Practice Key Driver Diagram Presenter should specify which key drivers we are focusing on in this session

Chapter Quality Network ADHD Project Jen Powell, MPH, MBA Team Meeting 1, Part 1: Running Effective QI Team Meetings Accelerating Improved Care for Children with ADHD Chapter Quality Network ADHD Project Jen Powell, MPH, MBA

Commercial Interests Disclosure Jen Powell I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved or investigative use of a commercial product/device in my presentation.

Objectives Understand the basics of using effective meeting skills Highlight the key components of a good quality improvement meeting Review ways to discuss measurement and data Objectives

Effective QI Team Meetings Get the job done: Keep the momentum going for QI efforts Increase efficiency: Provide a time and space for regular shared learning and review of data Engage everyone & improve communication: Encourage participation by all on the team; all participate in testing Provides a venue for building trust and collaboration among the team Highlight for the teams why effective meetings are important for building and maintaining capacity to do QI work in their practices.

Meeting Skills This is why having directed and effective meetings matters!

The First Meeting Collaboratively set ground rules or “norms” for the team. Start with some examples to get the conversation started Invite everyone’s input Keep the list to 5 or 10 Post during future meetings or include on meeting agendas Establish roles These can be changed at regular intervals if the team prefers One key to success in these meetings is to invite everyone’s input, which encourages building trust, which in turn can result in people feeling more comfortable to share their ideas.

Example Ground Rules: Start and end on time No sidebar conversations Come prepared and ready to contribute Don’t interrupt the person speaking Be open to hearing other people’s perspectives Question assumptions Speak only for yourself Honor the group Be honest Be respectful Create a safe environment Share all relevant information. Everyone has a chance to speak without interruption. No idea is a bad idea. All ideas and opinions will be respected. Individuals’ personal comments remain confidential Give specific example Speak about interests not positions Capture decisions and action items Silence means agreement Consensus, majority vote, or unanimous agreement are the way to make decisions Raise hands when you want to speak Make decisions based on clear information. Accept the fact that there will be differences of opinion. Attack the problem, not the person- "no blame game" Share time so that all can participate End meeting with a list of follow-up items and the person responsible for each Here are examples of ground rules orgs use for meetings. Use this list as a starting point for creating the ground rules you’d like for your team. Take time at one of the first meetings to agree to the list that feels ‘right’ to your team. LLCVI February 2008

Example Roles: Here are example meeting roles. It is helpful to designate roles early on in the process, so your meetings can be effective from the very beginning.

Meeting Management Always start and end on time. Use an agenda that includes standing items such as: Status report on completed tests Review of previous action items and status Highlight of decisions that need to be made during the meeting Discussion of measures and data New PDSA cycle ideas Update list of action items with due date and person responsible Brief evaluation of meeting It is really important to have a structure and plan for how and when a team will work together. Successful meetings are well managed. Everyone knows what to expect, decisions are made, time is respected, and everyone leaves knowing what is theirs to do.

Discussion of Data Example questions to guide discussion of measures and data: What do you notice about your measures? Are they moving? Is there a sudden dip or a big jump? Can you indicate what the change is with an annotation? Is the information what you need? Could you stratify any of the measures to give you a more granular picture of what is happening? Are there things you aren’t measuring that might we helpful to measure? It is important that the data are discussed at QI meetings. This may be a standing monthly agenda item and other weeks spend more time on the data gathered during testing. Or, they can come up with a schedule that works for them.

Evaluation of Meeting Plus/Delta is a simple, quick (5–10 min), and effective evaluation tool that works very well for this. To use, draw a vertical line down the center of an easel pad. At the top of the left column put a plus sign; at the top of the right put a triangle or delta sign. Under the plus write comments from meeting attendees about what went well during the meeting or what should be continued or brought forward for the next meeting. Under the delta write comments about what could be improved or done differently. This is a useful, quick tool for capturing how a meeting went in real time.

Other Suggestions Ask for input from others on agenda items ahead of time. Keep leadership informed of what is happening; ask for help and support as needed. Communicate work with the broader staff. Make it fun! What would motivate the folks at your site to get or stay involved? Remember, this is hard work that can take time!

Sample Agenda Date: Time: Attendees:   Review current agenda – add/remove items as needed (3 min) Highlight decisions that need to be made during the meeting (2 min) Review previous action items and discuss status (5 min) Review PDSA cycles run since last meeting and status (8 min) Review and discuss dashboard of data or monthly measures (10 min) Discuss new PDSA cycle ideas and make plans for tests (10 min) Update list of action items with due dates and person responsible (5 min) Evaluate meeting (2 min) This is an example of a 45 min QI meeting. Could add other items or additional time for an hour meeting.

