1. NQC Training of Trainers

2. National Quality Center (NQC)2 Welcome to the TOT Program Day 1 Module 1 – Day 1 8:00am – 9:00am (60 min)

3. National Quality Center (NQC)3 TOT Learning Objectives Understand quality improvement principles and their application to HIV care Design appropriate and helpful adult learning experiences that measurably advance quality improvement Improve the participants’ confidence facilitating quality improvement related training opportunities

4. National Quality Center (NQC)4 TOT Learning Objectives (cont.) Effectively plan the meeting logistics for upcoming workshops Understand how to routinely report to NQC on training activities, training participants and evaluation results Access resources dedicated to successful TOT participants

5. National Quality Center (NQC)5 Expectations from TOT Participants Learn about quality improvement  Expand knowledge of QI models and programs...  Expand knowledge of NQC programs and resources..  The training will present cutting edge and novel approach to facilitating quality management to an array of providers…  To share the principles of QM program with the local HIV service providers (across Ryan White Titles)..

6. National Quality Center (NQC)6 Expectations from TOT Participants Learn about training others  Improve training skills in CQI…  how to better conduct workshops for a variety of audiences…  Become a master at training for the RW program…  gain understanding of learning theories and how best to design training workshops…  develop confidence in facilitating training opportunities in HIV care environments…

7. National Quality Center (NQC)7 Expectations from TOT Participants Network with peers  Learn about best practices in developing agency leadership (on staff, executive and board level) and skills implementing QI programs…  Meet other quality management staff within the nation to exchange ideas, tools, techniques, etc…

8. National Quality Center (NQC)8 Expectations from TOT Participants Learn how to apply the knowledge  build my confidence in facilitating quality improvement and training opportunities in HIV care environments…  increase my mastery of quality improvement principles and their application in HIV care…  To learn some common pitfalls students and trainers may encounter while providing instruction on QM topics…

9. National Quality Center (NQC)9 TOT Agenda Overview Day 1: “The What”  Accelerated review of quality content. Day 2: “The How”  Designing a quality training for your audience. Day 3: “Delivery”  Nailing down the where, who, and when, technique, and practice

10. National Quality Center (NQC)10 Agenda – Day 1 8:00Welcome TOT Program and Group Activity 9:20QI Principles 11:00 PDSA Model 12:15Lunch 1:15 Learner-centered Training 2:00 Interactive QI Activities 3:30Building QI Infrastructure: Assessment of HIV Quality Program 4:30Mini-presentations: Five Minutes of Fame 5:00 Aha! Moments & Brief TOT Evaluation

11. National Quality Center (NQC)11 Agenda Highlights – Day 2 and Day 3 Day 2 – 8:00am – 6:00pm Using Assessment Five Step Model for Creating Effective Training Performance Measurement – Collecting and Using Data to Improve Quality Quality Resources Safari Design Your Training Module…plus Practice and Feedback ‘Paper Puppets’ - Game Day 3 - 8:00am – 4:00pm Quality Management Plans Quality Management in the Ryan White Program Generating Participant Feedback Nightmares, Mishaps, and Messes- It Can’t Get Worse Than This, Can It? Game Plan Going Forward: Your Personal Plan

12. National Quality Center (NQC)12 Details…… Methods Ground rules Parking lot TOT Guide Red Book Hand Out of Hand Outs Fears and challenges Contact list

13. National Quality Center (NQC)13 Faculty Introductions

14. National Quality Center (NQC)14 Participant Introductions  Name and agency  TOT Session hopes and concerns  Improvement story

15. National Quality Center (NQC)15 Quick Quiz

16. National Quality Center (NQC)16 How far have you traveled to get to the workshop? 1.less than an hour or two 2.less than 6 hours 3.across the country

17. National Quality Center (NQC)17 How many years of experience do you have in the HIV field? 1.< 2 2.2-5 3.5-10 4.10-20 5.feels like forever

18. National Quality Center (NQC)18 How many quality improvement workshops have you taught? 1.none 2.1-5 3.5-1 4.>15

19. National Quality Center (NQC)19 How do you rate your expertise in teaching other adults? 1.novice 2.experienced 3.very experienced 4.enough to know better

