Welcome to the “Preparing for the BTS College” WebEx!

October2andOctober7,2014

Please feel free to type a message in the bottom area of your screen if you have any questions.

If you do not see an image of a phone next to your name, please hang up and dial back in.

Welcome To the BTS College!You are now a member of the College with over

800 members, all working on collaborative improvement.

Objectives for the College: Equip you to operate a successful Collaborative improvement projectIncrease your ability to teach and use the Model for Improvement, an improvement strategy used in the Breakthrough Series (BTS)

IHI Faculty and Staff

Marie Schall, DirectorSandy Murray, Improvement AdviserKelly McCutcheon Adams, 2015 DirectorLauren Showalter, Program and Event Manager

Marie Sandy Lauren

The IHI BTS College Team

Kelly

WebEx Agenda

Orientation to the WebExCollaboration For ImprovementGetting Results: The Breakthrough Series Preparing for the College Session• Topic, team, timeline, storyboard• Beginning with the end in mind-Spread

Questions

Orientation To WebEx

L

How to mute your line to avoid background noise

Or

Press *6 on your phone to mute and

un-mute!

Option A Option B

1. Highlight your name

2. Right click3. Press mute!

Tools for Our Interaction!

To de-select any of these tools simply click the eraser icon.

To raise your hand

Emoticons and applause!

When polling Yes!When polling No!

Have more to say? Use the

Chat Box!Select who you would like to send the

message to:

College Members (…..and Some WebEx Fun)

M

Where are you joining from?

WebEx Introductory Session Objectives

To introduce IHITo enhance your understanding of collaborative learningTo understand BTS Collaboratives and what they have achievedTo begin or continue developing a concept for your collaborativeTo prepare for the College Session

Our VisionEveryone has the best care and health possible.

Who We AreIHI is a leading innovator, convener, partner,

and driver of results in health and health care improvement worldwide.

Our MissionTo improve health and health care worldwide.

About IHI

IHI’s Work: Five Key Areas14

The Way We Work: A Leverage Strategy

Goal: Build reach and will to accelerate the pace of improvement worldwide

Goal: Harvest, create, and test bold, innovative ideas and new models of care that support our strategic initiatives

Goal: Offer programming to transfer knowledge and build improvement capability

Goal: Leverage strategic partnerships and key initiatives to achieve ambitious improvement goals

Leading the Way16

Thought leadership and innovation

– Triple Aim– 100,000 Lives Campaign– 5,000,000 Lives Campaign– WIHI– Breakthrough Series College– Global Trigger Tool– Bundles– Patient Safety Officer Training

Ground breaking initiatives– STAAR– Open School– Project Fives Alive!– Maternal and Child Health (Malawi)

– IMPACTThe Conversation Project

Global conferences and meetings

– National Forum on Quality Improvement (25+ years)

– International Summit on Improving Patient Care in the Office Practice and the Community (15+ years)

– International Forum on Quality and Safety in Healthcare (17+ years)

– Latin America Forum – The APAC Forum on Quality

Improvement in Health Care– Strategic Partner Camps

Proven Methodology: Science of Improvement

W. Edwards Deming1900-1993

API’s Model for Improvement

Collaboration for Improvement

Top down

Bottom up

Leadership processes• Aim setting• Resource allocation• Review

Strategies for Improvement:

Spread of operational systems Collaborative projects Fundamental redesign Local incremental improvements Control of quality

Local improvement capability

Results

Defect removal

Cost and productivity improvement

Design of attractive products and services

An Integrated Approach to Improvement

What Is Collaboration?

Joint effort among multiple organizations that share resources and informationEach organization benefits individually, even though the organizations are working together

Discussion about Experiences --Positive and Negative

What has been your experience with any collaborative projects or Collaboratives you have experienced? – What has been good about them?– What could have been better?

Methods for Spreading Improvement

Breakthrough Series Collaborative modelExtension agentsEmergency mobilizationCampaign modelGrassroots organizingWave sequence (wedge and spread)Hybrid models

22

Getting Results: The Breakthrough Series

S

The IHI Breakthrough Series-How It Began

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

- Goethe

S

The IHI Breakthrough Series

An improvement method that relies on spread and adaptation of existing knowledge to multiple settings to

accomplish a common aim.

