SPREADING AND SUSTAINING STRATEGIES FOR SENIOR LEADERS AND TEAM MEMBERS St. Anthony Amofah, MD, MBA Medical Director, Helen B. Bentley Family Health Center, Inc Miami, Florida

WHY ARE WE HERE TODAY? Knowledge of burden of chronic diseases Desire to help to reduce health disparities Appreciation of value of Collaborative Models BPHC Expectation Desire to share selflessly and steal shamelessly on strategies to spread and sustain gains

OUTLINE Definition of Spread/Sustain Preparing for Spread Spreading Sustaining gains Take home messages Discussion (What else can we learn from each other?) GOAL: TO ENGAGE GROUP IN A DISCUSSION AT THE END OF WHICH EACH OF US WILL BE ABLE TO TAKE SOMETHING BACK TO OUR CENTERS ON HELPFUL STRATEGIES FOR SPREADING AND SUSTAINING CHANGES.

“SPREAD?” Learning from changes that have resulted in improvement in one area (provider panel, site, disease, etc) and then implementing them in other areas. “SUSTAIN?” Holding gains Maintaining improvements “Cementing” positive changes into system of care

PROCESS OF SPREADING PREPARING FOR SPREAD SPREADING SUSTAINING CHANGES

PREPARING FOR SPREAD (Minimum Necessary Requirements) (1) SELECT SPREAD TEAM Importance An effective team –Serves as the coach, coordinator, etc –Keeps plans moving forward –Keeps everyone focused –Serves as a reminder when people get distracted

PREPARING FOR SPREAD (Minimum Necessary Requirements) (1) SELECT SPREAD TEAM Membership –Provider from Pilot Team –Senior Leader –Team Leader/Member of Pilot Team –New Members: New Provider, New Support Staff, Office Manager Desirable New Member characteristics –Enthusiastic, Open to new ideas, People skills, Willing to work extra hours

PREPARING FOR SPREAD (Minimum Necessary Requirements) (2) PERFORM READINESS ASSESSMENT –Should be done by New Team –Must include Executive Director –Assign primary responsibility for areas needing work Importance Potential barriers to success are addressed Process helps team to “bond”

READINESS ASSESSMENT ALGORITHM Did Pilot Team Succeed? Importance of pilot team success Motivating to team, senior leader, other staff Lends credibility to changes made Measures of success Outcomes measures Process Structure Most likely reasons for failure Lack of visible management support Lack of effective team leadership Team not empowered

READINESS ASSESSMENT ALGORITHM Did Pilot Team Succeed? Is Improvement in Chronic Disease Care in Strategic Plan? yes no Management must assume ownership Go back to “drawing board’ and start Over (You are not ready for spread). SOLUTIONS

READINESS ASSESSMENT ALGORITHM Is Improvement in Chronic Disease Care in Strategic Plan? What is an “Effective” Strategic Plan (A living, breathing strategic plan) -Reflects Board/Management’s vision -Is shared regularly with middle management -Is translated into a departmental work plan with line staff involvement -Is evaluated periodically For this to be a useful step in improving chronic disease care -Center must have an effective strategic plan -Improving chronic disease care must be included in it.

READINESS ASSESSMENT ALGORITHM Did Pilot Team Succeed? Is Improvement in Chronic Disease Care in Strategic Plan? Are measures Included in PI Plan? Develop effective Strategic Plan Formal written proposal to Board/Mmt -Emphasize importance -Summarize goals/measures Formal proposal to PI Committee -Summarize importance -Give details of goals/objectives, evaluation method Include in PI calendar of activities Standing agenda item yes no Management must assume ownership Go back to “drawing board’ and start over (You are not ready for spread). SOLUTIONS

READINESS ASSESSMENT ALGORITHM Can staff maintain Registry? Reasons for inability to maintain Registry -No assigned primary responsibility for data entry -No accommodating delivery system design

READINESS ASSESSMENT ALGORITHM Is someone in Leadership Responsible for Spread? You are ready to spread yes no Assign responsibility -Person must attend/have attended a Learning session. Can staff maintain Registry? yes no Assign primary responsibility (?Admin. Clerk) Define accommodating delivery system design Recruit data entry clerk

PREPARING FOR SPREAD (Minimum Necessary Requirements) (3) DEVELOP A WRITTEN PLAN Importance –Serves as a roadmap Must include –Defined aim statement/key measures/action steps –Resources (Staffing, Equipment/Supplies, Funding) –Discussion of potential barriers –Support system –Communication plan –Responsible person for each objective and timelines. –(Consider plan for each model component)

