Welcome to the MHQP

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Welcome to the MHQP HealthForce MN Quality
Brownbag Room Monthly Noon Brownbag Fourth
Thursday Every Month
Nov 20 (3rd Thursday) Planning,
Implementation Project Management ( Linda
Setterlund from ICSI)

• PLANNING
• PI Inventory Management Prioritization
• Action plans
• Aims, Measures, Interventions
• Evidence-based medicine consensus building
• Evaluate frameworks Baldrige Magnet
• IMPLEMENTATION
• Coordinating the PI Program
• Leading Championing Facilitating PI teams
• Quality teams
• Service line teams
• Spread/deployment
• PROJECT MANAGEMENT

Slides are posted at http//www.healthforceminn
esota.org/pages/Programs/courses.html
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Register your Attendance

• Hopefully you provided your name organization
  when you signed in.
• If so
• Just say Hi in the Chat Pod and well
  capture your name and organization in the log.
• If not
• identify yourself and organization in
  the Chat Pod to the
• left of your screen.
• If there are more than one attending on your
  sign-in, tell us how many by saying Hi (tell us
  the number of attendees)

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Poll Who is Attending this Session ?

• Rural / Out state ?
• Metropolitan area ?
• Organization that has (or serves) both ?

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Poll Who is attending Organization Type ?

• Healthcare system
• Hospital
• Clinic or Clinic System
• Long term care
• Health plan
• Homecare / Hospice
• A Quality Support Organization
• Other ? (Identify other in Chat Pod)

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Poll What do you hope to gain by participating?

• I am a CPHQ and want to obtain CEUs for
  recertification. (Note this is not guaranteed
  at this time. We are still working on this)
• I am a healthcare quality professional and am
  interested in additional education.
• I am a healthcare professional interested in
  developing quality skills as a core competency.
• I am a healthcare professional interested in
  learning more about healthcare quality.

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Agenda

• PLANNING
• PI Inventory Management Prioritization
• Action plans
• Aims, Measures, Interventions
• Evidence-based medicine consensus building
• Evaluate frameworks Baldrige Magnet
• IMPLEMENTATION
• Coordinating the PI Program
• Leading championing Facilitating PI teams
• Quality teams
• Service line teams
• Spread/deployment
• PROJECT MANAGEMENT

NOTE None of the NAHQ/CPHQ slide deck was used
to create this session.
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PI PLANNING

• Performance improvement has become a broad focus
  of the healthcare organization or system.
• Governance of PI
• Who selects the initiatives?
• Who schedules when they will be done?
• Who tracks the status?
• How do you know who is working on what?
• Creating an inventory is a good first step.

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Poll Do you have an inventory of PI
initiatives ?

• Yes, we have one and there is a process to not
  only keep it accurate but also to use it during
  the budget process.
• Yes, we have one but there is no process to
  systematically maintain it.
• No, inventories are kept in departments.
• No, we have no inventories.

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PI Inventory Management

• There are many possible ways to
• categorize your PI initiatives
• Strategic Tactical Operational
• System Site Department
• Service Line
• Type of Change
• External or Internal

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Poll Whats the biggest obstacle to having a
coordinated/managed PI plan/inventory

• Leadership doesnt participate in this process
• We dont have a starting point
• We dont have processes
• We dont have a Champion
• Champions fear prioritization
• Lack of resources

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(No Transcript)
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Prioritization

• Immediate Safety
• External Drivers / Visibility
• Strategic plan
• Tactical Plan
• Local Site or Department operational plan
• Individual plans
• How are these drivers prioritized ?

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Prioritization Tool

• Matrix

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Poll Is there too much emphasis on core
measures ? What of your quality resources are
devoted to core measure abstraction, reporting
and analysis ?

• lt 10
• gt 10 lt 25
• gt 25 lt 50
• gt 50

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Action Plans

• What change is expected (outcome objective)
• What action is considered appropriate and
  How (action steps)
• Who is responsible for implementing the
  actions
• When positive change is expected and
  reevaluation should occur
• What measurement(s) of performance will be
  used

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Aims Measures - Interventions
Aims
Specific goals change what by how much by when
?
Measures
Interventions
What are you changing to make things better ?
Feasible data capture, reporting , and analysis
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Measures (If youre having trouble getting
started)

• I would suggest that quality professionals
  consider the following in their daily work (all
  reporting data should be presented in annotated
  run charts and control charts)
• select a small number of system-level measures
  that are evidence based and critical. Report
  quarterly results on a red/green scorecard to all
  managers, senior leadership and the board.
• report monthly on the subset of key indicators
  related to system-level measures for the areas
  targeted for improvement.
• Disseminate a weekly report of failures for
  system-wide priorities (e.g. safety or flow) to
  build the energy and passion for change and learn
  what fixes can be made in real time.
• Provide daily reporting of failures (and their
  mitigation) at the unit- or shift-manager level
  to promote situational awareness.
• Dr Uma Kotagal Senior VP for Quality and
  Transformation
• Cincinnati
  Childrens Hospital Medical Center
• Journal for Healthcare Quality
• Vol 30, No 5 , Sep-Oct 2008 pp 32-33, 54

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Frameworks for Planning/PI Mgt

