1. Kathleen Clanon, MD NQC Consultant
National TA Call: Engaging Provider Staff and Consumers in QI for Parts C and D October 11, 2007
Kathleen Clanon, MD
NQC Consultant

2. Agenda for the Call Short slide presentation:
Importance of engaging consumers and staff.
Potential roles in QI.
Barriers to participation.
Two Grantee’s Experiences:
Joan Vileno, Montefiore Hospital
Piper
Open discussion: what has and hasn’t worked in your programs.
Comments from panel of grantees and consumers
Some ideas to take away and try….

3. Key Stakeholders: Consumers
Most likely to be in touch with their peers’ lives; for example, can help
Design surveys and reports
Participate in focus groups or interviews to identify which improvements will likely make most difference for fellow consumers
Can serve as a “reality check” and help keep the providers from getting “lazy” or setting goals too low
They are the most effective counter-voice to bossy clinicians

4. Consumer Involvement Can Take Many Forms
Focus Groups
Needs Assessments
Key Informant Interviews
Client Satisfaction Surveys
PLWHA representation at all levels within the agency:
Board of Directors
Staff (representative of the client population being served by the agency)
Client or Patient Advisory Committee (CAC)
Serve on agency/grantee QC

5. Consumers on the QC: Barriers
Consumers may experience:
Feeling that their input isn’t being used
Lack of orientation and training
Unaware of opportunities to participate
Acronym angst
Fear of disclosure
Practical barriers: Transportation/childcare/$$/need to work/not enough time/illness or poor health
Grantees may worry about:
Consumers slowing down the process
Consumers may pass on unflattering info
Just can’t get consumers to come!

6. Two Flavors of Engagement Design: Integrate, or Separate?
What do you think?
Better for consumers to serve on the central QC, or have separate committees/input mechanisms?
If separate, how do the committees communicate with each other?
Should there be a formal nomination and selection process for consumers to serve on committees?

7. Two Flavors of Engagement Design: Integrate, or Separate?
Consumer QC/CAP
May be less intimidating; more input
More voices, more opportunities for people to contribute
Can tailor agenda and language better to consumer interests and knowledge
Serve on Central QC
Single committee is simpler
Ability to directly influence others during discussion
Challenges non-consumers to keep discussion understandable

8. Key Stakeholders: Provider Staff
Critical role in identifying improvement ideas; they know what is practical.
Often need their involvement to get access to data.
System change requires a team effort if it is to be sustainable.
Often more in touch than health planners are with challenges that patients/consumers are facing.

9. Barriers to Participation: Provider Staff
The Big Four:
Time
Turf
Trust
Turnover
Others:
Denial
Quality baggage

10. Grantees’ Experiences
Joan Vileno, QI Coordinator
Montefiore Medical Center
Bronx, NY
Anna Jackson
Peer Advocate
Family Care Network (Part D)
Oakland, CA

11. Open Discussion: What Has Worked in Your Quality Program?
Engaging consumers.
Engaging provider staff.
Successful strategies?
Instructive or entertaining failures?

12. Lessons Learned: Big Picture
Mentor
Educate
Facilitate

13. Lessons Learned: Consumer Involvement
Consumers get involved and stay involved when they see their input and recommendations implemented.
Consumer involvement should have written standards and a written plan (or a section in your QMP).
Dedicated training on quality for consumers is critical.
Highlight consumer contributions in every newsletter, report out, and conference call on quality.

14. Lessons Learned: Use Multiple Avenues for Consumer Involvement
Consumers can:
Serve on grantee/state Quality Committee(s)
Create separate quality of care consumer advisory committee
Train other consumers and provider staff on the what and why of quality improvement
Participate on improvement project teams
Give feedback/input about quality of program (surveys, focus groups..)
What else?

15. Consumer Involvement: Lessons Learned
Both documents are available via the NQC website
NationalQualityCenter.org
Pages include examples of standards for consumer involvement.
Extremely helpful consumer training resource.

16. Lessons Learned: Staff Involvement
Contract language can/should be very specific about their provider QI responsibilities.
Can use monitoring visits to look at/discuss actual examples/results of their QI work.
Offer to do training for their staff on QI

17. Lessons Learned: Staff Involvement
Show them the data you are getting.
Take on an improvement in your own internal processes and show them you are walking the walk.
Provide support staff to meetings; minutes and assisting with follow-up reminders
Reduce productivity targets/case loads for those participating in QI work
Pay for food for meetings (non-RWCA $)
Report at every meeting and in newsletters on progress of improvement work

18. Contact Information
Kathleen Clanon, MD
NQC Consultant
Oakland, CA
Joan Vileno, RN
Montefiore Medical Center, Bronx
Anna Jackson
Peer Advocate, WORLD
Bob Tracy
NQC Consumer Advisory Board

19. National Quality Center (NQC) NYSDOH AIDS Institute 90 Church Street—13th Floor New York, NY NQC-QI-TA NationalQualityCenter.org