1. Quality Improvement Community Workshop Day 1
FORGE AHEAD Program Transformation of Indigenous Primary Healthcare Delivery: Community-driven Innovations and Strategic Scale-up Toolkits
Quality Improvement Community Workshop Day 1

2. Workshop Overview
During the next 2 days, you will be presented with information and provided time to work in your own individual teams and also as a group
Presentations will be in this room
Team work during the breakout sessions will occur in separate rooms. Your Community Facilitator will guide you to your rooms and support your hands-on work
In the breakout rooms, there will also be a moderators to take notes and assist the facilitator
Presenters and the Western Team available throughout the day to answer any questions you might have

3. Workshop Objectives
Build capacity and collaborative relationships among the teams to improve community diabetes care
Develop and implement innovations using the readiness questionnaire, best practices, and surveillance data
Prepare teams to go back into their communities and follow through on the action plans they develop here today
Encourage linkages and partnerships with community type 2 diabetes programs as a means to improve patient access to available services.
1. Facilitate the re-organization of primary healthcare

4. Logistics
In your binder: agenda, disclosure form, evaluation form, expense form, questionnaires, reports, breakout room assignment
Morning break at 9:45 am – 10:00 am
Lunch 12:00 pm - 1:00 pm
Afternoon break at 3:00 pm – 3:15 pm
Disclosure Form
Contact information
Group photo
FORGE AHEAD Wave 1:
Ebb and Flow First Nation – MB
Kahnawake Mohawk Territory - QC
Maskwacis – AB
Miawpukek First Nation – NL
Tsuu T’ina Nation – AB
Waskaganish First Nation - QC

5. Logistics Questionnaires Team Functioning Gift cards
Workshop Evaluation form
Dinner is provided tonight in the Asher’s Room @ 5:30pm – look for the tables labelled “FORGE AHEAD”
Bathrooms
FORGE AHEAD Wave 1:
Ebb and Flow First Nation – MB
Kahnawake Mohawk Territory - QC
Maskwacis – AB
Miawpukek First Nation – NL
Tsuu T’ina Nation – AB
Waskaganish First Nation - QC

6. Opening Prayer

7. Introductions Welcome
Community Introductions - Facilitators please tell us about your team
Community Name and Location
Name, Position or Title of team members
What does your team hope to get out of FORGE AHEAD for your community?
Need to develop ice breaker
Welcome and Western team introductions (Stewart and/or Mariam 10 minutes)
Opening Prayer (Alex, 5 minutes)
Individual introductions of western team (Alex, Mike, Mariam, etc, 2 minutes)
Community Facilitators introduce the team and community (5 minutes per community)
Overview of workshop (5 minutes)

8. FORGE AHEAD

9. Funding Canadian Institutes of Health Research The Lawson Foundation
AstraZeneca Canada
This slide must be visually presented to the audience AND verbalized by the speaker. 9

10. Main Goal Of FORGE AHEAD
To work with community healthcare providers and community members to develop and evaluate PDSAs aimed at improving diabetes care and improving patient access to available services in First Nations communities
Guiding principles include:
Participatory Research and OCAP® principles
Capacity building
Community-driven and culturally appropriate collaborative research
Problem: Given high rates and impact of chronic disease in First Nations peoples, healthcare models that enhance chronic diseases are needed

11. The FORGE AHEAD Team
Strong multi- disciplinary and cross-jurisdictional teams from 9 provinces
Wave 1 Communities
Wave 2 Communities
First Nations community representatives
Indigenous and non-Indigenous healthcare providers
Clinician scientists
Academic researchers reflecting a wide variety of disciplines from across Canada
Assembly of First Nations (AFN)
First Nations and Inuit Health Branch (FNIHB) of Health Canada
Canadian Diabetes Association (CDA)
Heart & Stroke Foundation

