Welco elcome! me! Le Learnin arning g Se Session ssion/Summit - - PowerPoint PPT Presentation

Welco elcome! me!

Le Learnin arning g Se Session ssion/Summit /Summit

Day Two May 26th, 2017

2

Rec ecap of Da ap of Day On y One & e & Outline of the Day’s Activities

Jennifer Allison

3

Outcome Outcome Data Data

Su Succe ccess S ss Stori

• ries and

es and Bra Brain inst storm

• rming

ing

Bekah Thomas

4

CS CoII CS CoIIN Aim N Aim Stat Stateme ement nt

Source: Hospitalizations estimated from CDC WISQARS query April 2017, 2014 data; and Emergency Department treated and released cases estimated from the Healthcare Utilization Project, Nationwide Emergency Department Sample, 2013.

By May 2018, participants in the CS CoIIN will

Decrease the rate of injury-related mortality among 0-19 year

• lds by 5.83% relative to the participating state/jurisdiction

baseline rate for the CS CoIIN topic areas.

Deaths

Decrease the rate of injury-related hospitalizations among 0- 19 year olds by 3.81% relative to the participating state/jurisdiction baseline rate for the CS CoIIN topic areas.

Hospitalizations

Decrease the rate of injury-related ED visits among 0-19 year

• lds by 3.74% relative to the participating state/jurisdiction

baseline rate for the CS CoIIN topic areas.

ED Visits

5

Chal Challe lenge: nge: Coll Collecti ecting ng Real eal-Time Time Data Data

identify emerging issues prioritize resources and strategies evaluate interventions

Source: Chretien, J., Tomich, N.E., Gaydos, J.C., Kelley, P.W.: Real-Time Public Health Surveillance for Emergency Preparedness. Am J. Pub. Health 99(8), 1360-1363 (2009)

Access to timely data helps public health practitioners:

6

Stat States s Repo porti ting ng Real al-Ti Time me Ou Outc tcome

• me Dat

Data

Sta tate e or

• r

Ju Juri risdiction sdiction Cause use of

• f In

Injur jury Dea eath th Ho Hosp sp. ED ED Vi Visits sits Florida Interpersonal Violence Prevention √ √ √ Indiana Child Passenger √ √ Indiana Interpersonal Violence √ √ Kentucky Interpersonal Violence √ Kentucky Child Passenger √ Massachusetts Suicide and Self Harm √ √ Tennessee Falls Prevention √ √

7

Epi Epidem demiolog iologists ists

AKA your best friends for data

8

Tools t

• ols to Help
• Help Y

You

• u Star

Start

ICD-9 CM to ICD-10- CM Crosswalk Outcome Measure Worksheet

9

Dif Differences erences be betw tween een Ev Evalu aluati ation

• n and QI

and QI

Evaluation

• Retrospective
• Targeted population,
• ften paired with a

control group

• Perfect Data
• Formal datasets

QI

• Real-Time
• Small scale

population, growing as knowledge is gained

• Some data is better

than perfect data

• Preliminary and direct

data sources

10

Potent ntial ial Dat Data a So Sources urces

Ambulance Usage Records Traumatic Brain Injury Registries Medicaid Trauma Registries Child Death Review Infant Fatality Review Poison Control Centers Syndromic Surveillance System Death Registration System

11

Trau raumatic matic Bra Brain in Injur Injury y Reg egist istries ries

Source: National Association of State Head Injury Administrators. TBI Registries and Trauma Registries: State by State https://www.nashia.org/pdf/statestbi_registries_trauma_july_2016_revised.pdf Accessed May 18th, 2017

Florida

BRAIN AND SPINAL CORD INJURY CENTRAL REGISTRY (2013)

Indiana

State Medical Surveillance Registry for Traumatic Spinal Cord and Brain Injuries (2007)

Minnesota

TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY REGISTRY (1991)

Missouri

Brain and Spinal Cord Injury Registry (1986)

Nebraska

Brain and Head Injury Registry Act (1992)

New Hampshire

Brain and Spinal Cord Injury Registry (2000)

Tennessee

Title 68 Health, Safety and Environmental Protection Ch. 55: Head and Spinal Cord Injury Information System Part 2 (2010)

Virginia

Spinal Cord and Brain Injury Registry (2008)

12

Disc Discussion ussion

What other data sources can you use? What barriers to collecting and reporting data are you facing? How do you use outcome data when you do have it?