PREPARING FOR SPREAD (4) INTENSIVE EDUCATION PROCESS WHO? –Educate new team members, target staff, support staff, and then entire staff WHAT? –Provide education on: What changes are being made, why the changes are being made and how the changes will affect them HOW? –Review new Delivery System Design and how it differs from old. –Role Play –Then Review Model Components

PREPARING FOR SPREAD (Minimum Necessary Requirements) SUMMARY (1) SELECT A SPREAD TEAM (2) PERFORM READINESS ASSESSMENT (3) DEVELOP A WRITTEN PLAN (4) INTENSIVE EDUCATION PROCESS

SPREAD Commence changes –Target staff must huddle to clarify roles and patient flow on day of spread –Senior Leader/Management should be visible, troubleshoot and exude support on day 1 –End of day session to review issues and prepare for day 2 Identify overlapping functions and integrate Monitor adherence to written spread plan Use feedback (PDSAs) to fine tune process

SUSTAINING CHANGES 4 CRITICAL FACTORS FOR SENIOR LEADERS AND TEAM MEMBERS –(1) AN EMPOWERED, ENTHUSIASTIC TEAM –(2) A DYNAMIC KNOWLEDGE BASE –(3) STAFF BUY-IN –(4) VISIBLE MANAGEMENT SUPPORT HOW CAN AN ORGANIZATION EFFECTIVELY ACHIEVE THESE CRITICAL FACTORS

SUSTAINING CHANGES (1) EMPOWERED TEAM WHAT CAN AN EMPOWERED TEAM DO TO HELP TO SUSTAIN CHANGES? –Monitor written plan (provide feedback to stakeholders) –Keep changes in front of all –Facilitate on-going education process –Exude and infect others with enthusiasm –Share success stories (at staff meetings, on storyboards, in memos)

SUSTAINING CHANGES (1) EMPOWERED TEAM HOW CAN A CENTER DEVELOP AN EMPOWERED TEAM? –Support by management –Decision-making capability –Allowed room for errors –Mandated meeting time

SUSTAINING CHANGES (2)DYNAMIC KNOWLEDGE BASE ON WHAT? –Overall purpose of Collaboratives –Models utilized –How implementation of the models helps to achieve goals –Changes made in organization as a result of application of models –Supporting policies and procedures

SUSTAINING CHANGES (2)DYNAMIC KNOWLEDGE BASE HOW CAN A CENTER MAINTAIN SUCH A KNOWLEDGE BASE? –Quarterly General Staff In-service –On-going Provider education by local specialists, etc –Develop Clinical Pearls (Post in exam rooms) –Pop Quizzes –Story board posters –Role play –E mails –Newsletters, Peer-to peer, Shadowing, etc. (Consider Calendar of Educational Activities to improve chronic disease care)

(3) STAFF BUY-IN A major challenge Importance –Responsible for implementing most changes made.. –Necessary for sustaining this change –Necessary for initiating and sustaining other changes (re management credibility). 3 staff groups to address –Providers –Clinical Support Staff –Non-clinical Support Staff

CLINICAL SUPPORT STAFF BUY-IN –Typical problems Work Overload Apathy –Helpful Solutions Educate Embed in daily routine Feedback PROVIDER BUY-IN –Typical problems Work overload Perception of value of changes made Knowledge base –Helpful Solutions Increase knowledge base Optimize workload Feedback Compensation Plan Senior Management Support

SUSTAINING CHANGES (4) VISIBLE MANAGEMENT SUPPORT –Standing agenda item in meetings (Management, Board, PI meetings) –Policies and Procedures –Inclusion of roles in Job Descriptions –Staff Compensation Plan –Removal of barriers (staff resistance, equipment/supply needs, etc).

SUMMARY OF DISCUSSION Why Spread and Sustain Changes? Preparing for Spread –Select a Spread Team –Assess Readiness –Create a plan –Educate Spreading –Monitor adherence to plan –Remember PDSAs Sustaining changes –Enthusiastic team –Knowledge base –Management support

TAKE HOME MESSAGES HOW CAN TEAM MEMBERS ENGAGE SENIOR LEADERS TO MAINTAIN SUPPORT –Keep them informed –Involve in discussions, recommendations and decision-making –Give them assignments –Infect enthusiasm –Celebrate success together (Share success stories) –Share patient feedback

TAKE HOME MESSAGES WHAT CAN YOU DO AS A SENIOR LEADER TO SUSTAIN SPREAD? –Demonstrate your support –Demonstrate your support some more! –Do not stop Demonstrating your support

GENERAL DISCUSSION WHAT ELSE CAN WE LEARN FROM EACH OTHER?