fostering change: how to engage the practice julie osgood, ms senior director, operations...
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Fostering Change: How to Engage the Practice
Julie Osgood, MSSenior Director, Operations
MaineHealthSeptember 25, 2009
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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.
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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
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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
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“Systems are Systems are perfectlyperfectly
designed to get the designed to get the results they achieve” results they achieve” --Paul BataldenPaul Batalden
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Current “Systems”
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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%
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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%
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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
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Agree 52%
Strongly agree 44%
Disagree 4%
Overall, I feel that my time involved in the Collaborative was worth the effort
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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
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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
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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
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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
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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!)
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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
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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)
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MMC Family Medicine
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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
![Page 27: Fostering Change: How to Engage the Practice Julie Osgood, MS Senior Director, Operations MaineHealth September 25, 2009](https://reader035.vdocuments.site/reader035/viewer/2022070406/56649e0e5503460f94af7fb2/html5/thumbnails/27.jpg)
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
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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?
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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
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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
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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.
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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
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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)
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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
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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
![Page 36: Fostering Change: How to Engage the Practice Julie Osgood, MS Senior Director, Operations MaineHealth September 25, 2009](https://reader035.vdocuments.site/reader035/viewer/2022070406/56649e0e5503460f94af7fb2/html5/thumbnails/36.jpg)
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!
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What are your barriers?
• Brainstorm and connect with your colleagues!
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It’s Time to Start…
• Start where you are.• Use what you have. • Do what you can. ~ Arthur Ashe ~
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