THE FUTURE

WE'RE DESIGNING TOGETHER

BCBSM PGIP

June 13, 2008

TOMORROW CALLS…

� Past effects and current states

� Framing the future

� Answering different questions

Doing transformation� Doing transformation

� “I want to…”

IT’S BEHAVIOR CHANGE!

� Concepts that will help create new behaviors

� New solutions that will not only manifest the team’s

values but will also facilitate new behaviors toward values but will also facilitate new behaviors toward

work, colleagues and patients

� Tools and technology alone do not create change but

support and enable behavior that drives the model of

care

PATIENT CENTERED MEDICAL HOME

� Will we know it when we see it?

� How will we recognize it?

� What are the signs of the model?

� Who will introduce it?� Who will introduce it?

� Where will direction come from?

� Who will lead the change?

� Where is the toolkit?

� Where can I get trained?

� Where do we start?

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“TURNING THE TITANIC”

� Systems change

� Policy implications

� Spending-investment

� Family-owned medical practices� Family-owned medical practices

� Education

The Titanic…

“WORDS THAT CREATE WORLDS”

� Imagine

� ‘Balanced approach’

� Prosperity

� Certified� Certified

� Patient-Centered

� Investment

� Efficiency

� 6R’s2007

HOW CAN AN ORGANIZATION GET THERE

� Senior leadership aligns work with a strategic plan

� The organization aligns the planned care model and model for improvement with the quality management system

� The organization aggressively goes after “delivery � The organization aggressively goes after “delivery system design” and pushes the envelope

� PDSA cycles became part of daily work, not just a pilot team

� The organization monitors performance

� The organization reinvents itself around the world of the patient

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WHAT CAN YOU DO AS AN INDIVIDUAL?

� Be a change agent

� Talk about dreams

� Challenge the status quo

� Be a role model� Be a role model

� What, so what, now what!

� Focus on what you can influence

� Be patient

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WHAT CAN YOU DO AS A LEADER?

� Drive quality as a business strategy

� Align the internal management systems to support

quality

� Drive the spread process� Drive the spread process

� Be a role model and make this work a priority

� Devote time, energy and resources

� Dare to soar

� Be the lead sled dog

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THE BEGINNING

� Pre-work

� Team Building

� Learning Events

� Team Meetings

PDSA Cycles� PDSA Cycles

� Monthly Reports

� Team Conference Calls

� Team Webinars

� Breakdown the Day’s Activities

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PRE-WORK: PRACTICE MENTOR

� IHI Quality Tools

� Select practices that as ready-to-go

� Train the trainer

� Develop inter cadre of mentors based on KSA� Develop inter cadre of mentors based on KSA

� Assess the KSA for core competencies

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LEARNING EVENTS

� Primary care

� Physician organization

� Community

� Events led by trained individuals or organizations

� Learning events should have learning objectives and

learning outcomes

� Organizations or companies leading the charge should

be IACET (International Association for Continuing

Education and Training) for continuing learning events

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TEAM BUILDING

� Tools

� Invest in life coaches

� Leadership retreats

� Team retreats� Team retreats

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TEAM MEETINGS

� How to run meetings

� Planned care

� Huddles

� Learning time

Sharing time� Sharing time

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QUALITY IMPROVEMENT STRATEGIES

� Quality Improvement Tools

� Process Mapping

� PDSA

� Standard operating guidelines� Standard operating guidelines

� Practice management strategies

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MONTHLY STATUS REPORT

� Progress report

� Team evaluation

� Quality improvement status

� Mentor engagement and assessment� Mentor engagement and assessment

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TEAM CONFERENCE CALLS

� Access to mentor

� Access to physician

leadership

� Access to coach

Action items� Action items

� Action plan

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TEAM WEBINARS

� Ongoing learning events that integrate new approach

to training and education with eventual integration

into patient care

� Remote group visits

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CHALLENGES

� Work with them

� Coach them

� Non-confrontational strategies

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VISIONING THE FUTURE

Dream

Discovery“What gives life?”

(The best of what is)

APPRECIATING

Destiny Dream“What might be?”

(what the world is calling for)

ENVISIONING IMPACT

Destiny‘How to empower, learn,

And adjust/improvise?”

SUSTAINING

Design“What should be the ideal?”

CO-CONSTRUCTING

Cooperrider et al, 2000

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KEEPING IT REAL

� The ‘what’ is clear…

� The ‘why’ is evident…

� The ‘how’ is …

TRANSFORMATION

� Diagnose

� Envision the future

� Pave the road

� Implement Tabrizi, 2007

Lake St Clair

EXECUTING THE FUTURE

� ‘Lighthouse theory’

� Communicating the reality

� Score-carding

� Linking the ‘way’ with the ‘how’ � Linking the ‘way’ with the ‘how’

� Treating it as a ‘turnaround’

Big Red, Holland

Morgan et al, 2007