Quality Improvement Intervention tracking February 7, 2018: Coaching Session Quality Improvement Intervention tracking

Discussion for Today’s Session Intervention Tracking ---------------------------------- Key Components in the process Develop key interventions to test Monitor and Refine based on what is learned Adopt the interventions that worked and now ..............Disseminate what led to improvement As our practices are advancing through the phases of TCPi, with particular emphasis on using data to drive care and achieving progress on aims, there have been many conversations and discussions related to “What interventions with xxx metric are impacting performance?” Or “How are we tracking our interventions...what are we doing with the practices to influence change and result in improvement?” The recent graduating practices, as many of you know, and the need to demonstrate improvement has accelerated the need for a more structures approach to documenting QI work with both the metrics and milestones. But before we go directly to how best to track our interventions I want to spend a few minutes to briefly recap other key elements that play a vital role in the QI process that lead the improvements that you (coaches) are accomplishing with your teams.

The Model for Improvement 1 Establish your Aim 2 Establish your Measures Determine the Changes that you will test 3 The Model for Improvement, developed by a group called Associates in Process Improvement, begins with three fundamental questions:5  Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco, California: Jossey-Bass Publishers; 2009. Langley, et al., 2009

Plan-Do-Study-Act (PDSA) Define the objective, questions, and predictions. Answer the questions who, what, when, where? Plan data collection Do Perform the plan Document problems and observations Collect data and begin data analysis Study Complete the analysis of the data Compare to your predictions Summarize what was learned Act Adopt or abandon the change Plan the next cycle Decide whether a change can be implemented This is a fundamental approach that serves as the basis for many improvement frameworks and provides systematic steps for gaining valuable learning and knowledge for the continual improvement of a process. Plan- State objectives of the test, Make predictions, Develop a plan to carry out test Do- Carry out the test, Document problems and unexpected observations, Begin you data analysis Study- Complete the analysis of the data, Compare to your predictions, Summarize what was learned Act-Adopt or abandon the change, Most initiatives are a series of PDSA cycles occurring one after another, What was learned becomes input for further process improvement initiatives/efforts You need an ongoing monitoring system in order to “hold the gain” – easy to slip back into old ways The PDSA cycle gives us a way to quickly test changes on a small scale, observe what happens, tweak the changes as necessary, and then test again (perhaps with a larger or broader test group, if our confidence in the idea has grown). Instead of spending weeks or months planning out a comprehensive change, then putting it into practice only to find that it’s fundamentally flawed, the PDSA cycle enables rapid testing and learning.  Langley, et al., 2009

Developing Interventions Interventions are broadly defined as “purposeful efforts to secure positive change.”1 The goal of an intervention is “to improve the health and quality of life of patients or to maintain high standards of quality at lower costs.”2 or “to improve operations and standardize processes.” Interactive: Can someone describe how you worked with a practice to determine what interventions to test when involved in a quality improvement project? Describe the steps or process that you applied... Do you involve members of the front line...those closest to the work/process? Do you brainstorm with the QI team? Often QI interventions are designed intuitively without appropriate analysis of the current state (maybe not taking the time to flow out the process to look for gaps and opportunities) or without identifying what potentially can go wrong and results are often disappointing. 1Portela, Pronovost, Woodcock, Carter, & Dixon-Woods, 2015 2Van Bokhoven, Kok, & Van der Weijden, 2003

Interventions Documentation: Current State Inconsistent use of the ‘interventions’ column in Smartsheet Not used, improvement strategies are only documented in the ‘actions taken by the practice’ column Inability to aggregate interventions across all plans By milestone By metric This brings us back to the main topic of today’s coaching session. How do we document our successful interventions? How do we keep ‘track’ of them? How do we share our results across practices? As we know, opportunities for you (coaches) to influence/drive transformation in the practices are through the efforts to achieve milestone criteria and by assisting practice with QI work related to the incentive metrics We now have Smartsheet which, like previously with Excel, provided a standard structure; however, Smartsheet allows for version control of the plans, real-time updates with the ability to share with practices as indicated, and the ability to generate reports across all plans. However, our current state is inconsistent and we are unable to readily extract information from the plans in an efficient manner. This leads to numerous work-arounds to retrieve needed data/information and re-work, duplication of efforts to store needed documentation.

Interventions Documentation: Proposed State Consistent use of the ‘interventions’ column with a concise description of the intervention This may change as work is occurring Can be updated with final intervention that achieved the milestone/aim of metric Use the ‘actions taken by the practice column’ to provide specific details related to the process resulting in success Qualitative account is valuable for learning

Intervention Documentation Example of Proposed State Collaborative Decision Making

Intervention Documentation Example of Proposed State Pneumonia Vaccinations