II. Collaborative Overview

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Collaborative Overview ObjectivesApply all phases of the BTS Collaborative model to your own collaborativeAnticipate the challenges and complexities of designing, managing and guiding a successful collaborativeAdapt the Service Collaborative content to your own collaborativeAddress any questions about Faculty and Staffing

2

IHI Breakthrough Series(6 to 18 Months Time Frame)

Select Topic

(Develop Mission)

Planning Group

Develop Framework & Changes

Participants (10-100 Teams)

Prework

LS 1

P

S

A DP

S

A D

LS 3LS 2

SupportsEmail Phone Conferences

Extranet Visits Assessments

Sponsors Monthly Team Reports

DisseminationPublications,

Congress, etc.A DP

SExpert Meeting

AP1 AP2 AP3*

LS – Learning Session

AP – Action Period

*AP3 –continue reporting data as needed to document success

Holding the Gains

Peru Video What did you observe?What was the Collaborative experience like for the participants? For the leaders?What questions do you have?

BTS Service CollaborativeSummary and Materials

Service CollaborativeGoal: to demonstrate that health care can provide

unprecedented levels of service and satisfaction, focusing on the 8 dimensions of service from the Picker Survey

Service I Spring ’97 to Autumn ’9737 organizationsService II Autumn ‘99 to Summer ’0021 organizations SP

Service Collaboratives Focused on…

Treating the patient as an individual worthy of respect; Includes issues of privacy, physical comfort, emotional support, and patient and family choice and controlHelping the patient to interact with a complex health care system; Includes coordination of care, smooth transitions among sites and providers of care, and understandable information to facilitate decision making

Service II FacultyChair: National Leader in Patient Centeredness, Physician’s Assistant, President of Picker InstitutePlanning Group:– Hospital QI consultant, nurse, past participant– Health System QI leader, nurse, past faculty– Thoracic Surgeon, past participant– Health Center Administrator, past participant– Improvement Advisor-statistician who also worked on

two ED collaboratives

Service II Organizations

Representative sample– Hospitals, HMOs, Integrated Delivery Systems, and Office

Practices

Setting:– ED (3 teams)– Inpatient and across boundaries (10 teams)– Ambulatory Care (8 teams)

Participating Teams Were Usually from One Unit or Service Line

Day to Day Leader: Administrative Manager or Nursing LeaderTechnical Expertise: Quality Improvement, MarketingSystem Leader: Administrative VP or Clinical VP% of teams with a Physician=40%

Service Aim Examples

Increase by 20% the number of patients and families who rate the overall quality of care they receive in Emergency Department as excellentPatients entering our Clinic will be highly satisfied with care, as evidence by a 75% increase in willingness to recommend the clinic to their friends within 10 months Our ICU patients will feel respected, supported, and included in their care, and within 10 months will reach the following goals: – 90% of patients report being highly satisfied with their care– 75% of patients reported that the doctors and nurses

recognized their needs and treated them as individuals– These goals will be achieved in 10 months, with results being

spread to two other ICUs

MeasurementAll organizations had existing patient satisfaction collection systems that were inadequate for improvementPicker, Press-Ganey, or home grown systems were augmented with data collection specific to the units involved

Some MeasuresPercent of patients reporting satisfied or very satisfied with carePercent of patients reporting willing or very willing to recommend the providerPercent of patients reporting problems with care

Results Example-ED

Willingness to Recommend to Friends n=200 per month

020406080

100

Baseline Aug Sep Oct Nov Dec Jan Feb Mar Apr May

Month

Perc

ent

PercentGoal

Teams Worked on Multiple Dimensions of ServiceThey chose 3 or 4 areas from this list:

RespectComfortEmotional supportInformation and educationInvolving family and friendsContinuityAccessTransitions

Examples of Changes Tested-EDDischarge changes: Physician gives discharge instructions, RN follows up next dayPlace chairs in rooms, train physicians in communication skillsRoom before registration: Direct route to physician protocolPain management protocolTriage Nurse as customer service rep-waiting time, waiting roomBed supervisor in ED speeds admissionsWaiting Room converted to Health Info Resource Center

