1.  Frank H. Lawler, MD Julie Tolman, RN OU Physicians University of Oklahoma Health Sciences Center

2.  Science fair: a collection of amateur science projects, usually from middle or high school, in a large venue  Storyboard: A piece of large cardboard used to present various aspects of a project

3.  Inertia o “But we’ve always done it this way.” o Our quality is fine, thank you very much  Lack of leadership o Not an organizational priority o Failure to devote time and resources  Lack of motivation o No benefits seen or no reward system  Lack of time, interest o I’m too busy o I don’t really care about this stuff

4.  IDENTIFY a suitable QI project  PERFORM a study using accepted techniques o Initially, baseline measures accepted o Now must have baseline and remeasurement  PRESENT a “storyboard” of efforts and results.

5.  Storyboard approach o originated with a nurse who was helping a niece with a storyboard for a science fair o Identified a need for large academic practice to: encourage physicians and staff to identify quality improvement opportunities, implement them make a poster presentation in a competitive environment o Make it “fun”, but meaningful. o Add a “hint” of competition. o Throw in a ‘Scavenger Hunt” (based on learning from storyboards…) and “Trivia Contest” o Share “best practices” between the clinics. o Add a few giveaways…

7.  Have employees of a group practice to identify a specific quality issue relevant to their clinical practice  Teach/Reinforce the basics of Quality Improvement  two projects per clinical unit o 47 clinical units o 15+ administrative departments o 1 project must be clinical or patient outcomes

9.  “Lunch and Learns”  “Hands-on” Sessions (Quality Improvement nurses available to assist in project development and approaches)  Select topic important to providers/staff, and/or what you are already measuring…  Clinical Orientation – all new clinical employees learn QI process and develop a project/storyboard

11.  Clinical  Administrative  EMR  Patient Survey o Ease of obtaining test results  Patient Survey o Information about delays  Patient Survey o Patient Satisfaction  No-shows  Patient Outcomes

12. (…one of our early storyboards, no remeasurements or results)

13.  Employees were instructed to evaluate the frequency, severity, and source of suspected problems or concerns.  Health care practitioners participate in the evaluation of identified problems or concerns.  Identify a “physician sponsor” for every project.

15.  Required Elements o Introduction o Numeric goals with timeline o Baseline o Interventions o Results o “Lessons learned”, etc.  Supporting QI Summary (all the project details…)  Supporting documentation (sufficient to audit/verify the numbers)  Standard format (MS Word, MS Excel, MS Powerpoint)

16. Storyboard checklist:

18.  Measures were implemented by employees to resolve important problems or concerns that have been identified.  Health care practitioners as well as nursing and administrative staff participate in the resolution of the problems or concerns that are identified.  Encourage “returning” storyboards o => keep the project going after exhibits

20.  Numeric goals, with expected completion date  Baseline data (relevant to stated goals)  “Random samples” (to make it do-able)  Remeasure data (“apples” to “apples”)  Identify additional actions, as needed  Share the “lessons learned” throughout the organization  Continue to remeasure until goal has been SUSTAINED for a reasonable period.

21.  A reasonable deadline for submission was set (six weeks prior to Quality Week) to allow for review and grouping of the storyboards.  A structured format is required for all storyboards. Lunch meetings were offered on several occasions to assist employees with assembly of poster components and data elements. These were well-attended.

23.  Both the projects and the storyboards themselves tended to be quite creative. o - “life size” Elvis o pink/black/white boa attached to storyboard (but no remeasurement data…) o “blinking lights” and “music”  Separation of the quality of the project from the sheer creativity of the presentation proved difficult.  …transitioned to ELECTRONIC storyboards in 2011 o More CONTENT (rather than “fluff”) o More time to view/vote (24/7) o Available all year (not just during Quality Month) o Sharing “best practices”, as others face similar issues

25.  National Healthcare Quality Week (now “Month”)  Traveling exhibits  Three voting groups: o OU Physicians Quality Committee o all OU Physicians providers and employees o External payors (and outside healthcare quality professionals)  Awards in each category  “Grand Prize” (ribbon, trophy, certificate, “bragging rights”)  Everyone who attends exhibits receive a quality-related “door prize”  “limited edition” coffee mugs, for those submitting a project  Reception/Awards Ceremony – scheduled months in advance, Dean (College of Medicine) present awards

30.  Projects became more sophisticated over the years  increased requirements each year  Initial projects – “just an idea for what to work on”.  Current projects require baseline –and- remeasurement data  More “clinical substance” to the projects…  Physicians became involved in projects (not just staff)  Year 1 – 8 storyboards  7 th annual exhibits – 89 storyboards  2011: Electronic storyboards o Available for viewing 24/7 o Physicians and staff select winners in each category o At least 2 projects per clinic Clinical/patient outcomes Administrative

32. o Next step: Online search for “best practices” (find a similar project within the organization, and review how another clinic solved the same issue) o Continue to emphasize => data from EMR Projects focused on clinical and patient outcomes EMR Meaningful Use Patient Centered Medical Home

33.  http://survey.ouhsc.edu/LoginActiveDirectory.aspx?PageNu mber=1&SurveyID=mlKM3665&Preview=true http://survey.ouhsc.edu/LoginActiveDirectory.aspx?PageNu mber=1&SurveyID=mlKM3665&Preview=true   Questions?