Leading Quality Improvement Essentials for Managers Lesson 5: - PowerPoint PPT Presentation

July 20, 2016 These presenters have nothing to disclose Leading Quality Improvement Essentials for Managers Lesson 5: Practice Improvement Essentials Janet Porter, PhD Kathy Duncan, RN

Rhonda Dickman, RN, MSN, CPHQ Rhonda Dickman is a Quality Improvement Specialist with the Tennessee Hospital Association’s Tennessee Center for Patient Safety, supporting hospitals in their quality improvement work, particularly in the area of readmissions. She is also the clinical manager of the Tennessee Center for Patient Safety’s PSO (patient safety organization). Rhonda has worked in the field of hospital quality management since 2006 and has a clinical background in trauma, critical care, oncology, and organ donation. rdickman@tha.com 615-401-7404

3 Attendance Chat name and organization into the chat box Email Rhonda Dickman that you attended – rdickman@tha.com Log in to the webinar using your username and password: – User name: email address used to register – Password: the password you set up when you registered

4 Lead Faculty Kathy D. Duncan, RN , faculty, Institute for Healthcare Improvement (IHI), directs IHI Expeditions and manages IHI's work in rural settings. Previously, she provided spread expertise to Project JOINTS, co-led the 5 Million Lives Campaign National Field Team, and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She also served as the content lead for the Campaign's Prevention of Pressure Ulcers and Deployment of Rapid Response Teams areas. She is a member of the Scientific Advisory Board for the AHA NRCPR, NQF's Coordination of Care Advisory Panel, and NDNQI's Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the director of critical care for a large community hospital.

5 Supporting Faculty Janet Porter, MBA, PhD , serves as consultant to hospitals and physician practices for Stroudwater Associates. She has 35 years of experience as a hospital administrator, teacher, consultant, and public health leader. Dr. Porter served as the Chief Operating Officer of Dana- Farber Cancer Institute; the Associate Dean of Executive Education at the University of North Carolina’s School of Public Health; the Interim CEO of the Association of University Programs in Health Administration (AUPHA); and the Vice President, and then COO, of Nationwide Children’s Hospital in Columbus, Ohio. Currently teaching strategic management in the Healthcare Executive MBA program at the University of Miami, she is also an active adjunct professor at the University of North Carolina at Chapel Hill and Ohio State University. Dr. Porter received her BS and MHA from Ohio State University, and her MBA and PhD in health care strategy from the University of Minnesota.

Tennessee Leading Quality Improvement: Management Essentials Course Leading Change/Influencing Others - Session 2 June 8 JP Manage the Work Time Management – Session 3 June 22 JP Build the Project Management – Session 4 July 6 JP skills and capabilities Patient and Family Engagement – Session 1 May 25 JP needed to lead quality improvement Practice Improvement Essentials – Session 5 July 20 KD Manage Improvement efforts at the middle Identify and Spread Improvement - Session 6 August 3 KD manager level of an Incorporating Finance in Improvement– Session 7 August 17 organization Building and Creating Joy in Teams – Session 8 August 31 KD Develop Teams Leveraging Teams with Partners – Session 9 Sept 14 JP

7 Practice Assignment PDSA Driver Diagram

8 Today’s Objectives Identify the steps in go to full-scale phase Use adoption mechanisms needed to go full-scale Identify infrastructure issues that need to be addressed to go full-scale Apply methods to sustain improvement at each step in sequence

How might you use a driver diagram? 9

New Framework for Scale 10

Core Elements for Getting Results P11 at Scale “scale-up” - overcoming the system/infrastructure issues that arise during efforts to scale-up implementation “spread” – the leadership, social, and environmental factors that promote adoption and replication, with little modification, of an intervention within a health system Unpublished document: Kurapati, Laderman, et al., 2011.

Going to Full Scale P Barker, A Reid, M Schall, unpublished paper, April 2015

Phases of Scale Up Introduction of a new evidence based intervention for system-wide scale-up OR Adaptation and Scale up of a successful innovation in one part of the system to the rest of the system P13

Phases of Scale Up: Set-up Answer key questions: clear aim, what is full scale, define scalable unit Analysis of the existing programming strategies and protocols, Assemble best practices, build change package (expert group) baseline data collection P14

Phases of Scale Up Administrative unit includes core activities and support systems that need to be replicated in the larger health system. Intensively test local ideas, generate a set of context- sensitive interventions for scale up “change package” P15

Phases of Scale Up Test and further develop preliminary change package in a broader range of contexts representing the predicted full-scale environment P16

Phases of Scale Up Rapid deployment phase - well-tested set of interventions are deployed at large scale, adopted by frontline staff Focus on replication and sustainability P17

Adoption and Support Systems Best Practice Phases of Test Scale- exists Build Scalable Set-up Go to Full-Scale Scale-up Up Unit New Scale- up Idea Adoption Leadership, communication, social networks, culture of Mechanisms urgency and persistence Learning systems, data systems, infrastructure for scale-up, Support human capacity for scale-up, capability for scale-up, Systems sustainability P18

Adoption is a SOCIAL thing! A better …communicated through a …over idea… social network… time Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.

Stages of Adoption People who adopt new ideas 1. Awareness go through these 2. Persuasion five stages! 3. Decision 4. Implementation 5. Confirmation Prochaska J, Norcross J, Diclemente C. In Search of How People Change, American Psychologist, September, 1992.

Attributes of an Idea that Facilitate Adoption 21 Relative Simple Trialable Compatible Observable Advantage Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.

The Relationship of Quality Improvement and Quality Control Juran Trilogy Functions for Managers: • Quality Planning • Quality Control • Quality Improvement Source: Scoville R, Little K, Rakover J, Luther K, Mate K. Sustaining Improvement . IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016. (Available at ihi.org)

Driver Diagram: High-Performance Management System at the Front Line Source: Scoville R, Little K, Rakover J, Luther K, Mate K. Sustaining Improvement . IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016. (Available at ihi.org)

Driver Diagram: High-Performance Management System at the Front Line S1: Standardization S2: Accountability S3: Visual Management * S4: Problem Solving * S5: Escalation * S6: Integration S7: Prioritization S8: Assimilation S9: Implementation S10: Policy S11: Feedback S12: Transparency Source: Scoville R, Little K, Rakover J, Luther K, Mate K. Sustaining Improvement . IHI White Paper. S13: Trust Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016. (Available at ihi.org)

26 Practice: The Secondary Drivers seem like a great checklist of sorts for Sustainability. Can you think of an example for each ?