13

Spr Spreading eading Chan Change ge

Jane Taylor, Ed.D. Improvement Advisor to the Child Safety CoIIN

14

Obje Objectiv ctives es

• Identify spread ready changes
• State key components of a spread plan
• Develop simple tracking method for spread

adoption

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Improvement Hold Gains Spread

Creating a New System

Old W Old Way y

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• Test changes under a wide range of

conditions (robust design)

• Foolproof the new process/procedure
• Use technology where appropriate
• Learning from failure

During During T Test esting ing

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During During Impl Implementatio ementation

• Use multiple PDSA cycles to implement the change
• Collect data over time when conditions are expected

to change

• Redesign support processes for new process
• Address the social aspects of change
• Seek and use input from others, specially those

affected by the change, during testing

18

Improvement Hold Gains Spread

Creating a New System It’s much more organic than we thought

Ne New W w Way

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Degree of belief that the changes will result in improvement High

Prototype Pilot (s) Spread

Successful changes Changes still need further testing. There is a risk of moving to spread. Unsuccessful proposed changes Low Moderate

Whe Where re is is Your Chang

• ur Change?

e?

Source: The Improvement Guide, p. 145

20

Ide Identi ntifyin fying g Spre Spread ad Ready eady Changes Changes

Great ideas spread! Characteristics of spread-able ideas It is:

• a relative advantage
• compatible
• easy and simple enough to use

Try it (trial-ability) See it (observable)

Source: E. Rogers. Diffusion of Innovation

21

Charact aracteri eristics stics

Rating

Relative Advantage Compatibility Simplicity Trial-ability Observable

Think hink you u what what one ne it item m wor

• rth

thy of f sp spread read in in your ur project. project. Ra Rate th the chan hange ge on n a scale a scale of 1 f 1-5. . 1 1 - very y weak; weak; 3 - ok; k; 5 -very st strong

• ng

Source: The Improvement Guide, Pg. 200-201

22

Indiv Individual idual Adop doption of tion of Ideas Ideas

2.5% 13.5% 34% 34% 16%

Innovators Early Adopters Early Majority Late Majority Laggards

Source: adapted from The Improvement Guide, pg. 212

23

Ma Matc tchin hing Spre g Spread ad Act ctiv ivit itie ies t s to

• Stage

Stages s of

• f C

Cha hang nge

Awareness

• Broad marketing and communication

Persuasion

• Data feedback

Decision

• Case studies, individualized communication

Implementation

• Tools and resources
• Access to technical expertise

Confirmation

• Feedback
• Leadership

Source: adapted from The Improvement Guide

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Adapted from Ashkenas, 1995

SHARE INFORMATION SHAPE BEHAVIOR

Th The e Way y We Com e Communica municate e is Impor is Important tant

(C) 2001, Sarah W. Fraser

General Publications Personal Touch Interactive Activities Public Events Face-to-face Flyers Newsletters Videos Articles Posters Letters Cards Postcards Telephone email Visits Seminars Learning sets Modeling Road shows Fairs Conferences Exhibitions Mass meetings One-to-one Mentoring Seconding Shadowing

25

Mo Movi ving ng Spr Spread ead Strat Strategi egies es “to the Lef

• the Left”

What infrastructure changes be made to enable adoption? In Infra frastructure structure/r /rollout

• llout

In Indi divi vidual dual ado dopti tion

• n

Primary infrastructure and system level changes used to achieve outcomes Balance of individual adoption decisions and infrastructure/system changes used to achieve

• utcomes

Primarily individual decisions to adopt changes used to achieve outcomes Source: NICHQ Forum 2007 Cincinnati Children’s Hospital Medical Center

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Cre Creati ating ng an Orga an Organiz nizati ational

• nal Cul

Cultu ture re tha that t Enab Enables Inno les Innovati ation

• n

1. 1. Vis isio ion: Declare the importance of innovation; make it part of the project’s self image. 2. 2. For

• res

esig ight ht: Find out where technologies & people are going. Identify articulated and unarticulated needs of customers or those you serve. 3. 3. Str tretch tch Go Goal als: To make quantum improvements. 4. 4. Em Empowerment erment: Hire or engage good people and trust them; delegate responsibilities, provide slack resources, and get out the way. 5. 5. Com

• mmuni

munica cati tions

• ns: Open, extensive exchanges according to ground

rules in forums for sharing ideas, and where networking is each person’s responsibility. 6. 6. Rewar ards ds an and R d Rec ecog

• gni

nition tion: Innovation is an intensely human activity. Emphasize recognition more than monetary rewards.

