1. OneCF LLC2 Session 2 January 12, 2015 3:30-5pm Phone Number: (866) 537-0817

2. Welcome Bruce Marshall, MD Executive Vice President Clinical Affairs

3. OneCF LLC2 Teams & Coaches TeamCoach Boston Children’s HospitalJudy Hollingsworth Columbia NYCLaCrecia Thomas Nationwide Columbus Ohio Suzanne Michel Rush Chicago Illinois Staci Self University of Missouri Columbia Bob Zanni University of North CarolinaRandy Messier -3-

4. OneCF Center LLC2 Overall Aim: Assess and develop a CF care center that provides seamless care from the time of diagnosis through advanced care. This collaborative will focus on integrated care, smooth transitions (pediatric to adult), warm handoffs and transfers, and improvement of mesosystem care such as referral to specialists (e.g. Endo, GI, ENT, Psych) and inpatient care. -4-

5. Leadership of Health Care Quality and Improvement Development Program Overall Aim: Assess and develop personal and team leadership skills and abilities to lead quality and improvement as part of CF Pediatric, Adult and OneCF leadership team. Create conditions for successful improvement -5-

6. Agenda January 15, 2015 3:30Welcome! 3:40Overview of OneCF LLC2 and aim 3:45OneCF LLC2 Phases: Current Phase is assessment - surveys - coach site visit - learning/coaching plan 4:00Improvement knowledge and skills - Clinical microsystems - Dartmouth microsystem improvement curriculum - 5Ps 4:20 Rapid reports on progress so far (2 minutes/site) 4:45Task book review/final questions & clarifications 5:00Adjourn -6-

7. OneCF LLC2 OneCF PediatricsInpatientSpecialtiesAdult Assess and develop a CF care center that provides seamless care from the time of diagnosis through advanced care. This includes a focus on integrated care, smooth transitions (pediatric to adult), warm handoffs and transfers, and improvement of mesosystem care such as referral to specialists (e.g. Endo, GI, ENT, Psych) and inpatient care. 1.Baseline assessments 2.Improvement fundamentals 3.Everyone’s first focus: Pedi to adult transition 4.All teach, all learn -7- Diagnose s Advanced Care

8. Baseline Survey Timeline - Completed Team Quality Improvement Knowledge -8- Teams received the learning needs assessment Learning needs assessment deadline Learning needs assessment report sent to coaches November 28, 2014December 15, 2014December 22, 2014 1.Complete as a TEAM -OneCF -Pedi -Adult All reports sent to OneCF Coaches

9. Coach Site Visit Planning Learning/Coaching plan Itinerary –Travel –Detailed agenda Include improvement topics Meetings with people with CF/families Meetings with organizational leaders Create Value Stream Map in joint meeting -9-

10. Site Visit and Pre-Assessments Upcoming Deadlines: 360 Leadership Assessment: Monday, January 19 (66/270) Submit Learning/Coaching Plans: Monday, February 2 (2/6) - Coach site visit agenda details - Monthly plan 25/27 Completed (12/30/14) 26/27 Completed (12/30/14) Leader self-reports & 360 reports distributed first week of February -10-

11. Baseline Survey Timeline Leader Quality Improvement Knowledge -11- Self-assessment sent to leaders Leaders to submit 10 names for 360 survey Self-assessment deadline 10 names receive 360 survey 360 survey deadline December 12, 2014December 30, 2014January 5, 2015January 19, 2015

12. Learning/Coaching Plan -12-

13. Teams, Coaching and Leadership LeadershipTeams & Coaches Expectations 5Ps/performa nce Anticipate & assist with data Regular meetings- Provide time & space PDSA Rapid Tests of change with measures Sustain Inspire, Know & Tell Stories -13-

14. clinicalmicrosystem.org What is a clinical microsystem? How did this idea get started and how is it being used? -14-

15. clinicalmicrosystem.org Assumptions Many have heard of the idea and has various notions of what it means We all have more experience living in, working in, and using them; than we have studying, changing, and leading them -15-

16. clinicalmicrosystem.org How we improve what we make What society needs How we create, make health care Understanding Health Care as a System -16-

17. clinicalmicrosystem.org Which system is the unit of practice, intervention, measurement, policy? Self- care system Individual care-giver & patient system Microsystem Mesosystem Macrosystem Market / Geopolitical system -17-

18. clinicalmicrosystem.org High Performing Clinical Microsystems Information & Information Technology Staff Staff focus Education & Training Interdependence of care team Patients Patient Focus Community & Market Focus Performance results Process improvement Leadership Organizational support -18-

