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

Leading Quality Improvement

Essentials for Managers Lesson 5: Practice Improvement Essentials

July 20, 2016

These presenters have nothing to disclose

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

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Lead Faculty

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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.

Supporting Faculty

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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.

Build the skills and capabilities needed to lead quality improvement efforts at the middle manager level of an

• rganization

Manage the Work Manage Improvement Develop Teams

Leading Change/Influencing Others - Session 2 June 8 JP Time Management – Session 3 June 22 JP Leveraging Teams with Partners – Session 9 Sept 14 JP Patient and Family Engagement – Session 1 May 25 JP Practice Improvement Essentials – Session 5 July 20 KD Identify and Spread Improvement - Session 6 August 3 KD Building and Creating Joy in Teams – Session 8 August 31 KD

Tennessee Leading Quality Improvement: Management Essentials Course

Project Management – Session 4 July 6 JP Incorporating Finance in Improvement– Session 7 August 17

Practice Assignment

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PDSA Driver Diagram

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

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How might you use a driver diagram?

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New Framework for Scale

Core Elements for Getting Results 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

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Unpublished document: Kurapati, Laderman, et al., 2011.

Going to Full Scale

P Barker, A Reid, M Schall, unpublished paper, April 2015

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

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Phases of Scale 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

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Phases of Scale Up: Set-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”

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Phases of Scale Up

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

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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

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Phases of Scale Up

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Adoption and Support Systems

Adoption Mechanisms

Set-up Build Scalable Unit Test Scale- Up Go to Full-Scale

Support Systems Phases of Scale-up

Best Practice exists New Scale- up Idea

Leadership, communication, social networks, culture of urgency and persistence Learning systems, data systems, infrastructure for scale-up, human capacity for scale-up, capability for scale-up, sustainability

Adoption is a SOCIAL thing!

A better idea… …communicated through a social network… …over time

Rogers, E. M. (2003). Diffusion of

• innovations. New York, Free Press.

People who adopt new ideas go through these five stages!

• 1. Awareness
• 2. Persuasion
• 3. Decision
• 4. Implementation
• 5. Confirmation

Stages of Adoption

Prochaska J, Norcross J, Diclemente C. In Search of How People Change, American Psychologist, September, 1992.

Attributes of an Idea that Facilitate Adoption

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Relative Advantage Simple Trialable Compatible Observable

Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.

The Relationship of Quality Improvement and Quality Control

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) Juran Trilogy Functions for Managers:

• Quality Planning
• Quality Control
• Quality Improvement

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

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)

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 S13: Trust

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Practice:

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