12. Program Activities Overview
National-level Activities
Preparatory Activities
- Community Profile Survey – all 617 First Nations Communities
- Best Practice and Policy Literature Review
- Readiness Tools Development
In-depth Community-level Activities (~ 14 First Nations Communities)
Intervention
Activities
Community Readiness Consultations
Community-driven Quality Improvement Initiative
Clinical Readiness Consultations
Clinical Quality Improvement Initiative
Diabetes Registry and Surveillance System
Intervention (if any): Community and Clinical Readiness Consultations, Community and Clinical QI Initiatives, Diabetes Registry and Surveillance System
Wrap-up Activities
- Community and Clinical Readiness Consultations
- Readiness Tools Validation
- Cost Analysis - Common Indicators- Process Evaluation and Surveillance Data
- Scale-up Tool Kit Development

13. Community Participation
We recommend that each community form a Community Advisory Board to:
facilitate on-going community engagement
make community-level decisions
guide program activities to ensure community needs are met
share knowledge with the community
protect the interests, culture and ways of doing of the community in relation to FORGE AHEAD

14. Community Participation
Each community has a key contact person with joint decision-making power in planning the program and making decisions regarding their data
Each community has a Community Facilitator, a Community Data Coordinator and a Community and Clinical Team
Representatives on the Advisory Board, Steering Committee and in each of the FORGE AHEAD Working Groups

15. Community Facilitator and Data Coordinator
Your Community Facilitator will help guide you through your action plans and action periods
Community Facilitator will stay in constant communication with and support members of the Community and Clinical Team members during the program
Your Data Coordinator will help you prepare reports and graphs summarizing your community’s clinical data to evaluate your activities

16. Wave 1 Community Team Timeline
2015
Sept Oct
Nov Dec Jan Feb
2016
Mar Apr May Jun
Jul Aug Sept Oct
Workshop #1
Action period #1
Workshop #2
Workshop #3
Action Period #2
Action period #3
Nov Dec Jan
Wrap-up Activities:
Readiness Questionnaire
Interviews
Complete Readiness questionnaire

17. Community And Clinical Teams
Two teams of people from each community are working in the program (Community and Clinical Teams)
The teams each complete surveys and participate in workshops to:
identify the community needs, strengths and challenges
find new ways to care for people with diabetes
After the program is done, the team members will be asked to share their experience in participating in the program and their perceptions of the impact of the program

18. Readiness Consultations
The goal of the Community and Clinical Readiness Consultations is to assess the degree of readiness to address diabetes care
You have all completed the readiness questionnaire to help identify factors that influence the development and adoption of innovations in the community
Your Community Facilitator will share the results of the questionnaire with you today and start the consultation component of this work

19. Registry and Surveillance
Contains an up-to-date diabetes registry and surveillance system of adult patients diagnosed with type 2 diabetes
Online system, accessible 24hrs a day, identifies diabetes incidence/prevalence rates and care gaps
Access to the registry will be determined by individual CABs
Your Data Coordinator is your key contact for the system
Securely house: name, gender, year of birth, type of diabetes, health card #, Band status #, diagnosis date, and other clinical information (e.g. labs, meds, complications…)
Note: The FORGE AHEAD team will work with communities to determine the completeness of existing registry and surveillance systems.

20. Quality Improvement (QI) Initiatives
There are 2 quality improvement initiatives in FORGE AHEAD
One for the Community Teams
One for the Clinical Teams
The reason for having 2 separate initiatives is that in many communities there exists a division between community programs and the medical clinic, in others where there is more integration, it will be hard to separate the 2 and team members may overlap

21. QI Workshops
The workshops for both the Community and Clinical teams include 3 workshops separated by action periods. They are an opportunity to:
build capacity and knowledge with expert presentations;
plan community specific innovation/changes to be tested during action periods; and
share lessons learned across teams.