Objectives Understand the basics of using effective meeting skills Highlight the key components of a good quality improvement meeting Review ways to discuss measurement and data Objectives

Chapter Quality Network ADHD Project Jen Powell, MPH, MBA Team Meeting 1, Part 2: Using Flowcharts Accelerating Improved Care for Children with ADHD Chapter Quality Network ADHD Project Jen Powell, MPH, MBA

Commercial Interests Disclosure Jen Powell I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved or investigative use of a commercial product/device in my presentation.

Objectives Review the purpose and benefits of using flowcharts Discuss and analyze mehealth workflows Practice effective meeting skills

Screen shot of generic mehealth flowchart Screen shot of generic mehealth flowchart. These are what they created as part of their prework.

The Purpose of Flowcharts Creates a picture of the sequence of steps in a process You all came prepared today with a workflow around using mehealth in your practice. We are going to do a brief review of flowcharts here. Might want to ask the attendees if this is the first time to use a flowchart for any of the practices? (If most seem pretty comfortable with them, go very quickly through the next slides.)

The Benefits of Flow Charts Engages all members of the practice Replaces pages of written word with a picture Illustrates waste, delays, missteps and duplication in the process being studied Builds consensus within the practice Corrects misunderstandings about a process Builds common understanding of the process If you have some folks newer to using them, you could ask if they noticed or experienced any of the items listed from doing one in their practice.

Simple Flow Chart Example A flow chart simply shows a process from the defined beginning point to the defined end point.

Shapes Used in Flow Charts Different symbols mean different things.

Shapes Used in Flow Charts

Sometimes, it is really useful to use ‘swim lanes’ in a process flow to identify what happens when – before, during or after a visit. Or, they can be used to identify responsibilities by role (so each lane would be labeled as MD, MA, RN, etc…)

Tips for Useful Flow Charts Do’s Draft the current process before the ideal process Ask for input of all members of the practice, including patients Observe the process directly or ask a patient to give their perspective Draft the flow chart with post-it notes with all members involved Place the draft in a public place before finalizing Don’ts Have one person or discipline complete the chart Use a pre-determined template

Time for Action: Review and Modify your Flow Chart First, plan for your meeting! Identify roles for this team meeting Clarify aim: modify flowchart Determine how much time you will spend discussing each question Capture notes on the discussion to use in Team Meeting 2 List next steps and action items for follow-up Save time at the end to evaluate your meeting Let them know how much time they have for their meeting. Second bullet let them know the items are listed on the next slide. Remind them that they may want a timekeeper, recorder, facilitator, leader identified for this meeting. Quickly decide together how much time to spend on each of the items listed. Timekeeper can then keep the meeting on track. Suggest that as they review their flowchart they could consider putting activities or roles into swim lanes to make the information more specific. As they discuss their flowchart, have them note new activities or new responsibilities – these are the most likely places to find opportunities for testing change. Suggest they take notes of these items.

Time for Action: Review and Modify your Flowchart Questions for your discussion: Is the right person completing the appropriate tasks? Are there any missing steps? Are there steps that should be more detailed or broken into smaller pieces? Are there places in your workflow where you are unclear HOW they will work in your practice? These are the discussion items to focus on during this meeting time. They should get through as much of this as they can and leave with next steps and action items. Encourage them to use the post it notes to reconfigure their workflow steps if needed. Someone can take a picture of them laid out so they have a record.

Debrief your Meeting Use the Or, ask everyone to score the meeting on a 1-10 scale (higher number = more effective and efficient). Discuss results. This is a great practice to begin with this very first meeting! Make sure to capture the data from your debrief to inform your next meetings.

Evaluation of Meeting Plus/Delta is a simple, quick (5–10 min), and effective evaluation tool that works very well for this. To use, draw a vertical line down the center of an easel pad. At the top of the left column put a plus sign; at the top of the right put a triangle or delta sign. Under the plus write comments from meeting attendees about what went well during the meeting or what should be continued or brought forward for the next meeting. Under the delta write comments about what could be improved or done differently. Added here for reference if needed. This is a useful, quick tool for capturing how a meeting went in real time.

Objectives Review the purpose and benefits of using flowcharts Discuss and analyze mehealth workflows Practice effective meeting skills