Results in Service I and II

Final Team Assessments Service I at LS 3

0

2

4

6

8

10

12

14

16

1 1.5 2 2.5 3 3.5 4 4.5 5

# of

Tea

ms

Median Rating= 4.0% teams 4 or above =75%

Final Assessment Service II at LS3

0

2

4

6

8

10

12

14

16

1.0's 1.5's 2.0's 2.5's 3.0's 3.5's 4.0's 4.5's 5.0's#

of te

ams

Median=4.0Percent 4 or better=53%

Faculty and Staffing for Your Collaborative

Faculty and StaffingPlanning Group

ChairFaculty members (subject matter experts)Collaborative Leadership– Director– Improvement Advisor– Coordinator– System sponsor

IHI BTS ResourcingRole:

ChairFaculty (2-5) DirectorImprovement AdvisorCoordinatorSystem Leader for the organization hosting the collaborative

Time Commitment / Month:2 days1 day (each member)8 days3 - 4 days

10 days1/2 day

(BTS Team manages 10 -100 participating orgs.)

Creating the Planning Group

Expert Panel – 12-15Role: Supply Clinical

(e.g. subject matter) Content

Faculty – 2-6

Role: Develop content, plan, teach, coach in BTS

IHI Staff

Director, IA, Coordinator, System Sponsor

Chair

Advisers, Guest Speakers at Learning

Sessions

Attributes of a Great Leadership Group = Planning Group

Planning Group– IHI Staff: Director, IA, Coordinator, System Leader– Chair and Faculty

Skills and experience complement each other (clinical / non clinical, experience with Collaboratives)Fluid boundaries for rolesKnowledge and skills in technical (topic) area

Collaborative Director (8 Days per Month, 1/3rd Time)

Project management expert who understands improvement – Responsible for BTS processManages the overall CollaborativeCoaches the Chair and Faculty in the Breakthrough Series methodology Manages pre-work development, recruiting, Q&A, team reviewsCreates and facilitates meetings and conference call agendasWorks with Improvement Advisor to track teams’ and overall Collaborative’s progressCompiles and reviews organizations’ monthly reportsCoaches organizations at Learning Sessions and during Action Periods

Improvement Advisor (3-4 Days per Month 1/5th Time)

Expert in improvement theory and methods –responsible for outcomesCoordinates the development of the theory for the topic (aim, measures, changes)Packages changesDesigns a measurement system and addresses issues regarding measurement More time required for new topicsTeaches and coaches Faculty and teams on application of the Model for ImprovementAssesses Collaborative progress and recommends strategies to achieve Collaborative goals

Collaborative Coordinator (10 Days per Month, ½ Time)

Responsible for Collaborative administration, including project timeline, contracting, and financial managementWrites and edits correspondence, meeting materials, marketing materialsManages marketing, enrollment, prework activitiesManages Action Period activities: Mail, electronic mail, fax, conference calls, reporting processManages registration, payments, and project membershipCoordinates compliance with all Continuing Education requirementsManages Learning Session logistics

System Leader (1/2 day per month)• Responsible for all Collaborative Improvement at

sponsoring organization

• Charters Collaboratives and ensures they are consistent with mission, goals, and resources of organization

• Provides resources for Collaborative staff and faculty

• Provides executive review and guidance

Collaborative ChairNoted authority in Collaborative topicCreates a shared vision and provides intellectual leadership for the topicHelps form and guide FacultyAssists the Improvement Advisor to develop the change package and measurement systemChairs and teaches at Learning SessionsCoaches and mentors organizations to achieve goalsReviews Collaborative progressLoses sleep—Results Focused!

Faculty:Additional Subject Matter Experts

Viewed as credible experts in the selected topic (accomplished significant results).…. the “Dream Team”Represent multiple disciplines and multiple organizational structures - Primarily practitioners, some researchersSpecify goals, high leverage changes, teams for PreworkTeaches and coaches at Learning Sessions and during Action PeriodsAdvises the Chair and Director of teams’ progressOften volunteers in IHI BTS system

Attributes of a Great Planning Group

Skills and experience complement each other (clinical/non-clinical, experience with Collaboratives)Fluid boundaries for rolesKnowledge and experience in topic areaFor Faculty: Passionate about the topic and improvement

Please go to the Planning Guide section of the Workbook and complete the Worksheet for Collaborative Overview.

To the Workbook… 30

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