Learning Session 3: Team Action Planning

Questions We’re Running On What have we learned about process and outcome metrics? How can we work together on the consent process as our highest leverage impact on results? What will we do by next Tuesday to make improvements to our consent process?

What Have We learned? LS1: Pick one of four areas to focus on Communication Physician engagement Consent Optimizing clinical care of the potential donor Preliminary results were promising Was this enthusiasm versus true system redesign?

What have we learned? LS2: Action planning Refine the team’s current PDSA Add a new PDSA Stop the team’s current PDSA and start a different one

We also learned that redesigning our system is hard work!

87% OF POTENTIAL DONORS ARE “NO CONSENTS” The Learning Continues: January 2013 Review of Data C O N S E N T We shared this slide on last month’s call and felt is was worth showing again, as it sets up the discussion we have planned for today. Knowing we’ve got work to do, the questions is where? What’s the greatest opportunity to improve the true conversion rate? When we look at the potential donors from the past 2 years (2011=89, 2012=92), what are the reasons the donation stopped? It is striking to see that the overwhemling majority of the reasons why those stopped was due to a no consent by the family. Overall, 87% of potential donation opportunities in the past 2 years stopped because of a no consent. 87% OF POTENTIAL DONORS ARE “NO CONSENTS” 6

“Journey/Path” Process The Learning Continues: February 2013 Conference Call (-) YES (+) YES Yes “Finish Line” Outcome (-) NO (+) NO No So to relate what you just heard about the difference between process and outcome, I want to walk you through this next slide as another conceptual way to think about this. Let’s say on the x-axis represents the consent process or journey and the scale of how effective it was – from ineffective to very effective. On the y-axis is the consent outcome – either yes or no. For the sake of simplicity, let’s say there are 4 possibilities. Let’s start with the ideal scenario – an outcome of a yes consent and a process where we knew all the important process elements were done effectively – grave prognosis discussion that went well between the physician and family – it was well understood all their questions were answered – there was a pre-huddle between the OPO and hospital team to discuss patient’s suitablilty for donation and how best to carry out the donation discussion – the designated requestor had an established repoire with the family and felt well-prepared to offer the opportunity to donate – and there has been continual support of the family’s needs during this process – we would probably all agree that’s an effective consent process. Shown here with the “+Yes” We could envision an similar scneario – where all the consent process elements where effective as I just described, but the outcome was a NO – perhaps based on the previously known wishes of the patient. I’ve heard those referred to as “good no’s”. Those events we would categorize as “+NO”. But also think about the scenario, where we know that the process elements didn’t go as well as we would have like them too. Perhaps the grave prognosis was not well understood by the family and then they were approached about the donation opportunity and said “No”. We could categorzie events like that as the “-No” because we didn’t have the best consent process. Or the related scenario, where we could look back and see that some of the consent processes weren’t as effective as we’d like to see them go, yet despite that, we still got a yes, “-Yes”. The bottom line takeaway – every consent opportunity is worth studying! It’s not enough to know the outcome, we must also understand how we got there, the process. (-) Effective (+) “Journey/Path” Process 7

Potential Donors 2013 (Jan-Mar): Reasons for No Consents

How does the journey we’ve experienced so far inform our next steps?

April 2013 Learning Session 3 Action planning needs to focus on consent!

Without limitations, barriers or constraints: What is your best idea to change it? Small scale, test an idea on your next donation opportunities Throw out ideas: Identify your 3 experts and make sure one is called on the very next donation opportunity to identify learning and work with the family Nurse drives the grave prognosis discussion Coordinator triggers resource team activation Huddle before grave prognosis conversation to identify who will say what, when, etc. Bold can be simple!

May 14th Conference Call All teams prepare and report out on learnings and actions related to the consent process For example How did you test a small innovation around the consent process What did you learn from your designated requesters to put in place with your next donation opportunity

Important Reminders! The collaborative recipe requires all ingredients! Is your team actively engaged in all of them? Monthly conference calls Basecamp – posting resources and lessons learned Learning sessions Quality coaches Monthly team reports Reaching out to teams that have knowledge to share