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Spread and Sustainability. Robert A. Gabbay , MD, PhD Connie Sixta, PhD, RN, MBA. Where Do We Go From Here?. Creating an Improved Clinical System. Improvement. Hold Gains. Spread. NON-LINEAR MODEL BETTER. Improvement. Hold Gains. Spread. Design Spread.
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Spread and Sustainability Robert A. Gabbay, MD, PhD Connie Sixta, PhD, RN, MBA
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
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)
3 Keys to Improvement RESULTS Source: Institute for Healthcare Improvement
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
Adopter Categories Early Majority Late Majority Innovators Early Adopters Laggards 16% 2.5% 34% 13.5% 34% from Rogers, 1995
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.
Adoption is a social thing! A better idea… communicated through a social network… over time. Source: Institute for Healthcare Improvement
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.
Use Wedges to Hold the Gains Improvement DATA Ideas Wedges signify making the work routine. No backsliding!
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)
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?
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.
Keep Meeting With Your Team!!!!!!! YOUR PATIENTS DESERVE THE BEST CARE YOU CAN DELIVER