1. Meeting Quality-Improvement Milestones #14(19), #15(20), #16(21)
To QIA for possible use: Thank you for taking my call and listening to this opportunity we can offer to you, to help with quality improvement projects.

2. Today’s Objectives
Review scoring for 3 milestones 14, 15, 16, (19, 20, 21 for primary care)
Outline strategies for meeting each of these milestones
Review relevance of 3 milestones’ scores to phases
Open discussion

3. What’s the Goal and How Do You Get There?
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4. Milestone 14 (19 on primary care PAT): Practice uses an organized approach (e.g. use of PDSAs, Model for Improvement, Lean, FMEA, Six Sigma) to identify and act on improvement opportunities.

10. Milestone 15 (20 on primary care PAT): Practice builds QI capability in the practice and empowers staff to innovate and improve.

11. Empowering Staff
Provide basic information/education (listen to the recording of this webinar and the previous one on VCSQI website)
Ask staff what “problems” they are observing
Observe what makes patients upset
Listen for staff problems and “we should” from staff
Include staff in problem-solving
Create a standard work document together
Then score yourself a “3” on this milestone!
This Photo by Unknown Author is licensed under CC BY-NC-ND

12. Milestone 16 (21 on primary care PAT): Practice regularly produces and shares reports on performance at both the organization and provider/care team level, including progress over time and how performance compares to goals. Practice has a system in place to assure follow up action where appropriate.

13. Three parts to producing and sharing reports:
1. Practice regularly produces and shares reports on performance at both the organizational and provider/care level
2. Show progress over time and how performance compare to goals.
3. Practice has a system in place to assure follow up action where appropriate.
There are 3 parts to this milestone. We will briefly review each part.

14. Part 1: Producing Reports
Practice regularly produces and shares reports on performance at both the organizational and provider/care level.

15. Data Collection Select measures
Collect and document data to calculate measures (according to measure specifications)
Claims, EMR, separate data collection templates
Aggregate data for analysis

16. The Data Submission Tool: How To Send Data to VCSQI
There are varies methods for producing and sharing to the progress of the practice. For larger practices, there may be town halls, or for smaller practice a quick team meeting. Another way to be transparent with regard to performance would be to prepare reports or simply a chart. You may recall the data submission form pictured here that is used to submit quarterly data for your practice. This is a great tool to create a chart.

17. Use your data
When you complete the data submission tool, it automatically populates the percentages. That can be entered into chart features found in Word, Excel, or PowerPoint.

18. Quality Goals: To provide quality care to our patients by reaching 100% in the following areas
This is the product of that data. After this conference, we send an providing you with a template that can be used for this purpose.

19. Now sharing the information
Now sharing the information. By printing out the chart and discussing it at a team meeting, posting it on the breakroom wall, or creating a display board to prompt action are a few ways to share performance scores in no time

20. Part 2: Update Data
Show progress over time and how performance compare to goals.
Now that you have your baseline data…let your team, employees know how they are doing.

21. Quality Goals: To provide quality care to our patients by reaching 100% in the following areas
Simply update that graph to show scores overtime. Here is an example of data captured over various quarters.

22. Part 3: Analyzing Data
Practice has a system in place to assure follow up action where appropriate.
You have your data now…CMS asks that you analyze it and make improvement along the way.

23. Quality Goals: To provide quality care to our patients by reaching 100% in the following areas
Going back to your chart, review it…see areas that are low and make plans to improve it. For example, Documentation of Current Medications is low, this could prompt interventions such as additional training of your MA or nurse, checklists, or other procedures to help ensure that this was done. Thus evoking the PDSA model that continuously observes procedures and make adjustments in order to meet the goal.

24. A great way to become more transparent is to use display boards, that has a fascinating way to rally the practice around the goals and prompt thinking and planning across multiple disciplines.

25. 5 Phases of Transformation
Standardized work is one of the most powerful quality tools. Standard Work is a key foundation of Lean Thinking methodology which looks
at eliminating waste and reducing variation in a process. By documenting the current best practice, standardized work forms the baseline for continuous improvement. As the standard is improved, the new standard becomes the baseline for further improvements, and so on.
Questions you can ask to develop a standard:
How do the people work?
>> How often is an activity done?
>> How long does an activity take?
>> How do you know when you have done a good job?
How do the people connect?
>> Who interacts with whom?
>> How do you send information to each other?
How is the work improved?
When something goes wrong, what do you do?
How do you prevent problems?

26. 6-Month Transformation Roadmap, Tools, and Deliverables
Enroll
Prep
Phase 5 Complete
Prep
Call with TIA to review roadmap
Identify team members
Determine team meeting schedule
Webinar: VCSQI Sponsored Learning Session Understanding MACRA, MIPs, and APMs 
Phase 1
Select 2-3 measures
Identify bold AIM statement
Submit data (if applicable)
Webinar: Basic Quality Improvement Principals
Set Phase 2 target completion date
Phase 2
Prioritize remaining milestones
Evaluate each incomplete PAT milestone on VCSQI calls
Work with TIA to determine appropriate Change/QI tool for each milestone:
Standard Work
WWW action plan
Process Mapping
A3 or OFI Action Plan
PDSA
Attempt 1-2 small tests of change
Document 1-2 PDSA cycles
Set Phase 3 target completion date
Phase 3
Evaluate each incomplete PAT milestone on VCSQI calls
Work with TIA to determine appropriate Change/QI tool for each milestone
Attempt 1-2 PFE small tests of change
Document 1-2 PDSA cycles
Set Phase 4 target completion date
Phase 4
Set Phase 5 target completion date
Phase 5
Attempt 1 PFE small test of change
Document 1 PDSA cycle
Submit data (if applicable)
Now we can see how the three key elements from Data and Reports is used in completion of the OFI Action Plan – OFI is Opportunity for Improvement. This is a highly effective communication tool for helping teams define the opportunity they want to address, the current results for that process or outcome and the expected level of improvement, document the analysis of what is happening currently, as well as the new actions that will be performed to improve (including WHO, WHAT, WHEN, and HOW). After a defined time that the team agrees upon, the actions and results are reviewed again by the team to identify what worked or didn’t work and whether or not additional actions need to be identified for the next time frame. This tool can cover daily, weekly, monthly or any time frame identified as most appropriate by the team.

28. This Photo by Unknown Author is licensed under CC BY-SA