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
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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
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Agenda
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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
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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.
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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).
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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.
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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.
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Grantee-wide Vision
Strategic QM Plan (3-5 yrs)
QM Plan (annual)
Annual Goals
Workplan
Execution
Annual Evaluation
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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
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Elements of a Quality Management Plan
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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.
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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?“
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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?
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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?
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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
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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?
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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?
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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
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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?
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Part 5: Participation of Stakeholders
Tips
• List internal and external stakeholders and their
functions/responsibilities
• Include:
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•
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?
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Part 6: Evaluation
How will we evaluate our overall performance as a program?
• Evaluate infrastructure effectiveness
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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
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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
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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?
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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
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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
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Resources
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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?
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Kirkpatrick Model
• REACTION
• LEARNING
• BEHAVIOR
• RESULTS
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Bottom Line Question
• What do you do with the
information ?
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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
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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”
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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”
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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
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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
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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
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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
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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
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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.
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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.
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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?
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At your tables
Pair-share your stories…
then we will do a large group debrief
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Tips and Simple Rules
• Tips
• Simple Rules
 Pre-flight Prep
• (Page 175)
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•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?”
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What They Hear
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What We Hear
Pace
P
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a
u
s
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What They See
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What We See
•Body Stance/Movement
•Gesture
s
•Facial Expressions
•Eye Contact
•Nervousness
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Managing Nervousness
• Have a strategy for questions or
exercises
• Control your breathing
• Be prepared
• Move around
• Practice, practice, practice
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Managing Anxiety
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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.
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LEARNING...
•“A change in behavior
due to
experience or continued
practice.”
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•The Keys to the Success of this Project
•Teamwork
•Quality
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HOW YOU SHOW IT!
(Visual Aides)
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•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
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•MORALE
•Riding the Waves of Change
•change
change
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change
change
•TIME
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Flip Chart Examples
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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
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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.
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Purposes of Communication
•INVOLVE
•ENGAGE
•CLARIFY
•INFORM
•Awareness
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•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
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The Role of the “Traffic Cop”
Specific words and phrases useful in directing
traffic:






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Observing
Clarifying
Focusing
Stimulating
Balancing
Summarizing
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Dealing with Difficult Behaviors
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Intervention Strategies
•High-Level Intervention
•Medium-Level Intervention
•Low-Level Intervention
•Non-Intervention
•Prevention
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Tips
• Prevention
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• Intervention (page 194)
 Prepare
 Broken Record
 Practice intervention
 Gloom and Doom
comments
 Solutions to common
problems
 Structure of room
 Interrupter
 Rambler
 Side conversations
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Closing
“Don’t put people in learning experiences, put
them in doing experiences. Achieving
enables people to grow.”
Peter Drucker
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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
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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
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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
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Peer Presentation #1
QI Principles
Success is achieved through meeting the
needs of those we serve.
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Most problems are found in processes,
not in people.
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Do not reinvent the wheel – Learn from
best practices.
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Learn through small, incremental changes
to achieve continual improvements.
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Actions are based upon accurate and
measured data.
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Infrastructure enhances systematic
implementation of improvement activities.
Infrastructure
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Set Priorities and Communicate clearly
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Peer Presentation #2
PDSA Cycle
How can we accelerate
change and improvements
in HIV programs?
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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
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•Model for Improvement
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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?
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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?
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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?
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The PDSA Cycle
for Learning and Improvement
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•
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
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•
•
•
•
•
•
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’
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Balance between Performance Measurement
and Quality Improvement Activities
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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.
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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
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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?
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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?
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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.
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0%
0%
0%
107
1. Strongly Disagree
2.
3. Agree
4.
5. Strongly Agree
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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
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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
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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
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112
1. Not Effective
2.
3. Effective
4.
5. Very Effective
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Please rate the following agenda item:
Generating Participant Feedback
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113
1. Not Effective
2.
3. Effective
4.
5. Very Effective
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Please rate the following agenda item:
QM in the Context of the Ryan White Program
0%
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114
1. Not Effective
2.
3. Effective
4.
5. Very Effective
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Please rate the following agenda item:
Training Nightmares, Mishaps & Messes
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115
1. Not Effective
2.
3. Effective
4.
5. Very Effective
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Please rate the following agenda item:
Presenting and Facilitating Learning
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116
1. Not Effective
2.
3. Effective
4.
5. Very Effective
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Please rate the following agenda item:
Presentations & Role Play with Peers
0%
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117
1. Not Effective
2.
3. Effective
4.
5. Very Effective
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Please rate the following agenda item:
Game Plan Going Forward
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1. Not Effective
2.
3. Effective
4.
5. Very Effective
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Overall, I was satisfied with today.
0%
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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
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Overall TOT Assessment
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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 :-)