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Developing and Managing Quality Improvement Learning Collaboratives. September, 2010 Contributors: Brenda Joly PhD, MPH Maureen Booth, MRP George Shaler, MPH Ann Conway, PhD. Lessons from the MLC States. Overview. Evaluation background Components

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developing and managing quality improvement learning collaboratives

Developing and Managing Quality Improvement Learning Collaboratives

September, 2010

Contributors:

Brenda Joly PhD, MPH

Maureen Booth, MRP

George Shaler, MPH

Ann Conway, PhD

Lessons from the MLC States

overview
Overview
  • Evaluation background
    • Components
    • Case study process, rationale, theory
  • Findings and opportunities
    • Planning and start-up
    • Managing the Learning Collaborative
  • Implications
    • Sponsors
    • Local health departments
mlc evaluation
MLC Evaluation
  • Quality improvement goal:
    • To promote the application of QI methods
  • Evaluation tools:
    • Annual survey
    • Mini-Collaborative survey
    • Quarterly reports
    • Case studies
    • Key informant interviews
case studies
Case Studies
  • Who?
    • Mini-collaborative members and organizers
    • LHD quality improvement teams
  • Why?
    • Multiple perspectives
    • “On-the-ground” understanding
  • What?
    • Site visits, interviews, document review
    • Observations of meetings
key finding 1
Key Finding #1:

The Relevance of a Target Area is

Critical and Impacts Engagement

  • Who selected targets?
    • State sponsors or statewide body
    • Local input
  • What criteria were use in selection?
    • Relevance and alignment with priorities
    • Need demonstrated by data
key finding 2
Key Finding #2:

The Structure of a Mini-Collaborative

Affects its Effectiveness

  • What works best?
    • Involving senior leadership is essential
    • Having diversity in faculty adds value
    • Having a sufficient size to promote exchange
    • Working on a consistent QI project
    • Having clear roles and responsibilities
    • Having prior experience working together
key finding 3
Key Finding #3:

Defining Expectations & Communicating

Them in Advance Builds Confidence

  • What did we learn?
    • Goals of mini-collaboratives varied and evolved
      • Build QI skills
      • Improve quality within target area
    • Goals should be aligned with timeframe and participant readiness
    • Expectations for QI projects should be focused, realistic and communicated
key finding 4
Key Finding #4:

Advanced Planning Influences the

Effectiveness of Learning Collaboratives

  • Who planned the mini-collaboratives?
    • State sponsors
    • Broader group of state, faculty and others
  • What should be planned?
    • Model, curriculum, workplan, use of faculty and evidence, tools to assess participant knowledge and measures to monitor progress
key finding 5
Key Finding #5:

The Level of Effort Among Sponsors

and LHDs is Often Underestimated

  • What did we learn?
    • The planning and start-up phase is especially time consuming for sponsors
    • Having outside faculty helps
    • Level of effort is often underestimated if expectations are unclear or scope is unrealistic
    • Competing priorities are a reality
key finding 11
Key Finding #1:

Opportunities for Timely and Frequent

Application of QI Tools are Essential

  • What was most helpful?
    • Learning/using fewer tools
    • Training on when and how to use
    • Providing opportunity for immediate application
    • Providing feedback on use
    • Giving LHDs a chance to practice, practice, practice
key finding 21
Key Finding #2:

Communication With and Among

Members Enhances Learning Experience

  • What was most helpful?
    • Opportunities for ongoing information exchange
    • In-person meetings
    • Structured learning sessions
    • Communicating the value of QI to LHDs
    • Site visits to LHDs
    • Communicating clear expectations
key finding 31
Key Finding #3:

Several Factors May Strengthen or

Impede a QI Learning Collaborative

  • Facilitating factors?
    • Commitment to data driven QI and accreditation
    • Leadership buy-in
  • Impeding factors?
    • Concurrent QI skill development at state and local level
    • Lack of focus and clear expectations, unrealistic goals, turnover, and competing priorities
key finding 41
Key Finding #4:

It is Critical for Participants to Have

Access to Adequate Resources

  • Technical assistance:
    • There should be a good mix of content expertise and QI expertise among sponsors and faculty
  • Other resources:
    • Evidence needed to select QI intervention should be made available
    • Financial resources may boost efforts of LHDs
implications for sponsors
Implications for Sponsors
  • Some considerations…
    • Set time aside for advance planning
    • Recruit credible and skilled faculty
    • Assess QI knowledge beforehand
    • Recruit the enough and the right mix of participants
    • Embed the application of QI into the process
    • Communicate with the group frequently
    • Follow a structured approach
implications for lhds
Implications for LHDs
  • Some considerations…
    • Garner support of leadership and staff
    • Promote the value of QI
    • Align QI project with job responsibilities
    • Actively engage in information exchange
    • Use faculty and available technical assistance
    • Remain open to the process and outcomes
    • Document your efforts
    • Share your findings
developing and managing a quality improvement learning collaborative

