1. Group Medical Visits Health Literacy Patient Self-Management
Learning Session 3

2. Welcome back! Agenda Action Period questions Share progress & measures
Revelations
Challenges
Successes
Key concepts and strategies
Sustain the improvements
Objectives for the day:
Share progress and measures
Revelations in some practices
Discuss and plan for sustainability
Don’t forget:
Session evaluation
Compensation forms 2

3. Faculty/Presenter Disclosure
Speaker’s Name: Speaker’s Name
Relationships with commercial interests:
Grants/Research Support: PharmaCorp ABC
Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd
Consulting Fees: MedX Group Inc.
Other: Employee of XYZ Hospital Group
Presenters must disclose personal relationships with commercial interests (one slide per faculty member/presenter). Must be presented at all Mainpro+ certified events.

4. Disclosure of Commercial Support
This program has received financial support from [organization name] in the form
of [describe support here – e.g. educational grant].
This program has received in-kind support from [organization name] in the form
of [describe the support here – e.g. logistical support].
Potential for conflict(s) of interest:
[Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose product(s) are
being discussed in this program].
[Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program: [enter generic
and brand name here].
Presenters must outline connections/support for development/presentation of the program from commercial entities or organizations including educational grants, in-kind services (e.g., logistics) AND specific aspects of the faculty/presenter connections that a reasonable program participant might consider relevant to the presentation, (e.g., products made by companies named in Slide 1 that could be germane (relevant/pertinent?) to the presentation). Must be presented at all Mainpro+ certified events.

5. Mitigating Potential Bias
[Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated].
Refer to “Quick Tips” document
Presenters must outline connections/support for development/presentation of the program from commercial entities or organizations including educational grants, in-kind services (e.g., logistics) AND specific aspects of the faculty/presenter connections that a reasonable program participant might consider relevant to the presentation, (e.g., products made by companies named in Slide 1 that could be germane to the presentation). Must be presented at all Mainpro+ certified events.

6. Report out: Action period experiences
“All teach, all learn, all share”
Successes, challenges, keys to success
Tests of change - PDSAs
Measurement – what does the data tell us?
Patient experience
Share
Individual run charts that show an improvement
Any aggregate data on a run charts
What tests of change did you try based on the data?
Survey results – did patients like your changes?
Patient if possible to share their experience
GP and patient champ to start sharing – can use story board template (next 12 slides)
Can provide an optional storyboard template for teams to use

7. Sustainability
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8. Why focus on sustainability?
Up to 70% of change initiatives fail, impacting:
Best possible care
Staff and provider frustration
Reluctance to engage in future
Implementing a change in practice does not guarantee it will sustain long term. In order to continue to reap the benefits from your hard work you need to focus on how to ensure your change will ‘stick’.
The risk of failing to sustain your changes is not just clinical, but can effect provider and staff satisfaction and future change efforts.

9. What are you trying to sustain
With your team discuss what you would like to sustain, is it: A specific change?
A measured outcome from your efforts?
An underlying culture of improvement?
Relationships established?
A combination?
(5 min)
Before you focus on specific strategies to sustain your changes over time, you need to be clear on what it is you are trying to sustain. You may be trying to sustain:
A specific change you implemented
An outcome you have achieved through your work
An underlying positive culture and attitude towards improvement
Relationships you have established that contribute to your success now and into the future
Or a combination of these
In your team, discuss what your group would like to sustain.
Source: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and Improvement, 2007

