Spread and Sustainability Robert A. Gabbay, MD, PhD Connie Sixta, PhD, RN, MBA

Where Do We Go From Here?

Improvement Hold Gains Spread Creating an Improved Clinical System Improvement Hold Gains Spread NON-LINEAR MODEL BETTER API Lloyd Provost and Institute for Healthcare Improvement Design Spread

We’ve Talked A Lot About Improvement Model for Improvement: Aim Measurement Rapid testing of changes (PDSA cycles) Test lots of ideas! Expect some will “fail” Most will need refinement (PDSA cycles)

3 Keys to Improvement Will Change Thinking Execution Get it done! Make it last! Ideas Innovate, Harvest, Package RESULTS Source: Institute for Healthcare Improvement

Leadership Improvement Framework Setting Direction: Mission, Vision, and Strategy Changing the old; making the status quo uncomfortable Making the future attractive PUSHPULL Will Ideas Execution Establishing the Foundation Build a culture of improvement, learning. Set quality standards. Assure organizational alignment. Establishing the Foundation Build a culture of improvement, learning. Set quality standards. Assure organizational alignment. Source: Institute for Healthcare Improvement

Innovators Early Adopters Early Majority Late Majority Laggards 2.5% 13.5%34% 16% from Rogers, 1995 Adopter Categories

Developing a Spread Plan Is improvement a key strategic initiative? Is there a budget for spread? Has time been allocated for spread? Are goals and incentives aligned? Identify and develop your spread champions. Leverage your improvement data—tell your improvement story! Document your ROI and other benefits. Measure, show comparative data, and provide feedback. Develop learning “communities of practice” among those with similar roles.

Adoption is a social thing! A better idea… communicated through a social network… over time. Source: Institute for Healthcare Improvement

Tell Us About Your Spread Efforts

Sustaining Improvement Drop off in measures is common but preventable! Initial excitement, urgency wear off. Possible change fatigue. Pay particular attention to yearly measures (foot exams, eye exams, LDL tests, etc.) as you approach end of initial 12 months. If strong system of population management is in place should not see these decline. Staff/Provider turnover, particularly among change leaders.

Use Wedges to Hold the Gains DATA Wedges signify making the work routine. No backsliding! Ideas Improvement

Strategies to Hold the Gains Establish and document standard processes Make changes to job descriptions Use measurement and audits Pay attention to orientation and training Assign ownership Address the social aspects of change (who are the peer leaders, who talks to whom)

Your Sustainability Experience How are you checking to make sure changes are sticking? What kind of shared ownership exists in your practice for your improvement data? How have you been documenting revised processes and revised job duties?

Final Thoughts on Sustainability Patient engagement! Involve patients/families in your improvement efforts. Ask them what is working, what is not. Consider peer-based self-management support.

Keep Meeting With Your Team!!!!!!! YOUR PATIENTS DESERVE THE BEST CARE YOU CAN DELIVER

Questions?