20. Warm Up

21. National Quality Center (NQC)21 Final Details Fears and challenges process Trainer hat concept Who is in the room?

22. Module 2 Satisfaction Continuum

23. QI Principles Module 3 – Day 1 9:20am – 10:30am (60 min)

24. National Quality Center (NQC)24 Learning Objectives Be able to recognize underlying key quality improvement principles in day-to-day activities. Practice identifying strengths and weaknesses of programs in using the principles. Provide an opportunity to strengthen the participants’ ability to work in teams

25. National Quality Center (NQC)25 Agenda Quiz Quality Improvement Principle Presentation Group Exercise – ‘Principles In Action’ Reporting Back

26. Quiz

27. National Quality Center (NQC)27 What does CQI stand for? a.Community Quality Initiative b.Case Management Quality Ideas c.Continuous Quality Improvement d.Circular Quantum Invention

28. National Quality Center (NQC)28 What is the main difference between quality assurance and quality improvement? a.Quality assurance uses mainly a team approach b.Quality improvement focuses on statistical outliers for improvements c.Quality assurance and quality improvement are practically the same d.None of the above

29. National Quality Center (NQC)29 What is the most important principle for quality improvement? Quality improvement focuses on… a.Individual performers b.Routine measurement of performance c.Training of providers d.Systems issues

30. National Quality Center (NQC)30 Which of the following is NOT a statement by HAB about Quality Programs? a.QM programs need to look beyond clinical services to consider both supportive services and outcomes b.QM programs assess the extent to which HIV health services are consistent with the most recent Public Health Service guidelines c.The primary focus of the QM program is on performance measurement to assess clinical and non-clinical services d.Quality is the degree to which a health or social support service meets or exceeds established professional standards and user expectations

31. National Quality Center (NQC)31 The following performance data report is presented: PPD 95%, GYN 85%, and PCP Prophylaxis 55%. You advise the program to continue to measure… a.only PCP Prophylaxis b.GYN and PCP Prophylaxis c.All three indicators

32. National Quality Center (NQC)32 The results of an adherence QI project are presented after 10 months of work, improving the rate to 98% and it was kept between 95%-100% for the last 4 months. You advise the program to… a.Discontinue routine measurements b.Switch to quarterly measurements c.Keep monthly measurements

33. QI Principles

34. National Quality Center (NQC)34 Success is achieved through meeting the needs of those we serve

35. National Quality Center (NQC)35 Most problems are found in processes, not in people

36. National Quality Center (NQC)36 Do not reinvent the wheel – Learn from best practices

37. National Quality Center (NQC)37 Achieve continual improvement through small, incremental changes

38. National Quality Center (NQC)38 Actions are based upon accurate and measured data

39. National Quality Center (NQC)39 Infrastructure enhances systematic implementation of improvement activities

40. National Quality Center (NQC)40 Infrastructure enhances systematic implementation of improvement activities Infrastructure

41. National Quality Center (NQC)41 Set Priorities and Communicate clearly

42. National Quality Center (NQC)42 Improvement is about Learning  trial and learning method  share findings with staff to create staff ownership into improvement efforts  learn from others, peer learning  Focus on systems of care  and not on individual providers  systematize improvements Leadership  establish organizational commitment  resource commitment  support staff and activities Components for Success

43. National Quality Center (NQC)43 Infrastructure  quality is achieved through people working in teams  create infrastructure to support quality efforts  resources available to provide staff development + training Improvement Project  actions are based upon accurate and measured data  action oriented approach (rapid cycle(s))  test on small scale before implementation  improvements through continuous cycles of changes Components for Success

44. National Quality Center (NQC)44 ‘QI is not QA’ Quality AssuranceQuality Improvement Motivation Measuring compliance with standards Continuously improving processes to meet standards Means InspectionPrevention Focus Individuals, “bad apples”Processes and Systems Responsibility FewAll

45. National Quality Center (NQC)45 HAB’s Working Definition of Quality “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Institute of Medicine. Medicare: A Strategy for Quality Assurance. Vol. 1. (1990)

