Interprofessional CollaborationWhat does it look like…

Interprofessional Collaboration

As I began to prepare for this presentation, I began to research, after all, I was asked to speak about this and I wanted to be prepared!

So here’s a picture of what it initially looked like for me…

4) Now on to what interprofessional collaboration can look like!

The Beginning

Interestingly, I had no idea exactly what was in store for me.

I was asked to be part of an initiative, which was called the Outpatient Quality Improvement Network or OQUIN …

 

What is OQUIN?

Outpatient Quality Improvement Network (OQUIN) was started in 1999 to improve the cardiovascular health of SC.

At this time SC ranked 33rd nationwide in CV health.

The goal? Worst to first!

Initially 20 physicians, 3000 patients.

2011 - 9000 physicians, 1.94 million patients.

OQUIN has helped propel SC to 17th in CV health.

How did they do it? Collaboration was key!

OQUIN received medical summary information.

The data was then analyzed and returned to the practice in the form of a ‘report card’.

This report allowed the practices to monitor the CV health of patient population

This data was then used to drive decisions, care, quality improvements and research.

The Benefits…

Quality monitoring at no cost to the provider!

Comparisons to other local and national practices.

Quarterly reports to guide care and improvements.

Assistance with NCQA accreditation and medical home certification

But perhaps most importantly,

Nurses from some of the involved practices were trained in Lean Six Sigma to assist with research and quality improvement initiatives.

In 2012 OQUIN Announced something new…Pediatrics

This was exciting since:

Catching our clients at a younger age allowed for

more time to intervene and change health habits.

More time to improve their health =

improved health = decreased cost

Ultimately, improved health outcomes for the children of SC

Center of Pediatric Medicine

Where it all started…

Did you know…?

CPM:

one of the largest pediatric ambulatory care centers in the state of SC.

Approximately 18,000 patients

50,000 visits per year

Committed to obtaining PCMH certificationNCQA accreditation

The Tool: Lean Six Sigma and DMAIC

Lean Six Sigma quality improvement methodology developed Bill Smith and used by Motorola

Variation is the enemy!

LSS levels go to 7

Variation, defects/ million

It follows the steps of DMAIC, Define, Measure, Analyze, Improve, Control

The first step is look for something broken so you can fix it..

Starting, was the hardest part! LSS was

the guide…As with anything, starting was the hardest part!

But this is where LSS training kicked in

There were steps to follow to define the problem

A charter was developed

The question was developed

The timetable was mapped out

Team members were selected

The Team: Different Strengths

Different Perspectives

Project sponsors: OQUIN team

Champions: Tom Moran, Katy Smathers

Liaison: Sabrena O’Connor

ECW: Cindy Garnett

Nursing: Tammy Gladson, Susan Skyette

Physician: Doreen Patterson

IT: Daniel Leonard

Team charter is an important part of define

Team Charter includes:

Business case: So what?

Project Statement: What is broken?

Goal Statement: What is the goal?

Project Scope: What is the start and end point of the process in question?

Project Plan: Timeline!

Team Members: Who will help and why?

I was ecstatic when we discovered

we had a problem….!

Not all children were havingtheir heights measured with each visit…

No height = No BMI

We didn’t know why at this point and no intervention was planned, that would come much later..

Define summary…

The voice of the customer (VOC): Business case in charterHealth of the pediatric patientsClinic’s desire to become a patient centered medical home (PCMH)Initially, obesity counseling was not reimbursable

The critical to Quality (CTQ): GoalDiagnose patients with BMI’s greater than or equal to 85%, 100% of the time for patients aged 2 to 18 years of age.

The charter included a project plan, which outlined projected dates for the DMAIC steps. A SIPOC mapped the process.

Upon check in the nurse needed to obtain and chart a height and weight as both these calculations were needed to calculate a BMI.

Once these were inputted into the computer the obesity identification process ended.

So we had defined our problem…

Set goal the goal - 100% BMI identification

Reviewed the process with a SIPOC to discover what process was involved …

Height and weights were assessed during check in…

So what started the check-in process?

What ended the check-in process?

Then we begin to Measure…

Parameters were set for measurement of the problem…all children ages 2 – 18 years of age were to have heights and weights obtained on every visit.

A baseline measurement was needed so we met with Daniel in IT to determine which visits would be included.

The baseline measurement was established

We discovered only 77.55% of the appropriate visits had BMIs charted,

22.45% of the patients had no BMI recorded.

Why?

Here is where we had to analyze!

Why were we missing data?

Brainstorming and a cause and effect matrix revealed

Nurses were not obtaining heights on triage visits

Misconception that this data was not retrievable for meaningful use anyway!

So we worked to Improve…

The staff was engaged

A presentation of the importance of height and weight was made

The goal was to obtain heights, as well as, weights on all children ages 2-18 for BMI calculation

IT assisted with data collection, before and after to ensure parameters were the same

Process improvement implemented:Before 22.45% of BMIs missing, After 1.46% were missing.

We improved! Now how do we control the

gains?

To control the gains:

Owner’s Manuel

Chart Audits

IT

Obesity Identification Initiative

Barriers …

Being a new investigator,

Starting was the hardest part but the direction supplied by LSS, OQUIN and a visionary CPM management team helped.

It was difficult for everyone to see the relevance at first and in such a busy practice this is understandable

But,it was through working jointly on the Obesity Initiative and other projects that understanding and support have increased ….

Interprofessional Collaboration

The very act of mutual goal setting and problem solving increased respect and appreciation for the different strengths, ideas and opinions of each team member.

Their different roles, goals and perspectives enriched the process

Contacts from within and from without of GHS increased to get the job done.

Ultimately, building rapport and mutual respect.

We started a research project but ended with a interprofessional collaborative team!

Lastly, there is something new in

GreenvilleRecently OQUIN merged with the GHS.

It is now called the Care Coordination Institute.

This is very exciting for our community and for the upstate!