Source: NICHQ Forum 2007 Cincinnati Children’s Hospital Medical Center

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Comp Components of a

• nents of a

Spr Spread Pla ead Plan

28

IHI IHI Frame ramewor

• rk

k for

• r Spre

Spread ad

Set-up up

• Targe

get population pulation

• Adop
• pter

r audien ences es

• Suc

uccess ssful ul sites s

• Key

y partn tner ers

• Init

itial ial sprea ead d plan an

Soci cial al Syst ystem em

• Key

y messenger engers

• Communit

mmunities ies

• Technic

nical al suppo pport

• Trans

nsit ition ion issues

Kno nowle wledge ge Mana nagem emen ent Mea easur urem emen ent and nd Fee eedba back ck

Le Leader ership ship

• Topic

pic is a k key y strategic gic initiat iativ ive

• Goals

als and incenti tives s aligned gned

• Execut

cutiv ive e spons nsor

• r assigned

gned

• Day-to

to-da day manager agers ident ntif ified ied

Bett Better er Idea eas

• De

Develo elop p the case

• Describ

ribe the ideas as

Source: The Improvement Guide, pg. 196

29

IHI IHI Frame ramewor

• rk

k for

• r Spre

Spread ad

Set-up up

• Targe

get population pulation

• Adop
• pter

r audien ences es

• Suc

uccess ssful ul sites s

• Key

y partn tner ers

• Init

itial ial sprea ead d plan an

Soci cial al Syst ystem em

• Key

y messenger engers

• Communit

mmunities ies

• Technic

nical al suppo pport

• Trans

nsit ition ion issues

Kno nowle wledge ge Mana nagem emen ent Mea easur urem emen ent and nd Fee eedba back ck

Le Leader ership ship

• Topic

pic is a k key y strategic gic initiat iativ ive

• Goals

als and incenti tives s aligned gned

• Execut

cutiv ive e spons nsor

• r assigned

gned

• Day-to

to-da day manager agers ident ntif ified ied

Bett Better er Idea eas

• De

Develo elop p the case

• Describ

ribe the ideas as

Source: The Improvement Guide, pg. 196

30

IHI IHI Frame ramewor

• rk

k for

• r Spre

Spread ad

Set-up up

• Targe

get population pulation

• Adop
• pter

r audien ences es

• Suc

uccess ssful ul sites s

• Key

y partn tner ers

• Init

itial ial sprea ead d plan an

Soci cial al Syst ystem em

• Key

y messenger engers

• Communit

mmunities ies

• Technic

nical al suppo pport

• Trans

nsit ition ion issues

Kno nowle wledge ge Mana nagem emen ent Mea easur urem emen ent and nd Fee eedba back ck

Le Leader ership ship

• Topic

pic is a k key y strategic gic initiat iativ ive

• Goals

als and incenti tives s aligned gned

• Execut

cutiv ive e spons nsor

• r assigned

gned

• Day-to

to-da day manager agers ident ntif ified ied

Bett Better er Idea eas

• De

Develo elop p the case

• Describ

ribe the ideas as

Source: The Improvement Guide, pg. 196

31

IHI IHI Frame ramewor

• rk

k for

• r Spre

Spread ad

Set-up up

• Targe

get population pulation

• Adop
• pter

r audien ences es

• Suc

uccess ssful ul sites s

• Key

y partn tner ers

• Init

itial ial sprea ead d plan an

Soci cial al Syst ystem em

• Key

y messenger engers

• Communit

mmunities ies

• Technic

nical al suppo pport

• Trans

nsit ition ion issues

Kno nowle wledge ge Mana nagem emen ent Mea easur urem emen ent and nd Fee eedba back ck

