, but not being implemented
D
S
LS 3
S
p
r
e
a
d
IHI Collaborative Model
• Really does work in governmental ph setting,
when model is used as designed
– Evidence is known, there really is change package
for all teams in the collaborative
– Intervention, the what, is similar across the
different teams, the how is what teams figure out
and share with each other
– Learning sessions, followed by Action Periods
combined with TA
– Over time, collaborative goes from expert to team
centric, team driven
IHI Collaborative Model
• Really does work in governmental ph setting,
when model is used as designed
– Teams become empowered, and really like that
– More power if collaborative scope narrow and
specific
» Name of Collaborative means something
» Rapid cycle PDSA QI work
– Collaborative model makes sense, as teams learn
from the experts (training and TA) and from each
other (applying QI AND the ins and outs of the
change package)—more power than if work were
done in isolation, done separately
IHI Collaborative Model
• First SC Collaborative—Tobacco Use
Intervention in HD clinical settings
– 7 similar practice settings (WIC and FP)
– Menu of changes from Change package the
same for all teams (2As+R)
– QI training, and applying the changes in their
settings, rapid cycle PDSA
– Direct learning, team to team
– Since topic very specific, teams were able to
apply QI PDSA work with some rigor, and
evaluation results show this impact.
IHI Collaborative Model
• Less rationale for Model when
• No real change package (or each team has somewhat of its
own change package)
• Teams not implementing the same changes
• QI apllied to intervention(s) not rapid cycle—learning and
action cycle phases harder to implement
• There is rationale for collaborative QI learning
and applying to practice settings (just not IHI)
• Nature of collaborative then is QI, not the
intervention/change package as much
• Learning among teams is about applying QI to their
practice settings, not the intervention/change package as
much, across teams
IHI Collaborative Model
• Even with SC success, however, spread is very
very hard
• 2As+R deployment (statewide target by July 2010) in all
WIC, FP, HH, TB settings—embedded now in agency policy
• Even with collaborative knowledge, hard to get others to
adopt the evidence, across large organization
• Champions needed, must be cultivated, nurtured
IHI Collaborative Model
• 2nd Collaborative for SC will be implementing
work around early entry into prenatal care…
•
Most of the teams will not be implementing the same
change package, and/or evidence unknown or not clear
1. Accurate documentation in the birth record (from HD to provider
to hospital)
2. Internal referrals in the HD with pregnancy test results follow-up
3. From HD to provider referrals
4. Community referrals to providers
•
Focus on QI learning and sharing of QI experiences
– Much not rapid cycle QI
– More of a QI Collaborative
Switching Gears…..
…..Messaging
• Spitfire messaging helpful tool
• Segmenting the audience, figuring out what will resonate
with them, as individuals, as groups, important, even
within same organization
• Messaging of Voluntary Accreditation within SC State HD
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From HS perspective
From Commissioner’s perspective
From EQC, OCRM perspective
From Health Regulations perspective
From Administration perspective