19. clinicalmicrosystem.org Definition A health care clinical microsystem can be defined as the combination of a small group of people who work together on a regular basis—or as needed—to provide care and the individuals who receive that care (who can also be recognized as members of a discrete subpopulation of patients.) It has clinical and business aims, linked processes, a shared information environment and produces services and care which can be measured as performance outcomes. These systems evolve over time and are (often) embedded in larger systems/organizations. As any living adaptive system, the microsystem must: (1) do the work, (2) meet staff needs, (3) maintain themselves as a clinical unit. -19-

20. clinicalmicrosystem.org A Picture of Embedded Systems The Anatomy -20-

21. clinicalmicrosystem.org Patients Professionals Processes Patterns Purpose

22. A Picture of a Microsystem The Physiology -22-

23. clinicalmicrosystem.org A “Generic” Clinical Microsystem Model Entry, Assignment Orientation Initial Work-up, Plan for care Disenrollment Biological Functional Satisfaction Costs Beneficiary knowledge, including knowledge of life while not in direct contact with the health care system Satisfaction of need, monitoring, assessment of outputs Acute care Chronic care Preventive care Palliative care Biological Functional Expectations Costs -23-

24. clinicalmicrosystem.org So, why focus on the “clinical microsystem?” Basic “building block” of health care as a system (energy cell) Unit of clinical policy-in- use Locus of most workplace “motivators” and many “hygiene” factors Most variables relevant to patient satisfaction controlled here Where “good value” and “safe” care is made Where most health professional “formation” occurs after initial preparation It’s where everything happens with, for and to the patient and family -24-

25. clinicalmicrosystem.org Assess & Diagnose Your Clinical Microsystem Main Idea … Build Capacity from Inside Out The 5 “Ps” Use the Clinical Microsystems Workbook to continue to diagnose the strengths of your microsystem and to start identifying improvement opportunities -25-

26. clinicalmicrosystem.org Global Aim 1 2 3 Assessment Theme Global Aim Change Ideas Specific Aim Measures SDSA P DS A P D S A P DS A PDSA 1 3 2 Flowcharts Fishbones **Meeting Skills/5Ps/Communication Diagnose Treat Assess

27. clinicalmicrosystem.org So, how might you improve your own microsystem? It’s just like patient care o To improve a patient’s health status … You assess, diagnose, treat, and follow-up based on biomedical and care science o To improve a microsystem’s “health” status … You assess, diagnose, treat, and follow-up based on improvement science and the science of clinical practice -27-

28. clinicalmicrosystem.org Patients Professionals Processes Patterns Purpose

29. Assessing Your Practice “The 5Ps” of CF www.clinicalmicrosystem.org -29-

30. clinicalmicrosystem.org OneCF LLC2 OneCF Pediatrics Inpatient Specialties Adult Assess and develop a CF care center that provides seamless care from the time of diagnosis through advanced care. This includes a focus on integrated care, smooth transitions (pediatric to adult), warm handoffs and transfers, and improvement of mesosystem care such as referral to specialists (e.g. Endo, GI, ENT, Psych) and inpatient care. 1.Baseline assessments 2.Improvement fundamentals 3.Everyone’s first focus: Pedi to adult transition 4.All teach, all learn Diagnose s Advanced Care Think Population of People with Cystic Fibrosis for the 5Ps (pedi & adult together) -30-

31. Planning the Site Visit Learning/Coaching Plan Site Visit itinerary (includes Value Stream Mapping) Debrief an summary of visit Revise learning/coaching plan -31-

32. clinicalmicrosystem.org Value Stream Mapping with Your Coach With your ONECF Team (including people with CF/families) -32-

33. -33- Rapid Reports- 2 minutes each Aim: Share progress organizing to participate in OneCF LLC2 (Surveys, first meetings together to plan regular meetings using effective meeting skills, connecting with the coach)

34. Next Activities Draft 2 day coach site visit itinerary Continue to meet weekly and with coach Review Task book on OneCF LLC2 website (prepare for coach site visit and February 2, 2015 Adobe Connect) –Reading, videos, resources –Complete and upload short progress template Please check OneCF LLC2 site at 5PM ET Tuesday January 13 for task book. -34-

35. OneCF LLC2 Face-to-Face Meeting -35- Marriott BWI Airport March 26 6-9pm Everyone Friday March 27 8am-1pm PowerPoint and Poster progress reports with OneCF LLC1 presenting (also panel discussions) Friday, March 27 1pm-9pm OneCF LLC2 Everyone Saturday, March 28 8am-12pm OneCF LLC2 Everyone Saturday, March 28 12:30pm-4:30pm All CF Quality Coaches ** You will register yourself at the Marriott Hotel- information will be listed in the Taskbook.

36. Thank You -36- www.clinicalmicrosystem.org Please complete the Survey Monkey listed in the chat box.