SPREADING AND SUSTAINING STRATEGIES FOR SENIOR LEADERS AND TEAM MEMBERS

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SPREADING AND SUSTAINING STRATEGIES FOR SENIOR
LEADERS AND TEAM MEMBERS

• St. Anthony Amofah, MD, MBA
• Medical Director,
• Helen B. Bentley Family Health Center, Inc
• Miami, Florida

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WHY ARE WE HERE TODAY?

• Knowledge of burden of chronic diseases
• Desire to help to reduce health disparities
• Appreciation of value of Collaborative Models
• BPHC Expectation
• Desire to share selflessly and steal shamelessly
  on strategies to spread and sustain gains

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GOAL TO ENGAGE GROUP IN A DISCUSSION AT THE END
OF WHICH EACH OF US WILL BE ABLE TO TAKE
SOMETHING BACK TO OUR CENTERS ON HELPFUL
STRATEGIES FOR SPREADING AND SUSTAINING CHANGES.

• OUTLINE
• Definition of Spread/Sustain
• Preparing for Spread
• Spreading
• Sustaining gains
• Take home messages
• Discussion (What else can
• we learn from each other?)

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SPREAD?

• Learning from changes that have resulted in
  improvement in one area (provider panel, site,
  disease, etc) and then implementing them in other
  areas.

SUSTAIN?

• Holding gains
• Maintaining improvements
• Cementing positive changes into system of care

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PROCESS OF SPREADING
PREPARING FOR SPREAD
SPREADING
SUSTAINING CHANGES
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PREPARING FOR SPREAD(Minimum Necessary
Requirements)

• (1) SELECT SPREAD TEAM
• Importance
• An effective team
• Serves as the coach, coordinator, etc
• Keeps plans moving forward
• Keeps everyone focused
• Serves as a reminder when
• people get distracted

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PREPARING FOR SPREAD(Minimum Necessary
Requirements)

• (1) SELECT SPREAD TEAM
• Membership
• Provider from Pilot Team
• Senior Leader
• Team Leader/Member of Pilot Team
• New Members New Provider, New Support Staff,
  Office Manager
• Desirable New Member characteristics
• Enthusiastic, Open to new ideas, People skills,
  Willing to work extra hours

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PREPARING FOR SPREAD(Minimum Necessary
Requirements)

• (2) PERFORM READINESS ASSESSMENT
• Should be done by New Team
• Must include Executive Director
• Assign primary responsibility for areas needing
  work
• Importance
• Potential barriers to success are addressed
• Process helps team to bond

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READINESS ASSESSMENT ALGORITHM
Measures of success Outcomes measures Process Stru
cture
Did Pilot Team Succeed?
Importance of pilot team success Motivating to
team, senior leader, other staff Lends
credibility to changes made
Most likely reasons for failure Lack of visible
management support Lack of effective team
leadership Team not empowered
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READINESS ASSESSMENT ALGORITHM
Did Pilot Team Succeed?
SOLUTIONS
no
Management must assume ownership Go back to
drawing board and start Over (You are not
ready for spread).
yes
Is Improvement in Chronic Disease Care in
Strategic Plan?
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READINESS ASSESSMENT ALGORITHM

• For this to be a useful step in improving chronic
  disease care
• Center must have an effective strategic plan
• Improving chronic disease care must be included
  in it.

• What is an Effective Strategic Plan
• (A living, breathing strategic plan)
• Reflects Board/Managements vision
• Is shared regularly with middle management
• Is translated into a departmental work plan with
  line staff involvement
• Is evaluated periodically

Is Improvement in Chronic Disease Care in
Strategic Plan?
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READINESS ASSESSMENT ALGORITHM
SOLUTIONS
Did Pilot Team Succeed?
no
Management must assume ownership Go back to
drawing board and start over (You are not
ready for spread).
yes

• Develop effective Strategic Plan
• Formal written proposal to Board/Mmt
• Emphasize importance
• Summarize goals/measures

Is Improvement in Chronic Disease Care in
Strategic Plan?
no
yes

• Formal proposal to PI Committee
• Summarize importance
• Give details of goals/objectives, evaluation
• method
• Include in PI calendar of activities
• Standing agenda item

Are measures Included in PI Plan?
no
yes
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READINESS ASSESSMENT ALGORITHM
Can staff maintain Registry?

• Reasons for inability to maintain Registry
• No assigned primary responsibility for data entry
• No accommodating delivery system design

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READINESS ASSESSMENT ALGORITHM
Can staff maintain Registry?
Assign primary responsibility (?Admin.
Clerk) Define accommodating delivery system
design Recruit data entry clerk
no
yes
Is someone in Leadership Responsible for Spread?
no
Assign responsibility -Person must attend/have
attended a Learning session.
yes
You are ready to spread
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PREPARING FOR SPREAD(Minimum Necessary
Requirements)

• (3) DEVELOP A WRITTEN PLAN
• Importance
• Serves as a roadmap
• Must include
• Defined aim statement/key measures/action steps
• Resources (Staffing, Equipment/Supplies, Funding)
• Discussion of potential barriers
• Support system
• Communication plan
• Responsible person for each objective and
  timelines.
• (Consider plan for each model component)

