Transcript Stratis Health Current Work of the PRO

Building the Dream Team:
Managing a Quality Improvement
Collaborative
Jennifer Lundblad, PhD, MBA
President and CEO
Multi-State Learning Collaborative
August 7, 2008
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Presentation Outline
Quality improvement collaboratives are a tool that
can be used to help improve public health
practice. This session will provide:
 Description of a QI collaborative as an
educational methodology to support quality
improvement
 Discussions of when and why collaboratives
work
 Lessons learned by Stratis Health in
implementing collaboratives
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Stratis Health
 Independent, not-for-profit quality improvement
organization founded in 1971
 Mission: To lead collaboration and innovation in health
care quality and safety, and serve as a trusted expert in
facilitating improvement for people and communities
 Work with both providers and consumers to improve
health care
 Funded by federal and state contracts, corporate, and
foundation grants
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Stratis Health’s Approach
to Improving Quality
Stratis Health carries out its work by serving as a:
• Quality improvement expert and
clearinghouse
• Educator and trainer
• Facilitator and convener
• Data resource
• Consultant and supporter
QI Collaboratives are a tool frequently used by Stratis
Health to drive and support improvement.
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Quality Improvement Collaboratives
 Teams from participating organizations
focused on similar goals work together to:
 Learn about theory and proven strategies for improving care
 Try out tools to help achieve improvement
 Make and refine plans for improvement for their
organizations
 Develop a network of colleagues at other organizations
pursuing similar work
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QI Collaboratives: Methodology
 3-4 learning sessions over 12-18 months
 Typically facilitated by an external organization
 ‘Faculty’ experts help design and facilitate
 Teams measure and share results to track progress
 Strong role for measurement and tracking
 Storyboard presentations at learning sessions
 Proactive support between learning sessions
 Support, encouragement, and expertise offered through
regular conference calls, email, and Web site interaction with
faculty experts from the collaborative
 Final celebratory session (e.g., Outcomes Congress)
 Share learnings and disseminate results
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QI Collaboratives: Methodology (cont.)
 In addition to the standard or core
components to a collaborative, Stratis
Health often includes the following:
 On-site technical assistant visits to
participating organizations
 Senior leader reports
 Peer mentoring support
 Partnering/co-sponsoring with other
organizations with shared goals
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QI Collaboratives: Methodology (cont.)
 Pre-work: Get senior leader support, form team,




assess current data
LS1: Define aims and measures, develop plans for
tests of change, get ideas for improvement
LS2: Gather more ideas for change, gain deeper
understanding of testing and implementation, identify
and develop strategies to overcome barriers, learn
from other teams
LS3: Understand what is working and what isn’t, plan
for holding gains and spreading change, celebrate
early results
Action periods between learning sessions: test
changes and get feedback, conduct data collection
and reporting
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Collaborative: Examples
 The collaborative learning format has
been used:
 Nationally, by the Institute for Healthcare
Improvement (IHI)
» Branded as “Breakthrough Series”
 Many other regional, state, and local
organizations
» In Minnesota, includes Stratis Health, VHA
Upper Midwest, Institute for Clinical Systems
Improvement (ICSI)
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Collaborative: IHI Model
© 2002 Institute for Healthcare Improvement
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Action Research
 The collaborative improvement model is
based on Action Learning and Action
Research
 The model is not a clinical trial, nor is it a
traditional quality improvement project. It is
a collaborative model based on action
learning, and action research theory and
literature.
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Action Research (cont.)
 Collaborative improvement model has its
roots in action learning theory and principles.
Action learning is:
 “An approach to working with and developing
people that uses work on actual project problems
as the way to learn. Participants work in small
groups to take action to solve their problem and
learn how to learn from that action. Often a
learning coach works with the group in order to
help member learn how to balance their work with
the learning from that work.” (Yorks, et. al, 1999)
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Action Research (cont.)
 Model brings together a number of organizations
that are focusing their improvement work in a
shared area or with similar goals
 Action learning projects usually meet three
criteria (Yorks, et. al, 1999):
1)They are complex, overarching, and often crossfunctional
2)They are problems, opportunities, or difficulties for
which there is no single solution, and
3)They are actual problems, meaningful to
participants, and for which participants are
motivated to act
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QI Collaboratives in Public Health
What problems or topics in public
health practice lend themselves to the
Quality Improvement Learning
Collaborative approach?
In health outcomes?
In capacity building?
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QI Collaboratives: Do they work?
 Two Stratis Health (Minnesota)
examples shared here:
 22 small rural hospital immunization
improvement
 63 home health agency re-hospitalization
reduction
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Immunizations
2003-2004 CAH Collaboration - All Hospitals Combined
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Cycle 1: 10/02-1/23
Cycle 2: 2/03-5/31
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Pneumococcal
Cycle 3: 6/03-9/03
Influenza
Cycle 4: 10/03-1/04
MN HH Collaborative Agencies
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HH Compare
State Average
Month&Year
HH Compare National Average
Oct -07
Nov-07
Sep-07
Aug-07
Jul-07
Jun-07
May-07
Apr-07
Mar-07
Feb-07
Jan-07
Dec-06
Oct -06
Nov-06
Sep-06
Jul-06
Aug-06
Jun-06
May-06
Apr-06
Mar-06
Feb-06
Jan-06
Dec-05
Oct -05
Nov-05
Sep-05
Aug-05
Jul-05
Jun-05
Apr-05
May-05
Mar-05
Feb-05
Jan-05
Dec-04
Oct -04
Nov-04
Acute Care Hospitalization Scores (%)
30
20
Lower scores are better
Acute Care Hopitalization Scores
Data Range: Baseline - November 2007
50
40
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0
QI Collaboratives:
Why do they work?

