1. Diagnosing and coaching through challenges QI knowledge and Performance measurement

2. Challenge: Low QI knowledge Possible reasons: – New sites – Staff turnover – Expanding to a new QI area – Staff forgot or never understood to begin with.

3. Approaches to low knowledge Ongoing education and training (didactic and “on the job” – Measurement – QI projects – QM program Encourage peer-teaching at the clinic Guide toward resources (SOP’s, clinic notebooks, online, national training) Share lessons learned

4. Challenge: The site is not using the data Possible problems: – No one is interested in the information – No one is interested in making a change – They do not trust the data (quality) – They don’t think they can make it better – They don’t understand – There are too many problems

5. Don Berwick’s 4 stages Stage 0: what data? We have data? Stage I: “The data are wrong….” Stage II: “The data are right, but it’s not a problem…” Stage III: “The data are right, it’s a problem, but it’s not my problem…” Stage IV: “The data are right, it’s a problem, it’s my problem…” 5 plus one

6. Don Berwick’s stages plus five more Stage V: The data are right, it’s a problem, it’s OUR problem..” Stage VI: The data are right, it’s a problem, it’s OUR problem and we can change things..” Stage VII: “The data are right, it’s a problem, it’s OUR problem, we can change things and we have started” Stage VIII: “The data are right, it’s a problem, it’s OUR problem, we can change things and it is improving care” Stage IX: “The data are right it’s a problem, it’s OUR problem, we can change things and it is improving care, and it has been sustained” 6

7. Your job as a QI coach is to get sites from stage 0 to stage 9.

8. Make sure everyone understands What is being measured? Data analysis: What is the data telling us? Data sharing: Are the results being communicated clearly for all to understand? What should the team be doing in response to the results?

9. Performance measurement exercise Goals – Practice diagnosing the challenge to data use in a site – Practice developing a plan based on your diagnosis

10. Case discussion You (and a partner) are the coaches for clinic AB. Everyone else is the QI team They have just completed their first performance measurement and are reviewing the data. They are having a hard time prioritizing which indicator to work on for their first QI project. You have the data and roles in your folder Your goal as a coach by the end of your visit is to diagnose why they are having problems and help them to prioritize the first gap.

11. Exercise instructions Take 2 minutes to understand your character and to understand the case. – Ask yourself the questions (who am I, how am I feeling and what do I want to happen, how will I act) Role play 15 minutes Discuss in your group 5 minutes – How did you identify the problem? – What techniques did you use? – What was your plan as a coach to address the resistance? Share 3 minutes per group

12. Open discussion: peer sharing What have you tried in the past at the sites or in other situations to diagnose a problem? To address stalled performance measurement What other skills or approaches might be useful to have?