Support for Innovation and Improvement Learning Series

1
Support for Innovation and Improvement Learning
Series

• Foundations Session 2
• Improvement Charters
• Change Packages
• Presenter Connie Davis, MN, RN

2
Interactivity

• This session is to be interactive a real
  opportunity to share and learn from each other
  please feel free to raise your hand at any time
  to ask a question or make a comment
• You can also use the chat pod if you have any
  questions, comments, contributions, etc. we will
  pick up on these as we go along

3
What are we trying to accomplish?

• Understand the concept and key elements of an
  improvement charter
• Understand the concept and key elements of a
  change package

4
The improvement charter

• Key elements
• Aim statement
• Guidance
• Measures
• Team
• If you add your data and some narrative, it makes
  a great report to your leaders!

5
The improvement charter

• Provides vision and guidance for the improvement
  effort
• One or 2 page document
• Aim statement (answers question 1)
• Guidance
• 4-7 measures (answers question 2)
• Who is on the team leader, content experts,
  front line staff

6
Establish the aim

• Involve senior leaders
• Focus on issues that are important to your
  organization
• Write a clear statement of aim with numerical
  goals
• Guidance include anything to keep the effort
  focused (location, strategies, client
  populations, office, spread plans, etc.)

7
Example aim statement

• Improve the patient partnership in our office so
  that in one year
• no-show rate is decreased by 50
• 80 of patients have a self-management goal
• 40 of patients have improved self-confidence
• 75 say they would recommend us to a friend
• Guidance
• Budget, personnel
• Pilot size

8
How do we know that a change is an improvement?

• Measurement tells us whether or not we are
  hitting our target

9
About measurements

• Measurement is for learning, not judgment
• All measures have limitations, but the
  limitations do not negate their value
• Measures are one voice of the system. Hearing the
  voice of the system gives us information on how
  to act within the system
• Measures tell a story goals give a reference
  point

10
Measurement guidelines

• Need a balanced set of 4 to 7 measures report
  weekly or monthly to assure that system is
  improved
• Measures should reflect aim statement be
  specific
• Integrate measurement into routine
• Plot data for the measures over time and annotate
  graph with changes
• Post run charts where others can see update
  regularly

11
Types of measures

• Outcome measures
• Results - system level performance
• Process measures
• Inform changes to the system
• Balancing measures
• Unintended consequences
• What you are afraid might happen to another
  part of the system

12
Measurement example
13
Annotated run chart
14
Example of a Charter

• What are we trying to accomplish? Our Aim
  Statement is
• The Opportunity Center and Dr. Fits office
  practice will work together for the next 8 months
  to improve health literacy and better understand
  how to measure improvements for health literacy
  in our region. Key strategies include working
  together to build better relationships, enhancing
  understanding, and partnering with non-office
  practice resources.

15
Example of a Charter

• Improvement measures and goals that we will test
  through December 2009 include
• 95 of Dr. Fits patients will report that the
  health provider explained things in a way that
  was easy to understand
• 95 of Dr. Fits patients feel that the provider
  took their ideas, beliefs, and what they wanted
  into account as they worked on a care plan
  together
• 95 of literacy learners will use teach back for
  medications when prescribed
• we want to develop a measure for how much time
  this takes in the office practice and in the
  literacy program

16
Example of a Charter

• Guidance
• It is important to work on this now because many
  of the residents in our community are affected by
  low health literacy. Dr. Fit will start with
  his patients with chronic conditions and then
  apply what is learned to all patients. The
  literacy program will work with new learners each
  quarter.

17
Example of a Charter
How will we know that a change is an improvement?
Our measurements are
18
Example of a Charter
Team Members

• Jenny Jones Literacy Outreach Coordinator
• George Grant Literacy Practitioner
• Jill Jackson Literacy Student
• Dr Frank Fit Family Physician

• Tammy Teal Medical office assistant (MOA)
• Betty Blue Health authority practice support
  coordinator
• Alice Aim Opportunity Coordinator Exec. Director

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Criteria for Charter

• Clear aim statement?
• Is will described? Links to larger strategies?
• Is there any guidance?
• Are there numerical goals?
• Does the measurement package make sense?
• Are there outcome, process and balancing
  measures?
• Are there 4-7 measures?
• Is the team described? Does it make sense?
• REMEMBER--the charter will evolve!

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Change package

• Captures what is known about the ideal
• Created by experts evidence from literature
  those who have done it in practice
• Examples Advanced Access, Office Efficiency,
  Transforming Care at the Bedside, Decreasing
  Ventilator-Associated Pneumonia, Flow

21
Example of a change package

• Expanded Chronic Care Model-6 elements
• SMS Empower prepare patients to manage their
  health and health care
• DSD/reorient Assure delivery of efficient,
  effective clinical care and self-management
  support
• DS Support clinical care that is consistent with
  scientific evidence and patient preferences
• ETC

22
BCs Expanded Care Model
Build Healthy Public Policy
Community
Create Supportive Environments
Strengthen Community Action
Health System
InformationSystems
Self-Management Support/Develop Personal Skills
Delivery System Design/Re-orient Health Services
Decision Support
Prepared, Proactive Community Partners
Productive Interactions and Relationships
Prepared, Proactive Practice Team
Informed, Activated Patient
Activated Community
Population Health Outcomes Functional and
Clinical Outcomes
http//www.healthservices.gov.bc.ca/cdm/cdminbc/ch
ronic_care_model.html
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Self-management support develop personal skills

• Emphasize the patient's central role
• Use effective self-management support strategies
  that include assessment, goal-setting, action
  planning, problem-solving and follow-up
• Organize resources to provide support

24
A good change package will have different levels
of detail
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Next Supporting Innovation and Improvement Web
Conference

• Please fill out the survey
• Next call Nov 03, 2009
• Structured Collaboratives/Breakthrough Learning
  Series
• Supporting Action Periods
• Learning Communities