46. Break Mini-presentations and Five Minutes of Fame See Faculty

47. Model for Improvement and PDSA Cycle Module 4 – Day 1 11:00am – 12:15pm (75 min)

48. National Quality Center (NQC)48 Learning Objectives Familiarize participants with the Model for Improvement (MFI) Discuss application of MFI in HIV care Practice use of the PDSA Cycle in real life scenarios Strengthen the participants’ ability to problem solve using this quality concept

49. National Quality Center (NQC)49 In 1601, James Lancaster successfully conducted an experiment to illustrate the effectiveness of lemon juice to prevent scurvy. When did the British Navy adopt this treatment? 1.1602 2.1689 3.1757 4.1796

50. National Quality Center (NQC)50 In 1601, James Lancaster successfully conducted an experiment to illustrate the effectiveness of lemon juice to prevent scurvy. When did the British Navy adopt this treatment? 1.1602 2.1689 3.1757 4.1796 (195 years later)

51. National Quality Center (NQC)51 Treatment of Scurvy Stephen J. Bown - Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail; St. Martin's Press, 2004  In 1601 lemon juice, as a protective against scurvy, is recorded by James Lancaster.  In 1612, Woodall recommended citrus fruit for protection against scurvy on sea voyages.  In 1753 James Lind published A Treatise on the Scurvy which portrays his experiment on-board the ship Salisbury in 1747.  From 1772 to 1775 sailors on historic voyages with Captain James Cook remained free from scurvy.  In 1796 lemon juice was officially introduced in the British Navy as a prophylactic against scurvy.  In 1865 British Board of Trade adopted the policy for the merchant marine.

52. National Quality Center (NQC)52 How long did the NIH take to recommend the treatment of ulcer as suggested by Marshall in his 1984 Lancet Article? 1.2 years 2.5 years 3.10 years 4.20 years

53. National Quality Center (NQC)53 How long did the NIH take to recommend the treatment of ulcer as suggested by Marshall in his 1984 Lancet Article? 1.2 years 2.5 years 3.10 years 4.20 years

54. National Quality Center (NQC)54 Treatment of Ulcer – Marshall Timetable: 1979: Dr. Robin Warren, pathologist at Royal Perth Hospital, Australia found bacteria in stomach of patients 1981: Dr. Barry Marshall starts residency 1982: Marshall cultivates bacteria: Helicobacter pylori, 100% in Duodenal Ulcer and 77% in Gastric Ulcer 1984: first publication in Lancet; presents treatment of ulcer with common antibioticum 1994: National Institute of Health recommends treatment of ulcer as suggested by Dr. Marshall

55. National Quality Center (NQC)55 In an article in the Journal of Quality Improvement 92 QI projects were compared. What was the timeframe from problem identification to completion of first pilot? 1.23 days 2.60 days 3.397 days 4.504 days

56. National Quality Center (NQC)56 In an article in the Journal of Quality Improvement 92 QI projects were compared. What was the timeframe from problem identification to completion of first pilot? 1.23 days 2.60 days 3.397 days 4.504 days

57. National Quality Center (NQC)57 Survey of 92 Quality Improvement Projects in Journal of Quality Improvement Alemi F, Safaie F, Neuhauser D. “A Survey of 92 Quality Improvement Projects.” Journal of Quality Improvement 2001, 27(11): 619-632 504 days from problem identification to completion of first pilot  397 days from first team meeting to the end of first cycle  75 days to describe current situation in flowchart  62 days for data collection if change was improvement

58. National Quality Center (NQC)58 How can we accelerate change and improvements in HIV programs?

59. National Quality Center (NQC)59 Change Method The Model for Improvement (MFI) is a method to help accelerate change …and increase the odds that the changes we make are an improvement.

