Action Planning for Quality Improvement May 14, 2009 Kathy Reims, M.D. NQC Consultant Analee Beck Early Intervention Services - Program Coordinator Pueblo Community Health Center

Poll How satisfied are you with how your Quality Management Plan is implemented in your organization? Very satisfied We do well all things considered We could do better We struggle

Implementing the QM Plan

Call Objectives Understand the purpose of a QM action plan Learn about key components of good action planning Understand a best practice: translating your QM plan into action

Key Components of Action Plans A statement of what must be achieved. Align with the goals of a strategic, business, operational or quality management plan. Detailed steps of what must be done A schedule and timeline for each step Indication of who will be responsible for making sure each step is completed. Clarification of the resources needed.

Prerequisites for a Successful Action Plan √ Resources align with scope. √ Time allowance adequate for success. √ Clear goals and objectives. √ Alignment of stakeholder expectations. √ Realistic planning process.  

Action Planning Steps 1. Assess key tasks 2. Confirm skills required 3. Build your team 4. Define the tasks in more detail 5. Establish the interrelationships among the tasks

Action Planning Steps (continued) 6. Identify the milestones 7. Communicate the draft plan 8. Evaluate the draft plan against the resources you have 9. Get your entire action plan approved In reality, many of these steps are iterative, not strictly sequential.

You have thought about all the pieces…. View One using the puzzle as a model …time to execute!

Executing your Plan Create the infrastructure to get the job done Adjust meetings, reports and attend to the “culture” as needed

Monitor as you go Monitor Communicate progress Messaging important Standardize

Reflect and Celebrate Use the milestones Public forums Lessons learned, reflection, celebration

NQC Resources Action Planning Guide Strategies for Implementing your Quality Improvement Activities | http://nationalqualitycenter.org/index.cfm/5659

Early Intervention Services

About Pueblo Community Health Center Mission: To provide primary health care to those in need Vision: To be the primary health care provider of choice in Pueblo County by providing top quality care through accessibility, leadership and financial independence

Key Components of EIS Work Plan EIS Team providers, managers, and supportive staff Annual Work Plan - Framework RW Part C Funding Guidelines HIV/AIDS Chronic Care Model HIV/QUAL Project Core Indicators Annual Work Plan – Quality Monitoring HRSA Quarterly progress reports Clinical Audits and Financial Reports Quality Improvement Projects

WHO writes the action plan? Multi-disciplinary team Collaborative process begins half-way into a program year Progress to date is reviewed Team prepares to write new action plan

WHAT goes in the action plan? EIS Team providers, managers, and supportive staff Annual Work Plan - Framework RW Part C Funding Guidelines HIV/AIDS Chronic Care Model HIV/QUAL Project Core Indicators Annual Work Plan – Quality Monitoring Team defines: Goals and objectives Detailed clinical and non-clinical action steps Person responsible for each step Projected timeline for completion of each step

Portion of the EIS Workplan

WHEN are the action steps implemented? Team follows the timelines they have outlined Annual On-going Time-specific Start date and end date

HOW do we put “action” into our action plan? Team completes the action steps Continuous monitoring HRSA progress reports Clinical audits Financial reports Quality improvement projects

FOCUS-PDSA Quality Improvement Process Find a process or project for improvement Organize a team Clarify your current knowledge of the process Understand variations – current process Select an improvement Plan improvement Do the Improvement Study the results Act or Adjust to hold the gain

Find a process or project for improvement Improve access to patient information

ORGANIZE A TEAM EIS Clinic Staff, IT Specialists and Operations Department

CLARIFY YOUR CURRENT KNOWLEDGE OF THE PROCESS EIS Program does not have access to an Electronic Medical Records system

UNDERSTAND VARIATIONS – CURRENT PROCESS Patient information must be accessed from a variety of sources Recording patient information required double data entry

SELECT AN IMPROVEMENT QI project selected: create a unique multi-functional database

PLAN IMPROVEMENT Researched and collected all data sources and documents that supported patient care.

Acuity Worksheet

Clinical Care Flow Sheet

Intake Questionnaire

DO THE IMPROVEMENT Created database system Able to customize to better meet needs Data entry work flows designed

STUDY THE RESULTS Studied work flows Monitored data accuracy Monitored database changes

ACT OR ADJUST TO HOLD THE GAIN Assure all data entered for essential reports Formatting of reports for HRSA, HIV/QUAL and financial

Wrap Up Focused on a meaningful project impacted the infrastructure supporting the QM Plan as well as daily work Put together a multidisciplinary team and called in others as needed Identified key milestones, monitored progress Culture of accountability, flexibility, “can do” Communication and celebration

Questions or reflections?

Poll I learned at least one idea to improve the ability to translate my Quality Plan into action: Strongly Agree Agree Neutral Disagree

Contact Information Kathy Reims, M.D. Chief Medical Officer CSI Solutions, LLC kreims@spreadinnovation.com 720-890-8614 Analee Beck Early Intervention Services - Program Coordinator Pueblo Community Health Center abeck@Pueblochc.org

National Quality Center (NQC) 212-417-4730 NationalQualityCenter.org Info@NationalQualityCenter.org