1. Efficiently Implementing Protocols and Bundles: Engaging Stakeholders    December 9 from 2 – 3 pm    Hosted by: Stephanie Sobczak Courtesy Reminders: During the webinar, you may select *7 on your phone to speak, and use *6 to mute. Please refrain from placing the phone on HOLD during the presentation.

2. Welcome to IPAB! (“Fix it in 6”) This is a new approach to rapid cycle improvement. This design intentionally involves multiple stakeholders in a series of meetings to transparently discuss barriers, then use QI practices between meetings to close any gaps and achieve aims.

3. Our goal is to determine gaps and issues and achieve implementation of the solutions using 6 one-hour meetings as the base structure, plus specific tasks to be completed between those meetings. Meetings you will schedule are: 1)Stakeholder Meeting 2)Action Planning Meeting 3)Change Planning Meeting (Pilot and Small Test Design) 4)Progress Check Meeting 5)Implementation Planning Meeting 6)Implementation Follow-up Meeting “Fix it in 6”

4. Universal Design Any Partners for Patients topic you are working on will work in this model. As long as:  You aren’t taking on a brand new topic  You have a good idea what the gaps are, just need a method to solve the issues.

5. MeetingPurpose Pre-work Huddle Identify participants Gather information needed for stakeholders 1 – Stakeholders Meeting Identify gaps in best practices Determine other key stakeholders 2 – Action Planning Meeting Discuss priorities Identify low hanging fruit Identify processes to test 3 – Change Planning Meeting Involve staff doing the work Plan for just in time trials/tests 4 – Progress Check Meeting Reports on pilots and tests Decision to continue, or adopt the change 5 – Implementation Planning Meeting Discuss the implementation checklist Determine next steps 6 – Implementation Follow-up MeetingMonitor progress with implementation Determine accountable staff

6. Our Process Webinars will introduce the purpose of each stakeholder meeting and outline best practices for implementation and troubleshooting. Tools will be provided related to each of the meetings. The intention is hospital staff (team leads, etc.) should hold the meetings and implement best practices between webinars Coaching calls will be held to support your efforts

7. MeetingPurpose Webinar 1 Engaging Stakeholders Dec 9, 2 pm Optional Coaching call Dec 16, 2pm Pre-work Huddle Identify participants Gather information needed for stakeholders 1 – Stakeholders Meeting Identify gaps in best practices Determine other key stakeholders Webinar 2 Action Planning January 13, 2pm Optional Coaching call Jan 27, 2pm 2 – Action Planning Meeting Discuss priorities Identify low hanging fruit Identify processes to test Webinar 3 Change Planning February 10, 2 pm 3 – Change Planning Meeting Involve staff doing the work Plan for just in time trials/tests 4 – Progress Check Meeting Reports on pilots and tests Decision to continue, or adopt Webinar 4 Making Progress March 9, 2 pm 5 – Implementation Planning Meeting Discuss the implementation checklist Determine next steps Coaching Call on Implementation March 30 2pm 6 – Implementation Follow-up Meeting Monitor progress with implementation Determine accountable staff

8. Orientation to Topic Web Resources

9. Best Practice Mindset Shift Culture Tools Four Elements to Change Management

10. Shifting the Mindset Two big shifts in mindset are necessary in this approach: 1.Must move the action steps out of the meeting room and into the clinical areas. 2.Not working on action steps between meetings is unacceptable.  Meeting and planning alone don’t change outcomes….only making changes to actual practice will.

11. Think ahead How will the lead and senior leader champion address stakeholders who do not engage in the work between meetings?  Is there a good reason for lack of follow-up?  Is the right person involved in the task?  Is there a ‘resourcing’ problem making progress difficult or slow?  What is the plan if there are barriers?