60. National Quality Center (NQC)60 Many Models for change Advantages Disadvantages What I look for:  Simple  Robust MFI  3 Questions & PDSA Cycle  Non-Linear Do what makes sense  Action  Multiple levels Large to very small  Based in inquiry Fosters creativity Reduce shackle effect

61. National Quality Center (NQC)61 Model for Improvement* *Developed by the Associates in Process Improvement. Building on the work of W.E.Deming and Walter Shewhart

62. National Quality Center (NQC)62 What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement

63. National Quality Center (NQC)63 What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement

64. National Quality Center (NQC)64 What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement

65. National Quality Center (NQC)65 Change Improvement usually requires change….. however not all change is an Improvement!

66. National Quality Center (NQC)66 Change Ideas National Quality Center  http://nationalqualitycenter.o rg/QualityAcademy/ http://nationalqualitycenter.o rg/QualityAcademy/ QI Resources  Quality Resources ARV Management Adherence Self- Management/Consumer Involvement Case Management Chart Documentation Tools Best Practices Quality Resources ARV Management Adherence Self- Management/Consumer Involvement Case Management Chart Documentation Tools Best Practices IHI Change Packages  http://www.ihi.org http://www.ihi.org Search Changes (12 pages of packages)  Chronic Care Model  Access and Efficiency Generic Changes  Improvement Guide Langley et el Back of the book @ 90 categorized generic change ideas with definitions  http://www.ihi.org http://www.ihi.org

67. National Quality Center (NQC)67 Act Adapt? Adopt ? Abandon? 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 (on a small scale) Document problems and unexpected observations Begin analysis The PDSA Cycle for Learning and Improvement

68. National Quality Center (NQC)68 Act Adapt? Adopt ? Abandon? Next cycle? Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) Next cycle? Study Complete the analysis of the data Compare data to predictions Summarize what was learned Do Carry out the plan (on a small scale) Document problems and unexpected observations Begin analysis The PDSA Cycle for Learning and Improvement

69. National Quality Center (NQC)69 Plan The PDSA Cycle Do Study Act

70. National Quality Center (NQC)70 PDSA (test) Cycles … Have Been Going on for years “Negative results on the fish… Let’s try rubbing two sticks together.”

71. National Quality Center (NQC)71 Why Test ? Increase your confidence that the change will result in improvement in your organization Learn to adapt the change to conditions in the local environment Minimize resistance when you move to implementation

72. National Quality Center (NQC)72 This is different! The Cycles Build on Each Other… Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Very small scale test Follow-up tests Wide-scale tests of change Implementation of change

73. National Quality Center (NQC)73 PDSA Cycle Example Change: New CM Intake/Assessment Form AIM: Improve Access to HIV Primary Care DATA AP SD A P S D AP SD D S P A D S P A Cycle 1A: Revise “borrowed” CM form and test with one of Joanne’s clients on Tuesday Cycle 1B: Revise tool based on learning and test again with Karl’s clients next Monday Cycle 1C: Present refined tool to all 3 case managers and document feedback Cycle 1D: Revise and test tool with all (???) clients for one week Cycle 1?: Implement…. ??? ( wide scale ? )

74. PDSA Exercise

75. National Quality Center (NQC)75 How Do Tests Lead to Improvements? You learn something from each test That knowledge gets incorporated into the next test Over time, as you build knowledge and expertise, you design a change that will (more likely ) result in improvement in your environment

76. National Quality Center (NQC)76 Tips for First PDSA Cycles “What change could you test by next Tuesday?” Start Small  “Rule of 1”: 1 facility 1 office 1 provider 1 patient

77. National Quality Center (NQC)77 Shepherd your PDSA’s

78. National Quality Center (NQC)78 This is different! The Cycles Build on Each Other… Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Very small scale test Follow-up tests Wide-scale tests of change Implementation of change

79. National Quality Center (NQC)79 Tips for PDSA Cycles Learn from others (‘Steal shamelessly, Share senselessly’) Volunteers at first; move to others Useful, not perfect, data Use “huddles” to report Design toward sustainability

80. National Quality Center (NQC)80 What questions do you have? I have one for you …  Do you have any ideas for a next cycle.. ?

