1. Coaching challenge: Leadership

2. Objectives Review types of leaders that QI coaches need to work with Understand the goals of working with each type of leader Understand types of resistance that may arise when working with leaders Recognize reasons and possible solutions to resistance Adapted from NQC

3. Two levels of leaders to engage at a site Leaders of HIV clinics/QI Leader – HIV is their top priority (hopefully) – Day-to day responsibility for QM program – Main focus of coach, frequent communication Senior site/Organizational leaders – Many responsibilities and priorities beyond HIV – May have less QI knowledge (more QA/QC) – Less time Adapted in part from NQC

4. Goal of working with QI leader QI coaches should work closely with leader to build capacity so they: – Become a champion of QI – Understand all aspects of PM, QI and QM – Lead meetings – Ensure PMs are being done, QI is moving forward and is being monitored – Plan future QI work – Make sure QM program is meeting and on track

5. Building up the QI leader: Change in coaching role over time Active leadership by team leader Active leadership/involvement by coach Program timeline Project timeline Start PDSAs Completion 5 Adapted from The Team Handbook

6. Goal of working with a senior site or organizational leader Early goals: – They allow QI work to move forward – They support, value and recognize importance of quality Long term goals: – They celebrate successes and improved quality – They help to spread QI work throughout the organization

7. Engaging Senior site/organizational leadership Coach should work to develop supportive relationship between this more senior leader and QI work

8. Engaging senior leadership: general approaches QI advocacy training for leaders Sit down and discuss with leadership one on one Listen to concerns about resources, priorities Share experience and success stories from other sites and their own site

9. 30 minute exercise Listed on the next slide are possible problems at sites that may require you to work closely with the leader 1.For each scenario, describe some things you might see when you go to the clinic that would help you diagnose this problem. 2.List possible approaches and how you would work with the QI leader (or site leadership when necessary) to begin to solve these issues. Be as specific as possible.

10. Scenarios and solutions Example What this might look likeSome solutions QI leader does not understand the data The data are not being used Projects chosen do not reflect the gaps from the data Listening in the group, you note that the QI leader presents the data incorrectly Do a one-on-one walk through the data with the QI lead, doing teaching as you go along and asking questions to engage him/her. Have him “teach back’ -present back to you the results after you have walked through Work with him/her to create a simple way to present to the team

11. Scenarios and solutions What this might look likeSome solutions The team is not able to choose (too many problems) The site or higher leadership is not supportive The team is fighting The QM program is not established (no meetings) The team thinks nothing will work so is not willing to try The site has low QI knowledge