Fostering Change: How to Engage the Practice

Julie Osgood, MSSenior Director, Operations

MaineHealthSeptember 25, 2009

I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME

activity.

What is MaineHealth?

• Integrated healthcare delivery system serving central, southern, and western Maine (serves 11 counties)

• Established the AH! Asthma Health Program in 1998

• Ran asthma collaboratives in 2002-2006• Interest in improving asthma care and

outcomes in communities

Practice Engagement

• Why it’s important (need more here)– By engaging your practice early on in this

program, you will remove barriers to spreading this work throughout the year

Change is Hard

“Systems are Systems are perfectlyperfectly

designed to get the designed to get the results they achieve” results they achieve” --Paul BataldenPaul Batalden

Current “Systems”

All Teams : April 2002 to March 2003

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Classification Controller Meds

Aggregate Improvement

Pre

Post

+22%+52%

Team Improvements: April 2002 to March 2003

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

classification controller meds

MMC Family Practice Center

PrePost

+43%

+23%

As a result in the Collaborative, I feel our team...

0%

10%

20%

30%

40%

50%

60%

70%

80%

Is better able tomanage asthma

proactively

Has office visitsand interactions

w ith asthmapatients that are

now moreproductive

Is better able tomeet the needsof our asthma

patients

Finds ourasthma patientsbetter preparedto self-manage

their illness

Communicatesbetter w ith ourasthma patients

Questions

Perc

ent

Strongly agree

Agree

Undecided

Disagree

Strongly disagree

Agree 52%

Strongly agree 44%

Disagree 4%

Overall, I feel that my time involved in the Collaborative was worth the effort

How’d they do it?

Key lessons on practice engagement and success from TOP performers:

1. Team Function2. Clear goals 3. Communication/Sr. Leadership

involvement4. “S” in PDSA5. Support

How’d they do it?

Key lessons on practice engagement and success from TOP performers:

1. Team Function2. Clear goals 3. Communication/Sr. Leadership

involvement4. “S” in PDSA5. Support

Why a Team?

• Focus has changed from provider centered to patient centered

• Each team member has a role and contributes to the team

• Invigorates the practice• Improves patient care and satisfaction

Team Function• Clear roles for each team member

– Everyone has a responsibility for the patient with asthma. What are they?

– Map out what currently happens in your practice and then what you would like to happen. Who does what and why.

• Consider your patients as members of the team– Are their needs being met?

• Make decisions / negotiate• Share resources, knowledge, skills• Provide support, feedback• Acknowledge contributions

Team Function

• Meet on a regular basis as a team– Have written agendas which are distributed

prior to the meeting– Assign roles: Leader, Time Keeper, Recorder

(optional: facilitator)– Distribute minutes after meeting (focus on

ACTION items—who’s doing what by when– Make it fun! Provide lunch if possible (food will

get your team to show up!)

How’d they do it?

Key lessons on practice engagement and success from TOP performers:

1. Team Function2. Clear goals 3. Communication/Sr. Leadership

involvement4. “S” in PDSA5. Support

Clear Goals

• Create clear, achievable goals and share them widely– Post goals in a visible location—for staff and

patients– Provide regular updates on progress toward

goals (helps keep team motivated)

MMC Family Medicine

How’d they do it?

Key lessons on practice engagement and success from TOP performers:

1. Team Function2. Clear goals 3. Communication/Sr. Leadership

involvement4. “S” in PDSA5. Support

Communication

• Figure out who your key stakeholders are and get them involved early and often– Senior Leaders– CEO’s– Key administrators– Others

• Send monthly progress reports to senior leaders and get their buy-in– Aids in visibility of project and creates natural

“champions”– Aids in team accountability

Communication

• Schedule a time to meet with all providers on a monthly basis – A forum for updates, reviewing data,

discussing tests of change, and an opportunity to find providers that are ready to join the testing

– Maybe some healthy competition?

How’d they do it?

Key lessons on practice engagement and success from TOP performers:

1. Team Function2. Clear goals 3. Communication/Sr. Leadership

involvement4. “S” in PDSA5. Support

Model for Improvement

What are we trying to accomplish?

What change can we make that will result in improvement?

How will we know that a change is an improvement?

Framework

Source: The Improvement Guide, Langley, Nolan, Nolan, Norman, Provost

Act Plan

Study Do

Plan, Do, Study, Act

• Plan for change or test: who, what, when, where• Plan for collection of data: who, what, when,

where• Do: Carry out the change or test; collect data

and begin analysis• Study: Analyze data and summarize findings• Act on your findings and start next cycle.

The PDSA Cycle for Learning and Improvement

Act-What changes are to be made?

-Next cycle?

Plan- Objective

- Questions and predictions (Why?)

- Plan to carry out the cycle(who, what, where, when)

Study- Complete the analysis of the data

- Compare data to predictions

- Summarize what was learned

Do- Carry out the plan- Document problems and unexpected observations

- Begin analysis of the data

Study Your Tests of Change

• Too often teams implement a change and forget to study it (and subsequently forget the ‘Do’ where you have an opportunity to tweak the change)

Tips for Success

• Improvement occurs in small steps• Repeated attempts needed to implement

new ideas• Assess regularly to improve plan• Failed changes = learning opportunities• Plan communication• Engage leadership support

How’d they do it?

Key lessons on practice engagement and success from TOP performers:

1. Team Function2. Clear goals 3. Communication/Sr. Leadership

involvement4. “S” in PDSA5. Support

Support

• Look around you: identify peers who can support your efforts

• Know key staff who can provide technical support

• Use your team—lots of expertise sitting next to you

• Use listserv, conference calls, other opportunities to interact with others: you are in this TOGETHER!

What are your barriers?

• Brainstorm and connect with your colleagues!

It’s Time to Start…

• Start where you are.• Use what you have. • Do what you can. ~ Arthur Ashe ~