1. 1 Building the Dream Team: Managing a Quality Improvement Collaborative Jennifer Lundblad, PhD, MBA President and CEO Multi-State Learning Collaborative August 7, 2008

2. 2 Presentation Outline  Description of a QI collaborative as an educational methodology to support quality improvement  Discussions of when and why collaboratives work  Lessons learned by Stratis Health in implementing collaboratives Quality improvement collaboratives are a tool that can be used to help improve public health practice. This session will provide:

3. 3 Stratis Health  Independent, not-for-profit quality improvement organization founded in 1971  Mission: To lead collaboration and innovation in health care quality and safety, and serve as a trusted expert in facilitating improvement for people and communities  Work with both providers and consumers to improve health care  Funded by federal and state contracts, corporate, and foundation grants

4. 4 Stratis Health’s Approach to Improving Quality Stratis Health carries out its work by serving as a: Quality improvement expert and clearinghouse Educator and trainer Facilitator and convener Data resource Consultant and supporter QI Collaboratives are a tool frequently used by Stratis Health to drive and support improvement.

5. 5 Quality Improvement Collaboratives  Teams from participating organizations focused on similar goals work together to:  Learn about theory and proven strategies for improving care  Try out tools to help achieve improvement  Make and refine plans for improvement for their organizations  Develop a network of colleagues at other organizations pursuing similar work

6. 6 QI Collaboratives: Methodology  3-4 learning sessions over 12-18 months  Typically facilitated by an external organization  ‘Faculty’ experts help design and facilitate  Teams measure and share results to track progress  Strong role for measurement and tracking  Storyboard presentations at learning sessions  Proactive support between learning sessions  Support, encouragement, and expertise offered through regular conference calls, email, and Web site interaction with faculty experts from the collaborative  Final celebratory session (e.g., Outcomes Congress)  Share learnings and disseminate results

7. 7 QI Collaboratives: Methodology (cont.)  In addition to the standard or core components to a collaborative, Stratis Health often includes the following:  On-site technical assistant visits to participating organizations  Senior leader reports  Peer mentoring support  Partnering/co-sponsoring with other organizations with shared goals

8. 8 QI Collaboratives: Methodology (cont.)  Pre-work: Get senior leader support, form team, assess current data  LS1: Define aims and measures, develop plans for tests of change, get ideas for improvement  LS2: Gather more ideas for change, gain deeper understanding of testing and implementation, identify and develop strategies to overcome barriers, learn from other teams  LS3: Understand what is working and what isn’t, plan for holding gains and spreading change, celebrate early results  Action periods between learning sessions: test changes and get feedback, conduct data collection and reporting

9. 9 Collaborative: Examples  The collaborative learning format has been used:  Nationally, by the Institute for Healthcare Improvement (IHI) » Branded as “Breakthrough Series”  Many other regional, state, and local organizations » In Minnesota, includes Stratis Health, VHA Upper Midwest, Institute for Clinical Systems Improvement (ICSI)

10. 10 Collaborative: IHI Model © 2002 Institute for Healthcare Improvement

11. 11 Action Research  The collaborative improvement model is based on Action Learning and Action Research  The model is not a clinical trial, nor is it a traditional quality improvement project. It is a collaborative model based on action learning, and action research theory and literature.

12. 12 Action Research (cont.)  Collaborative improvement model has its roots in action learning theory and principles. Action learning is:  “An approach to working with and developing people that uses work on actual project problems as the way to learn. Participants work in small groups to take action to solve their problem and learn how to learn from that action. Often a learning coach works with the group in order to help member learn how to balance their work with the learning from that work.” (Yorks, et. al, 1999)

13. 13 Action Research (cont.)  Model brings together a number of organizations that are focusing their improvement work in a shared area or with similar goals  Action learning projects usually meet three criteria (Yorks, et. al, 1999): 1)They are complex, overarching, and often cross- functional 2)They are problems, opportunities, or difficulties for which there is no single solution, and 3)They are actual problems, meaningful to participants, and for which participants are motivated to act

14. 14 QI Collaboratives in Public Health What problems or topics in public health practice lend themselves to the Quality Improvement Learning Collaborative approach? In health outcomes? In capacity building?

15. 15 QI Collaboratives: Do they work?  Two Stratis Health (Minnesota) examples shared here:  22 small rural hospital immunization improvement  63 home health agency re-hospitalization reduction

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18. 18 QI Collaboratives: Why do they work?  Learning sessions:  Needs and values leveraged to make the case for change  New knowledge and proficiencies are gained  Motivation through positive peer pressure  Between session activities:  Expert guidance to address systems and structure issues and barriers  Allow participants to try out new behaviors back on the job

19. 19 QI Collaboratives: Why do they work? (cont.)  Measurement:  Ability for participants to benchmark their processes and results against peers  Collective results across the collaborative are compelling and motivational  Final celebratory session:  Engages senior administrative and/or clinical leadership  Leveraging management practices at the organizational level, while at the same time reinforcing motivation, systems, and work unit climate at the group level.

20. 20 Stratis Health’s Lessons Learned  Senior Leader engagement  Get commitment from senior leaders at participating organizations early on  Use multiple techniques to keep senior leaders involved and interested » Professional and trade association meetings, progress reports, letters  Clarify Expectations of participating teams/organizations  Lay out expectations for entire collaborative before organizations agree to participate » Reinforce at every opportunity  Use clear and consistent language  Ensure there is a shared understanding of tasks  Include storyboard development early in the process

21. 21 Lessons Learned (cont.)  Reinforce Quality Improvement Structure  Reinforce model for improvement and PDSA at each workshop  Rapid tests of change using PDSA cycle can be difficult in small organizations because of limited number of patients/clients  Support and Encourage Collaboration Participation  Offer CEUs for conference calls and workshops  Watch for leaders in the group and use their expertise  Keep measurement and reporting tools simple  Individual team/organization support between sessions is highly valuable  Offer template press releases about the collaborative for internal and external information sharing

22. 22 Reflections on QI Collaboratives in Public Health  The characteristics of many public health issues match the action learning criteria (i.e., complex, no single solution, meaningful)  Public health has a strong foundation for cross-organization collaboration…shared structures and demands, similarities in services, community orientation. Your ideas, questions, or comments?

23. 23 Contact and Resources Jennifer Lundblad, PhD, MBA President and CEO (952) 853-8523 jlundblad@stratishealth.org  Institute for Health Care Improvement  http://www.ihi.org/IHI/Topics/Improvement/SpreadingChanges/Lit erature/TheBreakthroughSeriesIHIsCollaborativeModelforAchievi ngBreakthroughImprovement.htm http://www.ihi.org/IHI/Topics/Improvement/SpreadingChanges/Lit erature/TheBreakthroughSeriesIHIsCollaborativeModelforAchievi ngBreakthroughImprovement.htm

24. 24 Stratis Health is a non-profit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities.