Transcript (Why?) - Plan to carry out the cycle

Fostering Change: How to
Engage the Practice
Julie Osgood, MS
Senior Director, Operations
MaineHealth
September 25, 2009
I have no relevant financial relationships with the
manufacturers(s) of any commercial products(s) and/or
provider of commercial services discussed in this CME
activity.
What is MaineHealth?
• Integrated healthcare delivery system serving
central, southern, and western Maine (serves 11
counties)
• Established the AH! Asthma Health Program in
1998
• Ran asthma collaboratives in 2002-2006
• Interest in improving asthma care and outcomes in
communities
Practice Engagement
• Why it’s important (need more here)
– By engaging your practice early on in this program,
you will remove barriers to spreading this work
throughout the year
Change is Hard
“Systems are perfectly
designed to get the
results they achieve”
-Paul Batalden
Current “Systems”
All Teams : April 2002 to March 2003
Aggregate Improvement
+52%
+22%
90%
80%
70%
60%
50%
Pre
Post
40%
30%
20%
10%
0%
Classification
Controller Meds
Team Improvements: April 2002 to March 2003
MMC Family Practice Center
+23%
90%
80%
+43%
70%
60%
50%
Pre
Post
40%
30%
20%
10%
0%
classification
controller meds
As a result in the Collaborative, I feel our team...
80%
Percent
70%
60%
Strongly agree
50%
Agree
40%
Undecided
30%
Disagree
20%
Strongly disagre
10%
0%
Is better able to Has office visits Is better able to
Finds our
Communicates
manage asthma and interactions meet the needs asthma patients better w ith our
proactively
w ith asthma
of our asthma better prepared asthma patients
patients that are
patients
to self-manage
now more
their illness
productive
Questions
Overall, I feel that my time involved in the
Collaborative was worth the effort
Disagree 4%
Agree
52%
Strongly agree
44%
How’d they do it?
Key lessons on practice engagement and
success from TOP performers:
1. Team Function
2. Clear goals
3. Communication/Sr. Leadership
involvement
4. “S” in PDSA
5. Support
How’d they do it?
Key lessons on practice engagement and
success from TOP performers:
1. Team Function
2. Clear goals
3. Communication/Sr. Leadership
involvement
4. “S” in PDSA
5. Support
Why a Team?
• Focus has changed from provider centered to
patient centered
• Each team member has a role and contributes to
the team
• Invigorates the practice
• Improves patient care and satisfaction
Team Function
• Clear roles for each team member
– Everyone has a responsibility for the patient with asthma. What
are they?
– Map out what currently happens in your practice and then what
you would like to happen. Who does what and why.
• Consider your patients as members of the team
– Are their needs being met?
•
•
•
•
Make decisions / negotiate
Share resources, knowledge, skills
Provide support, feedback
Acknowledge contributions
Team Function
• Meet on a regular basis as a team
– Have written agendas which are distributed prior to
the meeting
– Assign roles: Leader, Time Keeper, Recorder (optional:
facilitator)
– Distribute minutes after meeting (focus on ACTION
items—who’s doing what by when
– Make it fun! Provide lunch if possible (food will get
your team to show up!)
How’d they do it?
Key lessons on practice engagement and
success from TOP performers:
1. Team Function
2. Clear goals
3. Communication/Sr. Leadership
involvement
4. “S” in PDSA
5. Support
Clear Goals
• Create clear, achievable goals and share them
widely
– Post goals in a visible location—for staff and patients
– Provide regular updates on progress toward goals
(helps keep team motivated)
MMC Family Medicine
How’d they do it?
Key lessons on practice engagement and
success from TOP performers:
1. Team Function
2. Clear goals
3. Communication/Sr. Leadership
involvement
4. “S” in PDSA
5. Support
Communication
• Figure out who your key stakeholders are and
get them involved early and often
–
–
–
–
Senior Leaders
CEO’s
Key administrators
Others
• Send monthly progress reports to senior leaders
and get their buy-in
– Aids in visibility of project and creates natural
“champions”
– Aids in team accountability
Communication
• Schedule a time to meet with all providers on a
monthly basis
– A forum for updates, reviewing data, discussing tests
of change, and an opportunity to find providers that
are ready to join the testing
– Maybe some healthy competition?
How’d they do it?
Key lessons on practice engagement and
success from TOP performers:
1. Team Function
2. Clear goals
3. Communication/Sr. Leadership
involvement
4. “S” in PDSA
5. Support
Model for Improvement
What are we trying to accomplish?
Framework
How will we know that a
change is an improvement?
What change can we make that will
result in improvement?
Source: The Improvement Guide, Langley,
Nolan, Nolan, Norman, Provost
Act
Plan
Study
Do
Plan, Do, Study, Act
• Plan for change or test: who, what, when, where
• Plan for collection of data: who, what, when, where
• Do: Carry out the change or test; collect data and begin
analysis
• Study: Analyze data and summarize findings
• Act on your findings and start next cycle.
The PDSA Cycle for Learning
and Improvement
Act
-What changes
are to be
made?
-Next cycle?
Study
- Complete the
analysis of the
data
- Compare data to
predictions
- Summarize what
was learned
Plan
- Objective
- Questions and
predictions (Why?)
- Plan to carry out the cycle
(who, what, where,
when)
Do
- Carry out the plan
- Document problems
and unexpected
observations
- Begin analysis of the
data
Study Your Tests of Change
• Too often teams implement a change and forget
to study it (and subsequently forget the ‘Do’
where you have an opportunity to tweak the
change)
Tips for Success
• Improvement occurs in small steps
• Repeated attempts needed to implement new
ideas
• Assess regularly to improve plan
• Failed changes = learning opportunities
• Plan communication
• Engage leadership support
How’d they do it?
Key lessons on practice engagement and
success from TOP performers:
1. Team Function
2. Clear goals
3. Communication/Sr. Leadership
involvement
4. “S” in PDSA
5. Support
Support
• Look around you: identify peers who can
support your efforts
• Know key staff who can provide technical
support
• Use your team—lots of expertise sitting next to
you
• Use listserv, conference calls, other opportunities
to interact with others: you are in this
TOGETHER!
What are your barriers?
• Brainstorm and connect with your colleagues!
It’s Time to Start…
• Start where you are.
• Use what you have.
• Do what you can.
~ Arthur Ashe ~