Transcript Slide 1
Module 20 – Day 3 8:00am – 8:30am (30 min) Welcome to Day 3 Agenda – Day 3 8:00 8:30 9:15 10:15 11:00 11:30 12:30 1:15 2:15 3:00 4:00 2 Welcome & Warm-up Activity Quality Management Plans Generating Participant Feedback Quality Management in the Context of the Ryan White Program Training Nightmares, Mishaps & Messes Presenting & Facilitating Learning Lunch Presentation & Role Play with Peers Game Plan Going Forward Workshop Close, Session Evaluation, Kudos & Celebration Adjourn National Quality Center (NQC) Fears and Challenges 3 National Quality Center (NQC) Module 21 – Day 3 8:30 – 9:15am (45 min) Quality Management Plans Learning Objectives • Describe the role of a QM Plan in the overall quality program • Describe the elements of a good written QM Plan • Analyze a sample QM Plan to determine strengths and areas for improvement 5 National Quality Center (NQC) Agenda • • • • • • 6 Definitions of Terms HAB Expectations Elements of a QM Plan 10 Rules Resources Group Exercise National Quality Center (NQC) Grantee-wide Vision Strategic QM Plan (3-5 yrs) QM Plan (annual) Annual Goals Workplan Execution Annual Evaluation 7 National Quality Center (NQC) Definitions of Terms Quality Management Plan: A Quality Management Plan is a written document that outlines the program-wide HIV quality program, including a clear indication of responsibilities and accountability, performance measurement strategies and goals, and elaboration of processes for ongoing evaluation and assessment of the program. 8 National Quality Center (NQC) Definitions of Terms Quality Management Program: The term ‘quality management program’ encompasses all grantee-specific quality activities, including the formal organizational quality infrastructure (e.g., committee structures with stakeholders, providers and consumer) and quality improvement-related activities (performance measurement, QI project and QI training activities). 9 National Quality Center (NQC) Definitions of Terms Strategic Plan: A strategic plan is a document that describes the long-term (3-5 years) objectives of the QM program with stretch goals that are in line with the overall vision of the organization. 10 National Quality Center (NQC) Definitions of Terms Workplan: A workplan or implementation plan describes concrete steps in the implementation of an annual QM plan with a detailed description of responsibilities and timetables and milestones. At times, the workplan is folded into the overall QM plan. 11 National Quality Center (NQC) Grantee-wide Vision Strategic QM Plan (3-5 yrs) QM Plan (annual) Annual Goals Workplan Execution Annual Evaluation 12 National Quality Center (NQC) HAB QM Plan Expectations • Minimum Expectations Establish a quality management plan Establish processes for ensuring that services are provided in accordance with PHS guidelines & standards of care Further details are available at the HRSA HIV/AIDS Bureau website [hab.hrsa.gov]: Part A: hab.hrsa.gov/tools/title1/t1SecVIIChap5.htm Part B: hab.hrsa.gov/tools/title2/t2SecVIIIChap5.htm Part C: http://hab.hrsa.gov/tools/title3/sii_chapter_4.htm 13 National Quality Center (NQC) Elements of a Quality Management Plan • • • • • • 14 Quality statement Quality improvement infrastructure Performance measurement Annual quality goals Participation of stakeholders Evaluation National Quality Center (NQC) Exercise: Analyze a Sample Plan 20 mins • As a table group, choose either Sample Plan A pg 156 or Plan B pg 158. • As a group, use the QM Plan review sheet on page 154 to analyze the Plan you chose. • Be ready to share the rationale for your rating. 15 National Quality Center (NQC) Part 1: Quality Statement What do we want to be? • Brief purpose/mission statement describing the end goal of the HIV quality program to which all other activities are directed • Assume an ideal world and ask yourselves, "What do we want to be for our patients and our community?“ 16 National Quality Center (NQC) Part 1: Quality Statement Tips • Be brief • Be visionary • Include internal and external expectations • Make references to external legislative requirements on quality management How did your groups rate Plan A quality statement? Plan B? 17 National Quality Center (NQC) Part 2: Quality Improvement Infrastructure Tips • Not more than 3-5 pages (not every detail is needed) • Avoid naming individuals (just job functions) • List internal and external stakeholders • List linkages How did your groups rate Plan B? Plan A? 18 National Quality Center (NQC) Part 3: Performance Measurement How will we assess progress? • identify and quantify the critical aspects of care and services provided • develop indicators and measure the progress of the QM program 19 National Quality Center (NQC) Part 3: Performance Measurement Tips • develop quality indicators, keeping in mind three main criteria: Relevance, Measurability and Improvability • include the process for reviewing and updating the indicators (who/when/how) • include a portfolio of process, outcome and satisfaction measures • include strategies how to report and disseminate results and findings How did your groups rate Plan A? Plan B? 20 National Quality Center (NQC) Part 4: Annual Quality Goals What are the priorities for the quality program? • Quality goals are endpoints or conditions toward which the quality program will direct its efforts and resources • Develop annual goals; the following three criteria can be helpful: Frequency: How many patients/clients received and how many did not receive the standard of care/services? Impact: What is the effect on patient health if they do not receive this care/services? Feasibility: Can something be done about this problem with the resources available? 