Le Leader ership ship

• Topic

pic is a k key y strategic gic initiat iativ ive

• Goals

als and incenti tives s aligned gned

• Execut

cutiv ive e spons nsor

• r assigned

gned

• Day-to

to-da day manager agers ident ntif ified ied

Bett Better er Idea eas

• De

Develo elop p the case

• Describ

ribe the ideas as

Source: The Improvement Guide, pg. 196

32

IHI IHI Frame ramewor

• rk

k for

• r Spre

Spread ad

Set-up up

• Targe

get population pulation

• Adop
• pter

r audien ences es

• Suc

uccess ssful ul sites s

• Key

y partn tner ers

• Init

itial ial sprea ead d plan an

Soci cial al Syst ystem em

• Key

y messenger engers

• Communit

mmunities ies

• Technic

nical al suppo pport

• Trans

nsit ition ion issues

Kno nowle wledge ge Mana nagem emen ent Mea easur urem emen ent and nd Fee eedba back ck

Le Leader ership ship

• Topic

pic is a k key y strategic gic initiat iativ ive

• Goals

als and incenti tives s aligned gned

• Execut

cutiv ive e spons nsor

• r assigned

gned

• Day-to

to-da day manager agers ident ntif ified ied

Bett Better er Idea eas

• De

Develo elop p the case

• Describ

ribe the ideas as

Source: The Improvement Guide, pg. 196

33

IHI IHI Frame ramewor

• rk

k for

• r Spre

Spread ad

Set-up up

• Targe

get population pulation

• Adop
• pter

r audien ences es

• Suc

uccess ssful ul sites s

• Key

y partn tner ers

• Init

itial ial sprea ead d plan an

Soci cial al Syst ystem em

• Key

y messenger engers

• Communit

mmunities ies

• Technic

nical al suppo pport

• Trans

nsit ition ion issues

Kno nowle wledge ge Mana nagem emen ent Mea easur urem emen ent and nd Fee eedba back ck

Le Leader ership ship

• Topic

pic is a k key y strategic gic initiat iativ ive

• Goals

als and incenti tives s aligned gned

• Execut

cutiv ive e spons nsor

• r assigned

gned

• Day-to

to-da day manager agers ident ntif ified ied

Bett Better er Idea eas

• De

Develo elop p the case

• Describ

ribe the ideas as

Source: The Improvement Guide, pg. 196

34

IHI IHI Frame ramewor

• rk

k for

• r Spre

Spread ad

Set-up up

• Targe

get population pulation

• Adop
• pter

r audien ences es

• Suc

uccess ssful ul sites s

• Key

y partn tner ers

• Init

itial ial sprea ead d plan an

Soci cial al Syst ystem em

• Key

y messenger engers

• Communit

mmunities ies

• Technic

nical al suppo pport

• Trans

nsit ition ion issues

Kno nowle wledge ge Mana nagem emen ent Mea easur urem emen ent and nd Fee eedba back ck

Le Leader ership ship

• Topic

pic is a k key y strategic gic initiat iativ ive

• Goals

als and incenti tives s aligned gned

• Execut

cutiv ive e spons nsor

• r assigned

gned

• Day-to

to-da day manager agers ident ntif ified ied

Bett Better er Idea eas

• De

Develo elop p the case

• Describ

ribe the ideas as

Source: The Improvement Guide, pg. 196

35

Trac racking king Spre Spread ad

36

Trac racking king Spr Spread Pr ead Prog

• gres

ress

37

Di Displ splaying ying the the Sp Spre read ad of

• f One

One Ide Idea a

(Ni (Nigh ght t t tim ime rest restrict rictions ) ions )

Progress of spread of night time restrictions from one pilot site to 10 over 1 year

1 2 3 4 5 6 7 8 9 10 Jun-01 Jul-01 Aug-01 Sep-01 Oct-01 Nov-01 LS1 Dec-01 Jan-02 Feb-02 LS2 Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Setp 02 Oct-02 Nov-02

# facilities completed

System-wide Diffusion - Medication FMEA

Adopted from Iowa Health System

38

Dis Displa playing ying the the S Spre pread of ad of Mult Multiple iple Idea Ideas

