II. Collaborative Overview
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Collaborative Overview ObjectivesApply all phases of the BTS Collaborative model to your own collaborativeAnticipate the challenges and complexities of designing, managing and guiding a successful collaborativeAdapt the Service Collaborative content to your own collaborativeAddress any questions about Faculty and Staffing
2
IHI Breakthrough Series(6 to 18 Months Time Frame)
Select Topic
(Develop Mission)
Planning Group
Develop Framework & Changes
Participants (10-100 Teams)
Prework
LS 1
P
S
A DP
S
A D
LS 3LS 2
SupportsEmail Phone Conferences
Extranet Visits Assessments
Sponsors Monthly Team Reports
DisseminationPublications,
Congress, etc.A DP
SExpert Meeting
AP1 AP2 AP3*
LS – Learning Session
AP – Action Period
*AP3 –continue reporting data as needed to document success
Holding the Gains
Peru Video What did you observe?What was the Collaborative experience like for the participants? For the leaders?What questions do you have?
BTS Service CollaborativeSummary and Materials
Service CollaborativeGoal: to demonstrate that health care can provide
unprecedented levels of service and satisfaction, focusing on the 8 dimensions of service from the Picker Survey
Service I Spring ’97 to Autumn ’9737 organizationsService II Autumn ‘99 to Summer ’0021 organizations SP
Service Collaboratives Focused on…
Treating the patient as an individual worthy of respect; Includes issues of privacy, physical comfort, emotional support, and patient and family choice and controlHelping the patient to interact with a complex health care system; Includes coordination of care, smooth transitions among sites and providers of care, and understandable information to facilitate decision making
Service II FacultyChair: National Leader in Patient Centeredness, Physician’s Assistant, President of Picker InstitutePlanning Group:– Hospital QI consultant, nurse, past participant– Health System QI leader, nurse, past faculty– Thoracic Surgeon, past participant– Health Center Administrator, past participant– Improvement Advisor-statistician who also worked on
two ED collaboratives
Service II Organizations
Representative sample– Hospitals, HMOs, Integrated Delivery Systems, and Office
Practices
Setting:– ED (3 teams)– Inpatient and across boundaries (10 teams)– Ambulatory Care (8 teams)
Participating Teams Were Usually from One Unit or Service Line
Day to Day Leader: Administrative Manager or Nursing LeaderTechnical Expertise: Quality Improvement, MarketingSystem Leader: Administrative VP or Clinical VP% of teams with a Physician=40%
Service Aim Examples
Increase by 20% the number of patients and families who rate the overall quality of care they receive in Emergency Department as excellentPatients entering our Clinic will be highly satisfied with care, as evidence by a 75% increase in willingness to recommend the clinic to their friends within 10 months Our ICU patients will feel respected, supported, and included in their care, and within 10 months will reach the following goals: – 90% of patients report being highly satisfied with their care– 75% of patients reported that the doctors and nurses
recognized their needs and treated them as individuals– These goals will be achieved in 10 months, with results being
spread to two other ICUs
MeasurementAll organizations had existing patient satisfaction collection systems that were inadequate for improvementPicker, Press-Ganey, or home grown systems were augmented with data collection specific to the units involved
Some MeasuresPercent of patients reporting satisfied or very satisfied with carePercent of patients reporting willing or very willing to recommend the providerPercent of patients reporting problems with care
Results Example-ED
Willingness to Recommend to Friends n=200 per month
020406080
100
Baseline Aug Sep Oct Nov Dec Jan Feb Mar Apr May
Month
Perc
ent
PercentGoal
Teams Worked on Multiple Dimensions of ServiceThey chose 3 or 4 areas from this list:
RespectComfortEmotional supportInformation and educationInvolving family and friendsContinuityAccessTransitions
Examples of Changes Tested-EDDischarge changes: Physician gives discharge instructions, RN follows up next dayPlace chairs in rooms, train physicians in communication skillsRoom before registration: Direct route to physician protocolPain management protocolTriage Nurse as customer service rep-waiting time, waiting roomBed supervisor in ED speeds admissionsWaiting Room converted to Health Info Resource Center
Results in Service I and II
Final Team Assessments Service I at LS 3
0
2
4
6
8
10
12
14
16
1 1.5 2 2.5 3 3.5 4 4.5 5
# of
Tea
ms
Median Rating= 4.0% teams 4 or above =75%
Final Assessment Service II at LS3
0
2
4
6
8
10
12
14
16
1.0's 1.5's 2.0's 2.5's 3.0's 3.5's 4.0's 4.5's 5.0's#
of te
ams
Median=4.0Percent 4 or better=53%
Faculty and Staffing for Your Collaborative
Faculty and StaffingPlanning Group
ChairFaculty members (subject matter experts)Collaborative Leadership– Director– Improvement Advisor– Coordinator– System sponsor
IHI BTS ResourcingRole:
ChairFaculty (2-5) DirectorImprovement AdvisorCoordinatorSystem Leader for the organization hosting the collaborative
Time Commitment / Month:2 days1 day (each member)8 days3 - 4 days
10 days1/2 day
(BTS Team manages 10 -100 participating orgs.)