22. QI Action Periods
During the Action Periods, you will go home to your regular job/work and try to figure out how to carve out some time to meet and to develop and test innovations (changes) in your community
Workshops will cover a variety of strategies to help you face the day-to-day challenges (e.g., small changes, working meetings, huddles, sub-groups in your team)

23. “The initial information session was very important for us to get enthusiasm and impetus... for the project, and then we had another day… It was good to get the enthusiasm going again because things kind of fell off. Whenever we would meet as a group with the facilitators and the coaches, that was really worthwhile.” 1
1. Paquette-Warren et al, 2011
Ref P4H process paper

24. What to Expect?
Others who have participated in programs like this have told us that
they felt completely overwhelmed and lost after the first workshop and needed extra support from the Community Facilitator to stay motivated and committed
things get clearer and the second workshop helps to re-energize and get them back on-track
by the third workshop, most team members have a new way to think about making changes and trying new things

25. “When we started we were kind of not sure what’s, what’s going on
“When we started we were kind of not sure what’s, what’s going on.  After six months, we started to find a meaning [and understood] that if we continue doing this stuff, we will find a difference in our patients and the management of their diabetes.” 1
1. Paquette-Warren et al, 2011
Ref P4H process paper

26. “It is a very difficult process, the change process, and I’ve learned along the way that it’s persistence, it’s perseverance and strong leadership... people like [team lead] and advocates like [physician champion]... I think the leadership has really been what has driven it and what’s been behind the successes.” 1
1. Paquette-Warren et al, 2011
Ref P4H process paper

27. BREAK

28. Community Readiness

29. Readiness Consultations
The goal of the Community Readiness Consultations is to assess individual community readiness to address chronic disease care in the community
Matching strategies to community’s level of readiness is critical for success!
The community team will have 3-5 people
1 to 3 community primary prevention leaders, administrators, managers, workers/volunteers of existing community programs or services
at least one traditional health leader,
at least one community member living with diabetes,
at least one elder, and
at least one clinical care program leader.

30. Community Team Your team was put together because you:
Know the community
Are well connected in your community
Bring a variety of perspectives about your community
Have knowledge and perhaps are involved in community programs for diabetes

31. Community Readiness Questionnaire
The questionnaire helps identify factors that influence the development and adoption of innovations in the community
A small step to help tell the story of your community, and to help in planning to improve community programs

32. Community Readiness Questionnaire
There is no right or wrong answers
All information is useful to help your community plan for diabetes programs
High or low score does NOT mean one community’s activities or services are better or worse
Questions focus on both the community members’ and leaders’ perspective

33. Components
5 components of a community have been identified to be influential for improving chronic care for patients with diabetes
All the boxes except for the leader boxes are asked from both the leader and community member perspective

34. Components
Each component has been defined and include a number of items
Diabetes as a priority
Knowledge of resource needs
Involvement in services and programs
Involvement in obtaining resources
Knowledge of Diabetes
Knowledge of community level effects
All the boxes (climate, issue, effort
and resources) and …
All the boxes except for the leader boxes are asked from both the leader and community member perspective
Knowledge of clinical services
Knowledge of services and programs
Involvement with clinical leaders

35. Community Readiness Questionnaire
The questionnaire will be completed 3 times:
Before the first QI workshop,
During the second QI workshop, and
After the last workshop.
By completing it three times, we can capture changes in readiness over time.
First QI session for wave 1 is in January (see slide 36ish)

36. Readiness Reports
Readiness scores were calculated by averaging everyone’s responses on the community team.
The report includes a summary of the description team members provided to explain their answers (open box)
Providing the overall scores and the associated definition will give you a snap shot of how ready the community is to address diabetes

37. What to do with the Results?
Important to understand what the scores mean and their value and limitations
The point is to recognize how everyone interprets the scores
You will have a chance to modify to scores based on discussions with your team
After the scoring is final, there should be a focus on how to use the scores and information to guide the development of an action plan

38. Participatory Interpretation of Results
Interpreting the results is all about looking at the scores and using them to shape the story that best describes your community as it exists today
All team members take part in the process of interpretation and summarising the information
It is crucial to build upon the results by using LOCAL KNOWLEDGE. There are particular needs, desires and history that the readiness questionnaire does not capture.
There will likely be important local information teams knows about the community and clinic and there particular needs, desires and history that the readiness model cannot help with. For example, the community readiness with regards to resources may be a priority, but the readiness scores do not say if your community needs many different types of resources or lacks one type of resource (e.g., volunteers or buildings). Getting more resources may be a priority but it is through discussion that access to a bigger building, or access to a building with better medical equipment, or access to a building with room for physical activity is of particular need in your community.