21 National Quality Center (NQC) Part 4: Annual Quality Goals Tips • pick only a few measurable and realistic goals annually (not more than 5) • use a broad range of goals • establish thresholds at the beginning of the year for each goal 22 National Quality Center (NQC) Part 5: Participation of Stakeholders How will staff, providers, consumer and other stakeholders be involved in the QM program? • Engage internal and external stakeholders • Communicate information about quality improvement activities • Provide opportunities for learning about quality How did your groups rate Plan B? Plan A? 23 National Quality Center (NQC) Part 5: Participation of Stakeholders Tips • List internal and external stakeholders and their functions/responsibilities • Include: • Clinical providers Non-clinical providers Consumers Sub-grantees Representatives from agency, such as hospital, network, etc. List proposed training opportunities for staff and providers How did your groups rate Plan A? Plan B? 24 National Quality Center (NQC) Part 6: Evaluation How will we evaluate our overall performance as a program? • Evaluate infrastructure effectiveness Was the quality committee effective in its efforts to improve the quality of HIV care/services? Does the quality infrastructure require any changes to improve how quality improvement work gets done? • Evaluate QI activities Were annual quality goals for quality improvement activities met? How effectively did you meet your goals? Did the implementation of the annual work plan go as planned? Did you meet established milestones? Were stakeholders informed about ongoing quality activities? Were staff and providers trained on QI methodologies and tools? • Performance measures 25 Were the measures appropriate to assess the clinical and non-clinical HIV care? Are the results in the expected range of performance? National Quality Center (NQC) Part 6: Evaluation Tips • Detail when and who is performing the evaluation • Compare annual QI goals with year-end results • Use findings to plan next year’s activities; learn and respond from past performance • Routinely use organizational assessment tools How did your groups rate Plan B? Plan A? 26 National Quality Center (NQC) The 10 QM Plan Rules Rule 1 - Size doesn’t matter; longer isn’t better Rule 2 - 80% planning, 20% writing (old software programming rule) Rule 3 - Don’t reinvent the wheel; use someone else’s plan to get started Rule 4 - Be inclusive, even it takes a little longer to get a working plan (Make it a plan of many “Parts”) Rule 5 - No plan is complete until it addresses consumer input 27 National Quality Center (NQC) The 10 QM Plan Rules (cont.) Rule 6 - The perfect is the enemy of the good (A “perfect” plan was probably written by a consultant and nobody else has a clue what it says) Rule 7- Keep your goals focused (A few visionary annual goals are better than lots of useful ones) Rule 8 - Plans are only as good as their implementation Rule 9 - If you haven’t changed the plan throughout the year, you probably haven’t looked at it Rule 10- If you haven’t looked at the plan in 6 months, bring it to the next QC meeting 28 National Quality Center (NQC) Resources • • • • • 29 NQC QM Plan Checklist HIVQUAL Workbook HIVQUAL Group Learning Guide HAB Title I Manual NQC website (sample plans and QM materials) National Quality Center (NQC) Module 22 – Day 3 9:15 am – 9:45 am (45min) Evaluating Training Effectiveness Framing Question • How and what do you measure? 31 National Quality Center (NQC) Kirkpatrick Model • REACTION • LEARNING • BEHAVIOR • RESULTS 32 National Quality Center (NQC) Bottom Line Question • What do you do with the information ? 33 National Quality Center (NQC) Break •Module 23 – Day 3 •10:15am – 11:00am (45 min) Quality Management in the Context of the Ryan White Program Objectives • Review the main components of the legislative framework • Be able to describe current HRSA expectations for quality improvement programs • Practice analyzing sample programs for adherence to the expectations 36 National Quality Center (NQC) Ryan White Treatment Extension Act of 2009 • “The chief elected official/ grantee… shall provide for the establishment of a clinical quality management program to assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infection, and as applicable, to develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV health services” 37 National Quality Center (NQC) Ryan White