1. Guidance to Creating a Culture for Quality: 301 Session: Improve Your Care and Services with Consumer Input
Needs the full title as identified by the workshop submission. Changes made
Needs workshop number, presenters names, date and time of workshop
Dan Tietz
Thursday, November am to 11:30 am
RWA-0252

2. NQC and Quality Workshops at 2012 AGM

3. NQC at 2012 AGM Networking Opportunities - Interact with your peers…
Tue, Nov 27 12pm: HIVQUAL Regional Group– Thurgood Marshall Ballroom West
Wed, Nov 28 12pm: in+care Campaign - Thurgood Marshall Ballroom South
NQC Exhibit Booth - Stop by our booth…
NQC Office Hours - Meet one of our NQC coaches...

4. NQC Workshop Session 3 Agenda
Presentations: 20 minutes
Consumer Involvement Framework - Daniel Tietz, NQC Manager for Consumer Affairs
A Lesson from the Field - Al Bishop, Manger Robeson Health Care Corporation
Interactive Individual and Group Activity: 30 minutes
Consumer Involvement Organizational Assessment Scoring
Recorder Report Back and Discussion: 20 minutes
Presentation: 10 minute
Overview of Training of Consumers on Quality and Resources Adam Thompson, NQC Peer Consultant
Q&A, Aha Moments: 10 minutes
No workshop evaluation being done during the session

5. Learning Objectives
Understand the importance of consumer participation in quality management (QM) programs
Learn and develop effective strategies to overcome common barriers in engaging consumers and receiving meaningful input in QM programs
Know where to access existing resources to improve participation of consumers in quality improvement efforts

6. Consumer Involvement in QM
Quality improvement (QI) models used in health care were created for the automotive industry
Critical dimension of QI is determining consumer needs as well as developing products and services that meet and exceed customer expectations.
Adapted for use in health care settings, although many medical disciplines are still grappling with how and to what extent they should involve consumers
So think about consumer involvement, what a framework should look like. We know that in the automotive industry, a critical component of quality improvement is listening to customer needs and wants to meet and exceed expectations. This has been adapted by business, think about cell phones, MP3 players, we are all customers who have wants and needs. Well this has been adapted in health care setting, but many are still trying to figure out how to involve consumers and it’s not always easy

7. Technical vs. Experiential
This slide also shows both the technical or provider and experiential aspects of quality. Providers prepared medications to dispense, consumers take the meds

8. Conceptual Framework PLWHA Involvement in QM/QI
Defines the ways to involve PLWHA in HIV facility-wide QI activities and the mechanisms during each stage of the QI process
So as we move to define an conceptual framework for consumer involvement in QM/QI, we need to determine the different ways that PLWHA can be systematically involved in the different level of the quality improvement process.

9. for Consumer involvement
Framework
for Consumer involvement
in QM/QI
Routinely
Solicit
Input
From
PLWHA
Communicate
QI activities
to PLWHA
Annually
Assess
Levels of
Involvement
Appoint to
QM teams/
committees
Engage
CAB
in QI
1. Routinely solicit input from consumers who receive HIV primary care:
Conduct satisfaction surveys, focus groups, or patient interviews to gather ideas for improvement from the consumer perspective
Clearly define and prioritize ideas for improvement and share with staff and patients for feedback
Discuss key findings during QM committee meetings
When appropriate, form a CAC to routinely solicit feedback on the goals of QI activities, methods of data collection, and what will be done with the results through agency-wide QI activities
Engage the consumer advisory committee and/or a broader patient population in discussions about key findings and areas for improvement
2. Implement QI activities that are reflective of the needs of those receiving HIV primary care services:
Engage PLWHA when planning QI activities such as selecting annual QI goals or prioritizing clinical performance measures
Routinely present HIV clinical performance data results to consumers
Explain and discuss routine performance data reports with consumer representatives and solicit their recommendations when planning next steps
3. Formalize the engagement of PLWHA to actively participate in QI activities and support them in this process:
- Nominate and appoint appropriate consumers as equal members on QI teams to identify and improve aspects of HIV care
- Develop skills-building and training opportunities for consumers so they can fully participate in agency-wide HIV QM committees and QI teams
- Build further understanding among HIV staff about the benefits of engaging consumers in QI activities
- Link QI activities of the HIV QM program with CAC discussions
4. Routinely inform consumers of evolving QI activities via multiple communication venues and media:
- Openly share the results of QI activities, including performance data results and updates from quality improvement projects, with all patients via displays in the waiting room, storyboards, or newsletters
- Inform consumers about facility-wide QI activities and in doing so, highlight their role in improving key aspects of HIV care
- Celebrate and publicize the successes of consumer involvement in QI activities among patients and staff ``
5. Annually assess the programmatic level of consumer involvement across the entire HIV agency:
Develop and/or adopt a standardized assessment tool to evaluate the level and effectiveness of consumer involvement
Conduct this assessment annually and discuss the results with the quality management committee
Respond to the findings and make adjustments moving forward

