a problem-solving experience in population health€¦ · and problem-solving in the emerging...

EMORY R O L L I N S S C H O O L O F

P U B L I C H E A L T H

Emory Centers for Training and Technical Assistance

PARTICIPANT GUIDE CASE IN POINT:

A PROBLEM-SOLVING EXPERIENCE IN POPULATION HEALTH

Prepared by: Emory Centers for Training

and Technical Assistance

TABLE OF CONTENTS WELCOME & INSTRUCTIONS 2-4 ROUND 1: PROBLEM SOLVING 5-7 ROUND 2: LEADERSHIP 8-10 ROUND 3: COMMUNICATION 11-13 ROUND 4: SYNTHESIS 14 APPENDIX: ROUND 1 TOOLS 15-24

This publication was supported by Cooperative Agreement Number, 6 NU36OE000008-02-02, funded by the Centers for Disease Control and Prevention Academic Partnerships to Improve Health (APIH) initiative through the Association for Prevention Teaching and Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the Association for Prevention Teaching and Research.

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Emory Centers for Training and Technical Assistance

WELCOME!

Background Case in Point: A Problem-Solving Experience in Population Health was the aim of a cooperative agreement between Association for Prevention Teaching and Research (APTR), the Centers for Disease Control and Prevention (CDC), and Emory Centers for Training and Technical Assistance to establish a workforce improvement project to respond to the critical need for multidisciplinary training materials for population health for C D C fellows and public health agencies. The objectives of the project were to:

• Use a systematic approach to develop, pilot test, and prepare for dissemination 3 sets of case studies targeted for learners from various disciplines, population health entities and Population Health Workforce Branch (PHWB) fellowship programs.

• Build learners' skills in multi-disciplinary collaboration and integration, effective communication, leadership, and problem-solving in the emerging population health context.

• Contribute to improvements in competencies of the population health workforce.

Introduction The Case in Point: A Problem-Solving Experience is designed to develop your skills in the areas of problem solving, communication, and leadership within the context of a real-world population health scenario. In addition to the three areas, we have designed this case experience to provide opportunities for you to:

• Get acquainted with and begin to establish camaraderie within your interdisciplinary teams

• Articulate ground rules for collaborating with others who have a stake in population health

• Understand team roles and styles of working

• Solicit input and practice effective listening

• Lead and contribute amongst peers

WELCOME!

Case in Point: A Problem-Solving Experience Format The Case in Point: A Problem-Solving Experience is split into four rounds, followed by a large group debrief sessions. In each round, your team will receive one or more tasks to complete. A team advisor will be assigned to your team to walk you through the case study instructions, answer any questions and explain the expected deliverables. At the end of each round, there will be an opportunity for your team to debrief as a part of a large group, to learn from the experiences of other interdisciplinary teams.

The timing for each round will be provided by your team advisor.

The agenda for the four case study rounds, including

discussions, is as follows:

ROUND 1: PROBLEM SOLVING

ROUND 2: LEADERSHIP

ROUND 3: COMMUNICATION ROUND 4: SYNTHESIS

WELCOME!

Instructions: Before You Start To begin the case experience, sit with your pre-assigned interdisciplinary team. A high performing team is comprised of people serving in different roles who bring needed expertise and varied experiences to completing a task. Team members will often fill a role they naturally gravitate toward, and may fill more than one role. A person's role can change over time on a given team or in different groups. Each team role has its strengths and weaknesses, and each role has equal importance.

• Note taker: Identify a team member to be your note taker.

• Timekeeper: Identify a team member to be your timekeeper.

• Monitor: Identify a team member to ensure that your team stays on task, meets objectives, and does not get distracted by non-relevant discussion.

• Presenter: Presents results to other groups during debrief sessions.

• Other Roles: Decide if your team requires any additional roles.

It is suggested that you identify the following

roles within your team:

Also, this is a good time to establish ground rules for working together, if you have not done so in your pre-work meetings with your team.

Getting started Take 15 minutes to review the background information for the case study. Stick to the time allotment and allow your team members to fully review and digest the case study materials at their own pace. If you finish early, compile some takeaway points that you'd like to d iscuss with the team or sit quietly. You do not need to be an expert in the history or outcome of the scenario to complete this case study, so there should be no need to research additional information.


Purpose of Round 1 To uncover root causes of complex problems through use of problem solving tools, to evaluate options for interventions and achieve consensus on a proposed intervention.