81. National Quality Center (NQC)81 Model for Improvement *Developed by the Associates in Process Improvement. Building on the work of W.E.Deming and Walter Shewhart

82. National Quality Center (NQC)82 Both Good changes and a robust model for improvement (one that incorporates learning and action ) are both needed to help accelerate change and increase the odds that the changes we make are an improvement.

83. National Quality Center (NQC)83 Change Hats ! Where might you teach the Model for Improvement ? How might you change this module to better fit your audience?  to better fit your own style?

84. National Quality Center (NQC)84 Lunch with a New Friend ! Schedule:  60 minutes Lunch. Meet someone new! Reminder:  Bring your Organizational Assessment for the afternoon session.

85. National Quality Center (NQC)85 References Moen, Ronald, Thomas Nolan; “Process Improvement” Quality Progress, 1987, p62 Langley, Gerald, Kevin Nolan and Thomas Nolan; “The Foundation of Improvement,” Quality Progress, June 1994, p. 81 Langley, Gerald, Kevin Nolan, Thomas Nolan, Cliff Norman, and Lloyd Provost; “The Improvement Guide” San Francisco, CA; Jossey-Bass, 1996 Nolan, Kevin; “ASQs Accelerating Change Collaborative Series: A Challenge for Industry,” Quality Progress, Jan 1999, p55

86. Learner-Centered Training Module 6 – Day 1 1:15pm – 2:00pm (45 min)

87. National Quality Center (NQC)87 Group Timed Quiz (pgs.89 and 90)

88. National Quality Center (NQC)88 Magic Remotes

89. National Quality Center (NQC)89 Subject Matter Experts Typically Are: 1.Consciously competent 2.Consciously incompetent 3.Unconsciously incompetent 4.Unconsciously competent

90. National Quality Center (NQC)90 Skill Development Progression

91. National Quality Center (NQC)91 Stages Of Knowledge 1. You do not know what you do not know. (unconscious incompetent) 2. You know what you do not know. (conscious incompetent) 3.You know what you know. (conscious competent) 4.You do not know what you know. (unconscious competent) Mr. House - Hewlett Packard© 1993 Total Quality Learning, Inc.

92. National Quality Center (NQC)92 Which of the following physical factors affects learning? a.Noise level b.Time of day c.Structure d.Room temperature e.All of the above

93. National Quality Center (NQC)93 Adult Preferences Regarding a Learning Environment PHYSICAL FACTORSEMOTIONAL FACTORSLEARNING FACTORS Learning Setting:Social Needs:Learning Styles: Noise LevelLearn AloneAuditory LightingLearn with OthersVisual TemperatureKinesthetic Structure Time of Day Motivation: Extrinsic Intrinsic

94. National Quality Center (NQC)94 A Standard Way to Keep People Engaged in Learning Is to: a. Summarize key points frequently b. Use dramatic gestures to make points more forcefully c. Ask good questions and allow people time to think & respond d. Repeat key points numerous times to support short term memory

95. National Quality Center (NQC)95 Questioning Strategies: a Method To Keep Learners Involved Which questions best reinforce your instructional goals? Develop them in advance! Open or closed ended?

96. National Quality Center (NQC)96 Questioning Samples What are all the ways you could incorporate this material into your workshop design? Which aspects of this training are most and least compelling for you? Does this segment on questioning help you? (how?) Why is it important to create questions in advance? What will be the difficulty in translating this material to your actual use? On a scale of 1-5, with one as low and 5 being high, how confident are you that you can incorporate these principles into your planning activities?

97. National Quality Center (NQC)97 Which of the Following are Not Preferences the Instructor Must Recognize? a.Participant apparel b.Learning style c.Setting d.Motivation e.Social needs

98. National Quality Center (NQC)98 From the Following Options, which is the MOST Learner-Centered? a.Case study b.Role Play c.Self Assessment d.Large group discussion e.Lecture

99. National Quality Center (NQC)99 A Key Ingredient: the Level of Involvement

100. National Quality Center (NQC)100 We tend to remember… a.30% of what we hear b.50% of what we read c.20% of what we say d.90% of what we say and do e.None of these is correct

