Engaging Staff and Consumers in QI Work

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Engaging Staff and Consumers in QI Work
Quality Institute Workshop

• All Grantees Meeting
• August 2006

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Session Goals

• Identify key stakeholders clinical, non-clinical
  and consumers, and their roles in QI work.
• Review practical and attitudinal obstacles to
   stakeholder participation  and discuss
  strategies for engaging their hearts, minds, and
  schedule books.
• Know where to access best practices and tools.

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Questions (including Yours)

• What is buy-in?
• Why is it important to a QI program?
• What do we mean by stakeholders? (Who has a
  stake? Who cares? Whos affected?)
• How do you engage stakeholders?

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Stakeholder Involvement Themes from the
Literature   www.isixsigma.com Definition St
akeholder Anyone who is affected by or can
influence a project.   Alternative
definitions People who are, or might be,
affected by any action taken by an organization.
Examples customers, owners, employees,
associates, partners, contractors, suppliers,
related people or those located nearby.
 

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Key Stakeholders

• Title I/II

• Title III/IV

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Key Stakeholders

• Title I/II
• Grantee/DOH
• Planning Council
• Consumers
• Provider reps clinical and support
• Other DOH depts Medicaid, MCH, mental
  health/subs abuse
• Data people
• Title III/IV, HOPWA

• Title III/IV
• Clinicians
• Non-clinical staff
• Consumers
• Dentists
• Nutritionists
• Data people
• Title I/II

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www.ihi.org  

• Themes from the Literature www.ihi.org
• Quality is not a department.
• An organization will only make meaningful and
  sustainable quality improvements when people at
  every level feel a shared desire to make
  processes and outcomes better every day, in bold
  and even imperceptible ways.
• Identify the Adopter Audiences
• There are different audiences within the group.
  Those that are key to the process being improved
  must make the decision to adopt the improvements.
• Develop and Use Key Messengers
• Key messengers are those who advocate for the
  improvement to be spread. Key messengers play an
  integral part in the communication campaign by
  building awareness and providing information
  about the improvements to others
• Spreading Change
• Involves leadership, strategy, making the case
  for a better idea, communication, understanding
  the social system, managing best practices, and
  measurement and feedback.
• .
• .
•  
•  

 
 
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Discussion Questions

• What have you observed to be positive and
  negative influences on stakeholder involvement in
  QI?
• What is the job description for staff in QI work?
  For consumers?
• What institutional supports make it most possible
  to involve them?
• What hearts and minds strategies are most
  effective?

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Key Stakeholders Clinicians

• Expensive personnel with erratic
  ability/willingness to carve out admin time
• Compensation/reimbursement tied to productivity
  rather than quality
• Tradition of apprenticeship and artisanal
  approach to work, rather than systems approach
• Minimal training in QI and in administration
• Widespread and entrenched resistance to report
  cards

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Physician Resistance

• 2003 National Survey of Physicians and Quality of
  Care (not HIV-specific).
• N 1,837 (52.8) returned surveys.
• Findings
• 49 had access to aggregated pt data
• 25 had access to outcomes data about their own
  pts
• 34 had participated in some system redesign
  effort
• 69 said quality info about individual MDs should
  NOT be accessible to the public

Audet AM, et al Measure, Learn, and Improve
Physicians Involvement in Quality Improvement.
Health Affairs, 24 3 843 May/June 2005 843-853.

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Key Stakeholders Non-Clinician Provider Staff

• Critical role in identifying improvement ideas
  they know what is practical.
• System change requires a team effort if it is to
  be sustainable.
• Often more in touch with challenges that
  patients/consumers are dealing with

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Key Stakeholders Consumers

• Most in touch with realities of other consumers
  lives, can help predict which changes are likely
  successful .
• Help keep the providers from getting lazy and
  setting goals too low.
• Critical in prioritizing issues to focus on what
  has the most impact?

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Key Stakeholders Provider Organizations and
Partners

• Hard work to coordinate between govt agencies.
• Providers may be suspicious of EMA or State
  leadership concern about unfunded mandate
  and/or QM data used to defund agencies
• Aligning efforts of all RWCA funding streams has
  many benefits.

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HIV Chronic Care Model
All Titles
Community
Food bank, volunteers, child care.
RWCA Continuum of Care
CAREware, Labtracker Aries
AETC training Dissem DHHS Guidelines
Group visits, planned visits, CM
Client advocacy, peer mentoring
Informed, Activated Patient/Client
Prepared, Proactive Care Team
Productive Interactions
Improved Outcomes
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Engaging Stakeholders What Works? (ideas from
the Group Learning Guide)

• Convey importance of QI to external agents
• Organize educational activities to promote
  quality
• Recognize staff for QI efforts
• Institutionalize improvements
• Demonstrate program successes
• Commit resources

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Engaging Stakeholders What Works?

• Show them the data.
• Focus both on what needs to be better and on what
  is working and needs to be spread.
• Use competitiveness to inspire people.
• Reward transparency show participants that they
  will not be punished for being open about what
  needs to be fixed.
• Assign time and resources to show this effort is
  important to the organization.

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Engaging Stakeholders What Works?