IHI Breakthrough Series(6 to 18 Months Time Frame)

Select Topic

(Develop Mission)

Planning Group

Develop Framework & Changes

Participants (10-100 Teams)

Prework

LS 1

P

S

A DP

S

A D

LS 3LS 2

SupportsEmail Phone Conferences

Extranet Visits Assessments

Sponsors Monthly Team Reports

DisseminationPublications,

Congress, etc.A DP

SExpert Meeting

AP1 AP2 AP3*

LS – Learning Session

AP – Action Period

*AP3 –continue reporting data as needed to document success

Holding the Gains

IHI Goals for a BTSAchieve results (e.g.)– 90% of all children within each Community

Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017. (Early Years)

– Reducing surgical site infections by 30%– Reducing waits and delays by 50%– Reducing exacerbations for patients with CHF

by 50%

Goals for a BTSAccelerate improvement-get results faster!Define, document, and disseminate good ideasBuild clinical (and community) leaders of change

The IHI Breakthrough Series Is Not:

Research for new clinical knowledgeSingle-setting (single team) focusSmall changes to existing systemsAn on-going learning networkA consulting engagement

Contrast: Collaborative vs. Consulting Model

Collaborative• Learning from one is spread to others• One-to-one contact - Always apply to others

Consulting• Objective is single focus improvement• Spread is difficult

Attributes of a Successful BTS Collaborative

Clear aim that is important to the organizationAction-orientedResults focused - accelerate improvement-Defined timeframeChange ideas with a pedigree (Change Package developed from ideas supplied by experts in the topic)Use of Model for Improvement

Attributes of a Successful BTS Collaborative (Cont.)

Support system for the participants to collaborateLeadership structure to keep up the paceA culture is established with specific values: • Everybody learns, everybody teaches• A sense of “family” and support• Urgency-need results now!

Learning from the BTS:Project Progress Assessment Scale

0.5 - Intent to Participate1.0 - Charter and team established1.5 - Planning for the project has begun2.0 - Activity, but no changes2.5 - Changes tested, but no improvement3.0 - Modest improvement3.5 - Improvement4.0 - Significant improvement4.5 - Sustainable improvement5.0 - Outstanding sustainable results

Relationship Between Factor Ratings and % 4’s in BTS

%4's vs total factor ratings

0

10

20

30

40

50

60

70

80

90

100

15 17 19 21 23 25 27 29 31 33 35Total Ratings on 7 Factors

perc

ent 4

's

Seven Factors Rated 1-5(Score of 21 = Middle ratings of factor)

• Great Change Package• Measures that Work• Focused topic • Results focused chair, faculty• Individualized support• Leverage Early Adopters •Teams are motivated Worst 9 performing BTS’s

Best 9 performing BTS’s

= 3 Collaboratives

IHI Experience: Specific Factors that Contribute to Success in Project Set-up

Ripe topic with at least moderate degree of belief that theory will lead to improvementUse of clear Charter for recruiting teamsTeams have will and resourcesSponsors involved Change ideas with a pedigree (Change Package developed from ideas supplied by experts in the topic)– Ideas most powerful– Ideas sequenced

IHI Experience: Factors that Contribute to Success in Project Execution Action Oriented: Use of Model for Improvement-lots of testingMeasurement system that connects testing to tracking progress– Each team has goals with measures to match– Required monthly reporting with measurement tracked monthly

Great Learning sessionsRobust Action Periods– Good communication system (listserv/extranet/ great calls)

Oversight– Tracking progress, participation, connecting teams, fostering

shared learningA culture is established with specific values: • Everybody learns, everybody teaches• A sense of “family” and support• Urgency-need results now!

Improving Collaborative Performance

Ovretveit J., Bate P., Cleary P., Cretin S., Gustafson D., McInnes K., McLeod H., Molfenter T., Plsek P., Robert G., Shortell S., Wilson T. Quality collaboratives: lessons from research. Quality and Safety in Health Care 2002; 11(4):345-351.

Review the above mentioned article on mistakes made in collaboratives before the College Session

At the session, we will discuss the mistakes you “almost made” and how to avoid them

Summary: What Makes the Breakthrough Series Work?