Program Quality Requirements • “RWCA grantees are directed to establish clinical quality management programs to …” • “assess the extent to which HIV health services are consistent with the most recent Public Health Service (PHS) guidelines…” • “develop strategies for ensuring that such services are consistent with the guidelines for improvement in access to and quality of HIV health services” 38 National Quality Center (NQC) Ryan White Program Quality Requirements “RWCA grantees are directed to establish clinical quality management programs..” which include: Development of a comprehensive clinical quality management infrastructure, including routine QM meetings with crossfunctional representation Description of QM program in a written quality plan, with a clear indication of responsibilities and responsible parties Inclusion and involvement of key stakeholders in your quality program Designated leaders for quality improvement and accountability 39 National Quality Center (NQC) Ryan White Program Quality Requirements • “assess the extent to which HIV health services are consistent with the most recent Public Health Service (PHS) guidelines…” which includes: Development and/or adaptation of quality indicators for key clinical and service categories Routine performance measurement of key care aspects Sharing of performance data with program staff Use of data to improve the organization’s performance on key services 40 National Quality Center (NQC) Ryan White Program Quality Requirements • “develop strategies for ensuring that such services are consistent with the guidelines for improvement in access to and quality of HIV service…” that include: Linking performance data results to quality improvement activities Establishment of quality improvement teams with cross- functional representation Integration of changes into routine program activities 41 National Quality Center (NQC) Key Characteristics of a Quality Management Program Patient-centeredness is a fundamental focus of quality care and undergirds the 5 characteristics that follow. 1. A systematic process with identified leadership, accountability, and dedicated resources available to the program 2. Use data and measurable outcomes to determine progress toward relevant, evidenced-based benchmarks 3. Focus on linkages, efficiencies and provider, and client expectation in addressing outcome improvement 42 National Quality Center (NQC) Key Characteristics of a Quality Management Program (cont.) 4. A continuous process that is adaptive to change and that fits within the framework of other programmatic quality assurance and quality improvement activities 5. Ensure that data collected are fed back into the quality improvement process to assure that goals are accomplished and that they are concurrent with improved outcomes 43 National Quality Center (NQC) Individual/Group Exercise • Review the Quality Expectations Case Study on page 173. • Individually, rate the components described for compliance with the required elements. • Be ready to discuss your ratings with your table group. 44 National Quality Center (NQC) •Module 24 - Day 3 •11:00am – 11:30am (30 min) Training Nightmares and Mishaps Critical Incident Think of a time when you were training (or you were in a training) and something really went wrong. It was a genuine nightmare. It comes to mind easily and quickly because it was so vivid. 46 National Quality Center (NQC) Make a few notes • What happened, when and where did it happen? • Why did it happen and who was involved? • What was it about the situation that made it so painful for you? • What did you do? 47 National Quality Center (NQC) At your tables Pair-share your stories… then we will do a large group debrief 48 National Quality Center (NQC) Tips and Simple Rules • Tips • Simple Rules Pre-flight Prep • (Page 175) 49 National Quality Center (NQC) •Module 25 – Day 3 •11:30am – 12:30pm (60 min) Tools for Effective Presentation and Group Facilitation Framing Question “In your experience, what types of things make for a great presentation?” 51 National Quality Center (NQC) What They Hear 52 National Quality Center (NQC) What We Hear Pace P 53 a u s e National Quality Center (NQC) What They See 54 National Quality Center (NQC) What We See •Body Stance/Movement •Gesture s •Facial Expressions •Eye Contact •Nervousness 55 National Quality Center (NQC) Managing Nervousness • Have a strategy for questions or exercises • Control your breathing • Be prepared • Move around • Practice, practice, practice 56 National Quality Center (NQC) Managing Anxiety • • • • • 57 Plan for it Relaxation techniques Positive visualization Keep perspective Familiarize yourself with the training environment, audience, and content National Quality Center (NQC) •They forget 70% of what we tell them. •What is the 30% we want them to remember? •© HOWICK ASSOCIATES, Inc. 58 2004 National Quality Center (NQC) LEARNING... •“A change in behavior due to experience or continued practice.” 