Spread and SustainabilityRobert A. Gabbay, MD, PhDConnie Sixta, PhD, RN, MBA

Where Do We Go From Here?

Improvement

Hold Gains

Spread

Creating an Improved Clinical System

Improvement Hold Gains Spread

NON-LINEAR MODEL BETTER

API Lloyd Provost and Institute for Healthcare Improvement

Design Spread

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

WillChange Thinking

ExecutionGet it done!Make it last!

IdeasInnovate, Harvest,

Package

RESULTS

Source: Institute for Healthcare Improvement

Leadership Improvement FrameworkSetting Direction: Mission, Vision, and Strategy

Changing the old; making the status quo uncomfortable

Making the future attractive

PUSH

PULL

WillIdeas Execution

Establishing the FoundationBuild a culture of improvement, learning.

Set quality standards.Assure organizational alignment.

Source: Institute for Healthcare Improvement

InnovatorsEarly

Adopters

EarlyMajority

LateMajority

Laggards2.5% 13.5% 34% 34% 16%

from Rogers, 1995

Adopter Categories

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

Tell Us About Your Spread Efforts

Sustaining ImprovementDrop 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

DATA

Wedges signify making the work routine.No backsliding!

Ideas

Improvement

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

Questions?