39. Changing the Results
If the team believes that a item score does not represent their community, the score can be adjusted only once (during this workshop).
These readiness scores cannot be changed again after today.
Scores can only be changed through team discussion and consensus
The Community Facilitator will record these changes during the breakout session

40. Community Readiness Report
The report will include:
The overall knowledge score and overall action score and associated descriptions
All of the item scores and associated descriptions
Summary of the qualitative answers provided in the open-ended boxes

41. Knowledge & Action Readiness Scores
Knowledge Readiness Score: how much a community understands diabetes and how much of a concern and priority it is for the community.
Action Readiness Score: what is being done about diabetes, how involved the community is in improving diabetes, and actions that have been taken.

42. Sample Overall Scores KNOWLEDGE READINESS SCORE ACTION READINESS SCORE3
AWARNESS – there is some knowledge and awareness of the issue, and as a result people would like something to be done. However other community priorities stop diabetes from being an important issue. 2
INITIATION – activities are underway with some community member and leader involvement. And some resources are used and assigned to efforts.

43. Knowledge of community level effects
Sample Item Score
Summary of Community Leaders Readiness
Item
type
Item definition
Item Score
Score definition
KNOWLEDGE
Knowledge of diabetes
asks how much do community leaders know about diabetes? This focuses on knowledge about the causes, signs, symptoms of diabetes, as well as an understanding of prevention, treatment and care of diabetes.  2
Very little – they may have heard of diabetes and know that it has to do with a person’s health, but they may have limited or wrong information about the causes, signs and symptoms (for example, they may think there is nothing a person can do to prevent or treat diabetes, or that only overweight people get it).
Knowledge of community level effects
asks how much do community leaders know about the effects of diabetes at the community level? This focuses on knowledge of how many people have diabetes in the community, and the ways in which diabetes is impacting the community.  4
 Some –they may know how many people are living with diabetes, and have some understanding of ways in which it affects your community (for example, making other health problems worse, stress on families, or can limit work and recreation).

44. Take Home Message
The readiness report is meant to provide a snapshot of your community based on team members’ input
To help you succeed in improving care for people with diabetes, the changes you make must be appropriate for your community’s stages of readiness!

45. Breakout Session

46. Readiness Breakout Session
60 minutes to meet as a team to discuss your individual Clinical Readiness Report
The Community Facilitator will present the results and help guide the discussion
what do the scores mean to you?
any questions or issues?
any adjustment to the scores?
The Western team will be available for support

47. Breakout Session Objectives
Everyone understands what the scores mean and their value and limitations
Start to shape the story that best describes your community as it exists today using the score and local knowledge
Change/finalize the scores based on discussions and team consensus
Start to think about how to use the scores to guide the development of an action plan

48. Facilitation Tool: Interpreting with Your Teams
USE THE FOLLOWING QUESTIONS TO GUIDE A DISCUSSION:
Does the team understand the results as you presented them?
What do the results mean to them?
Do they think the scores are useful? In what ways are they useful?
Do these scores represent what is happening in the community/clinic today?
Does everybody agree that your community/clinic is reflected well in the readiness scores?
Do any members have different perspectives on what the scores should be?
What reasons do different members provide for the difference in their perspective about the community/clinics level of readiness?
Does everyone agree that the team can use this information to shape future planning?
How does the team envision using this information in the program?

49. Presentation and Interpretation of Results
Question Period
Presentation and Interpretation of Results

50. Question Period
Are there any questions, about what the scores mean and their value and limitations?
Did any team change their scores based on discussions and team consensus?
Any comments, or concerns about the readiness scores and how they can play a role in facilitating improvements to diabetes care in your community?

