Spread and Sustainability

1. Spread and Sustainability Robert A. Gabbay, MD, PhD Connie Sixta, PhD, RN, MBA

2. Where Do We Go From Here?

3. Creating an Improved Clinical System Improvement Hold Gains Spread NON-LINEAR MODEL BETTER Improvement Hold Gains Spread Design Spread API Lloyd Provost and Institute for Healthcare Improvement

4. We’ve Talked A Lot About Improvement • Model for Improvement: • Aim • Measurement • Rapid testing of changes (PDSA cycles) • Test lots of ideas! • Expect some will “fail” • Most will need refinement (PDSA cycles)

5. 3 Keys to Improvement RESULTS Source: Institute for Healthcare Improvement

6. Leadership Improvement Framework Setting Direction: Mission, Vision, and Strategy Making the future attractive PULL PUSH Changing the old; making the status quo uncomfortable Will Execution Ideas Establishing the Foundation Build a culture of improvement, learning. Set quality standards. Assure organizational alignment. Source: Institute for Healthcare Improvement

7. Adopter Categories Early Majority Late Majority Innovators Early Adopters Laggards 16% 2.5% 34% 13.5% 34% from Rogers, 1995

8. Developing a Spread Plan • Is improvement a key strategic initiative? • Is there a budget for spread? • Has time been allocated for spread? • Are goals and incentives aligned? • Identify and develop your spread champions. • Leverage your improvement data—tell your improvement story! • Document your ROI and other benefits. • Measure, show comparative data, and provide feedback. • Develop learning “communities of practice” among those with similar roles.

10. Adoption is a social thing! A better idea… communicated through a social network… over time. Source: Institute for Healthcare Improvement

11. Tell Us About Your Spread Efforts

12. Sustaining Improvement Drop off in measures is common but preventable! • Initial excitement, urgency wear off. • Possible change fatigue. • Pay particular attention to yearly measures (foot exams, eye exams, LDL tests, etc.) as you approach end of initial 12 months. • If strong system of population management is in place should not see these decline. • Staff/Provider turnover, particularly among change leaders.

13. Use Wedges to Hold the Gains Improvement DATA Ideas Wedges signify making the work routine. No backsliding!

14. Strategies to Hold the Gains • Establish and document standard processes • Make changes to job descriptions • Use measurement and audits • Pay attention to orientation and training • Assign ownership • Address the social aspects of change (who are the peer leaders, who talks to whom)

16. Your Sustainability Experience • How are you checking to make sure changes are sticking? • What kind of shared ownership exists in your practice for your improvement data? • How have you been documenting revised processes and revised job duties?

17. Final Thoughts on Sustainability • Patient engagement! • Involve patients/families in your improvement efforts. • Ask them what is working, what is not. • Consider peer-based self-management support.

18. Keep Meeting With Your Team!!!!!!! YOUR PATIENTS DESERVE THE BEST CARE YOU CAN DELIVER

19. Questions?