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Building the Dream Team:Managing a Quality Improvement

Collaborative

Jennifer Lundblad, PhD, MBAPresident and CEO

Multi-State Learning CollaborativeAugust 7, 2008

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Presentation Outline

Description of a QI collaborative as an educational methodology to support quality improvement

Discussions of when and why collaboratives work

Lessons learned by Stratis Health in implementing collaboratives

Quality improvement collaboratives are a tool that can be used to help improve public health practice. This session will provide:

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Stratis Health

Independent, not-for-profit quality improvement organization founded in 1971

Mission: To lead collaboration and innovation in health care quality and safety, and serve as a trusted expert in facilitating improvement for people and communities

Work with both providers and consumers to improve health care

Funded by federal and state contracts, corporate, and foundation grants

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Stratis Health’s Approachto Improving Quality

Stratis Health carries out its work by serving as a:• Quality improvement expert and

clearinghouse• Educator and trainer• Facilitator and convener

• Data resource

• Consultant and supporter

QI Collaboratives are a tool frequently used by Stratis Health to drive and support improvement.

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Quality Improvement Collaboratives

Teams from participating organizations focused on similar goals work together to: Learn about theory and proven strategies for improving care Try out tools to help achieve improvement Make and refine plans for improvement for their

organizations Develop a network of colleagues at other organizations

pursuing similar work

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QI Collaboratives: Methodology

3-4 learning sessions over 12-18 months Typically facilitated by an external organization ‘Faculty’ experts help design and facilitate

Teams measure and share results to track progress Strong role for measurement and tracking Storyboard presentations at learning sessions

Proactive support between learning sessions Support, encouragement, and expertise offered through

regular conference calls, email, and Web site interaction with faculty experts from the collaborative

Final celebratory session (e.g., Outcomes Congress) Share learnings and disseminate results

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QI Collaboratives: Methodology (cont.)

In addition to the standard or core components to a collaborative, Stratis Health often includes the following: On-site technical assistant visits to

participating organizations Senior leader reports Peer mentoring support Partnering/co-sponsoring with other

organizations with shared goals

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QI Collaboratives: Methodology (cont.)

Pre-work: Get senior leader support, form team, assess current data

LS1: Define aims and measures, develop plans for tests of change, get ideas for improvement

LS2: Gather more ideas for change, gain deeper understanding of testing and implementation, identify and develop strategies to overcome barriers, learn from other teams

LS3: Understand what is working and what isn’t, plan for holding gains and spreading change, celebrate early results

Action periods between learning sessions: test changes and get feedback, conduct data collection and reporting

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Collaborative: Examples

The collaborative learning format has been used: Nationally, by the Institute for Healthcare

Improvement (IHI)» Branded as “Breakthrough Series”

Many other regional, state, and local organizations» In Minnesota, includes Stratis Health, VHA

Upper Midwest, Institute for Clinical Systems Improvement (ICSI)

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Collaborative: IHI Model

© 2002 Institute for Healthcare Improvement

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Action Research

The collaborative improvement model is based on Action Learning and Action Research The model is not a clinical trial, nor is it a

traditional quality improvement project. It is a collaborative model based on action learning, and action research theory and literature.

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Action Research (cont.)

Collaborative improvement model has its roots in action learning theory and principles. Action learning is: “An approach to working with and developing

people that uses work on actual project problems as the way to learn. Participants work in small groups to take action to solve their problem and learn how to learn from that action. Often a learning coach works with the group in order to help member learn how to balance their work with the learning from that work.” (Yorks, et. al, 1999)

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Action Research (cont.)

Model brings together a number of organizations that are focusing their improvement work in a shared area or with similar goals

Action learning projects usually meet three criteria (Yorks, et. al, 1999):

1)They are complex, overarching, and often cross-functional

2)They are problems, opportunities, or difficulties for which there is no single solution, and

3)They are actual problems, meaningful toparticipants, and for which participants aremotivated to act

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QI Collaboratives in Public Health

What problems or topics in public health practice lend themselves to the

Quality Improvement Learning Collaborative approach?

In health outcomes?

In capacity building?

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QI Collaboratives: Do they work?

Two Stratis Health (Minnesota) examples shared here: 22 small rural hospital immunization

improvement 63 home health agency re-hospitalization

reduction

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Immunizations 2003-2004 CAH Collaboration - All Hospitals Combined

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10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Cycle 1: 10/02-1/23 Cycle 2: 2/03-5/31 Cycle 3: 6/03-9/03 Cycle 4: 10/03-1/04

Pneumococcal Influenza

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Acute Care Hopitalization Scores Data Range: Baseline - November 2007

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20

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40

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Month&Year

Acu

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(%)

MN HH Collaborative Agencies HH Compare State Average HH Compare National Average

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QI Collaboratives:Why do they work?

Learning sessions: Needs and values leveraged to make the case for change New knowledge and proficiencies are gained Motivation through positive peer pressure

Between session activities: Expert guidance to address systems and structure issues

and barriers Allow participants to try out new behaviors back on the job

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QI Collaboratives:Why do they work? (cont.)

Measurement: Ability for participants to benchmark their

processes and results against peers Collective results across the collaborative are

compelling and motivational Final celebratory session:

Engages senior administrative and/or clinical leadership

Leveraging management practices at the organizational level, while at the same time reinforcing motivation, systems, andwork unit climate at the group level.

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Stratis Health’s Lessons Learned

Senior Leader engagement Get commitment from senior leaders at participating organizations

early on Use multiple techniques to keep senior leaders involved and

interested» Professional and trade association meetings, progress reports, letters

Clarify Expectations of participating teams/organizations Lay out expectations for entire collaborative before

organizations agree to participate» Reinforce at every opportunity

Use clear and consistent language Ensure there is a shared understanding of tasks Include storyboard development early in the process

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Lessons Learned (cont.)

Reinforce Quality Improvement Structure Reinforce model for improvement and PDSA at each workshop Rapid tests of change using PDSA cycle can be difficult in small

organizations because of limited number of patients/clients

Support and Encourage Collaboration Participation Offer CEUs for conference calls and workshops Watch for leaders in the group and use their expertise Keep measurement and reporting tools simple Individual team/organization support between sessions is highly

valuable Offer template press releases about the collaborative for internal

and external information sharing

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Reflections on QI Collaborativesin Public Health

The characteristics of many public health issues match the action learning criteria (i.e., complex, no single solution, meaningful)

Public health has a strong foundation for cross-organization collaboration…shared structures and demands, similarities in services, community orientation.

Your ideas, questions,or comments?

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Contact and Resources

Jennifer Lundblad, PhD, MBAPresident and CEO(952) 853-8523jlundblad@stratishealth.org

Institute for Health Care Improvement http://www.ihi.org/IHI/Topics/Improvement/SpreadingChanges/Li

terature/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.htm

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Stratis Health is a non-profit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for

people and communities.