10. A Lesson From the Field Robeson Health Care Corporation
Region IV Part C RW Grantee in North Carolina
Established Consumer Advisory Committee (CAC) in October 2003 initially focusing on consumer education
Main challenge: rural south east is difficult location to be open about HIV/AIDS due to stigma
Staff began involving consumers in shared healthcare decision-making leading to better health outcomes and constructive feedback to staff
Adopted “Patient Satisfaction Survey for HIV Ambulatory Care” which became annual feedback instrument for consumers
What is CAC? Subsequent slides have CAC?

11. A Lesson From the Field Robeson Health Care Corporation
Surveys were cumbersome and difficult to tally due to software issues
April 2010: CAC members start receiving HAB performance measure data summaries to discuss during meetings and provide feedback to staff on how improvements could be made
Examples of feedback provided on no show rates:
call client prior to appointment
give client appointment card last time in the clinic for next appointment
Send written appointment reminder via mail

12. A Lesson From the Field Robeson Health Care Corporation
Consumers October 2011 CAC Meeting: Quality Manager introduced Oral Health HAB measure along with cause and effect diagram along with examples how it was used to 8 consumers and 2 staff members present and staff worked in collaboration to complete diagram outlining 4 main areas to focus on (environment, resources, people and processes)
Clients provided concrete input based on visually seeing how tool was used to identify problems, dissect and identify root cause

13. A Lesson From the Field Robeson Health Care Corporation
January 2012 CAC Meeting: Cause and Effect Diagram used to address missed dental appointments (10 consumers, 6 staff present)
CAC met to prioritize solutions and viability to implement
Recommendations presented to Corporate Performance Improvement Committee (CPIC) to improve quality of care
Consumers voices were heard and they are and continue to be vital to quality improvement!

17. Individual Activity
Each audience member receives, reviews, and individually scores the “Consumer Involvement Organizational Assessment Tool.”
Once audience members have chosen their score, they will be asked to please stand up and go to the place on the wall that corresponds to their score
The workshop moderator will ask audience members a series of questions asking for show of hands:
Type of Ryan White Grantee/Sub-grantee (Part A – F)
High or low HIV incidence geographic location
Hospital, Community Health Center, AIDS Service Organization

18. Group Activity
Each group chooses a leader/facilitator and a recorder (someone to report back to the larger group)
Group members will have a facilitated discussion on where each Ryan White Grantee/Sub-grantee placed their scored and why they chose the score
During facilitated discussion, recorder will capture key points including challenges, barriers, successes and lessons learned with consumer involvement in QI. In addition, group members should provide recommendations to the recorder on TA/capacity building needs, resources, and strategies that will lead to improvements in the scoring that individual members chose
The recorder for each group will report back to the larger group on the discussion

19. Consumer Capacity Building Resource

20. Training of Consumers on Quality (TCQ)
To build capacity of consumers to be equal partners in the planning, implementation, and evaluation of quality improvement efforts at both clinical and regional levels
To increase the number of people living with HIV/AIDS (PLWHA) formally engaged in ongoing quality management committees, quality improvement teams, and regional quality improvement activities

