1. Sustainability and Spread A Panel Discussion

2. Issues That Affect Sustainability Turnover of provider or staff Over-extension of the team champions Irregular or non-existent team meetings New quality initiative becomes organizational focus (resources, support) New processes dependent on a person instead of implemented changes

3. What did your Community Health Center do to sustain the improvements and outcomes of the Collaborative?

4. To sustain, how did you….. Orient new providers/staff to new processes? Educate new providers/staff regarding the models- -performance improvement and chronic care model Secure senior leader support, organizational focus Support provider and staff champions Assure changes are process-related not person- related Maintain the registry data and monthly reports Schedule team meetings Other

5. What type of spread did your CHC plan? Explain your strategy for selection of the first spread site? Provider to provider Clinic to clinic Disease to disease System to system

6. How did you manage the spread population registry and data? Expansion of software (DEMS) and hardware amongst Definition/reporting of Spread Population versus POF and measures Reports—how often, what’s included, sent to whom Comparing/sharing of data (providers, clinics)

7. What did you do to promote support from system sponsors? The Senior Leader The Board Provider Physicians Management Staff Others

8. How did you obtain the additional resources needed to support spread? I.S. staff (data entry and system support) Trainers Physician educators/champions Equipment/supplies Space Time for meetings, training and planning Other

9. What was your spread communication strategy? Newsletter describing: –The urgency or need for change –Changes tested and implemented –New learnings from staff/providers Publishing the outcomes/measures Reports at management, physician meetings Staff testimonials at staff meeting Presentations at Board meetings Other

10. How did you educate new team members in the following areas? Chronic Illness Model Use of the DEMS Performance Improvement Model Disease expert knowledge (disease) New changes, new processes Other

11. How did you achieve collaboration amongst the spread sites? Weekly planning meeting of the system spread team Monthly conference calls for all team members at spread sites Planned learning sessions amongst spread teams Use of the list serv Contributions for monthly report from all spread teams Informal networking or mentoring process Other

12. What particular barriers did you your CHC overcome during the spread process?

13. What advice would you give teams anticipating or managing spread?

14. Each team will have the next ten minutes to discuss potential or real spread activities and identify the two issues that present the largest challenge