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PREPARING FOR SPREAD

• (4) INTENSIVE EDUCATION PROCESS
• WHO?
• Educate new team members, target staff, support
  staff, and then entire staff
• WHAT?
• Provide education on What changes are being
  made, why the changes are being made and how the
  changes will affect them
• HOW?
• Review new Delivery System Design and how it
  differs from old.
• Role Play
• Then Review Model Components

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PREPARING FOR SPREAD(Minimum Necessary
Requirements)

• SUMMARY
• (1) SELECT A SPREAD TEAM
• (2) PERFORM READINESS ASSESSMENT
• (3) DEVELOP A WRITTEN PLAN
• (4) INTENSIVE EDUCATION PROCESS

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SPREAD

• Commence changes
• Target staff must huddle to clarify roles and
  patient flow on day of spread
• Senior Leader/Management should be visible,
  troubleshoot and exude support on day 1
• End of day session to review issues and prepare
  for day 2
• Identify overlapping functions and integrate
• Monitor adherence to written spread plan
• Use feedback (PDSAs) to fine tune process

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SUSTAINING CHANGES

• 4 CRITICAL FACTORS FOR SENIOR LEADERS AND TEAM
  MEMBERS
• (1) AN EMPOWERED, ENTHUSIASTIC TEAM
• (2) A DYNAMIC KNOWLEDGE BASE
• (3) STAFF BUY-IN
• (4) VISIBLE MANAGEMENT SUPPORT
• HOW CAN AN ORGANIZATION EFFECTIVELY ACHIEVE THESE
  CRITICAL FACTORS

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SUSTAINING CHANGES

• (1) EMPOWERED TEAM
• WHAT CAN AN EMPOWERED TEAM DO TO HELP TO SUSTAIN
  CHANGES?
• Monitor written plan (provide feedback to
  stakeholders)
• Keep changes in front of all
• Facilitate on-going education process
• Exude and infect others with enthusiasm
• Share success stories (at staff meetings, on
  storyboards, in memos)

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SUSTAINING CHANGES

• (1) EMPOWERED TEAM
• HOW CAN A CENTER DEVELOP AN EMPOWERED TEAM?
• Support by management
• Decision-making capability
• Allowed room for errors
• Mandated meeting time

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SUSTAINING CHANGES

• (2)DYNAMIC KNOWLEDGE BASE
• ON WHAT?
• Overall purpose of Collaboratives
• Models utilized
• How implementation of the models helps to achieve
  goals
• Changes made in organization as a result of
  application of models
• Supporting policies and procedures

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SUSTAINING CHANGES

• (2)DYNAMIC KNOWLEDGE BASE
• HOW CAN A CENTER MAINTAIN SUCH A KNOWLEDGE BASE?
• Quarterly General Staff In-service
• On-going Provider education by local specialists,
  etc
• Develop Clinical Pearls (Post in exam rooms)
• Pop Quizzes
• Story board posters
• Role play
• E mails
• Newsletters, Peer-to peer, Shadowing, etc.
• (Consider Calendar of Educational Activities
  to improve chronic disease care)

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(3) STAFF BUY-IN

• A major challenge
• Importance
• Responsible for implementing most changes made..
• Necessary for sustaining this change
• Necessary for initiating and sustaining other
  changes (re management credibility).
• 3 staff groups to address
• Providers
• Clinical Support Staff
• Non-clinical Support Staff

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• CLINICAL SUPPORT STAFF BUY-IN
• Typical problems
• Work Overload
• Apathy
• Helpful Solutions
• Educate
• Embed in daily routine
• Feedback
• PROVIDER BUY-IN
• Typical problems
• Work overload
• Perception of value of changes made
• Knowledge base
• Helpful Solutions
• Increase knowledge base
• Optimize workload
• Feedback
• Compensation Plan
• Senior Management Support

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SUSTAINING CHANGES

• (4) VISIBLE MANAGEMENT SUPPORT
• Standing agenda item in meetings
• (Management, Board, PI meetings)
• Policies and Procedures
• Inclusion of roles in Job Descriptions
• Staff Compensation Plan
• Removal of barriers (staff resistance,
  equipment/supply needs, etc).

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SUMMARY OF DISCUSSION

• Why Spread and Sustain Changes?
• Preparing for Spread
• Select a Spread Team
• Assess Readiness
• Create a plan
• Educate
• Spreading
• Monitor adherence to plan
• Remember PDSAs
• Sustaining changes
• Enthusiastic team
• Knowledge base
• Management support

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TAKE HOME MESSAGES

• HOW CAN TEAM MEMBERS ENGAGE SENIOR LEADERS TO
  MAINTAIN SUPPORT
• Keep them informed
• Involve in discussions, recommendations and
  decision-making
• Give them assignments
• Infect enthusiasm
• Celebrate success together (Share success
  stories)
• Share patient feedback

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TAKE HOME MESSAGES

• WHAT CAN YOU DO AS A SENIOR LEADER TO SUSTAIN
  SPREAD?
• Demonstrate your support
• Demonstrate your support some more!
• Do not stop Demonstrating your support

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GENERAL DISCUSSION

• WHAT ELSE CAN WE LEARN FROM EACH OTHER?