51. Team Functioning Questionnaire
Please take 10 minutes to answer the questionnaire and hand it in once you are done

52. LUNCH Asher’s Room

53. Quality Improvement Initiatives
PDSA cycles

54. Key to Quality Improvement
Making things better requires making changes, but not all changes result in improvement
It is critical to identify the changes that are most likely to make things better
consider readiness consultation results

55. Key to Quality Improvement
Also, it is important to find out if a specific change actually resulted in improvement
think of the registry and surveillance information  how can this information be used to see if change made a difference?

56. The Model for Improvement
3 questions to set a time-specific and measurable goal to make changes for a specific population or an issue
Plan-Do-Study-Act (PDSA) cycles to test changes on a small scale
Designed to implement change more quickly than traditional quality improvement planning
References
1. Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
2. The Plan-Do-Study-Act (PDSA) cycle was originally developed by Walter A. Shewhart as the Plan-Do-Check-Act (PDCA) cycle. W. Edwards Deming modified Shewhart's cycle to PDSA, replacing "Check" with "Study." 3.

57. Model for Improvement 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?
PLAN DO
STUDY
ACT
References
1. Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
2. The Plan-Do-Study-Act (PDSA) cycle was originally developed by Walter A. Shewhart as the Plan-Do-Check-Act (PDCA) cycle. W. Edwards Deming modified Shewhart's cycle to PDSA, replacing "Check" with "Study." 3.

58. Question#1: What are we Trying to Accomplish?
Improvement requires identifying priority areas and setting aims that are:
Clear and time-specific (date for achievement of goals)
Measurable
Define the specific population of patients or other system that will be affected
Should provide real value to community members
Mike, HQO had this statement listed on their website related to this question of the MFI, not sure if you want something like this on the slide. Aiming for small, incremental change (e.g., moving from below average to average, or changing by 10%) does not represent a real breakthrough in quality and may not justify the stakeholder’s time investment. For support in setting a stretch goal, it is helpful to review practices of leading organizations in the field. If there are no clear examples, aim to decrease i.e., suboptimal care, adverse events or undesirable wait times by half as a first step, or improve a measure by 50%.

59. Question#2: How will we Know a Change is an Improvement?
Measures
Examples
Outcome measures:
what are the results?
infection rates or attendance in programs
Process measures
how did it work or not work?
program activities were always cancelled, or reminder s were always sent the day before an activity or appointment
Balancing measures
are changes in one area causing problems in another?
staff vs client satisfaction, or financial implications

60. Question# 3: What Change can we make that will Result in Improvements?
Change concepts are broad principles that provide general direction for planning improvements, e.g. the readiness questionnaire results
Change ideas are more specific and practical, e.g. using a radio announcement, sending program information to patients with diabetes, building an exercise program, developing healthy cooking classes

61. Plan-Do-Study-Act (PDSA) Cycle
Is a tool to help test a change in a real world settings by planning it, trying it, observing the results, and acting on what is learned
Testing ideas quickly and on a small number of people/patients
Build from one cycle to the next until there is enough evidence and confidence to implement a change across the system
This process allows the improvement effort to increase belief the change will result in improvement, measure the amount of possible improvement and evaluate the costs and side effects of change before jumping to implementation

62. The PDSA Cycle ACT PLAN STUDY DO 1 3 2 4 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 data analysis 1 3 2 4
Reference

63. Why Test? Increase belief that the change will result in improvement
Document how much improvement can be expected from the change
Learn how to adapt the change to conditions in the local environment
Minimize resistance upon implementation
Evaluate costs and side-effects of the change

64. Examples
Building a New Walking Trail

66. What is your Team Trying to Accomplish?
Scenario: Readiness Score: 2 community leader knowledge of programs Information: leaders know that a walking program exists but they don’t know who the program is for, what it is trying to do, or how successful it is. Local Knowledge: Participation rates are low because community members that have left the program say that walking the same trail every day gets repetitive and boring.