101. National Quality Center (NQC)101 Experience and Learning

102. National Quality Center (NQC)102 Which of the Following is Not an Example of Active Involvement? a.Making a presentation b.Participating in a discussion c.Watching a demonstration d.Engaging in a simulation

103. National Quality Center (NQC)103 Left Untreated, Information Disappears from Short Term Memory in: 1.3-5 minutes 2.60 seconds 3.30 seconds 4.15 second 5.None of the above

104. National Quality Center (NQC)104 Short Term Memory Information that passes our filters needs to be stored and organized Left untreated, information disappears in 15 seconds or less Research suggest 5-9 “chunks” of information can be stored in short term memory Chunking information Source: Telling Ain’t Training, ASTD, Harold Stolovitch, Erica Keeps, 2006

105. National Quality Center (NQC)105 Visual Learners Prefer, Enjoy or Require: a.Written material to study new concepts b.A good joke or story they can repeat or tell to others c.Gestures when making a point d.Frequent breaks to rest their eyes e.Words to accompany a cartoon

106. National Quality Center (NQC)106 Adult Learning Styles Visual Learners Auditory Learners Kinesthetic Learners Presentations that are multi-sensory will increase learning and retention for most adults

107. National Quality Center (NQC)107 Training Development Guide Step 1 – Topic and Rationale Step 2 – Performance Objectives Step 3 – Activities Step 4 – Evaluation Step 5 – Feedback “A Universal 5 Step Model That Gets Great Results”

108. National Quality Center (NQC)108 Research Suggests People Learn Best when: a.There is a lot of detailed content b.They are shown how things are done c.They see what’s in it for the organization d.They get to try things for themselves e.They are told how things work

109. National Quality Center (NQC)109 I Learn Best When… Column AColumn B someone who knows something I don’t explains an describes it to me. I observe a demonstration. I attend lectures in which an instructor presents information to me. I see what’s in it for the organization. there is a lot of detailed content. what is presented to me is organized according to the logic of the content. I am shown how things are done. I attend long learning sessions. I am in a formal instructional setting. I am told how things work. I dialogue and discuss with someone who knows something I don’t. I get involved and try things out during a demonstration. I attend sessions in which an instructor engages me in a two-way interaction. I see what’s in it for me. there is minimal and meaningful content. what is presented to me is organized according to the logic of how I learn. I get to try things for myself. I attend short learning sessions. I am in an informal work and learning setting. I experience how things work. Source: Telling Ain’t Training, ASTD, Harold Stolovitch, Erica Keeps, 2006

110. National Quality Center (NQC)110 Contemporary Historical Roots Andragogy = Unified Theory of Adult Learning (Malcolm S. Knowles, 1973) 1.Adults prefer self direction 2.Adults learn more easily when they can relate the learning to their past experiences 3.Real life events dictate adult’s specific learning needs and interests 4.Adults are pragmatic in their learning – they seek an impact on life or work related situations

111. National Quality Center (NQC)111 Learning is Defined as... a.Retaining facts accurately in long term b.A change in behavior due to experience or continued practice c.Successfully driving knowledge from core skills sets d.Correctly replicating in a work environment techniques discussed in a session

112. National Quality Center (NQC)112 Learning, Defined… “ A Change in Behavior Due to Experience or Continued Practice.” LEARNING = CHANGE Learning is adaptation to the environment, allowing survival. Humans have a huge capacity for learning. The ability to learn varies by individual. Your job is to facilitate change through learning for individuals. Source: Telling Ain’t Training, ASTD, Harold Stolovitch, Erica Keeps, 2006

113. National Quality Center (NQC)113 Which of These Learning Conclusions Is False? a.Adults resist situations where they are not treated with respect b.Adults will strive to do their best when they are physically comfortable c.Adults prefer a serious, no nonsense tone to maximize learning d.Adults prefer practical results from learning e.Teachable moments are determined by that adults needs and interests

114. National Quality Center (NQC)114 Lecture When the instructor’s notes become the student’s notes without passing through the minds of either of them!

