The Quality Improvement Project MODULE 5: TEAM WORK AND MAKING CHANGE October 2015

Objectives 1. Explore teams and team function in QI and how this can make a difference in the success of your QI project 2. Explore change management concepts and how these apply to QI October 2015

SUCCESS IN QI IS STRONGLY RELATED TO TEAM FUNCTION! October 2015

Who is on a QI Project team?  5-8 people generally (not too big, not too small)  Project sponsor (senior person in your clinic)  Content expert (often the facilitator of the team)  Champions of your idea  People involved in all parts of the process  Data support  Skeptics (better to know what the resistance will be)  Someone knowledgeable about QI/Change  Patients October 2015

Facilitator and Team Member Roles  Facilitator should set out in advance with your QI team what the expectations are  Be aware for team members who are displaying “self-oriented” behaviours that can be destructive October 2015

Team Member Task Oriented Behaviours Facilitator Task Oriented Behaviours Team Member Relationship Oriented Behaviours Facilitator Relationship Oriented Behaviours Self Oriented Behaviours Provide information Ask for clarification Bring discussion back to purpose Collect and analyze data Summarize what has been said Ask clarification questions Suggest alternative ideas or solutions Record PDSA plans on worksheets Set agenda Honour timelines Define the work (Charter) Provide data Teach & use QI tools Set up work groups and plans for between meetings Summarize Facilitate team consensus Use PDSA worksheets Offer encouragement and positive feedback to other members Listen – one voice at a time Indicate agreement – voice, nod, smile Ask open ended/ exploratory questions Check with the team for agreement Design warm ups that help team to know each other Establish ground rules Write on flip chart so all can see Use parking lot – and come back to it! Ensure opportunities for all to contribute/ participate Use active listening Make sure members are heard by team Give positive recognition Acknowledge feelings of frustration or anxiety Celebrate successes Provide treats! Side conversations “Talking over” others Multi-tasking Negative body language (eye rolling, crossed arms, move away from table, shake head) Not participating Bringing up the same issue repeatedly; stalling the team discussion Arriving late October 2015

The teams for the QI project  You (the residents) are the leaders of the team  For the QI Project you must demonstrate that you have consulted with at least two other staff members (and not just physicians)  You should try to meet them face to face  Consider having an agenda and objectives for the meeting  This is NOT about blaming anyone for the gap you found  Thank them for their time  Keep them informed October 2015

Sample Agenda for a resident meeting with clinic staff Meeting to discuss Practice Improvement project December 1, 2014, 12-1pm in conference room Invited: Resident 1, Resident 2, Clerk 1, Nurse 1 Objective for the meeting: To gain input from team members in the FHT to help us complete our Practice Improvement project on the topic of FOBT screening 1. Introductions (who are you, why you called the meeting, everyone introduces themselves) 2. Approval of agenda (ask for input/changes/questions) 3. Approval of minutes (from past meeting) 4. Presentation of practice audit results (Resident X will lead, 10 min) 5. Root cause analysis using process mapping exercize (Resident Y to lead, 15 min) 6. Discussion about next steps (Resident 1 to lead, 5 min) 7. Next meeting (if required) October 2015

Role play a meeting Groups of 4+ residents Assign roles: Resident (Chairs meeting) Nurse Clerk Another doctor Others… (patient, allied health, executive director, lab tech) Resident should introduce your practice gap and tell them that you are seeking to understand root causes of that gap. Feel free to use the tools your previously learned: 5 Whys, Cause and Effect diagram/Fishbone, Process Map or other brainstorming techniques October 2015

Debrief…  Was it a successful meeting?  Did you feel it was easy to explain your project goals and get input?  Who was missing from the meeting?  What would be the next step you would take? October 2015

Making change October 2015

Making Change  Expect resistance to your idea  You need to be the constant champion for the change you want to make  Some people are early adopters, some are laggards, some are in between  Physicians can be particularly resistant to change October 2015

Making Change: Key elements for change Beckhard Change Model C = D x V x F > X C = change D = desire for change V = vision for the future F = practical first steps X = cost of change October 2015

 Goals of patient care more pressing than system problems  Inbuilt sense of autonomy, “lone healer” so may want to solve the problem on their own  Critical thinkers (look for negative) and need certainty so can shoot down ideas  MDs more accepting of “technical” change but less so “adaptive” change (more on this…) so can shy away from complex solutions Hussey, R et al. (2013) NHS Improving Healthcare White Papers. Doctors: leaders of change Barriers to MDs making change October 2015

Technical vs Adaptive Change – QI is a bit of both TECHNICAL CHANGE  Uses knowledge that has been proven/tested  Implemented by “authority”  Simple ADAPTIVE CHANGE  Learn new ways of doing, experiment  Implemented by the people with the problem  Complex, takes time, can be stressful October 2015

Reflection on making change  Think about a time that you went through a change in an organization or team that you were a part of  What made the change process go well?  What made it more difficult?  How can you apply these lessons to making change with your QI idea? October 2015