21. TCQ Learning Objectives
Increased understanding of the Ryan White Program and its quality requirements and expectations
Increased understanding of basic vocabulary for quality improvement tools, methodologies, activities, and processes
Increased competency to be a consumer champion in local or regional quality management committee activities
Increased confidence in participating in quality improvement teams through an understanding of team decision-making processes, team roles, and processes to address specific aspects of HIV care
Increased understanding of the various forms of individual and systematic consumer involvement, and identification of appropriate methods of involvement

22. TCQ Learning Objectives
Increased awareness of basic HIV care and treatment terminologies so that participants better understand basic indicator definitions and performance data reports
Increased knowledge related to health numeracy and health literacy, and understanding of performance measurement, including indicator development, data collection methodologies, and data reporting
Exposure to other patients, consumer quality leaders, and peer experts in patient involvement who can provide community support and leadership

23. TCQ Expectations for Participants
Complete an online application and submit documentations (2 hour)
Complete a standardized survey to assess basic QI competencies (1 hour)
Actively participate in all 3 pre-work webinars (3 hours)
Overview of Ryan White quality expectations
Reading of two essays on different methods of involvement (agitation, activism, advocacy)
Provider/patient relationship and peer mentoring (3rd webinar will be in-person on June 20)
Completion of all pre-work assignments (6 hours)
Attend and actively participate in a 2-day face-to-face TCQ session (2 days)
Get further involved in quality improvement activities by the supporting organization
Attend and actively participate in post-TCQ conference calls and complete post TCQ assessment tool (4 hours)

24. Expectations for Supporting Ryan White Grantees
Commitment to further engage the TCB participant in ongoing quality improvement activities
Actively supporting the TCQ participant in the application process
Submission of written letter of support agreeing to accept applicant as member of organizations QM committee, team or other QI efforts and describing roles, responsibilities and organization’s expectations
Assist the TCQ participant in making travel arrangements, if needed
Review and offer feedback to consumer on personalized action plan
Coach/mentor consumer to support active engagement in QI activities for continued capacity development
Participate in post-training evaluation activities via webinars, focus groups or interviews to assess program impact

25. TCQ Application/Selection Process
Interested applicants must
apply on-line
submit a resume or bio-sketch
submit letter of reference
submit a letter of support from a Ryan White grantee
Incomplete applications will not be considered 25

26. Application/Selection Process
Approximately 30 individuals will be selected to participate in the pilot
Location, dates and times yet to be determined for second pilot (first held in Philadelphia)
Need to ensure diverse pool of training participants (demographics/geography/funding stream)
Applications need to have a strong commitment from supporting organization
Applicants should successfully demonstrate previous experience(s) in HIV quality improvement activities
Applicants should have the ability to communicate and disseminate information with existing consumer networks in their local jurisdictions
Why is there a second pilot? 26

27. Post-TCQ Session Activities
Upon completion of the TCQ program, participants are expected to:
Return to local supporting organization on implementing personalized action plans
Establish and sustain a collaborative relationship with a TCQ peer mentor
Once the pool of TCQ graduates is established, these individuals may go on to be mentors themselves
Complete a post-TCQ skills assessment

28. Post-TCQ Session Activities
Participation in TCQ webinars to sustain the “community of learners”
Sharing of lessons learned for consumer involvement in QI activities
Identification of emerging barriers to consumer involvement
Development of strategies for increased consumer involvement
Testimonials by TCQ graduates and supporting organizations regarding consumer engagement in QI activities

29. Aha Moments and Action Planning
What have you learned from this workshop?
What will you do differently in response to this workshop?
Evaluations will be electronic. No evaluations will be done in a session. Please delete

30. NQC Offerings NQC Website Quality Academy
HIVQUAL Regional Groups On-Site TA
in+care Campaign NQC Trainings

31. NQC Resources

32. Other Consumer Capacity Building Resources
Can you add the link to the slide?

33. Other Consumer Capacity Building Resources

34. Other Consumer Capacity Building Resources

35. Other Consumer Capacity Building Resources

36. Daniel Tietz NQC Program Manager for Consumer Affairs det01@health
Daniel Tietz NQC Program Manager for Consumer Affairs Adam Thompson NQC Peer Consultant Al Bishop Robeson Health Care Corporation

37. National Quality Center
NationalQualityCenter.org