59 National Quality Center (NQC) •The Keys to the Success of this Project •Teamwork •Quality 60 National Quality Center (NQC) HOW YOU SHOW IT! (Visual Aides) 61 National Quality Center (NQC) •Adult Learning •I Hear •I See • I Do • I Do Frequently and Receive Feedback •I Forget •I Remember •I Understand •I Perform Successfully •© Howick Associates, Inc. 1997 62 National Quality Center (NQC) •MORALE •Riding the Waves of Change •change change 63 change change •TIME National Quality Center (NQC) Flip Chart Examples • • • • • 64 A variety of color adds interest to your visual Letters should be a minimum of 2 inches high Write no more than 10 lines on a page By now you should see that this is an example of how not to construct a flip chart What could be done to make this better? • A variety of color adds interest to your visuals • Letters should be a minimum of 2 in. high • Write no more than 10 lines on a page • Write on every other page if paper is thin National Quality Center (NQC) Training is a blend of presentation and facilitation 65 National Quality Center (NQC) Facilitation—A Brief Review The word facilitate has its origin in the Latin word facilis, which means “easy.” Group work is potentially made easier by the contributions of a facilitator. 66 National Quality Center (NQC) Purposes of Communication •INVOLVE •ENGAGE •CLARIFY •INFORM •Awareness 67 •Understanding •Acceptance •Commitment National Quality Center (NQC) Interactive Presenting • Checking expectations & needs as you go… • Parking lot • Checking questions * open * closed • Application questions • Small group / pairs discussion 68 National Quality Center (NQC) The Role of the “Traffic Cop” Specific words and phrases useful in directing traffic: 69 Observing Clarifying Focusing Stimulating Balancing Summarizing National Quality Center (NQC) Dealing with Difficult Behaviors 70 National Quality Center (NQC) Intervention Strategies •High-Level Intervention •Medium-Level Intervention •Low-Level Intervention •Non-Intervention •Prevention 71 National Quality Center (NQC) Tips • Prevention 72 • Intervention (page 194) Prepare Broken Record Practice intervention Gloom and Doom comments Solutions to common problems Structure of room Interrupter Rambler Side conversations National Quality Center (NQC) Closing “Don’t put people in learning experiences, put them in doing experiences. Achieving enables people to grow.” Peter Drucker 73 National Quality Center (NQC) Lunch •Module 27 – Day 3 •1:15pm – 2:15pm (60 min) •Presentations and Role Play with Peers Objectives • Present and facilitate discussion in a safe environment • Record development goals based on the role play 76 National Quality Center (NQC) What Are We Doing? • Form groups of 3; if possible, each person presents on a different topic • Go anywhere you like; take TOT Guide with you • Identify a time keeper • Each presenter has 5 minutes to present and 10 minutes to facilitate a discussion 77 National Quality Center (NQC) What Are We Doing? • During each presentation, the 2 “learners” select a difficult behavior; the presenter can practice intervention strategies • After each presentation, the “learners” provide constructive feedback • Make sure to manage time well • Be back by 1:45…to document areas for personal improvement 78 National Quality Center (NQC) Peer Presentation #1 QI Principles Success is achieved through meeting the needs of those we serve. 80 National Quality Center (NQC) Most problems are found in processes, not in people. 81 National Quality Center (NQC) Do not reinvent the wheel – Learn from best practices. 82 National Quality Center (NQC) Learn through small, incremental changes to achieve continual improvements. 83 National Quality Center (NQC) Actions are based upon accurate and measured data. 84 National Quality Center (NQC) Infrastructure enhances systematic implementation of improvement activities. Infrastructure 85 National Quality Center (NQC) Set Priorities and Communicate clearly 86 National Quality Center (NQC) Peer Presentation #2 PDSA Cycle How can we accelerate change and improvements in HIV programs? 88 National Quality Center (NQC) Model for Improvement • Improvement is about learning trial and error (scientific method) improvements require change, however not all changes are an improvement • Measure your progress only data can tell you whether improvements are made integrate measurement into the daily routine • Improvements thru continuous cycles of changes Plan-Do-Study-Act approach changes are initiated on a small scale to test them before implementation 89 National Quality Center (NQC) •Model for Improvement 90 National Quality Center (NQC) Model for Improvement •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? 91 National Quality Center (NQC) Model for Improvement •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? 92 National Quality Center (NQC) Model for Improvement •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? 