Creating the Planning Group
Expert Panel – 12-15Role: Supply Clinical
(e.g. subject matter) Content
Faculty – 2-6
Role: Develop content, plan, teach, coach in BTS
IHI Staff
Director, IA, Coordinator, System Sponsor
Chair
Advisers, Guest Speakers at Learning
Sessions
Attributes of a Great Leadership Group = Planning Group
Planning Group– IHI Staff: Director, IA, Coordinator, System Leader– Chair and Faculty
Skills and experience complement each other (clinical / non clinical, experience with Collaboratives)Fluid boundaries for rolesKnowledge and skills in technical (topic) area
Collaborative Director (8 Days per Month, 1/3rd Time)
Project management expert who understands improvement – Responsible for BTS processManages the overall CollaborativeCoaches the Chair and Faculty in the Breakthrough Series methodology Manages pre-work development, recruiting, Q&A, team reviewsCreates and facilitates meetings and conference call agendasWorks with Improvement Advisor to track teams’ and overall Collaborative’s progressCompiles and reviews organizations’ monthly reportsCoaches organizations at Learning Sessions and during Action Periods
Improvement Advisor (3-4 Days per Month 1/5th Time)
Expert in improvement theory and methods –responsible for outcomesCoordinates the development of the theory for the topic (aim, measures, changes)Packages changesDesigns a measurement system and addresses issues regarding measurement More time required for new topicsTeaches and coaches Faculty and teams on application of the Model for ImprovementAssesses Collaborative progress and recommends strategies to achieve Collaborative goals
Collaborative Coordinator (10 Days per Month, ½ Time)
Responsible for Collaborative administration, including project timeline, contracting, and financial managementWrites and edits correspondence, meeting materials, marketing materialsManages marketing, enrollment, prework activitiesManages Action Period activities: Mail, electronic mail, fax, conference calls, reporting processManages registration, payments, and project membershipCoordinates compliance with all Continuing Education requirementsManages Learning Session logistics
System Leader (1/2 day per month)• Responsible for all Collaborative Improvement at
sponsoring organization
• Charters Collaboratives and ensures they are consistent with mission, goals, and resources of organization
• Provides resources for Collaborative staff and faculty
• Provides executive review and guidance
Collaborative ChairNoted authority in Collaborative topicCreates a shared vision and provides intellectual leadership for the topicHelps form and guide FacultyAssists the Improvement Advisor to develop the change package and measurement systemChairs and teaches at Learning SessionsCoaches and mentors organizations to achieve goalsReviews Collaborative progressLoses sleep—Results Focused!
Faculty:Additional Subject Matter Experts
Viewed as credible experts in the selected topic (accomplished significant results).…. the “Dream Team”Represent multiple disciplines and multiple organizational structures - Primarily practitioners, some researchersSpecify goals, high leverage changes, teams for PreworkTeaches and coaches at Learning Sessions and during Action PeriodsAdvises the Chair and Director of teams’ progressOften volunteers in IHI BTS system
Attributes of a Great Planning Group
Skills and experience complement each other (clinical/non-clinical, experience with Collaboratives)Fluid boundaries for rolesKnowledge and experience in topic areaFor Faculty: Passionate about the topic and improvement
Please go to the Planning Guide section of the Workbook and complete the Worksheet for Collaborative Overview.
To the Workbook… 30
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