Eliminating Missed HPV Vaccination Opportunities: One Performance Improvement At A Time Toolkit Antonia Blinn Massachusetts League of Community Health Centers

Action plan (WWW) What: Action/Commitment Who: Responsibility By When: Deadline 2

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Chaos becomes clear. A simple method to visually display the various steps, events, and operations that constitute a process. What is Process Mapping? 5

When to Utilize Process Mapping? Process mapping is used to: gain agreement on the scope of the project better understand the process to be improved reveal unnecessary, complex, and redundant steps in a process compare actual processes against the expected process identify steps where additional data can be collected 6

Perceptions of a Process What we think it looks like: What we wish it would look like: Do not jump to “What we wish it would look like” What it actually looks like: V

1. Form the appropriate team, gather materials (banner paper, Post-It ® notes, markers, dots) and find a wall space large enough to accommodate the completed map. 2. Define the process to be reviewed. Name it. Agree on the process start and end. The start and end should match the scope of the project written in the charter. 3. Determine how complex and detailed of a map you will need to give you what you want. 4. Assign symbols: - Rectangle for steps - Oval for start and stop - Diamond for decision Steps to Develop a Process Map 8

5. Identify the process steps  Start by rapidly writing process steps on Post-It ® notes and placing them on the paper.  Write large with one process step or item per Post-It ® note.  Don’t worry about order, don’t worry about priorities, just list them!  Now sequence the steps - arrange the steps the way work is currently done and draw arrows.  Validate the map to ensure it represents the situation as it really is today. Change the process map to correspond with the physical process. Steps to Develop a Process Map (continued) 9

Validate the Process Map 1. Are the process steps identified correctly? 2. Is every feedback loop closed? 3. Does every arrow have a beginning and ending point? 4. Is there more than one arrow from an activity box? Perhaps it should be a diamond. 5. Is there anything missing? 6. Do the workers who do the process every day agree that the map reflects reality? 7. Ask the questions: What happens if…? What could go wrong? Who…? How…? When…? 8. Update the map Walk through the actual process with the entire team. 10 Change the process map to match the actual process.

Example: Process Map Task Direction Start End Start End Review Or Decision 11 Baseline Patient Contact Information Collection Process

What is Change Acceleration Process (CAP)? A good technical solution is simply not enough for success 12

Changing Systems & Structures Current State Transition State Improved State Creating a Shared Need Shaping a Vision Mobilizing Commitment Making Change Last Monitoring Progress Leading Change Change Acceleration Process 13

Leading ChangeHaving a sponsor/champion and team members who demonstrate visible, active, public commitment and support of the change. Creating A Shared Need The reason to change, whether driven by threat or opportunity, is instilled within the organization and widely shared through data, demonstration or demand. The need for change must exceed its resistance. Shaping A Vision The desired outcome of change is clear, legitimate, widely understood and shared; the vision is shaped in behavioral terms. Mobilizing Commitment There is a strong commitment from constituents to invest in the change, make it work, and demand and receive management attention; Constituents agree to change their own actions and behaviors to support the change. Making Change Last Once change is started, it endures, and learnings are transferred throughout the organization. Change is integrated with other key initiatives; early wins are encouraged to build momentum for the change. Monitoring Progress Progress is real; benchmarks set and realized; indicators established to guarantee accountability. Changing Systems And Structures Making sure that the management practices (Staffing, Development, Rewards, Measures, Communication, Organizational Design, and Information Technology Systems) are used to complement and reinforce change Change Acceleration Process 14

Mobilizing Commitment: Why is this Important?  Understanding the key stakeholders whose support and commitment will “make or break” the change effort  Key difference between success and failure Mobilizing the Commitment of Key Stakeholders is Essential to the Success of the Change 15

Mobilizing Commitment Tool: Stakeholder Analysis Used For:  Identifying stakeholders and understanding resistance  Developing strategy to eliminate or lessen resistance 16

Name (Key Stakeholders) Issues / Concerns “Wins” Influence Strategy Strongly Against Moderately Against Neutral Moderately Supportive Strongly Supportive Mobilizing Commitment Stakeholder analysis & resistance tool 17

Shaping a Vision Tool: Elevator Speech Used For:  Clearly and simply stating the need for change and describing the future state  Rallying the support and commitment of key stakeholders 18

Elevator Speech Simple 4-part formula for your elevator speech: “What our effort is about....” “Why it is important to do....” “What success will look like....” “What we need from you....” 19

StakeholdersMessageMediaWhoWhen/Where (inform, persuade, influence) (written, newsletter, bulletin board, senior leader memo, events, meeting one-on-one, department meeting, all staff mtg., offsite meeting Which team member? Dates/Times Announce the Project Shaping the vision Mobilizing Commitment (what’s in it for this group/individual) Begin to monitor progress Changing Systems & Structures Communication Plan 20

Resources and Contact Information Massachusetts League of Community Health Centers –Antonia Blinn HPV Initiative (Join or get on list serve) –Allison Hackbarth MA Chapter of American Academy of Pediatrics (MCAAP) –Cynthia McReynolds MCAAP Website has quick links to key HPV materials: 21