Timing For Round 1, you will have approximately 2 hours to complete the two tasks assigned to your team. You may choose to divide your time the following way:

• (10 mins) Team discusses initial reactions to the population health scenario • (10 mins) Review the overview of Social Causes below and instructions for both tasks • (30 mins) Utilize assigned tool to complete task 1 • (40 mins) Utilize assigned tool to complete task 2 • (10 mins) Narrow down interventions and come to consensus on a proposed intervention • (20 mins) Team preparation for report out

Overview of Social Causes Social Determinants of Health refers to conditions into which we are born, and in which we grow, work, live, and age, along with the wider set of forces and systems that shape the conditions of everyday life and thereby, health. (Commission on Social Determinants of Health, World Health Organization, 2008)

Life Course Theory proposes that each life stage influences the next and that social, economic, and physical environments interacting across the life course have a profound impact on individual and community health 1 identifies 5 principles of life course theory:

1. Lifespan Development: Human development and aging are lifelong processes

2. Time and Place: The life course of individuals is embedded and shaped by the historical times and places they experience over their lifetime

3. Timing: The developmental antecedents and consequences of life transitions, events and behavioral patterns vary according to their timing in a person's life

4. Linked Lives: Lives are lived interdependently and socio-historical influences are expressed through this network of shared relationships

5. Agency: Individuals construct their own life course through the choices and actions they take within the opportunities and constraints of history and social circumstance

Population Health is defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group"2. The term also refers to an approach that "focuses on interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and wellbeing of those populations."

1 Elder G H , Johnson MK, Crosoe R. T h e Emergence and Development of Life C o u r s e Theory. In: Mortimer J T , Shanahan M J , eds . Handbook of the Life Course. Boston, MA: Springer; 2003 .

2 Kindig D, Stoddart G. What is Population Health? American Journal of Public Health. 2003;93(3) :380-383.


Round 1 Instructions Now that you have familiarized yourselves with the background of the population health scenario and the overview above, you are ready to begin with the first of your two tasks.

1 TASK 1: Uncover the Risks behind the Risks - Social Causes

As a team, use the tool your team advisor assigns to explore possible social determinants for this case (either Four Levels of a Systems View, Tackle Complex Problems in 4 Steps, OR Explore the Story). Do not rush to a solution - the purpose of this task at this point is to look beyond the obvious and fully understand the problem and its root causes.

• From the lens of social determinants, what are the key causes and effects of the situation? How do social and environmental inequalities contribute to health disparities in this case?

• How have the following factors affected the trajectory of the case so far: health and wellness, attitudes and perceptions, ways in which decisions are made?

• What could have prevented the population health crisis presented in the scenario?

Once you have worked through the tool assigned by your team advisor, write down some answers to these additional general questions to help you think about the outcomes of the situation for the population(s) affected. Be prepared to succinctly report out on the tool you used and your answers to the following three questions.


2 TASK 2: Propose Needed Population Health Approaches or Interventions

In your current roles in your organization, you've been invited to join an interdisciplinary team (your team for this case experience) to address the population health scenario. Your charge is identify an intervention on behalf of your organization utilizing the roles available on your team.

As a team, use the tool your team advisor has assigned to determine possible interventions from a population health perspective (Delphi Technique; Rose, Bud, Thorn; or Qualitative Ranking). Be sure to take into consideration the various expertise and perspectives around the table in your team. Then, evaluate your draft recommendations - what are the risks/benefits of each approach, what's going to realistically work, who is your audience, do you do all next steps at same time or sequentially?

By the end of this round, identify 1 to 3 interventions, then narrow down your preferred intervention for moving forward. Be prepared to report on the tool your team used and your recommended population health approach (intervention) to the scenario during the debriefing session following Round 1.

1. Write your top 1-3 interventions here:

2. Next, discuss and evaluate your three options briefly. Consider - what are the risks/benefits of each approach, what's going to realistically work, who is your audience, do you do all next steps at same time or sequentially?

3. Lastly, write down the one intervention you are choosing here:

ROUND 2: LEADERSHIP

Purpose of Round 2 To practice leadership individually and as a team while planning to mobilize a population health intervention.

