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Developing and Managing Quality Improvement Learning Collaboratives September, 2010 Contributors: Brenda Joly PhD, MPH Maureen Booth, MRP George Shaler,

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Presentation on theme: "Developing and Managing Quality Improvement Learning Collaboratives September, 2010 Contributors: Brenda Joly PhD, MPH Maureen Booth, MRP George Shaler,"— Presentation transcript:

1 Developing and Managing Quality Improvement Learning Collaboratives September, 2010 Contributors: Brenda Joly PhD, MPH Maureen Booth, MRP George Shaler, MPH Ann Conway, PhD Lessons from the MLC States

2 Overview Evaluation background –Components –Case study process, rationale, theory Findings and opportunities –Planning and start-up –Managing the Learning Collaborative Implications –Sponsors –Local health departments

3 MLC Evaluation Quality improvement goal: –To promote the application of QI methods Evaluation tools: –Annual survey –Mini-Collaborative survey –Quarterly reports –Case studies –Key informant interviews

4 Case Studies Who? –Mini-collaborative members and organizers –LHD quality improvement teams Why? –Multiple perspectives –“On-the-ground” understanding What? –Site visits, interviews, document review –Observations of meetings

5 Literature-Based Theory

6 Planning and Start-Up

7 Key Finding #1: Who selected targets? –State sponsors or statewide body –Local input What criteria were use in selection? –Relevance and alignment with priorities –Need demonstrated by data The Relevance of a Target Area is Critical and Impacts Engagement

8 Key Finding #2: What works best? –Involving senior leadership is essential –Having diversity in faculty adds value –Having a sufficient size to promote exchange –Working on a consistent QI project –Having clear roles and responsibilities –Having prior experience working together The Structure of a Mini-Collaborative Affects its Effectiveness

9 Key Finding #3: What did we learn? –Goals of mini-collaboratives varied and evolved Build QI skills Improve quality within target area –Goals should be aligned with timeframe and participant readiness –Expectations for QI projects should be focused, realistic and communicated Defining Expectations & Communicating Them in Advance Builds Confidence

10 Key Finding #4: Who planned the mini-collaboratives? –State sponsors –Broader group of state, faculty and others What should be planned? –Model, curriculum, workplan, use of faculty and evidence, tools to assess participant knowledge and measures to monitor progress Advanced Planning Influences the Effectiveness of Learning Collaboratives

11 Key Finding #5: What did we learn? –The planning and start-up phase is especially time consuming for sponsors –Having outside faculty helps –Level of effort is often underestimated if expectations are unclear or scope is unrealistic –Competing priorities are a reality The Level of Effort Among Sponsors and LHDs is Often Underestimated

12 Managing the Learning Collaborative

13 Key Finding #1: What was most helpful? –Learning/using fewer tools –Training on when and how to use –Providing opportunity for immediate application –Providing feedback on use –Giving LHDs a chance to practice, practice, practice Opportunities for Timely and Frequent Application of QI Tools are Essential

14 Key Finding #2: What was most helpful? –Opportunities for ongoing information exchange –In-person meetings –Structured learning sessions –Communicating the value of QI to LHDs –Site visits to LHDs –Communicating clear expectations Communication With and Among Members Enhances Learning Experience

15 Key Finding #3: Facilitating factors? –Commitment to data driven QI and accreditation –Leadership buy-in Impeding factors? –Concurrent QI skill development at state and local level –Lack of focus and clear expectations, unrealistic goals, turnover, and competing priorities Several Factors May Strengthen or Impede a QI Learning Collaborative

16 Key Finding #4: Technical assistance: –There should be a good mix of content expertise and QI expertise among sponsors and faculty Other resources: –Evidence needed to select QI intervention should be made available –Financial resources may boost efforts of LHDs It is Critical for Participants to Have Access to Adequate Resources

17 Implications for Sponsors Some considerations… –Set time aside for advance planning –Recruit credible and skilled faculty –Assess QI knowledge beforehand –Recruit the enough and the right mix of participants –Embed the application of QI into the process –Communicate with the group frequently –Follow a structured approach

18 Implications for LHDs Some considerations… –Garner support of leadership and staff –Promote the value of QI –Align QI project with job responsibilities –Actively engage in information exchange –Use faculty and available technical assistance –Remain open to the process and outcomes –Document your efforts –Share your findings

19 Developing and Managing a Quality Improvement Learning Collaborative September 2010 Contributors: Cathy Montgomery, M.S., ASQ-CQIA Cathy Montgomery, M.S., ASQ-CQIA Sandra Ruzycki, M.P.H., Quad-R Sandra Ruzycki, M.P.H., Quad-R Baker, Clay, DeSoto, Duval, Glades, Martin, Nassau, St. Baker, Clay, DeSoto, Duval, Glades, Martin, Nassau, St. Johns and St. Lucie County Health Departments Johns and St. Lucie County Health Departments Lessons from Florida