115. National Quality Center (NQC)115

116. National Quality Center (NQC)116 Learning Is Made Easier When… 1.A climate exists which induces interest and participation 2.The “learner” is ready to learn 3.The learner knows the terms and principles involved in the task 4.The learning experiences are arranged in a logical order 5.As many senses as possible are involved

117. National Quality Center (NQC)117 Learning Is Made Easier When…(Cont.) 6.The learner can relate the new experience to previous experiences 7.The learner’s efforts are reinforced 8.The timing, duration and location of the learning experience are appropriate

118. National Quality Center (NQC)118 My memory trick ! Environment is participatory and pleasant (physically) Ready Context and Chunking Senses, bridge, reinforce

119. Module 7 Adult Learning: Interactive Games (IGs) Experience an IG Participant Presentations Discussion on IGs

120. National Quality Center (NQC)120 Experiential Learning - Tennis Ball Game Work in groups of 8  7 people represent key steps in the verification of eligibility process  1 person is the quality officer and data collector Need experience

121. National Quality Center (NQC)121 Experiential Learning – Tennis Ball Game Organization  7 form a circle representing the steps in the process  1 stand aside and observes/ records data Quality Officer Equipment  1 tennis ball (orange)  representing the steps in the process  stop watch or watch with second hand to measures time

122. National Quality Center (NQC)122 Process One person throws the ball to the person across from him/her in the circle. Remember to whom you threw it. The receiver throws it to another person, again remembering to whom it is thrown. The last person passes it to the start person. Rules  Start and stop with same person  Maintain the same sequence  Don’t drop the ball

123. National Quality Center (NQC)123 Process The quality officer: 1. Records time from beginning to end (with second hand watch) 2. Enforces all rules Start and stop wrong person  Start over Sequence violated  start over Ball dropped  start over 3. Judgment Call Execution done incorrectly in any other manner  start over

124. National Quality Center (NQC)124 No where good enough! Need to cut the time in half!

125. National Quality Center (NQC)125 St. Elsewhere does it better!

126. National Quality Center (NQC)126 Debrief our experience

127. National Quality Center (NQC)127 3 Approaches Improvement  Standardization  Incremental Improvement  Innovation

128. National Quality Center (NQC)128 Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Process and Balancing Measures Outcome Measures Repeated Use of the PDSA Cycle and PDSA Measures

129. National Quality Center (NQC)129 PDSA Tip #2: “Oneness”

130. National Quality Center (NQC)130 PDSA Tip #3

131. National Quality Center (NQC)131 Uh Oh…….  Your process when “X” is on vacation involves coverage from another building Will your process work?

132. National Quality Center (NQC)132 PDSA Tip #4 Move to Robust Testing Full, Sustained Implementation AP SD A P S D AP SD D S P A DATA 1. Early tests are simple and designed to succeed (larger and more) 2. Test over a variety of conditions to identify weaknesses 3. Later tests designed to predict and prevent failures

133. National Quality Center (NQC)133 Change Hats? Where might you use this experiential learning? What might be pitfalls of this game? What are strengths of this game? Adapt?

134. National Quality Center (NQC)134 Another Interactive Process Mini Presentations:  NQC Game Guide:  HIVQUAL Group Learning Guide:  Making Sure You HIV Care is the Best it Can Be:

135. National Quality Center (NQC)135 Quality Improvement Publications  20 interactive exercises for trainers to teach quality improvement in HIV care  Covers all key quality improvement concepts: Data and Measurement, Systems, Developing Changes, Testing and Making Changes and Cooperation  Includes rationale for game, target audience, key concepts, materials needed, instructions, background information, and discussion points

136. National Quality Center (NQC)136 NQC Game Guide

137. National Quality Center (NQC)137 Quality Improvement Publications  23 interactive quality improvement workshops for HIV health care providers  Follows the HIVQUAL Model, including workshops to develop the QI infrastructure and conduct QI activities  Each workshop instructions include: training objectives, target audience, key concepts, materials needed, instructions, agenda, background information, handouts, presentation slides