Timing For Round 2, you will have approximately 2 hours to complete the 2 tasks assigned to your team. You may choose to divide your time the following way:

• (10 mins) Team reviews instructions • (40 mins) Individual brainstorm and complete team discussion for task 1 • (60 mins) Team discusses and completes assigned questions together in task 2 • (10 mins) Team preparation for report out

Round 2 Instructions Throughout the first round, your team considered many aspects of population health that may not pertain to your day-to-day job functions or roles. Now, each member of your team should think about the perspective or expertise they have uniquely contributed, or would contribute to your proposed intervention.

ROUND 2: LEADERSHIP

GREEN LIGHT! Plan to Implement Your Recommendations from Round 1 Congratulations! Your team's recommendations from Round 1 have been successfully received and now you've been tasked with implementing them. Your focus is on internal inter-professional planning with your organization's leadership relevant to the population health case (e.g. division directors, etc.).

Task 1: Perspectives Take a few minutes to individually think of how you, in your specific career path, role, or discipline (e.g. informatics, management, health communication, health economics, etc.) might uniquely contribute, add value, or bring a distinct perspective or resources to other members on your team to contribute to the proposed intervention.

Write down some of your thoughts here, then share and discuss with your team:

Task 2: Implementation Assume your team has been given the assignment to coordinate the implementation of the proposed population health solution, while keeping your population lens card in mind. Come to consensus on your answers to the following questions below. Your team's final answers should represent expertise from each individual contributor working as part of the unified solution. Write your responses beneath each question.

1. What are the first action steps your team will need to take to implement your intervention?

ROUND 2: LEADERSHIP

2 Task 2: Implementation ..continued

2. How might you organize your implementation team (roles, reporting structures, rules of engagement)?

3. What personnel, resources, or assistance are needed at the federal, state, and local levels to implement your intervention? How will you go about requesting this assistance? Who will do the asking and why?

4. What barriers might you encounter, and how will you address them?

5. How will you know your team's intervention has been successful?

ROUND 3: COMMUNICATION

Purpose of Round 3 To articulate (in writing and verbally) the dimensions of the population health scenario and intervention to be delivered.

Timing For Round 3, you will have approximately 1 hour to complete the two tasks assigned to your team. You may choose to divide your time the following way:

• (10 mins) Review Round 2 materials, team discusses initial reactions • (10 mins) Team discusses and completes task 1 • (10 mins) Team discusses and completes task 2 • (20 mins) Team utilizes prompts to complete task 3 • (10 mins) Team preparation for report out

Overview of Communication Single Overriding Communication Objective (SOCO) is the key outcome or change you want to see as a result of communicating to your main audience.

Round 3 Instructions Your team has identified the best intervention for the population health problem from Round 1 and you have a plan for implementation from round 2. Now, you must communicate your proposed intervention to get buy-in from a key audience that will contribute to the solution.

During the wrap-up with the larger group, you will be asked to describe your main audience, selected spokesperson and deliver your main message and SOCO.


1 Task 1: Identify the Audience for a Message Who is the main audience you would like a message about the population health scenario and your intervention to reach? In selecting the audience, consider who can best reach and impact the situation for the population on your population lens card. Examples: local public health officers, physicians, business owners/employers, administrators of healthcare facilities, politicians, faith-based or community agencies, etc.

2 Task 2: Select a Designated Spokesperson Instructions: As a team, identify a spokesperson who will convey a message to the main audience. The spokesperson, or person delivering your statement, and the way a message is delivered, can be just as important as the words you say.

Think about the main audience you identified in the previous task. Who would be the most relevant spokesperson to relay a message to this audience for your proposed intervention, and why?

In selecting the spokesperson, consider who:

• Has the authority to speak for the agency or entity responsible for the solution • Is credible with the media and public • Is adaptable and a quick study • Is knowledgeable about the incident, effects, and actions • Is flexible while staying on message during questions • Communicates technical information in terms a layperson can understand

List their job title and name, if known, here:


3 Task 3: Prepare to Verbally Present Your Message and SOCO Instructions: Develop a brief message and S O C O that the spokesperson you identified in the last task will use as the foundation to give a statement for a press conference, briefing, or other public communication to your main audience. This message should be no longer than 3 minutes.

In a B R I E F paragraph, state the key points you want to communicate about the scenario/population health problem, with a particular focus on the population from your population lens card to your spokesperson. This statement should reflect what you would like to see in a summary briefing about your topic.

As you refine the message, keep in mind the main audience your spokesperson will be addressing, their priorities and interests (relevant to this population health situation and otherwise), as well as any special needs or communication challenges that the population could face in receiving your message, understanding it, finding it credible, and acting on it.

