1. South Carolina MLC-3 Experiences Opinions* *Subject to change after 2 nd collaborative experience

2. IHI Breakthrough Series (10 month time frame) Modified for SC Select Topic (develop mission) June 2008 Planning Group Develop Framework & Changes Participants: (4 county teams from Region 8, and 3 county teams from Region 4 selected by regions) Prework LS 1 LS 3 LS 2 SpreadSpread Expert Meeting AD P S AD P S AD P S NOTE: Evidence is known, but not being implemented

3. IHI Collaborative Model Really does work in governmental ph setting, when model is used as designed – Evidence is known, there really is change package for all teams in the collaborative – Intervention, the what, is similar across the different teams, the how is what teams figure out and share with each other – Learning sessions, followed by Action Periods combined with TA – Over time, collaborative goes from expert to team centric, team driven

4. IHI Collaborative Model Really does work in governmental ph setting, when model is used as designed – Teams become empowered, and really like that – More power if collaborative scope narrow and specific » Name of Collaborative means something » Rapid cycle PDSA QI work – Collaborative model makes sense, as teams learn from the experts (training and TA) and from each other (applying QI AND the ins and outs of the change package)—more power than if work were done in isolation, done separately

5. IHI Collaborative Model First SC Collaborative—Tobacco Use Intervention in HD clinical settings – 7 similar practice settings (WIC and FP) – Menu of changes from Change package the same for all teams (2As+R) – QI training, and applying the changes in their settings, rapid cycle PDSA – Direct learning, team to team – Since topic very specific, teams were able to apply QI PDSA work with some rigor, and evaluation results show this impact.

6. IHI Collaborative Model Less rationale for Model when No real change package (or each team has somewhat of its own change package) Teams not implementing the same changes QI apllied to intervention(s) not rapid cycle—learning and action cycle phases harder to implement There is rationale for collaborative QI learning and applying to practice settings (just not IHI) Nature of collaborative then is QI, not the intervention/change package as much Learning among teams is about applying QI to their practice settings, not the intervention/change package as much, across teams

7. IHI Collaborative Model Even with SC success, however, spread is very very hard 2As+R deployment (statewide target by July 2010) in all WIC, FP, HH, TB settings—embedded now in agency policy Even with collaborative knowledge, hard to get others to adopt the evidence, across large organization Champions needed, must be cultivated, nurtured

8. IHI Collaborative Model 2 nd Collaborative for SC will be implementing work around early entry into prenatal care… Most of the teams will not be implementing the same change package, and/or evidence unknown or not clear 1.Accurate documentation in the birth record (from HD to provider to hospital) 2.Internal referrals in the HD with pregnancy test results follow-up 3.From HD to provider referrals 4.Community referrals to providers Focus on QI learning and sharing of QI experiences – Much not rapid cycle QI – More of a QI Collaborative

9. Switching Gears….. …..Messaging Spitfire messaging helpful tool Segmenting the audience, figuring out what will resonate with them, as individuals, as groups, important, even within same organization Messaging of Voluntary Accreditation within SC State HD – From HS perspective – From Commissioner’s perspective – From EQC, OCRM perspective – From Health Regulations perspective – From Administration perspective