Developing and Managing a Quality Improvement Learning Collaborative

September 2010

Contributors:

Cathy Montgomery, M.S., ASQ-CQIA

Sandra Ruzycki, M.P.H., Quad-R

Baker, Clay, DeSoto, Duval, Glades, Martin, Nassau, St.

Johns and St. Lucie County Health Departments

Lessons from Florida

plan plan plan
Plan, Plan, Plan
  • Use data to determine target area
    • Overweight and obesity among children 6-19
  • Create partnerships
  • Outline timeframes and expectations Ψ
  • Establish criteria for selecting participants

Ψ = lesson learned

establish facilitator goals
Establish (facilitator) Goals
  • Use of quality improvement tools and methods
  • Support participants in their projects
  • Communicate project impacts and outcomes
    • Local, state, national venues
slide25

Select an Improvement Model

  • Quality Improvement Control Story Ψ
    • Founded on PDCA
  • Integrates QI tools and methods throughout the process
training and tools
Training and Tools
  • Assess participant’s knowledge of QI tools Ψ
  • Provide relevant training
    • Just-in-time
    • Face-to-face Ψ
  • Allow participants to practice using tools and process
results training
Results: Training
  • Participation in QI training improved overall knowledge of QI tools – 84%
    • Baseline = 84%
  • Confident in their ability to use QI tools – 68%
    • Baseline = 62%
  • % of participants that rated level of use of QI tools after training as:

moderate – 58%

    • Baseline = 62%

high – 21%

    • Baseline = 15%

*Surveys conducted March 2009 (baseline) and February 2010

results tools
Results: Tools

% of participants that indicated a high readiness to:

  • Use QI tools in other initiatives – 83% (n = 15)
  • Incorporate QI tools into ongoing work – 67% (n=12)
  • Development of evaluation measures – 56% (n = 10)
  • Present QI tools to CHD staff – 50% (n=8) Ψ
technical assistance
Technical Assistance
  • Conduct coaching calls
    • Using quality improvement process and tools
    • Creating action plans and storyboards
    • Developing methods and measures for evaluation
    • Analyzing data results
  • Resources
    • Subject matter expertise
    • Books, articles, and research related to QI and projects
    • Evaluation database
collaborative teams
Collaborative Teams
  • Counties created teams consisting of internal staff
    • 65% of participants indicated multiple CHD programs were represented on team
    • 3 of 9 counties had QI program staff on the team
results collaborative teams
Results: Collaborative Teams
  • Team meetings were random and unproductive Ψ
    • 53% of participants stated team meetings were only slightly productive
    • 53% moderately or slightly agreed there was consensus on project goals and procedures
  • % of participants that strongly or moderately agreed project team members:
    • Got along well – 94%
    • Treated each other fairly – 71%
    • Had necessary skills for this project – 65%
results chd support
Results: CHD Support

59% rated level of CHD support was very or somewhat supportive

71% indicated staff time and resources were fully, mostly or somewhat available

communication
Communication
  • Provide venues for participants to share ideas
    • Monthly conference calls/web ex
    • Face-to-face meetings
    • SharePoint site
  • Conduct one-on-one coaching calls
  • Communicate progress of collaborative projects Ψ
results communication
Results: Communication
  • % of participants who rated the following resources as useful
    • One-on-one coaching calls: 65%
    • Monthly conference calls: 65%
    • SharePoint site: 59%
    • Collaborating with other MCLC counties: 71%
    • Collaborating with other agencies: 53% Ψ
  • % of participants who agreed or strongly agreed HPI provided:
    • Effective communication: 94%
    • Effective project coordination: 95%
slide37

Overall Experience

  • 76% rated their overall experience as excellent or good
  • 94% rated the level of success of their project as excellent or good
  • 88% indicated they were likely to participate on another learning collaborative
  • 76% reported they were likely to implement a new QI project in their CHD
lessons learned
Lessons Learned Ψ

What else did we learn?

  • Planning and implementation is time consuming
    • 41.2% of participants spend 1-5 hours per week on project; others indicated they spend more time!
  • Don’t assume what they know
  • Competing priorities are a reality