Ideas for key points to include in your paragraph:

• Situation (What happened?) • Intervention (What has been/will be the population health response?) • Anticipated Result (What resolution can the audience expect? When?)

Write your final message using the key points here:

S O C O

What is the one change or action you want to see in your main audience as a result of this message?

Lastly, be prepared to share your message and SOCO during the debriefing session following this round as if you were briefing your spokesperson.

ROUND 4: SYNTHESIS

Purpose of Round 4 To synthesize the overall case experience and lessons learned.

Timing For Round 4, you will have approximately 45 minutes to complete the one task assigned to your team. You may choose to divide your time the following way:

• (10 mins) Review Round 4 task instructions, write ideas for key takeaways individually • (25 mins) Team discusses and completes task 1 • (10 mins) Team preparation for report out

1 Task 1: Synthesize Your Learning and Experience with Your Team When large scale, real-world population health challenges arise, interdisciplinary teams must come together quickly with new "personnel" from different sectors contributing to sustainable, large-scale solutions - just as your team did through the case experience tasks.

1. Write down some of your ideas for key takeaways here:

Prepare to Present

Prepare to report back to the larger group with your team's takeaways.

2. As a team, come up with 3-5 takeaways (e.g. tips, lessons learned) that represent your team's experience.

APPENDIX ROUND 1 TOOLS

TASK 1 TOOL

Four Levels of a Systems View (Senge)

1.1 First Level: Events Identify the problem. Events are markers in time where multiple variables are observed.

Most of the world spends its time at the event level. It is how we perceive the world while going about our daily business. When we view problems at this level our

solutions tend to be reactive.

What are the events or actions that led to the problem or situation? List them here:

A good systems thinker is someone who can see four levels operating simultaneously for a problem or situation: events, patterns of behavior, systems, and mental models.

2. Second Level: Patterns of Behavior Observe the patterns. Patterns are the changes in variables that occur over time. Since these variables are frequently observed as parts of events, to see these patterns we start by asking ourselves the question, "Which events seem to go together?" That is, we speculate that certain events are in some way related. Then, using the accumulated memories of the events, we view them as a series in order to see a pattern.

What are some possible patterns you see happening in this case? List them here:

TASK 1 TOOL

Four Levels of a Systems View (Senge) ...continued

3 Third Level: Systems & Structure Determine the potential causes and relationship between the events. The structure supports and creates the patterns we see in the events. It may not be easy to see the structure, but the patterns we can see tell us that the structure must be there. Structures are composed of cause-and-effect relationships.

What factors are contributing to the pattern(s) we are observing? List them here:

4 Fourth Level: Mental Models Mental models are the prevailing motivations and assumptions held (and generally unvoiced) by people/ stakeholders. They are thoughts and reasoning that must have existed to cause the situation to be the way it is. Elements include attitudes, beliefs, morals, ethics, expectations, values, and experiences.

What are some of the elements you see at play here? List them here:

TASK 1 TOOL

Tackle Complex Problems in 4 Steps (adapted from Korn Ferry)

1. Define the problem. Shut off your solution machine and get clear about what needs fixing. Rigor in problem definition pays off in better solutions. Start by defining what the problem is and what it isn't. Be as clear and succinct as possible. It may be helpful to work backwards: write a desired outcome statement that describes what will be better when the problem is solved to support your problem definition.

Write your problem definition here:

2. Gather relevant information. Gather data from the population health scenario or the members on your team on who, what, when, why, and how the problem occurred. Differentiate facts, opinions, and guesses (FOG).

List some of this key information here:

TASK 1 TOOL

Tackle Complex Problems in 4 Steps (adapted from Korn Ferry)... continued

3. Drill down to root causes. Why has this problem occurred? Keep asking "why" until you uncover as many underlying causes as you can.

Write down some of the root causes here:

4. Ask more questions. Get curious and explore all angles of the problem. What solutions have been tried and what were the results? What are the forces that perpetuated the problem? What resources exist for finding, testing, and implementing a solution? What constraints?

List the highlights of your questions and possible answers here:

TASK 1 TOOL

Explore the Story (from The Fifth Discipline Fieldbook, Senge et. al.)

Step 1: The Problem Is...