93 National Quality Center (NQC) The PDSA Cycle for Learning and Improvement • • Act Plan What changes are to be made? Next cycle? • • • • Objective Questions and predictions (why) Plan to carry out the cycle • (who, what, where, when) Study Do • Complete the • analysis of the data • Compare data to • predictions • Summarize what • was learned 94 • • • • • • Carry out the plan Document problems and unexpected observations Begin analysis of the data National Quality Center (NQC) Peer Presentation #3 Performance Measurement ‘How to develop an indicator’ 96 National Quality Center (NQC) Balance between Performance Measurement and Quality Improvement Activities 97 National Quality Center (NQC) What is a quality indicator? A quality indicator is tool to measure specific aspects of care and services that are optimally linked to better health outcomes while being consistent with current professional knowledge and meeting client needs. 98 National Quality Center (NQC) Dimensions of Quality Technical Quality Provider Perception of Quality of HIV Care Experience Quality Consumer Perception of Quality of HIV Care •Leonard Berry, Texas A&M University, IHI conference 2001 99 National Quality Center (NQC) What makes a good indicator? • Relevance Does the indicator affect a lot of people or programs? Does the indicator have a great impact on the programs or patients/clients in your EMA, State, network or clinic? • Measurability Can the indicator realistically and efficiently be measured given finite resources? 100 National Quality Center (NQC) What makes a good indicator? (cont’d.) • Accuracy Is the indicator based on accepted guidelines or developed through formal group-decision making methods? • Improvability Can the performance rate associated with the indicator realistically be improved given the limitations of your services and population? 101 National Quality Center (NQC) Module 28 Going Forward Reporting •Module 29 – Day 3 •3:00pm – 4:00pm (60 min) Evaluation Day 3 The way the course was delivered today was an effective way for me to learn. 0% 0% 0% 0% 0% 104 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) I had sufficient opportunity to participate today. 0% 0% 0% 0% 0% 105 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) Materials were useful during the day. 0% 0% 0% 0% 0% 106 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) The agenda and content for today were logically organized. 0% 0% 0% 0% 0% 107 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) Overall, I was satisfied with the session facilitator(s). 0% 0% 0% 0% 0% 108 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) I will refer to or use the materials going forward. 0% 0% 0% 0% 0% 109 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) My knowledge and /or skills increased as a result of today. 0% 0% 0% 0% 0% 110 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) The workshop had the right balance of lecture and interactive activities. 0% 0% 0% 0% 0% 111 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) Please rate the following agenda item: Quality Management Plans 0% 0% 0% 0% 0% 112 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) Please rate the following agenda item: Generating Participant Feedback 0% 0% 0% 0% 0% 113 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) Please rate the following agenda item: QM in the Context of the Ryan White Program 0% 0% 0% 0% 0% 114 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) Please rate the following agenda item: Training Nightmares, Mishaps & Messes 0% 0% 0% 0% 0% 115 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) Please rate the following agenda item: Presenting and Facilitating Learning 0% 0% 0% 0% 0% 116 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) Please rate the following agenda item: Presentations & Role Play with Peers 0% 0% 0% 0% 0% 117 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) Please rate the following agenda item: Game Plan Going Forward 0% 0% 0% 0% 0% 118 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) Overall, I was satisfied with today. 0% 0% 0% 0% 0% 119 1. Strongly Disagree 2. 3. Agree 4. 5. Strongly Agree National Quality Center (NQC) How ready are you to plan and facilitate a QI workshop? 0% 0% 0% 0% 0% 1. Not Ready 2. 3. Mostly Ready 4. 5. Very Ready •10 120 National Quality Center (NQC) Overall TOT Assessment 121 National Quality Center (NQC) How to you rate the effectiveness: TOT Nomination Process 0% 0% 0% 0% 0% 122 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) How to you rate the effectiveness: TOT Pre-Work 0% 0% 0% 0% 0% 123 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) How to you rate the effectiveness: TOT Session 0% 0% 0% 0% 0% 124 1. Not Effective 2. 3. Effective 4. 5. Very Effective National Quality Center (NQC) Overall, how satisfied were you with the TOT Program experience? 0% 0% 0% 0% 0% 125 1. Not Satisfied 2. 3. Satisfied 4. 5. Very Satisfied National Quality Center (NQC) Overall, how do you rate the TOT Guide? 0% 0% 0% 0% 0% 126 1. Not Satisfied 2. 3. Satisfied 4. 5. Very Satisfied National Quality Center (NQC) Overall, how satisfied were you with the TOT Faculty? 0% 0% 0% 0% 0% 127 1. Not Satisfied 2. 3. Satisfied 4. 5. Very Satisfied National Quality Center (NQC) Thank You :-)