20 Planning and Start-Up

21 Plan, Plan, Plan Use data to determine target areaUse data to determine target area –Overweight and obesity among children 6-19 Create partnershipsCreate partnerships Outline timeframes and expectations ΨOutline timeframes and expectations Ψ Establish criteria for selecting participantsEstablish criteria for selecting participants Ψ = lesson learned

22 Use Criteria

23 Childhood Obesity Mini-Collaborative

24 Establish (facilitator) Goals Use of quality improvement tools and methodsUse of quality improvement tools and methods Support participants in their projectsSupport participants in their projects Communicate project impacts and outcomesCommunicate project impacts and outcomes –Local, state, national venues

25 Quality Improvement Control Story ΨQuality Improvement Control Story Ψ –Founded on PDCA Integrates QI tools and methods throughout the processIntegrates QI tools and methods throughout the process Select an Improvement Model

26 Training and Tools Assess participant’s knowledge of QI tools ΨAssess participant’s knowledge of QI tools Ψ Provide relevant trainingProvide relevant training –Just-in-time –Face-to-face Ψ Allow participants to practice using tools and processAllow participants to practice using tools and process

27 Results: Training Participation in QI training improved overall knowledge of QI tools – 84%Participation in QI training improved overall knowledge of QI tools – 84% –Baseline = 84% Confident in their ability to use QI tools – 68%Confident in their ability to use QI tools – 68% –Baseline = 62% % of participants that rated level of use of QI tools after training as:% of participants that rated level of use of QI tools after training as: moderate – 58% –Baseline = 62% high – 21% –Baseline = 15% *Surveys conducted March 2009 (baseline) and February 2010

28 Results: Tools Use QI tools in other initiatives – 83% (n = 15)Use QI tools in other initiatives – 83% (n = 15) Incorporate QI tools into ongoing work – 67% (n=12)Incorporate QI tools into ongoing work – 67% (n=12) Development of evaluation measures – 56% (n = 10)Development of evaluation measures – 56% (n = 10) Present QI tools to CHD staff – 50% (n=8) ΨPresent QI tools to CHD staff – 50% (n=8) Ψ % of participants that indicated a high readiness to:

29 Technical Assistance Conduct coaching callsConduct coaching calls –Using quality improvement process and tools –Creating action plans and storyboards –Developing methods and measures for evaluation –Analyzing data results ResourcesResources –Subject matter expertise –Books, articles, and research related to QI and projects –Evaluation database

30 Evaluation Database

31 Managing the Learning Collaborative

32 Collaborative Teams Counties created teams consisting of internal staffCounties created teams consisting of internal staff –65% of participants indicated multiple CHD programs were represented on team –3 of 9 counties had QI program staff on the team

33 Results: Collaborative Teams ΨTeam meetings were random and unproductive Ψ –53% of participants stated team meetings were only slightly productive –53% moderately or slightly agreed there was consensus on project goals and procedures % of participants that strongly or moderately agreed project team members: –Got along well – 94% –Treated each other fairly – 71% –Had necessary skills for this project – 65%

34 Results: CHD Support 59% rated level of CHD support was very or somewhat supportive59% rated level of CHD support was very or somewhat supportive 71% indicated staff time and resources were fully, mostly or somewhat available71% indicated staff time and resources were fully, mostly or somewhat available

35 Communication Provide venues for participants to share ideasProvide venues for participants to share ideas –Monthly conference calls/web ex –Face-to-face meetings –SharePoint site Conduct one-on-one coaching callsConduct one-on-one coaching calls Communicate progress of collaborative projects ΨCommunicate progress of collaborative projects Ψ

36 Results: Communication % of participants who rated the following resources as useful% of participants who rated the following resources as useful –One-on-one coaching calls:65% –Monthly conference calls: 65% –SharePoint site: 59% –Collaborating with other MCLC counties: 71% –Collaborating with other agencies: 53% Ψ % of participants who agreed or strongly agreed HPI provided:% of participants who agreed or strongly agreed HPI provided: –Effective communication: 94% –Effective project coordination: 95%

37 76% rated their overall experience as excellent or good76% rated their overall experience as excellent or good 94% rated the level of success of their project as excellent or good94% rated the level of success of their project as excellent or good 88% indicated they were likely to participate on another learning collaborative88% indicated they were likely to participate on another learning collaborative 76% reported they were likely to implement a new QI project in their CHD76% reported they were likely to implement a new QI project in their CHD Overall Experience

38 Lessons Learned Ψ What else did we learn? Planning and implementation is time consumingPlanning and implementation is time consuming –41.2% of participants spend 1-5 hours per week on project; others indicated they spend more time! Don’t assume what they knowDon’t assume what they know Competing priorities are a realityCompeting priorities are a reality


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