1 2 3 4 5 6 7 8 9 10

Policy Makers participating

Policy Maker Education and Conversations

1 2 3 4 5 6 7 8 9 10

# of Police Departments Trained in the last 6 months

Enforcement- Training of Law Enforcement Officers

Number of Schools

Schools Requiring CheckPoints Registrations for Parking Permits

Number of Site

CheckPoints Programs for Parents

Adopted from Iowa Health System

39

1 2 3 4 5

Site 1 Site 2 Site 3 Site 4 Site 5 Site 6

Key Changes

Entry in each cell designates status of each of key changes in each location

Monit Monitori

• ring

ng th the Changes e Changes

Adopted from Iowa Health System Bl Blank ank= Not started; Red ed= Incomplete; Yel ellow= Partially Complete; Gr Gree een= Complete

40

Spr Spread ead Ti Tips ps

• Design to facilitate adoption.
• Address resistance
• Move changes to the “left” – infrastructure, IT, policy
• Mobilize the political will for the change.
• Foster innovation
• Create and execute a comprehensive Spread

strategy/plan

• Remember: communicate, communicate, communicate!

41

Paired Discussio aired Discussion: n: Pre Preparin paring g For

• r Spre

Spread ad – 10 mi 0 min

• Pair up with someone at your table and

choose who will be the “seller” and who will be the “listener” (3 min)

• Seller: Select one change idea for spread

and use the criteria for “assessing ideas for spread” to sell the change idea (4 min)

• Listener: Provide feedback, using the

criteria for “assessing ideas for spread”(3 min)

• General Q/A – 5 min

42

Wor

• rki

king ng Se Sessi ssion

• n

Action ction Planni Planning ng & Go & Goal al Settin Setting g

• Ses

ession sion Go Goal als: s:

• Complete any worksheet or tool you have not yet completed
• Draft a 90

90-da day y aim aim st stat atement ement for each secondary driver you selected in your draft driver diagram

• Begin drafting a team

eam re recruit cruitmen ment t and and outreach utreach plan to make sure you have the appropriate partners to achieve your aim

• Review your st

storyboar yboard and prepare to present it to another team

• Designate who will present each storyboard during the peer

feedback session

• Tool
• ols:

s:

• 90-Day aim statement
• Team recruitment excel book (electronic only)
• Recruiting for a collaborative handout
• Storyboard

43

Peer F eer Fee eedbac dback: k: 20

20 mi minu nutes es pe per t r tea eam

In Inst struc ructions tions: Strategy Team 1 presents storyboard (10-15 min).

Teams discuss (5-10 min). Repeat for Strategy Team 2.

Strategy Team 1 Strategy Team 2 CNMI MI CPS Vermont CPS CNMI MI IPV Pennsylvania IPV Con

• nnect

ecticut cut SSHP Massachusetts SSHP Fl Flor

• rida

da All Teams Texas CPS Ken entu tuck cky CPS Tennessee FP Mi Missouri ssouri IPV Tennessee IPV Texas xas TDS & SSHP Tennessee TDS Indiana diana CPS Missouri CPS Indiana diana IPV Minnesota IPV Ken entu tuck cky SSHP Vermont SSHP Ken entu tuck cky TDS New Hampshire TDS Ma Massac ssachusetts husetts FP Pennsylvania FP Mi Missour ssouri SSHP Virginia SSHP No North th Da Dakota ta TDS Wisconsin TDS

44

Web P eb Por

• rtal R

tal Revie view & w & Updating Updating Team eam Inf Informati

• rmation
• n

Jenny Stern-Carusone

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CS CoIIN CS CoIIN Web P eb Por

• rtal

tal: : Lo Logging gging On On

Username = Firstname.Lastname Password = *Unique If you forgot your password

46

CS CoII CS CoIIN N Web P eb Por

• rtal

tal Organizat Organization ion

• Driver Diagrams
• Aim Statements
• State Reports
• Fact Sheets
• Contact Information
• Membership Lists
• Resource Libraries
• Event Archives
• Team Run Charts
• Aggregate Run

Charts

• Feedback Loop
• Feedback Loop
• Technical

Assistance

Team Profiles PDSA Submissions Monthly Report Submissions Archives and Resources

47

Stat tate T e Team R eam Repor eport t Out Out

Wh What Are at Are You Going

• u Going to Do
• Do by Ne

y Next xt Tue uesda sday? y?

Jennifer Allison

48

Mo Moving ving For

• rward &

ard & Achie hieving R ving Res esults: ults:

Ne Next xt St Step eps s for the

• r the Chi

Child Saf ld Safety ty CoI CoIIN IN

Jennifer Allison