67. Example: Walking Trail
Aim Statement: Improve community member satisfaction in the walking program by varying the walking trail
Goal: Provide more than one walking trail in the walking program
Result: Within 2 weeks a new and appropriate trail was established because of the rapid testing to speed-up learning. The same protocol will be repeated to provide a 3rd walking trail.

68. Example: Walking Trail Addition
Goal: Provide more than one walking trail in the walking program
Plan: Establish new trail to respond to community member feedback about the walking program being boring and repetitive
Do: Staff test out 2 new trails to see if they would work well in the walking program (i.e. safety, length, etc.)
Study: Staff report that one trail was too muddy, particularly for new mothers pushing strollers. The other trail required a short drive, but otherwise seemed good.
Act: Check to see if the community van can be used to transport program participants to the new site. Also, the new trail should be walked in the morning and at dusk to see if there was enough light to complete the walk.
Plan: Walk the potential trail again, and also take a participant through the trail to get some feedback.

69. Multiple Cycles to Implement a New Walking Trail
Establishing a new walking trail within 2 weeks.
Cycle 5: The next week, the trail was walked at dusk with torches and a community member. The result was a new and safe trail.
Improve community member satisfaction in the walking program by introducing new walking trails
Cycle 4: On the fourth day , the second trail was walked at dusk. The lighting was poor, and made the trail dangerous.
Learning
Cycle 3: On the third day, the second trail was walked in the morning, and the trail remains a good option.
What about if resources not available – i.e. van to get to new trail or to supply the torches
What about communicating with leaders about the program…. Did readiness improve? What other PDSAs could be done at the same time as establishing a new trail?
Cycle 2: : The next day, a second trail was tested, and it seemed like a good option.
Cycle 1: A new trail was tested by a staff member. The trail was too muddy.

70. What did we Learn?
We want failures during testing… not during implementation!
We want to learn reasons for failed tests
Change not executed well – or at all!
Support processes inadequate
Hypothesis was wrong:
Change did not result in local improvement
Or local improvement did not impact global measures
Need to collect information/data during testing
Sharing saves time!
Not all test are equal…

71. Measurement and Data Collection During PDSA Cycles
Collect useful data, not perfect data – the purpose of data is for learning and quality improvement, not evaluation
The FORGE AHEAD western team will take care of evaluation of the program as a whole

72. Measurement and Data Collection During PDSA Cycles
Use a pencil and paper until information system is ready (e.g. registry and surveillance)
Use qualitative data (feedback, experience, observation) rather than wait for quantitative data
Record what went wrong during the data collection

73. Activity: PDSA vs Task Have a meeting
Bring a dietician to a community event to see if it improves meal planning for community members
Call another FORGE AHEAD community team to learn from their experiences in expanding their walking program
Community program staff read a research paper on implementing diabetes programs in First Nation communities
Community program staff huddle daily to discuss their work for the day as a team

74. Remember! Small tests Quick tests
Test now (versus waiting to get it right)
Test failures (the null hypothesis)
Consensus – No!
Don’t confuse tasking with testing
Testing is a team sport!

75. Identifying Community Priorities

76. Model for Improvement 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?
PLAN DO
STUDY
ACT
References
1. Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance.
2. The Plan-Do-Study-Act (PDSA) cycle was originally developed by Walter A. Shewhart as the Plan-Do-Check-Act (PDCA) cycle. W. Edwards Deming modified Shewhart's cycle to PDSA, replacing "Check" with "Study." 3.

77. Things to Consider
The readiness results can support the identification of areas for improvement
Focusing on the areas with low readiness scores is often the best way to make successful improvements
Aligning priorities to existing mission statements or strategic plans in the community can make it easier to implement innovations/changes (i.e. buy-in and acceptance)
It is important for the team to reach consensus about what the areas of focus should be
Action plans, strategic plans, or mission statements that already exist in a clinic, or in community program
There may be strong interest by the community in certain areas for improvement (e.g., it is known that the community wants more access to face-to-face clinical services or that there is desire for more physical activity programming).
How easy will it be to accomplish the goal? How expensive will it be? For example, does it require expertise the clinic or community do not have?
Existing plans, strategic plans, missions statements, community goals that already exist
Building off of plans can ensure consistency, cooperation, and build off of already existing efforts/energies
There may be an existing interest by the community and/or patients for certain areas of improvement
(e.g., it is known that the community wants more access to face-to-face clinical services or that there is desire for more physical activity programming
How easy it will be to accomplish the goal or make improvements? How expensive will it be? Its it feasible?
How expensive will it be? For example, does it require expertise the clinic or community do not have?

