Improvement Science in Action

Prework Call Sandy Murray, Debbie Ray, Jonathan Merrell

March 6th , 2014

Oregon Health Authority

Welcome to the Transformation Center

Improvement Science in Action Program

2

Ron Stock, M.D.

Director of Clinical

Innovation

Your Program Faculty and Staff 3

Jonathan Merrell Faculty

Debbie Ray Faculty

Kathryn Brooks Project Manager

Sandy Murray Faculty

Any OHA staff?

WebEx Tips 4

Please do not place your phone on hold!

Getting back in…

Mute/unmute (*6 on your phone)

Asking questions

Hands, voice, chat…just ask ‘em!

WebEx Tips 5

Please use Chat to “All

Participants” for

questions

For technology issues

only, please Chat to

“Host”

WebEx Technical

Support:

1- 866-569-3239

Dial-in Info: Communicate

/ Join Teleconference (in

menu)

Raise your hand

Select Chat recipient

Enter Text

Your Questions Are Important 6

Can speak them, “chat” them, raise hand….just please do ask them!!

OHA – ISIA Participants 7

Org # Proj Org # Proj Org # Proj

AllCare Intercommunity CCO Trillium

Cascade Jackson Care Con. Umpqua

Columbia Pacific Co-ord Care OHA(non DMAP)

Western OR Ad.Health

DMAP (OHA) Pacific Source Central OR Willamette CCO

Eastern Ore CCO

Pacific Source Columbia Yamhill Co.

FamilyCare, Inc PrimaryHealth Josephine

Heath Share Transformation Center

Where Are You Today? 8

ISIA Program Background

Specially designed for those of you actively involved in health care improvement projects

A unique hands-on approach providing a firm grounding in the concepts, tools and methods you’ll need to execute improvement projects

Whether you are new to quality improvement or looking to deepen your experience and skills, this program will change your perspective on improvement science and advance your capabilities as a leader in this critical discipline

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ISIA Program Objectives

As a result of this program, you will be able to:

Shape and frame an improvement project to increase the probability of success

Gain skills for executing an improvement project

Define and apply a set of measures to analyze and assess project success

Use the Model for Improvement to develop, test, and sustain reliable improvements

Use the organizational and human dimensions of change in planning and executing an improvement project

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Comprehensive Curriculum The program features a mix of conceptual and practical

learning:

Developing a project charter that clearly justifies and focuses the work

Framing a challenging yet realistic project aim

Understanding organizational dynamics of change and the psychology of improvement work, and use them to build an effective team

Using systems thinking, driver diagrams, and change concepts to generate effective process changes

Using PDSA cycles to: – Identify promising ideas for change,

– Test and adapt the changes to work reliably in your environment

– Implement the changes to achieve more reliable and effective process

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Comprehensive Curriculum, cont.

Creating a comprehensive measurement plan, including operational definitions, data collection methods, reporting, and training

Applying analytical tools including run charts, Pareto diagrams, scatter plots and Shewhart charts to analyze, interpret, and respond appropriately to data

Understanding and applying important principles of reliability science to the design of processes

Understanding implementation as a distinct phase of improvement with key principles and approaches for sustainability

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OHA ISIA Agenda At A Glance April 30th to May 2nd, 2014

Time Wednesday 30 April Thursday 1 May Friday 2 May

7:15-8:00 Breakfast and Registration Breakfast Breakfast

8:00-8:30 Intro, Welcome, Overview Opener and Review/Questions Opener

Run charts The Third Question: Getting Great

Ideas for Change: Change Concepts Overview of Science of

Improvement

Strength Deployment Inventory

Reliability Science and Your Project

Model for Improvement Testing Changes

6 Essential Skills for Improvement

Lunch-1 hour

The First Question (Aim, Charter,

Driver Diagram, MUSIQ, Charter

assessment)

Strength Deployment Inventory Accelerating Testing

The Second Question

(Measurement, Family of

Measures, Outcome, Process,

Balancing)

