1. Overview Colorado HIV-STIC NIATx Process Improvement Model Linda J. Frazier November 8, 2011 Colorado Springs, CO

2. The NIATx Way

3. What is Process Improvement? An experiment in change Using a structured process Guided by the customer Driven by data Based on the Model For Improvement in The Improvement Guide, by Langley, Nolan, Nolan, Norman, & Provost

4. NIATx Learning Collaborative Model Learning Sessions Coaching Peer Mentoring The NIATx Website All-Member Calls

5. Questions to Consider What is it like to be our customer? What are we trying to accomplish? How will we know if a change works? What changes can we test that may result in improvement? How can we sustain positive changes?

6. Model for Improvement Start by asking three questions: 1.What are we trying to accomplish? 2.How will we know a change is an improvement? 3.What changes can we test? (next Tuesday!) Model for Improvement Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996

7. NIATx Aims Reduce Waiting Times Reduce No-Shows Increase Admissions Increase Continuation Rates

8. Five Key Principles: Evidence- based Predictors of Change* 1.Understand and involve the customer 2.Focus on key problems 3.Appoint an influential change leader 4.Seek ideas from outside the organization 5.Do rapid-cycle testing (PDSA Cycles) Gustafson and Hundt, 1995

9. Key Points Identify the top 5 problems that keep the Executive Sponsor awake at night Conduct a Walk-through Strategically select the project (one aim + one level of care + one location/population) Assigns between one and seven (at most) people to achieve the aims of the selected project Use Rapid Cycle PI – PDSA to test what works Measure Change – ongoing before, during & after

10. Key Change Team Roles Executive Sponsor Selects Team Appoints Change Leader Selects Key Problems Works to Remove Barriers & Facilitate PI Change Team Change Leader – ability, leverage, time Change Team – small, appointed by Executive Sponsor, tasked with specific process Data Coordinator – tracks metrics, compiles results

11. Conducting a Change Exercise PDSA cycles  Plan the change  Do the plan  Study the results  Act on the new knowledge Rapid cycle changes  Changes should be doable in 2-3 weeks

13. (Title) Name(s) of presenter(s) Organizational Affiliation Initial Assignments that get projects started on the right foot The NIATx Way Problem Awareness Walk-through Visual Modeling Tools Nominal Group Technique Identifying potential solutions

14. (Title) Name(s) of presenter(s) Organizational Affiliation Initial Assignments that get projects started on the right foot Appointing roles Executive Sponsor and Change Leader Change team Identifying your starting point Establish a baseline

15. (Title) Name(s) of presenter(s) Organizational Affiliation Initial Assignments that get projects started on the right foot Agency preparation Inform the staff about Process Improvement Communicate about why, who is primarily involved, and what is going on