78. Step 1: Identify Potential Areas for Improvement
Encourage your team to identifying a small number of areas (2-4) to help focus improvement efforts (ensure the group is NOT trying to do too many things at once)
This whole process helps the team consider all relevant areas for improvement and supports decisions to focus on improvements that are most likely to be successful
Do not forget to use the readiness scores, the teams interpretation of the readiness scores, although it is up to the teams to decide which areas to focus on
Focusing on weaknesses of the readiness scores are often the best ways to make improvements
The list will be long, the prioritizing is critical and feasibility is important, it’s not about consensus but what is bugging the team the most what do you want to do in the next 2 weeks

79. Step 2: Develop the Short List
Once the potential areas for improvement have been identified, the team can flag the areas that they believe are most likely to bring positive results
Consider feasibility at this point
how easy will it be to accomplish this?
how expensive will it be?
do we have the experts needed?
Do not forget to use the readiness scores, the teams interpretation of the readiness scores, although it is up to the teams to decide which areas to focus on
Focusing on weaknesses of the readiness scores are often the best ways to make improvements
The list will be long, the prioritizing is critical and feasibility is important, it’s not about consensus but what is bugging the team the most what do you want to do in the next 2 weeks

80. Breakout Session

81. Priority Breakout Session
45 minutes to meet as a team to identify community priorities
The Community Facilitators help guide the discussion moving from a full list of areas for improvement - to identifying priorities - to change concepts and ideas
The Western team will be available for support

82. Breakout Session Objectives
Develop a list of potential areas for improvement
Identify a small number of priority areas to focus on in FORGE AHEAD
List some change concepts (broad principles to help plan improvements)
Start thinking about change ideas (more specific and practical than change concepts)
Do not forget to use the readiness scores, the teams interpretation of the readiness scores, although it is up to the teams to decide which areas to focus on
Focusing on weaknesses of the readiness scores are often the best ways to make improvements
The list will be long, the prioritizing is critical and feasibility is important, it’s not about consensus but what is bugging the team the most what do you want to do in the next 2 weeks

83. Question/Answer Period
We covered a lot of material today, any questions?
Should Alex run this session
Summarize what we covered today
Preview tomorrow work
Ask if anything content needs to be explained/ re-examined
Ask if anything about how the training is run and organized can be changed for tomorrow
Ask if the CF have any concerns about their role, about troubles they may encounter, about parts of the program they are unsure about or do not know what to expect, if they expect any troubles/issues to arise.
Ask what they are confident about, and as a team write on the board a list of things they are confident about. Then ask what they are not confident about in fulfilling their role in the program, and write this on the board. (use this information to guide what we cover in workshop and/or future training).

84. Question Period

85. Community Plenary

86. Networking

87. Summary of the Day

88. Question-Answers Period
We covered a lot of material, any questions?
Should Alex run this session
Summarize what we covered today
Preview tomorrow work
Ask if anything content needs to be explained/ re-examined
Ask if anything about how the training is run and organized can be changed for tomorrow
Ask if the CF have any concerns about their role, about troubles they may encounter, about parts of the program they are unsure about or do not know what to expect, if they expect any troubles/issues to arise.
Ask what they are confident about, and as a team write on the board a list of things they are confident about. Then ask what they are not confident about in fulfilling their role in the program, and write this on the board. (use this information to guide what we cover in workshop and/or future training).

89. Thank you for spending the day with us. See you tomorrow!
Tomorrow starts at
8:30 am
Start time tomorrow is 8:00am,
Remember to bring your binders