1. Flying in a Learning Collaborative Adapted from: The Game Guide: Interactive Exercises for Trainers to Teach Quality Improvement in HIV Care New York State Department of Health AIDS Institute Health Resources and Services Administration HIV/AIDS Bureau

2. Plan: for change Do: make changes Study: impact of change Act: on changes that work Learning Collaborative

3. What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? ActPlan StudyDo Model for improvement Aims Measurement Langley, Nolan et al 1996 Change Ideas Trial & Learning

4. Current State –Divide into 10 teams –Select a Flight Engineer- design and fly plan –Select a Manager- measure the distance and keep time –Select a Quality Improvement Consultant- team satisfaction –Remaining Team members Observers – 10 minutes or less to fly the plane or disqualified

5. Time Minutes Day Distance Feet Day Satisfaction % Thumbs Up Day Run Charts

6. Include observers in your Team Test Idea(s) using PDSA cycles Record: Distance, Satisfaction and Time Learning Session 1: Action Period 1

7. PDSA Cycle Plan: State objectives. Make predictions Make conditions explicit. Develop plan (5 W’s, How) Do: Carry out the test. Document problems, surprises, and observations. Begin analysis. Study: Complete analysis, synthesis Compare data to predictions. Record under what conditions results could be different. Summarize what was learned. Act: Adopt, adapt or abandon based on what was learned. Build knowledge into next PDSA Cycle

8. To Be Considered a PDSA Cycle  The test or observation was planned (including a plan for collecting data)  The plan was attempted (do the plan)  Time was set aside to analyze the data and study the results  Action was rationally based on what was learned

9. Share PDSAs and other Change Ideas Profile Success Discuss Challenges Network Learning Session 2: Action Period 2

10. Change that Worked Short flight distances Nose dives Wanders off-target Use heavier paper Change launch angle Add tape weight to rear Reinforce plane body with clips

11. How do we stay the course and help others? Making your system reliable Standardizing work changes, forms and other supporting documents Auditing and Measurement Spread Learning Session 3

12. What are we trying to accomplish (aim)? –To have maximum distance, in the least amount of time, with the highest team satisfaction How will we know that a change is an improvement (measures)? –Time –Distance –Team Satisfaction What changes can we make that will lead to improvement? –Colleagues, Faculty, Change Package, GSK, CoP, Chartering Your Course

13. The Game Guide: Interactive Exercises for Trainers to Teach Quality Improvement in HIV Care, August 2006, New York State Department of Health AIDS Institute Health Resources and Services Administration HIV/AIDS Bureau. Langley, G.J., Nolan, K.M., Nolan, T.W., Norman,C.L., ProvostL.P. (1996). The Improvement Guide; A Practical Approach to Organizational Performance, 1996. Debbie Barnard, MS, CPHQ; Quality and Improvement Consultant; Improvement Model Seminars, 2007. Michael Murray, PhD; Small Steps; Big Changes Seminars, 2006. Acknowledgements