12. Detecting Your Gaps A.You know what the gap is (usually a “hard- coding” issue) – Great! Ready to move on… B.You think you know but are not certain  Go through a detailed gap analysis C. You have no idea what the gap is; just are not moving the dial. Select one of these:  Detailed gap analysis  Chart audits?  Stratify your data and look for patterns?  Gather patient and staff feedback?  Do an FMEA or RCA? Adopted Minnesota’s Roadmaps (with permission)

13. Review of Assessment Tools For your clinical topic, select a method to do an assessment:  Improvement Workbook – Sec 1, Worksheet  Top Ten Checklist  Topic Gap Analysis Documents  Any other resources you may have

14. Who should organize this effort? Preferably someone with skills in leading meetings Someone with the time to coordinate meetings Someone with knowledge of the clinical issue

15. Stakehol der Meeting Action Planning Change Planning Meeting for Pilot or Small Test Design Progress Check Implem en- tation Planning Implem en- tation Follow- up Day 1 Day 7 1 week later Day 10 3 days later Day 17 1 weeks later Day 31 2 weeks later Day 60 4 weeks later Within 2 months to implementation Example plan – schedule meetings in advance

16. Stake- holder Meeting Action Planning Change Planning Meeting Progress Check Implemen- tation Planning Imple- men- tation Follow- up Day 1Day 14 2 weeks later Day 21 1 week later Day 35 2 weeks later Day 60 3+ weeks later Day 90 4 weeks later 3 month plan of scheduled meetings Jan 12 Jan 25 Feb 1 Feb 13 Mar 5 Apr 5 Pre-schedule all meetings – get them on the participants calendars

17. Before the First Meeting General Pre-Work for the Team Lead:  Schedule six 1 hour meetings at specific intervals  Determine who will be included and invite them  Clearly state what the gap is in the invitation  Gather evidence about the bundle or protocol, including “current state” outcome or process measure data  Summarize, document, and share any work done to-date before the meeting

18. Scheduling problems Q: Do we schedule the meeting based on who can attend, and what if people cancel? A: Identify 3 key people that need to be present and schedule the first 2 meetings according to their availability. Reschedule only if more than 1 of the 3 key people cancel (Or ask for a substitute to attend)

19. Remember The purpose of these meetings is to prevent patient harm What is more important than that? Not easily accommodating cancellations sends a strong initial message where harm prevention priority is in your hospital – leaders must lead this as a culture change

20. Why a 1 Hour meeting? Why only a 1 hour meeting?  Sets the tone to efficiently address the topic – keep focus narrow; limit side conversations and tangents  Stick to the agenda – designed for one hour  Avoid going over 60 minutes  Add issues to the Parking Lot

21. 1 – Stakeholders Meeting Task List 1:  Identify who will be impacted by the change  Invite them to a 1 hour meeting  Explain the purpose and provide any evidence or background material in advance  Send an agenda

22. 1 – Stakeholders Meeting Hour 1 – Stakeholder Meeting Agenda  Brief introductions (if needed) & Review agenda  Review purpose of the meeting  Identify gaps in best practices – use existing checklist/assessment or brainstorm.  Determine any issues that can be easily resolved: “Why aren’t we doing _____?”  Set assignments for follow-up

23. Stakeholders Meeting Agenda

24. 1 – Stakeholders Meeting Stakeholder Assignments - 1  Fix the “quick fixes”  Discuss gaps in practice with other stakeholders  Get feedback about barriers or opportunities for improvement  Determine readiness for change through dialogue with others Those who attended this meeting should do these action items before the next meeting.

25. Talking outside of the meeting In some work cultures, “what is discussed in a meeting stays in the meeting”. In this case, discussion with others between meetings is vitally important because: 1)Learning is improved by hearing other’s perspectives on the challenge 2)“Sets the tone” in the hospital that this is important and will be resolved

26. WHA Quality Resources Recorded webinars Improvement Workbook Implementing a Protocol webpage on the Quality Center On-Site Resources

27. Questions?

28. Please complete the brief post-webinar survey We value your feedback and will follow- up with you if requested Thank you! Stephanie Sobczak ssobczak@wha.orgssobczak@wha.org