Transcript 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
2
 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.
Muskie Interim Evaluation
3
 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.
Applying the Lessons
4
 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.
Collaborative Model for Achieving
Breakthrough Improvement
5
SYSTEMS ARE PERFECTLY
DESIGNED TO PRODUCE THE
RESULTS THEY ACHIEVE
MCPP Healthcare Consulting, Inc.
IHI’s* Breakthrough Series
6
 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.
Proven Model that Works
7
 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.
Breakthrough Method (IHI)
8
Participants
Select
Topic
Experts &
Planning
Group
Prework
Identify
Change
Concepts
P
A
P
D
A
S
LS 1
P
D
A
S
LS 2
D
S
LS 3
Supports
E-mail
Visits
Web-site Phone
Assessments
Senior Leader Reports
MCPP Healthcare Consulting, Inc.
Learning
Congress and
Publications
IHI Key Elements
9
 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.
Conclusions-Successes
10
 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.
Conclusions – Opportunities
11
 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.
MLC-3 Levels of Collaboratives
12
National Level –Target Areas
with multi-state TAG
Collaboratives
State
Level
State
Level
State
Level
State
Level
State
Level
State
Level
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
Individual
TAG
MCPP Healthcare Consulting, Inc.
Well Done Key Elements
13
 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.
Mixed Success – Key Elements
14
 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.
Opportunities for Improvement* – Key Elements
15
 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.
Take Time to Assess Status
16
 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.
Harnessing the Power
17
 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.
Harnessing the Power
18
 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.
Harnessing the Power
19
 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.
Harnessing the Power
20
 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.
Addressing “Impeding” Factors
21
 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.
Adopting Success in Other States
22
 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.
Table Groups Strategize
23
 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.
Final Comments
24
MEASUREMENT, IMPROVEMENTS TO
BREAKTHROUGH MODEL, REFERENCES AND
RESOURCES, AND CHANGE VERSUS
IMPROVEMENT
MCPP Healthcare Consulting, Inc.
Measurement Tips
25
 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.
Measurement Tips
26
 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.
Improvements to BTS by IHI
27
 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.
Some QI References - Handout
28
 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.
Change versus Improvement
29
 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.
THANK YOU!
What questions do you have?
Contact Marni Mason at
[email protected]
or 206-613-3339
MCPP Healthcare Consulting, Inc.
30