Learning sessions:


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

Needs and values leveraged to make the case for
change
New knowledge and proficiencies are gained
Motivation through positive peer pressure
Between session activities:
Expert guidance to address systems and structure
issues and barriers
Allow participants to try out new behaviors back on
the job
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QI Collaboratives:
Why do they work? (cont.)
 Measurement:
 Ability for participants to benchmark their
processes and results against peers
 Collective results across the collaborative are
compelling and motivational
 Final celebratory session:
 Engages senior administrative and/or clinical
leadership
 Leveraging management practices at the
organizational level, while at the same time
reinforcing motivation, systems, and
work unit climate at the group level.
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Stratis Health’s Lessons Learned
 Senior Leader engagement
 Get commitment from senior leaders at participating organizations
early on
 Use multiple techniques to keep senior leaders involved and
interested
» Professional and trade association meetings, progress reports, letters
 Clarify Expectations of participating teams/organizations
 Lay out expectations for entire collaborative before
organizations agree to participate
» Reinforce at every opportunity
 Use clear and consistent language
 Ensure there is a shared understanding of tasks
 Include storyboard development early in the process
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Lessons Learned (cont.)
 Reinforce Quality Improvement Structure
 Reinforce model for improvement and PDSA at each workshop
 Rapid tests of change using PDSA cycle can be difficult in small
organizations because of limited number of patients/clients
 Support and Encourage Collaboration Participation



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Offer CEUs for conference calls and workshops
Watch for leaders in the group and use their expertise
Keep measurement and reporting tools simple
Individual team/organization support between sessions is highly
valuable
 Offer template press releases about the collaborative for internal
and external information sharing
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Reflections on QI Collaboratives
in Public Health
 The characteristics of many public health issues match the
action learning criteria (i.e., complex, no single solution,
meaningful)
 Public health has a strong foundation for cross-organization
collaboration…shared structures and demands, similarities in
services, community orientation.
Your ideas, questions,
or comments?
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Contact and Resources
Jennifer Lundblad, PhD, MBA
President and CEO
(952) 853-8523
[email protected]
 Institute for Health Care Improvement
 http://www.ihi.org/IHI/Topics/Improvement/SpreadingChanges/Lit
erature/TheBreakthroughSeriesIHIsCollaborativeModelforAchievi
ngBreakthroughImprovement.htm
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Stratis Health is a non-profit organization that leads
collaboration and innovation in health care quality and safety,
and serves as a trusted expert in facilitating improvement for
people and communities.
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