Teamwork Skills Understanding Variation (Pareto,

Histograms, Scatter and Intro to

Shewhart charts) The Third Question: Getting Great

Ideas for Change (Logical methods,

use of data, Flow Charts, Fishbone,

Affinity, Force Field Analysis Graphical Excellence

Generating Ideas: Creativity

Methods

Close 5:45 Clarification of Next Day and

Homework Assignments

Clarification of Next Day and

Homework Assignments

Clarification Upcoming Calls and

Assignments End 4:00

6 pm -7 pm Office Hours (Team Consultations) Office Hours (Team Consultations)

Prework Overview-Pre-work Packet 14

Resources-Debbie

Key WebEx dates-Debbie

Expectations-Debbie

Project selection and scoping-Sandy

Developing a project charter-Sandy

Examples of project charters-Sandy

Developing your driver diagram-Jonathon

Who should attend ISIA-Sandy

Project Selection

Purpose on CCO:

1. To Improve the lifelong health of all Oregonians,

2. Increase the quality, reliability and availability of

care for all Oregonians, and

3. Lower or contain the cost of care so it is affordable

for everyone.

Drivers: What drives or influences how we run and support the organization?

Mainstay What processes add value to the customer?

Support What processes are necessary to support the business?

Patient

Family

Community

Viewing A CCO as a System

Based on Deming’s view of the organization as a System)

©Profound Knowledge Products, Inc. 2008 All Rights Reserved

Purpose

CareOregon- Mid Level System Map

OHA Improvement Project Areas of

Focus

Integration of physical and behavioral health care;

Coordinating with community public health, community mental

health, and long-term care supports and services;

“Hot spotting” or “Super-utilizer” initiatives;

Provider and patient engagement;

Reduction of health disparities;

Coordinated, community approach to palliative and hospice care;

Adoption of Patient-Centered Primary Care Standards.

Alternative payment methodologies (e.g., global payments, bundled

payments) to align incentives to improve efficiency, effectiveness

and quality of health care;

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What Some Other Systems Have

Focused On….

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Debbie input

Who Should Attend ISIA?

Key CCO people who will be shaping and working with

improvement projects.

The project you are walking in the door with is a "playing

field”

– goal is to learn improvement science applied specifically to

improvement projects.

This may mean that you have no one attending with any

subject matter expertise related to the project itself.

– If have lucky CCO/subject matter knowledge overlap that person

would be high priority attendee

--Smart to do a good job connecting to subject matter experts

related to your project to flesh out draft charter and Driver

Diagram before ISIA workshop.

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Using the Model for

Understanding Success

in Quality (MUSIQ)

Copyright © Institute for Healthcare Improvement

Using MUSIQ

• Gives us a method to reflect on the set-up and

contextual support for our projects at the beginning of

the Wave.

• Opportunity to make adjustments to project and

organizational support system early in the project.

MUSIQ References

• Kaplan HC, Brady P, Dritz M, et al. The influence of context on quality

improvement success in healthcare: a systematic review of the

literature. Milbank Q 2010;88:500e59.

• Kaplan HC, Provost LP, Froehle CM, Margolis PA. The Model for

Understanding Success in Quality (MUSIQ): Building a Theory of

Context in Health Care Quality Improvement. BMJ Qual Saf. August,

2011 (doi:10.1136/bmjqs-2011-000010).

• Kaplan HC, Provost LP, Froehle CM, Margolis PA. An Exploratory

Analysis of the Model for Understanding Success in Quality (MUSIQ) ,

Health Care Management Review, 2012, in press.

Kaplan, HC, Provost LP, Margolis PA. Using the Model for Understanding

Success in Quality (MUSIQ) to Guide Quality Improvement, IHI Forum

presentation , 2011

INSTRUMENTS

Successful Quality Improvement is Like

Making Beautiful Music…

CHANGE CONTENT CHANGE PROCESS CONTEXT

Evidence-Based Care

Processes and Bundles

QI Methods—Model for

Improvement, PDSA Cycles…

Culture, Leadership,

Resources, Training,

Motivation…

PERFORMANCE SPACE PIECE OF MUSIC

The Model for Understanding Success in Quality (MUSIQ): building a theory of

context in healthcare quality improvement

Heather C Kaplan, Lloyd P Provost, Craig M Froehle, Peter A Margolis4

Background: Quality improvement (QI) efforts have become widespread in

healthcare, however there is significant variability in their success. Differences

in context are thought to be responsible for some of the variability seen.

