Performance Partnerships: Producing Results with Smoking Cessation

1. Performance Partnerships:Producing Results with Smoking Cessation Smoking Cessation Leadership Center

2. What is a Performance Partnership? • Partnership organized around a specific, measurable result • Model developed in the 90’s that has produced a variety of measurable results in areas from reducing child abuse and teen pregnancy to salmon restoration and bay cleanup

3. The Performance Partnership Model • Originated during the Clinton-Gore years • Part of Reinventing Government • Based on experience in Oregon • Has been used around the nation and the world with good results

5. The Performance Partnership Model • Model requires assembling a group of partners all interested in attacking the same issue • Model asks four questions

6. The Four Questions • Where are we now? (baseline) • Where do we want to be? (target) • How will we get there? (multiple strategies) • How will we know we are getting there? (measures)

7. Setting the Baseline • Need a jumping-off point against which to measure progress • Statistical baselines are good– teen pregnancy rates, school dropout rates, childhood immunization rates • In the case of smoking cessation– how many clinicians intervene with smoking patients?

8. Setting a Target • This requires complete agreement on a single measurable outcome • Agreement on the what rather than the how • This provides the focus for the partnership

9. Multiple Strategies • No one party owns the answer to “How will we know we are getting there?” • Allow a wide array of strategies– even competing strategies– to be used by the various partners • Loose governance structure • This maximizes engagement and commitment among partners

10. Measures Keep Partners on Track • Devise a measurement strategy • Both process and outcome measures are needed • If measures are moving in the wrong direction, regroup and rethink strategies • Publicize progress to keep partners involved

11. Celebrate Successes • As you progress toward your goal, honor those who are making a difference • Add new partners as you go • Tolerate a messy process; just keep communications lines open among partners

12. An Example: The Smoking Cessation Initiative of the ADHA • Thirteen dental hygienists from clinical practice, academe, and the association formed a task force • Leadership from elected president of ADHA • Support from Smoking Cessation Leadership Center • Facilitation from expert on performance partnerships

13. How ADHA Answered the Four Questions • Where are we now?– About a quarter of hygienists intervene with patients who use tobacco. • Where do we want to be? We can double that in three years • How will we get there? Very broad work plan using state affiliates to deliver at the grass roots. • How will we know we are getting there? Develop an evaluation plan with pre- and post-tests.

14. The SCI Communication Plan • Developed a web site • Created a liaison in each state affiliate organization • Created scripts and protocols to help clinicians broach the subject of quitting with patients • Publicized the initiative through local channels and nationally through newsletter and meetings

15. The Partnership Prototype • American Dental Hygienists Association represents the nation’s 130,000 dental hygienists. • The newly elected president agreed to put tobacco cessation on her short list of projects for her term of office. • She chose 14 movers and shakers for a tobacco task force, including two past presidents, the next president and a key association staffer.

16. The Partnership Prototype • SCLC held a meeting in September 2003. • Group agreed on baseline– 25 percent of hygienists now intervene with their clients regarding tobacco. • Target– 50 percent in three years.

17. The Approach • Multiple strategies centering around referral to quitlines and raising awareness • Implemented through the state affiliate organizations, which have named tobacco liaisons • Measurement of progress to be aided by ADHA’s research institute and by academic members of task force

19. The Results • 56 percent of respondents offered tobacco treatment at all or most visits. • 71 percent of respondents focus on and intervene with higher-risk clients, including clients with tobacco-related oral findings. • Of those who visited the web site, 78 percent said they had incorporated cessation information from the site into their practice.

20. Performance Partnerships Lessons Learned

21. Performance Partnerships • Use data as a tool for motivation and management.

22. Performance Partnerships • Information technology can accelerate measurable progress dramatically.

23. Performance Partnerships • Circumvent hierarchy and turf.

24. Performance Partnerships • Focus on measurable results tied to a vision. MEASURABLE RESULTS VISION

25. Performance Partnerships • Draw from all sectors and all levels of government using an open door policy. Don’t forget to include non-traditional partners.

26. Performance Partnerships • Focus on better use of existing resources. • people • money • time

27. Performance Partnerships • Employ multiple strategies. Allow partners to “agree to disagree” on the strategy as long as they agree on the result.

28. Performance Partnerships • Measure progress frequently. Measure today!

29. Performance Partnerships • Agree to flexibility in exchange for accountability.

30. Performance Partnerships • Generally, use an inductive approach rather than a deductive approach--just get started!

31. Performance Partnerships • Tolerate mesy messyn messiness and asymMetRy.

32. Performance Partnerships • Encourage self-organizing efforts.

33. Performance Partnerships • Reward progress, but remember rewards don’t have to be financial. • They can include lots of positive attention, flexibility, increased trust and other non-traditional benefits.

34. Performance Partnerships • De-emphasize programs. Emphasize partnerships and cross-sector initiatives.

35. Example of State and County Initiatives • The New California Gold Rush • Washington Quits! • Oregon Tobacco Freedom • Do You CAARD? (California Diabetes Educators) • It’s Quitting Time L.A.!

36. For more information on implementing a Performance Partnership in your area, contact Catherine Saucedo at csaucedo@medicine.ucsf.edu or call 415.502.8880. http://smokingcessationleadership.ucsf.edu