1. Who Does What Improvement Facilitator Training Session 2

2. Objectives Review the Model for Improvement Take a current process and improve it for screening Understand principles of improved processes Facilitate a team to consider new roles for a process 2

3. Model for Improvement 3

4. 4 If you can’t describe what you are doing as a process, you don’t know what you’re doing. - W. Edwards Deming. Form a Team Map Your Current System Set Your Aim Measure for Improvement Test Changes Every Improvement Project has these Elements:

5. Aim The Blue Meadow Clinic team will increase offers of selected screening maneuvers to patients targeting strategies on those who don’t self- present for screening. The aim is to increase the rate of patients who receive offers of screening from our current baseline of 70% to 85% by November 30 th, 2013. 5

6. Outcome Measures Number of eligible patients seen each week who were offered opportunistic screening. Number of eligible patients contacted each week through outreach and offered screening. 6

7. Process Measures Reliability of documentation of offers of screening, daily sample from outreach and/or opportunistic patient charts Reliability of daily huddles that include reminders for opportunistic screening, weekly 7

8. Change Concepts ASaP High Leverage Changes Standard documentation Panel-based care coordination by the team Continuity of patient-provider relationship Enhanced communication with patients and across provider teams What specific ideas might a team test? 8

9. Blue Meadows Team Physician Lead representing 6 providers MOA representing 3 MOAs Receptionist Nurse POET Improvement Facilitator On Wolf EMR 9

10. 10 Most problems within a practice can be traced back to a process problem, as opposed to a people problem. - Willis, 2005 Principles of Process Improvement Can the process be more … Patient centered? Efficient? Reliable? Effective?

11. What is a Process? A series of steps that together achieve an objective. Should have a clear beginning and end. A system is made up of a series of processes. 11

12. Who could do what for opportunistic screening ? 12 yes C. Room Ready? A. Patient Enters Clinic B. Receptionist welcomes patient, confirms demographics and provider attachment, marks arrival in schedule I. Provider Enters Visit Room D. Receptionist invites patient to wait in appropriate visit room E. Receptionist invites patient to take a seat in the waiting room F. When room available, receptionist invites patient to wait in appropriate visit room G. Patient Enters Visit Room H. MOA Enters Visit Room and prepares chart for visit no 12

13. Physician Reception Adapted from EPICS II New Cancer Screening Process Patient Patient Calls For Appointment RN Discusses screening with patient Provides FOBT/FIT or refers for colonoscopy, as appropriate,and/or Provides req for mammography, and/or Completes PAP Discusses screening with patient Provides FOBT/FIT or refers for colonoscopy, as appropriate,and/or Provides req for mammography, and/or Completes PAP Validation patient address & primary care physician Validation patient address & primary care physician Rooms Patient Checks for active rules (pap & mgrm) Books f/u for pap or advises to call for appnt, &/or Prints mgrm req for patient Rooms Patient Checks for active rules (pap & mgrm) Books f/u for pap or advises to call for appnt, &/or Prints mgrm req for patient RN or MOA Runs Pap, Mammogram and Colorectal due reports on patients scheduled for any appt in coming week. Where screening is not up to date, prepares appropriate requisitions and attaches to chart. RN or MOA Runs Pap, Mammogram and Colorectal due reports on patients scheduled for any appt in coming week. Where screening is not up to date, prepares appropriate requisitions and attaches to chart. Books Appointment mammo or CR – books with physician PAP – offers RN Pap clinic or appt with physician Books Appointment mammo or CR – books with physician PAP – offers RN Pap clinic or appt with physician Patient Attends Appointment Patient Leaves Clinic Assumptions: Set up rule for women 21-69 without a pap in last 3 years (viewable by RNs and MOA) Set up rule for women 50-69 without a mammogram in last two years (viewable by RNs and MOA) Run report of all active patients (50-74) due for colorectal screening Cross-reference patients on list with Netcare to check for previous tests and update chart by printing/scanning record to Wolf (Nurses/MOA) Set up rule for all patients 50- 74 without FOBT or FIT result in past year AND without colonoscopy in past 10 years (viewable by physician) Assumptions: Set up rule for women 21-69 without a pap in last 3 years (viewable by RNs and MOA) Set up rule for women 50-69 without a mammogram in last two years (viewable by RNs and MOA) Run report of all active patients (50-74) due for colorectal screening Cross-reference patients on list with Netcare to check for previous tests and update chart by printing/scanning record to Wolf (Nurses/MOA) Set up rule for all patients 50- 74 without FOBT or FIT result in past year AND without colonoscopy in past 10 years (viewable by physician) 13

14. Summary Facilitate a conversation with the team to explore options about who could, and who should, take on any new tasks. Make decisions based on principles... – Will this change be more effective for reaching our aim? – Will this change be more efficient in delivering care? – Is this change more patient centred? – Is this change more reliable? 14