Will • Visible commitment (Participating)• Create peer pressure (Learning Sessions) • Focus on results (Monthly reports)

Ideas• Focus on content (Change Package)

Execution• Focuses on testing, learning, adapting, implementing

Preparation: Review of the Preparatory Materials

See Preparatory Materials • Topics – page 3• Leadership Team – page 4• Timeline – page 6• Storyboard – page 8• Driver Diagram – page 12• Agenda – page 11

M

See Resource File on Driver Diagrams

40

S

IA Track Content at CollegeIA role in expert meetingIA role with Charter and with Pre-Work Starting to draft the Change PackageGetting started on a Measurement systemAssessing team progress Science of Improvement and the theory behind the BTS model (Deming’s system of profound knowledge)Key improvement principles guiding IA workRelationship of research and improvement effortsDeveloping effective graphs to display measures1. Why plot key measures in time order?2. How often to plot data throughout the improvement effort3. Specify a balanced set of measures for all improvement efforts4. Choose the appropriate statistics to plot5. Conserve measurement resources through sampling and integration into daily work6. Develop excellent visual displays of the measures

S

Director Track Content at CollegeHow we use the technical content (charter, change package and measurement)Preparing teams, material and faculty for the collaborativeDesigning and running Learning Sessions (agendas, faculty, exercises, outputs) and Action Periods (conference calls, online discussion, reporting and feedback to teams, and senior leader engagementGuiding (tracking progress, milestone reviews) and closing a collaborativeProblem solving and planning your collaborative

M

Beginning With the End in Mind:

The BTS is a part of an overall strategy for spread of

improvement throughout your organization

S

Improvement

Hold Gains

Spread

Creating a New System

Improvement Hold Gains Spread

BETTER

The Total Health Care System

Small-scale tests of change

System or Population of Focus for the BTS (Defined by team’s Aim)

Target Population for Spread

A PS D

A PS D

A PS D

A PS D

A PS D

A PS D

Examples of Spread

For a hospital:– Two units to all units– One patient population to all patients

For an Integrated Delivery System:– Two clinics to all clinics– One chronic disease to several

For a Quality Improvement Organization (QIO):– Five hospitals to all hospitals

For a national organization:– One region to all regions

So…Why Think About Spread Early in Your Collaborative Planning?

For those planning a collaborative:– Helps identify which organizations to invite to

collaborativeFor your teams:– Aids in team’s selection of their pilot

population– Can think about who to involve and cultivate

relationships for spread

Exercise: Building A Long-Term Spread Strategy (from Prework)

1. Do you expect to spread the work of your Collaborative teams to the rest of your organization? What is the timetable for this?

2. What (or who) are the appropriate "units" for adopting changes from your change package? Who will make the decision to begin using the new ideas in their practice? Some examples of potential “units” include physicians, surgeons, emergency departments, hospitals, nursing units in a hospital, clinics, laboratories, or pharmacists.

3. How many total units do you intend to spread to? This could be all eligible units or some defined subset of them.

4. How many units will you select to attend your initial Collaborative? What percentage of the total units is this? How will you select these initial units?

Example: VHA Advanced Clinic Access Spread Project

Spread What: A sustainable system for patient access by spreading a set of key access changes

1. Do you expect to spread? What is the timetable?– Yes. March 2001-Jan 2003

2. What (or who) are the appropriate "units" for adopting changes from your change package?

– Organizations (e.g. clinics)3. How many total units do you intend to spread to?

– More than 1,800 clinics throughout the US. All clinicians (approximately 4,500) in six clinic types (Primary Care, Eye Care, Audiology, Cardiology, Orthopedics, Urology) in 172 medical centers and over 400 outpatient facilities.

4. How many units will you select to attend your initial Collaborative? What percentage of the total units is this? How will you select these initial units?

– 134 clinics representing approximately 13%– Those with strong opinion leaders eager to improve– Will recruit teams in each of six clinic types

Our Planning

Counts on…..– Your team completing the storyboard prior to the BTSC– This spread exercise is part of it− We have allocated time in the agenda to discuss the questions this

raised for your team

● Have not allocated time to do the exercise at the BTSC

● So… please do complete it prior to the BTSC

Next Steps: Getting Ready For The College Session

Complete Roles and Responsibilities Matrix in Pre-work PacketReview the Model for Improvement:http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx

or by video:http://www.ihi.org/offerings/VirtualPrograms/OnDemand/ImprovementModelIntro/Pages/default.aspxDiscuss your spread strategy with a senior leader in charge of system-wide improvementDecide on a Collaborative Topic Create a Storyboard

– Please print out 1 copy and bring to the CollegeFaculty and Staffing WebEx REQUIRED

– Audio recording available but recommend attending call.

M

Faculty and Staffing WebEx Information

Date: Wednesday, October 15, 2014Time: 1:00 - 2:00 pm EST Session #: 651 613 230 #