1. Quality Improvement Breakout Neil Korsen, MD, MSc MaineHealth April 16-17, 2009

2. Objectives Describe a basic structure for running an effective meeting List some of the reasons that small tests of change (PDSA cycles) are useful in quality improvement Design an appropriate small test of change as part of an improvement activity

3. Effective Meetings A simple approach to making the best use of the time we spend in meetings –Organizing the agenda –Meeting roles –Ground rules

5. Meeting Roles Leader –Prepares agenda, moves thru agenda, elicits participation Recorder –Minutes, list of action items at the end Timekeeper –Monitors time on each item and lets leader know if over time Facilitator –Manages group process to balance participation and keep on task

6. Meeting Ground Rules Agreed to by the group Reviewed at the beginning or posted to remind all of what was agreed to.

7. Ground Rules Clinical Integration Staff Meetings –Begin and end the meeting on time –Speak only to the agenda item on the table –No interruptions –Be sure there is a parking lot for additional items –Work to includes others’ ideas –Commit to decisions –Come prepared –Have fun –If you are opposed, try to propose

8. Rhythm of Improvement Daily huddles – Which patients coming in today are candidates for mental health assessment? (5-10 min) Weekly check-ins – What small tests of change are we working on and what are we learning? (15-30 min) Monthly partnership meetings – How are we doing in implementing integrated services? (60 min)

9. Model for Improvement 1.What are you trying to accomplish? (Aim Statement) 2.How do you know if a change has resulted in an improvement? (Measurement) 3.What changes can you make in a process to promote improvement? (PDSA cycles) A P S D

10. PDSA Cycle Plan Identify: -the problem -the most likely causes -potential solutions Do Implement solutions and collect data Study Analyze data and develop conclusions Act Recommend action/ further study

11. PDSA Cycles Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA

12. Why Test Changes? Increases belief that the change will result in improvements in your setting Learn how to adapt the change to conditions in your setting Evaluate the costs and “side-effects” of changes Minimize resistance when spreading the change throughout the organization

13. Designing PDSA’s Think small at first: –One clinician –A few patients –A day or two Think creatively – use your team Learn from initial tests, then gradually enlarge Work on one thing at a time

14. Exercise Think about a PDSA that your team has developed. –How could you make that PDSA smaller and more focused? Talk to people around you