• Magnet Forces ()
• Transformational Leadership
• Quality of Nursing leadership (1)
• Management style (3)
• Structural Empowerment
• Organizational Structure (2)
• Personnel Policies Programs (4)
• Community the Healthcare Org (10)
• Image of Nursing (12)
• Professional Development (14)
• Exemplary Professional Practice
• Professional Models of Care (5)
• Consultation Resources (8)
• Autonomy (9)
• Nurses as Teachers (11)
• Interdisciplinary Relationships (13)
• New Knowledge, Innovations Improvements
• Quality Improvement (7)
• Empirical Quality Outcomes

• Baldrige Categories
• Leadership
• Strategic Planning
• Customers
• Measurement,
• analysis,
• knowledge mgt
• 5. Workforce
• 6. Process mgt
• 7. Results

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Coordinating the PI Program
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Evidence-based Medicine Consensus Building

• Guidelines, Protocols
• Evidence-based documents outlining
• practices for prevention, detection or
• treatment of specific health conditions
• Foundation for consensus-based
• improvement initiatives
• randomized control trials, cohort studies,
  Meta-analysis
• of primary studies..

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Evidence-based Practice

• Guideline uses
• Implementation Resource
• Guide for Care Delivery System Design
• Clinical and Educational Resource

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Evidence-BasedQuality/PI

• Based on clinical research and health services
  research
• Promotes a culture of excellence through using
  research

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Consensus Building

• Achieving consensus on best practice
• Why consensus in QI
• Sets the stage for process improvement
• Eliminates time spent on disagreement during
  implementation
• Secures engagement for improvement
• Encourages individual practice that matches best
  and evidence-based practice

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Consensus Building

• Steps
• Write out the issue
• Suggest alternative solutions
• Use multi-voting to reduce long lists
• Use rating votes
• Discuss areas of disagreement openly
• Discuss outcome of vote..everyone heard?

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Consensus Building

• What is consensus? I can live with that
• . . . and
  support it
• When consensus?
• Decisions being made require commitment of all
• Decisions affecting many people
• Multiple areas/departments are involved
• Implementation will require buy in of many for
  success of the project/process

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Consensus Building

• Keys to Success
• Trust
• Everyone must understand the topic/problem
• All should contribute
• To disagree is OK.may be healthy
• Separate issues from personalities
• Commit the time to reach consensus--dont rush

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Consensus Building

• Barriers to Achieving Consensus
• Getting everyone on board at the same time
• Commitment of Time and other Resources
• MN-nice! Lacks buy-in
• Organization with multiple sites
• Resistance

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Implementation Dispersion(Spread / Deployment)

• The final frontier no matter the scope of your
  project
• Where the rubber hits the road
• Spread is not a cookie cutter process

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Implementation Structure

• Use multi-disciplinary teams for improvement
• The responsibility and accountability for
  improving processes is within all levels of the
  organization

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Implementation Teams

• Why use facilitated teams for dispersion?
• Quicker and more efficient improvements
• Buy-in by more staff due to direct involvement
• Harnesses the collective wisdom of all staff
• Empowerment increases job satisfaction
• Helps to control and manage change
• Prevents manager/champion burn-out

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Leading Championing Facilitating

• PI Team Roles
• Executive Sponsor
• Champions
• Facilitator

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Poll Who are your facilitators ?

• We rarely use facilitators from other than the
  quality department.
• Lean / 6-sigma have expanded the pool through
  green black belts
• We expanded the pool through in-house quality
  training (provide details in chat pod)
• Other (identify in chat pod)

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Standing Quality/PI Teams/Committees

• Patient Safety
• Patient Access/Flow
• Joint Commission Chapters
• Service Lines
• Others? (identify in chat pod)

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Deployment / Spread At-a-Glance Tool
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PROJECT MANAGEMENT

• Proof-of-Concept
• Is this a good idea ?
• Have one employee try it on one patient
• Pilot
• More of a formal project step
• Where PDCA earns its money
• Fully implement

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Project Management Critical Success Factors

• Accountable
• Exec Sponsor, Champion, Facilitator
• Project Charter
• Deliverables with milestones
• Efficient Effective meetings
• Valusek rule you get one hour with clinicians
• Spread is not a cookie-cutter process

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Summary

• PLANNING
• PI Inventory Management Prioritization
• Action plans
• Aims, Measures, Interventions
• Evidence-based Medicine consensus building
• Evaluate frameworks Baldrige Magnet
• IMPLEMENTATION
• Coordinating the PI Program
• Leading Championing Facilitating PI teams
• Quality teams
• Service line teams
• Spread/deployment
• PROJECT MANAGEMENT

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Update on CPHQ Exam Prep Course

• Date/Time
• Saturday March 14 0800-1500
• with self-pay networking dinner after
• Sunday March 15 0900-1300 ??
• Place
• VA Hospital Auditorium
• Contact (if you havent already)
• skipvalusek_at_comcast.net

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2009 BrownbagsSend suggested topics to

• skipvalusek_at_comcast.net

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Welcome to the MHQP HealthForce MN Quality
Brownbag Room Monthly Noon Brownbag Fourth
Thursday Every Month
Dec 18 (3rd Thursday) Evaluation
Integration ( Cally Vinz from ICSI)

• Evaluating team performance
• Evaluating corporate scorecards
• Pay for performance
• Complaint management
• Integrating quality/PI and informatics
• Creating the feedback loops

Slides are posted at http//www.healthforceminn
esota.org/pages/Programs/courses.html