10. Strategies to sustain the changes
Be clear about the benefits(use measurement)
Establish and document standard processes and have a plan for ongoing training
Establish an ongoing measurement processes
Make changes to job descriptions and policies and procedures to reflect change
Celebrate success!
Some strategies for holding the gains once initial improvements have been made (tested and implemented):
1. To work towards sustaining a change long term patients, staff and providers need to be clear what the benefits are in terms of patient care, workplace satisfaction, and personal practice. Using measurement to show the improvements will help to support the change. When each stakeholder can explain ‘what’s in it for me’ the change is more likely to sustain.
2. The permanence of the change should not depend on specific people, but should become embedded in the work processes. One of the ways to do this is to establish and document standard processes, so that even if there are staff changes everyone will know what the new process is and be able to follow it. Additionally, a plan for training new employees will help to ensure that the new responsibilities and new processes are understood and carried out correctly, and ensues continuity in practice over time.
3. Data collection continues so that the practice has information about whether the gains are being maintained. It may be that the data collection schedule can be reduced, with data collection occurring less frequently or with a smaller sample. The objective here is to monitor the new system, and guide improvements as they are tested and implemented.
4. One suggestion for embedding the change and making it permanent is to review job descriptions so that new personnel will know immediately what is involved in their responsibilities. Additionally, make sure that any documentations of policies and procedures reflect any change in process.
5. It is important to celebrate when an achievement has been reached, but also important to celebrate when that achievement has been sustained for a period of time. Keep focus and energy up by celebrating with your team your continued best practice and reminding yourselves of the good work you have done.
Source: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and Improvement, 2007

11. Predictors of sustainability
Staff, providers and patients can describe why they like the change and it’s impact
Providers and staff are confident and can assist in explaining to others
Job descriptions reflect new roles
Measurement is part of the practice and used to monitor progress
The change is no longer ‘new’, but ‘the way we do things around here’
Once you have made some changes towards sustaining your gains, how will you know that your work is paying off? There are some simple ways to tell if your change is more likely to sustain over time.
When you ask staff, providers and patients about the changes you have made they will be able to describe to you why the change is a good one and the impact it will have on both patient care and staff/provider experience in the clinic.
Providers and staff are confident that they could explain the new way of working to others and help to train new staff or providers.
Any effected job description has been changed to reflect changes in roles
Measurement is ongoing even after the change has been implemented. The measures are reviewed regularly to monitor progress and any changes indicating a loss in gains results in a correction.
People effected by the change do not describe it as ‘new’ or ‘being tested’ but accept it as the ‘new way of working’.
Source: NHS Improvement leader’s Guide: Sustainability, NHS Institute for Innovation and Improvement, 2007

12. Sustainability activity
At your table, develop a plan for increasing the probability of sustaining your improvement work
Use one or more of the strategies outlined in the previous slide, or come up with others
Share your ideas with the group
(Use the blank PDSA form)
At your table, develop a plan for sustainability of your improvement work
Use one or more of the strategies outlined in the previous slide
Be prepared to share your ideas with the group
Answer the questions:
What are you trying to sustain?
How will you know that your efforts are being sustained?
What changes will you try that will increase in chances of sustaining your changes?

13. Facilitating the spread of improvements
Explain benefits of GMV’s, patient self management and health literacy
Address concerns & questions of providers
Use the data
Share your work with others
Explain the benefits of the improved system (e.g., why it is better for patients, for providers, greater efficiency, etc.)
It is especially important to address the concerns and questions of providers, i.e., to answer the questions “What’s in it for me? What’s in it for my patients?” Having physicians and front line staff able to explain through their own experience what the changes have meant to them and/or their patients is a powerful message that helps to attract others to the changes.
Through your improvement work, you have the evidence to demonstrate how the next system is better. The best evidence is the run charts from your work that demonstrate that the changes can result in measurable improvement. Consider how your team will continue to track and review data – who will do this? How often, etc?
Be prepared to share your work with others: use your storyboard to build a presentation that you can use to explain what you did, how you did it, and the results that you got. Take every opportunity to talk with others about your practice team and what it learned as the improvement work progressed.
Source: Holding the Gains and Spreading the Improvement to Others, IHI Presentation , IHI.org, 2001

14. Next Steps… Ongoing support Informal meeting and calls
(3, 6, 12 months) - to help you sustain changes already made and continue to make improvements
Informal meeting & calls - to share new experiences and discoveries (decide when, how often and where with who)
Session evaluation
Compensation forms