1. Actions Set a clear aim for the performance of your eligibility system Define why your key audiences (governor, legislature, public) should support it given their interests Establish specific actions steps to get there in the next year

2. Sustainability and Spread Learning Session 3 April 24, 2003 Ron Moen

3. Sustain Improvement Spread Improvement Improvement Creating a New System

4. Sustainability: “Hold the Gains” Sustainability means continuing to profit from gains rather than experiencing a one-time effect of your efforts (You have achieved something that you wish to sustain)

5. Old System New System Some Inhibitors:  “We met our goals”  “We assumed the improvement would hold”  Other priorities took all resources away (not on senior management’s radar screen)  Did not learn how to hold the gains  No infrastructures are in place Hold the Gains:

6. Readiness for “Hold the Gains”  Success of collaborative team  Intention  Organizational priority  Leadership responsibility

7. Three Key Components of a Strategy to Hold the Gains 1. Communication 2. Infrastructure 3. Design Effective Control System

8. Hold the Gains: 1. Communication  Aim, successes, learning's, and benefits to all stakeholders  Document the new process  Keep in contact with your team and other teams

9.  Training and development of new skills  Changes to job descriptions, policies, and procedures  Assign ownership for improvement and maintenance work of the new process  Involvement of senior leaders in taking responsibility for the efforts to sustain the change and remove inhibitors that might allow slippage back to the old system Hold the Gains: 2. Infrastructure

10. Hold the Gains: 3. Design Effective Control System Design using the Model for Improvement Use the 3 questions PDSA Cycles

11. 1.What are we trying to accomplish? Hold the gains after successful improvement 2.How do we know a change is an improvement? Performance/outcome measures will remain at the improved level 3.What changes can we make that will result in improvement?  Standardization  Identify and remove any special causes 3. Design Effective Control System

12. Some PDSA Cycles: Plan to standardize and verify conformance to the standard Sustain the change by using run charts or control charts to monitor outcome measures 3. Design Effective Control System

13. Sustain Improvement Spread Improvement Improvement Creating a New System

14. Target Population for Spread Population of Focus for your BTS Aim Spread - Other offices - Other departments - Other counties - Other key systems

15. Spread: Spread means making improvements beyond the scope of the Collaborative Team

16. Readiness for Spread  Success of collaborative team  Intention  Organizational priority  Leadership responsibility

17. Five Key Components of a Strategy for Spread 1.Infrastructure 2.Communication 3.Social System 4.Schedule for spread 5.Measurement and Feedback

18. Spread: 1. Infrastructure  Topic a key strategic initiative  Set up the project  Executive sponsor: sets the agenda  Day-to-day leader: the driver  Target population: who will be the adopters of the changes  Communication plan: start early  Measurement strategy: system wide  Staging plan - The plan to reach all units in the target population over time with all of the changes

19. Spread: 2. Communication  Distinguish between communicating awareness and technical knowledge  Use multiple communication channels  Identify and train your key messengers (Change agents, content expert, opinion leaders)

20. Adapted from Ashkenas, 1995 SHARE INFORMATION SHAPE BEHAVIOUR General Publications flyers newsletters videos articles posters Personal Invitation letters reports postcards Interactive Activities telephone email visits seminars learning sets modeling Face-to-face one-to-one mentoring seconding shadowing The WAY in which we communicate is important

21. Spread: 3. Social System  Content, context, and community  Understand the relevant circumstances affecting peoples’ ability/willingness to adopt the changes  Take advantage of the existing relationships within the system  Develop “communities of practice” among those with similar roles  Don’t forget improvement knowledge

22. Spread: 4. Schedule for Spread  Consider completeness and coverage as a way to direct the spread  Completeness: all changes, limited offices  Coverage: all offices, limited changes

23. Design a flexible spread program Offices Parts of the System 100% Coverage Completeness

24. Spread: 5. Measurement and Feedback  Data collected on: -Outcome measures -Measures to track spread of specific changes  Reporting to provide feedback  Data and reporting at different levels within the organization