Quality Improvements

Quality Improvement Initiatives There are 2 quality improvement initiatives in FORGE AHEAD One for the community teams One for the clinical teams

Community Quality Improvement Initiative Goal: to facilitate the development, implementation and evaluation of actions plans by community teams (based on the results of readiness consultations); to present strategies to increase healthy lifestyles (based on the results of the best practice literature review) to enhance linkages and partnerships between community type 2 diabetes and clinical care programs to improve patient access to available healthy lifestyle resources/services; and Workshop #1: Brainstorming, Issue Identification, Identify Strengths & Resources, and Develop Action Plan Workshop #2: Update on Tasks, and Re-assessment of Action and Plan/Tasks Workshop #3: Evaluation and Sustainability Note: Community leaders will be asked to share their experiences, and assess the workshops, activities and innovations/projects/programs developed and implemented. Note: The workshops of the intervention (see project 6 and 9) will be implemented with videoconferencing over several months. Community facilitators and the FORGE AHEAD team will provide feedback and support locally or via teleconference and e-mail. At the end of the intervention, readiness consultations will be repeated and clinical data will be extracted from surveillance systems to measure outcomes.

Clinical Quality Improvement Initiative Goal: to facilitate the re-organization of primary healthcare by clinical teams (i.e. develop and implement innovations) using the results of the clinical readiness consultations and data in the registry and surveillance systems; to enhance knowledge of diabetes care, team-based care, self-management, quality improvement tools, use of population level data, etc.; to enhance linkages and the building of partnerships between community type 2 diabetes and clinical care programs to improve patient access to available healthy lifestyle resources; and Workshop #1: Diabetes care , Team-based care, and Quality Improvement Strategies/tools Workshop #2: Quality Population Level Data , Patient Navigation, and Self-management Workshop #3: Evaluation and Sustainability Note: Clinical team leaders will be asked to share their experiences, and assess the workshops, activities and innovations/projects/programs developed and implemented. Note: The workshops of the intervention (see project 6 and 9) will be implemented with videoconferencing over several months. Community facilitators and the FORGE AHEAD team will provide feedback and support locally or via teleconference and e-mail. At the end of the intervention, readiness consultations will be repeated and clinical data will be extracted from surveillance systems to measure outcomes.

Quality Improvement Initiatives Teams will participate in educational workshops, have ongoing support from the Community Facilitator and the Western Team, and be asked to track their activities during action periods Both initiatives are one year long and include: A series of 3 workshops separated by approx. 3 month action periods Work-shop #1 Work-shop #3 Work-shop # 2 (3 month action period) (3 month action period) (3 month action period) One year

QI Workshops The workshops for both the community and clinical teams are an opportunity to: build capacity and knowledge with expert presentations; plan community specific innovation/changes to be tested during action periods; and share lessons learned across teams. The first workshop will be done in-person to help establish relationships and enhance interaction among the participants and the Western Team.

Community Quality Improvement Initiative The Community-Driven Quality Improvement Initiative will include 3 workshops separated by 2-3 month action periods: to facilitate the development, implementation and evaluation of actions plans by community teams (based on the results of readiness consultations – project 3); to enhance linkages and partnerships between community type 2 diabetes and clinical care programs to improve patient access to available healthy lifestyle resources; and to present strategies to increase healthy lifestyles (based on the results of the best practice literature review (project 2) Workshop #1: Brainstorming, Issue Identification, Identify Strengths & Resources, and Develop Action Plan Workshop #2: Update on Tasks, and Re-assessment of Action and Plan/Tasks Workshop #3: Evaluation and Sustainability Note: Community leaders will be asked to share their experiences, and assess the workshops, activities and innovations/projects/programs developed and implemented. Note: The workshops of the intervention (see project 6 and 9) will be implemented with videoconferencing over several months. Community facilitators and the FORGE AHEAD team will provide feedback and support locally or via teleconference and e-mail. At the end of the intervention, readiness consultations will be repeated and clinical data will be extracted from surveillance systems to measure outcomes.

Clinical Quality Improvement Initiative Clinical Quality Improvement Initiative - three workshops separated by 2-3 month action periods to facilitate the re-organization of primary healthcare by clinical teams (i.e. develop and implement innovations) using the results of the clinical readiness consultations (project 5) and data in the registry and surveillance systems (project 7 and 8); to enhance linkages and the building of partnerships between community type 2 diabetes and clinical care programs to improve patient access to available healthy lifestyle resources; and to enhance knowledge of diabetes care, team-based care, self-management, quality improvement tools, use of population level data, etc. Workshop #1: Diabetes care , Team-based care, and Quality Improvement Strategies/tools Workshop #2: Quality Population Level Data , Patient Navigation, and Self-management Workshop #3: Evaluation and Sustainability Note: Clinical team leaders will be asked to share their experiences, and assess the workshops, activities and innovations/projects/programs developed and implemented. Note: The workshops of the intervention (see project 6 and 9) will be implemented with videoconferencing over several months. Community facilitators and the FORGE AHEAD team will provide feedback and support locally or via teleconference and e-mail. At the end of the intervention, readiness consultations will be repeated and clinical data will be extracted from surveillance systems to measure outcomes.

"That was a good launch. There was some theory behind what we're doing, the research based evidence. Other participants' experiences were shared. It was just good to network… which we don't get to do, hardly ever".1 “The initial information session was very important for us to get enthusiasm and impetus... for the project, and then we had another day… It was good to get the enthusiasm going again because things kind of fell off. Whenever we would meet as a group with the facilitators and the coaches, that was really worthwhile.” 1 1. Paquette-Warren et al, 2011 Ref P4H process paper

"They did all the sessions about the different components of how to manage chronic diseases ... That was really helpful ...The process stuff like tests of change and how to approach some of the little projects ... I found that to be helpful.“ 1 1. Paquette-Warren et al, 2011 Previous participants in these types of program found the sessions overwhelming, but had greater comfort and positive views about their added value (educational content and format) at the end of the program.

QI Workshops – Building Capacity and Knowledge Expert presentations will be used to help increase participants’ knowledge of diabetes care, healthy lifestyles and self- management readiness, re-organization of primary healthcare and team-based care quality improvement tools population level data (registry and surveillance) sustainability