• Release time from other duties to work on QI
  project
• Provide support staff to meetings minutes and
  assisting with followup reminders
• Reduce productivity targets/case loads for those
  participating in QI work
• Pay for food for meetings (non-RWCA )
• Report at every staff meeting and in newsletters
  on progress of work

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How does this apply to my program?(Pair
one-to-one,discuss.)
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National Quality Center (NQC)NYSDOH AIDS
Institute90 Church Street13th FloorNew York,
NY 10007-2919888-NQC-QI-TANQCTA_at_health.state.ny.
usNationalQualityCenter.org
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Involving Consumers in New York StateHIV
Quality of Care Programs
AIDS INSTITUTE
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Purpose

• A Ryan White Title II initiative designed to
  improve the quality of HIV care for consumers -
  People Living with HIV/AIDS (PLWHA) in New York
  State.

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Goals

• To involve PLWHAs and to educate them about HIV
  quality of care initiatives
• To exchange feedback between HIV quality of care
  programs and the PLWHA community and
• To inform PLWHA about HIV policy, program issues,
  and to solicit recommendations directly from
  consumers.

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New York State Quality of CareConsumer Advisory
Committee

• Structure
• Membership up to 25 committee members
  representing PLWHA populations in New York State
  (by geographic region, gender, race, ethnicity,
  and risk-groups)
• Committee Member Selection Structured
  nomination process and the identification of
  PLWHA leaders from existing consumer groups (all
  Ryan White grantee planning bodies, CPGs/PPGs,
  Designated AIDS hospitals, DTCs, CBOs, LTI,
  etc)

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New York State Quality of Care Consumer Advisory
Committee

• Structurecontinued
• Meetings quarterly with topic specific
  sub-committees
• Governance bylaws have been written and adopted
  by committee members that include clear ground
  rules, roles, and responsibilities of committee
  members and
• Committee Co-Chairs two consumer co-chairs 1
  appointed by NYSDOH and 1 elected by peers.

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Past and Current Activities of the New York
StateQuality of Care Consumer Advisory Committee

• Committee first met on July 24, 2002
• orientation and training to educate committee
  members about New York State Quality of Care
  Program standards (ex. training using consumer
  curriculum developed in 2001 by Joseph Rukeyser,
  Ph.D.
• Making Sure your HIV Care is the Best It Can
  Be
• provider survey was developed, disseminated,
  collected, and summarized to assess current
  consumer involvement in quality of care programs
  (63 out of 114 facilities in New York State
  responded) and
• pilot testing of new performance indicators (ex.
  lab work to assess patients awareness of
  essential lab results, and a prevention project
  for all AIDS Institute funded HIV ambulatory care
  facilities in NY State).

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Past and Current Activities of theNew York State
Quality of Care Consumer Advisory
Committeecontinued

• Input into guidelines committees (members
  participate in HIV Clinical Guidelines and HIV
  Prevention Guidelines Committees)
• Review and comment on upcoming publications and
  materials (ex. chapters on clinical HIV
  guidelines, consumer satisfaction surveys, and
  performance data releases)
• Input into the development and dissemination of a
  patient medical health journal to allow consumers
  to maintain their HIV records
• Development of best practice guide - how to
  obtain consumer feedback through a structured
  approach and
• Presentations at national and international
  HIV/AIDS conferences (Bangkok-2004, Toronto-2005,
  Staying Alive-2006).

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Lessons Learned

• Continuous consumer feedback in government-funded
  quality of care programs is critical to enhance
  the quality of HIV care
• Providing a venue to dialogue with consumers
  helps to identify community issues not identified
  by provider groups and/or staff
• Consumers get involved and will stay involved
  when they see that their input and
  recommendations are being implemented (ex
  assisting in the development of indicators that
  measure HIV quality care and
• Meeting cost - approximately 3,000/meeting on
  average for travel and food expenses. Staff
  time, conference calls, and meeting materials are
  not built into this amount.

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Contact Information

• Dan Tietz, Consumer Advocate
• Division of HIV Health Care
• NYS Department of Health, AIDS Institute
• [phone] - det01_at_health.state.ny.us

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Involving Providers in the Detroit Eligible
Metropolitan Area (DEMA) Quality Management
Process
Jewell J. Martin, RN, MHSA, Program
Administrator Bridget D. Lamar, MSHA, Operations
Manager Simone Douglas Anthony, MHSA, Performance
Assessment Consultant Sandra Cook, MA,
Performance Assessment Consultant City of
Detroit Department of Health and Wellness
Promotion HIV/AIDS Programs [phone] douglass
_at_health.ci.detroit.mi.us
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Purpose

• To effectively engage Ryan White Title I/II
  providers in the Detroit EMAs quality management
  process.

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Goals

• To have a cross-section of Ryan White Title I/II
  providers represented on the quality committee
• To actively involve providers in the quality
  management decision making process
• To determine an equitable selection process

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Method
Service categories were divided into four
groups (primary care, case management, mental
health/substance abuse and supportive services)
to ensure equitable representation Providers
represented in each service category voted to
determine which provider would represent the
service category
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Method Contd

• Language included in provider contracts to
  ensure compliance with quality management
  initiatives
• Emphasis on representation of core services and
  priority ranking of service categories

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Outcome

• Equitable representation of providers on
  quality committee
• Committee Structure Planning Council, Consumer,
  Providers, HOPWA, HIV Prevention, Ryan White
  Title I Staff
• Provider buy-in in selection process and
  participation

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Outcome Contd

• Data driven quality management process
• ?Data is extracted from the web-based Client
  Data System (CDS) and analyzed
• Process initiated to develop the EMA-wide
  quality initiative with provider buy-in and
  participation
• The Client Data System is a web-based data
  management system that was developed by the DEMA
  for use by the Ryan White Titles I, II, III and
  IV providers.