138. National Quality Center (NQC)138 GLG Workshops HIV Quality Program Exercises Leadership for Quality Quality Management Plan Support for Quality Program Facilitation of Quality Program Sustainability of Quality Program Evaluation of Quality Program Additional Exercises Leadership for Quality Sustaining the Quality Program Evaluation of Quality Program Improvement Project Exercises Constructing a Sample Data Collection Improvement Project Memo Team Roles Brainstorming Flowchart Cause-and-Effect Diagram Selecting a Pilot Test Planning a Pilot Test Evaluating a Pilot Test Data Presentation Systematize Improvements Team Self Evaluation Putting it All Together: An Improvement Project Cycle

139. National Quality Center (NQC)139 Consumer Involvement Working in partnership with people living with HIV/AIDS (PLWHA) and diverse communities is critical to the success of any HIV program. Experience has shown that PLWHA provide a critical and necessary perspective on the development, implementation, and evaluation of programs and services that are designed to ultimately meet their needs as the consumers of those services

140. National Quality Center (NQC)140 Options for Interactive Activities Interactive games (individual or group) Case studies or scenarios Quiz Role play

141. National Quality Center (NQC)141 Time to Share What interactive exercises around quality improvement do you suggest to your fellow TOT participants? How can you use interactive activities most effectively, and what are some rules to engage participants in these activities?

142. Break

143. Building QM Infrastructure Module 8 – Day 1 3:30- 4:30pm (60 min)

144. National Quality Center (NQC)144 Session Plan 10 mins- Individual review of your OA and fill out worksheet page 96. (Or team if more than one here from a program.) 35 mins total: 25 mins- Pairshare with someone from same Part or similar program; 10 mins- Individuals/teams fill out Action Plan on page 97. 15 mins- Large group debrief.

145. National Quality Center (NQC)145 Debrief What are all the elements necessary to support quality improvement in your organization?

146. National Quality Center (NQC)146 Change to training hat…

147. National Quality Center (NQC)147 Mini-presentations: Five Minutes of Fame Module 10 – Day 1 4:30pm – 5:00pm (30 min)

148. National Quality Center (NQC)148 Presentation Topics Reflecting on your experiences as a trainee, what are your lessons learned about facilitating and training others? Share your most recent experience in a workshop on quality management. Thinking back on workshops that you have attended, which one is the most memorable? Why? What was your scariest workshop experience? Which tools and resources have you found most helpful to prepare for a training workshop?

149. Sharing of Aha! Moments and Brief TOT Evaluation Module 11 – Day 1 5:00pm – 5:30pm (30 min)

150. National Quality Center (NQC)150 Evaluation Personal Highlights or Aha!! Moments Polling Survey Went Well / Do Differently

151. National Quality Center (NQC)151 The way the course was delivered today was an effective way for me to learn. 1.Strongly Disagree 2. 3.Agree 4. 5.Strongly Agree

152. National Quality Center (NQC)152 I had sufficient opportunity to participate today. 1.Strongly Disagree 2. 3.Agree 4. 5.Strongly Agree

153. National Quality Center (NQC)153 Materials were useful during the day. 1.Strongly Disagree 2. 3.Agree 4. 5.Strongly Agree

154. National Quality Center (NQC)154 The agenda and content for today was logically organized. 1.Strongly Disagree 2. 3.Agree 4. 5.Strongly Agree

155. National Quality Center (NQC)155 Overall, I was satisfied with the session facilitator(s). 1.Strongly Disagree 2. 3.Agree 4. 5.Strongly Agree

156. National Quality Center (NQC)156 My knowledge and/or skills increased as a result of today. 1.Strongly Disagree 2. 3.Agree 4. 5.Strongly Agree

157. National Quality Center (NQC)157 The workshop had the right balance of lectures and interactive activities. 1.Strongly Disagree 2. 3.Agree 4. 5.Strongly Agree

158. National Quality Center (NQC)158 Overall, I was satisfied with today. 1.Strongly Disagree 2. 3.Agree 4. 5.Strongly Agree

159. National Quality Center (NQC)159 How ready are you to plan and facilitate a QI workshop? 1.Not Ready 2. 3.Mostly Ready 4. 5.Very Ready

160. Thank You :-)