Start your sentence with the phrase: "The problem is ..." Seek to define the problem in no more than 3 sentences. Make sure your description of the problem is as accurate as possible; stick to the facts. Do not jump to conclusions by including a suggestion of the solution; be nonjudgmental. Specify any assumptions you make.

Define your problem here:

Step 2: Telling the Story

How did internal thinking, processes, practices, and procedures contribute to or create the circumstances?

Bring the story or stories underlying your problem to the surface. This process is also known as model building. You develop a theory or hypothesis that makes sense, is logically consistent, and could - if accurate - explain why the system is generating the problems you see. Then you test the story you have created. The team should purposely maintain many divergent ideas for as long as possible, even if they seem to contradict at first.

Write your story here:

TASK 1 TOOL

Explore the Story (from The Fifth Discipline Fieldbook, Senge et. al.)

Step 3: Make a List

One key factor is... Identify and write down the key factors that seem likely to capture the problem or are critical to telling the story. The point of this exercise is not to settle on any of these statements as "right" or "wrong."

Write your key factors here:

TASK 2 TOOL

Delphi Method This method helps to solicit expert opinion on solutions and builds consensus for the way forward. For purposes of this activity, this method is amended and used to create potential solutions, interventions, approaches.

INSTRUCTIONS: One person is the designated facilitator or leader for this task. Each member of the team is considered one of a panel of experts who are selected for a reason (they hold knowledge on an opinion or view; they represented their particular expertise or school). The facilitator asks each member to write their ideas for a solution on a piece of paper, one idea per sheet. Responses are collected and analyzed by the team, then common viewpoints are consolidated and conflicting viewpoints are identified and discussed. This process repeats as the team gradually work towards synthesis and building consensus on 1-3 interventions or approaches.

Write your 1-3 interventions here:

Next, discuss and evaluate your three options briefly. Consider - what are the risks/benefits of each approach, what's going to realistically work, who is your audience, do you do all next steps at same time or sequentially?

Lastly, write down the one intervention you are choosing here:

TASK 2 TOOL

Rose, Bud, Thorn (Luma Innovation Tool)

This tool can help identify insightful ideas and solutions in an innovative way.

INSTRUCTIONS: Select a member of the team to set and start a timer for 5-10 minutes. When the timer begins, participants will write one idea per sticky note and as many ideas as possible for each color:

• Pink st icky notes are for Rose ideas - something that is working well or ideas that are positive that could be leveraged for an intervention.

• Green st icky notes are for Bud ideas - an area of opportunity or ideas that have yet to be explored for an intervention.

• Yellow st icky notes are for Thorn ideas - something that isn't working or something negative that you want to avoid in your intervention.

After the timer has stopped, each person can share their ideas and post them on a wall. Like sticky notes should be affinity-grouped, and then groups can be given a title or name that captures the theme. Each affinity group may have a combination of pink, green, and yellow sticky notes. The goal is to group ideas according to what is written on the notes - not the color. Once the groups have been made, talk about color patterns that emerge and what they might mean.

After each group of sticky notes has a name that captures the essence of all ideas, the team can vote to determine if the group of ideas or an individual idea is something you want to pursue as you seek to define 1-3 interventions.

Write your 1-3 interventions here:

Next, discuss and evaluate your three options briefly. Consider - what are the risks/benefits of each approach, what's going to realistically work, who is your audience, do you do all next steps at same time or sequentially?

Lastly, write down the one intervention you are choosing here:

TASK 2 TOOL

Qualitative Ranking Tool This tool generates potential solutions and then rates the solutions on 5 key factors for prioritization.

INSTRUCTIONS: As a team, use this tool to ideate potential solutions, interventions, approaches to the problem

Step 1: Brainstorm as a team for 5-10 minutes potential ideas for solutions, interventions, approaches to the population health problem.

Step 2: As a team, rate each idea/solution/intervention by working across the key factors below. Rate each intervention on each factor using a 1 to 5 scale. The higher the total score, the greater the approach.

RATING 1-5 INTERVENTION 1 INTERVENTION 2 INTERVENTION 3 INTERVENTION 4 INTERVENTION 5

Control: Extent to which the group controls the problem and can control or influence the solution

Difficulty: Judgment about the relative difficulty or ease of working through the problem to a solution

Time: Judgment about the relative length of time it will take to resolve the problem

ROI: Approximate, expected payoff from solving the problem

Resources: Amount of resources required to solve the problem (people, money)

TOTAL S C O R E

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