Objective: To develop a conceptual model that can be used by organizations

and QI researchers to understand and optimize contextual factors affecting the

success of a QI project.

Context: “…characteristics of the organizational setting, of the individual, of his

or her role in the organization, and of any other environmental factor that may

shape [quality improvement effectiveness]”

MUSIQ

Development of MUSIQ

Environment

Competition

Managed Care Penetration

Medicare/Medicaid Influence

Regulation

TQM Adoption by Others

Accreditation

P4P

Organization

Size

QI Leadership

Culture

Ownership

Teaching Status

QI Maturity

System Affiliation

Location

Physician Involvement

Customer Focus

Financial Health

Organizational Structure

Service Mix

Physician Arrangements

Volume

Implementation Approach

Motivation to Implement QI

Innovativeness

Process Management

Microsystem

Motivation to Change

Champion

Physician Leadership

Culture/Climate

Capability for Change

QI Team

Physician Involvement on Team

Group Process

Team Leadership

Team QI Skills

Group Climate

Support

Prior QI Experience

Prior Experience Working

Together

QI Support & Capacity

Data Infrastructure

Resources

Infrastructure for QI

QI Consultants

QI Workforce Focus

Miscellaneous

Strategic Importance to Organization

•Systematic search identified 47 studies empirically examining context in QI.

•66 Contextual Factors Identified

MUSIQ: Model for Thinking About Context

Key features of MUSIQ include:

– Applicable to QI in a health care setting using a broad

range of QI approaches

– Useful for QI projects within a single or multiple

microsystems

– Organized based on nested levels of the health care

system

– Focuses on modifiable factors

– Makes relationships among contextual factors explicit

Kaplan et al. BMJ Quality & Safety, 2011

MUSIQ CALCULATOR (Excel Spreadsheet)

Let’s look at the worksheet

Summary

Context is important in the success of QI

initiatives and needs to be examined

systematically

Using MUSIQ you can…

– Identify aspects of context that must be addressed

before or during the execution of your QI projects

– Plan strategies to modify context for increased

success

Your Assignment

Please complete the MUSIQ

– Ideal is to do with team using a discussion, then

consensus approach

– If no team yet do yourself—from your perspective--

prior to ISIA Workshop (WS)

Prework Assignments 35

1. Develop a draft charter and driver diagram

– If you would like faculty review prior to our workshop please send

(between now and 14 April) – debbieray.quality@yahoo.com

2. Use the MUSIQ tool to determine MUSIQ score for the

project

– Best if done with your team but, if not team yet do from your

perspective

– Bring MUSIQ results to ISIA Workshop-we will use it there

Logistics 36

1. Conference begins with breakfast at 7:15 a.m., April 30th. Instructions

begin at 8 a.m. The conference concludes at 4 p.m. on Friday, May

2nd.

2. Remember to reserve your room at the Eugene Hilton. See flyer or

contact your Innovator Agent for details.

3. Make certain that you bring adequate copies, or electronic capability, of

your charter and DD to the Workshop with which your team can work

– Your team will use workshop time to review/revise/improve charter

and DD and further develop your project

4.Bring an IBM compatible laptop with Excel on it (1 per 2 people) for use

on our second day

– Must have administrative rights so you can load an Excel file

Our Next WebEx

Charter and Driver Diagram Call (1 hour)

– Tuesday, April 8th

– 12:30-1:30 pm PT

Need 2 volunteers to share their rough draft charter

and driver diagram

Connection Information • 1. Go to https://ihi.webex.com (Note: There is no “www” in the

address.)

• 2. Join the session titled OHA-IHI Improvement Science in Action

Pre-work Call (you’ll need to enter your name and email address)

• 3. Once you’ve joined the session, dial in by phone:

• Phone number: 866-469-3239

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Improvement Science in Action

Skill based curriculum

Interactive sessions

Professional development

Focus on your improvement projects

Faculty team coaching

Networking

Rewarding

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Contact Information 39

For questions about the program, contact:

Monica Hammer, Transformation Analyst

monica.hammer@state.or.us or 971-673-2832

Send prework assignments to: Debbie Ray, Faculty

debbieray.quality@yahoo.com

Your Questions Are Important 40

Can speak them, “chat” them, raise hand….just please do ask them!!