NCA TBC Session 5 Standardization Case Study Theory Burst

1. How to Spread Change
PDSA to SDSA and beyond!
1
Grace Capreol, Coach
Kasey Harding – Team Leader

2. Learning Objectives
● Using a real example of change to define the steps of spreading
from PDSA – SDSA
● Using specific criteria for determining the potential success of
standardization
●Outlining a communication strategy for leadership and staff before
and during standardization
●Defining evaluation measures for standardization
●Dissemination of successful standardization

3. Testing
Changes
Standardizing
Spreading
Standardizing to Spreading

4. SOGI Data Collection Project Outline
4
To follow the “best practices” guidelines and recommendations to collect
Sexual Orientation and Gender Identity (SOGI) data on all CHC patients over
the age of 13, thereby creating an environment of inclusive and affirming
healthcare for all patients.
Goals and Objectives
1. Inclusive and affirming environment of care for all patients.
2. Enhanced healthcare services for LGBTQ population
3. Targeted healthcare services for at risk populations
4. Improved resources for LGBTQ population
5. Staff and patient education opportunities

5. PDSA 1:
Pod
Evaluate &
Create
Action Plan
PDSA 3:
Expand to
other
clinical
teams
Timeline for Rollout
Dec. ‘15 Jan ‘16 Feb ‘16
PDSA 2:
Time Study
Apr ‘16
Data Review
May ‘16
Survey Monkey
Qualitative review
Data Review
Newsletter
Article to
Agency
Data Review
June ‘16
PDSA 4:
SOGI for Peds
Report out to
Performance
Improvement (PI)
Committee
Training
Training for
Microsystem
Team
July ‘16
Data Review
RN/LPN
TrainingEHR
Change
Decision on
Agency
Roll-Out
Playbook

6. PSA, MA,
Provider
Training
Agency
Go-Live
Data review
PI Committee
Meeting
Timeline for Rollout
6
Aug ‘16 Sept ‘16 Oct ‘16 Nov ‘16 Dec ‘16 Jan ‘16
System
Change
Dashboards
NOVO
Site Meetings
& Retraining
Internal
Resource Page
Published
Data Review
PI Committee
Meeting

7. 00/00/00 7
Improvement Ramp

8. First Step: What do we aim to achieve?
8

9. Process Map – identify areas for improvement
9
Stars indicated every point of contact
with a patient where access to
SOGI data may be important.
Ex: Patient Registration & Preferred Name

10. Specific Aim Statements
How are we measuring success?
10

11. PDSA – Helps keep track of progress toward SDSA
11
Predictions – what does your POD expect will happen from this test of change?
How are you going to measure those expectations?

12. First Question to ask yourself
Is the process standardized?

13. 1. Is the process Failure free over time?
 Can Your team can count on it not to fail when everyone is doing following the process?
 If one person overlooks it, will another catch it?
 Are there clear specifications and communication?
 Is the process supported by technology to reduce failure (EHR)?
2. Is there an expectation of No Variation except per Clinical Criteria or Judgement
3. Is the process LEAN with minimal steps in the process?
4. Will you use the standard for developing staff competency and training new employees?
5. Is there a process owner, from Start to Finish?
Is it understood that there can be No Individual Autonomy to Change the Process?
Do you have methods for constantly learning and improving a standardized process?
Is the process standardized?

14. Standard Workflow for CHCI SOGI Collection
14

15. Playbook and Standardized Questionnaire
15

16. Evidence exists from one POD that the
standard achieved the desired result, and
should be tried by another POD.
Be sure that a process standard is
successful in more than one POD before
undertaking broad “spread”.
Ihi.org
Geisinger Quality Institute

17. Evidence from first Pod
• Pod was able to increase
SOGI collection rates from
0% to over 70% of patients
seen in 12 months.
• Team reported low burden
to collect & document data
• December marked transition
to SDSA
17

18. Ok, we’ve got this great process that is
working well for our POD.
How do we know if we are
ready to spread our work?
Ihi.org
Geisinger Quality Institute

19. How Will You Know?
 A process recognizable by all in the workplace as “the way
we do things” here
 Five staff members can regularly articulate the process
steps when asked individually to describe
 A “miss” (defect) in the process flow can be immediately
identified so that it can corrected
 There is a process in place to identify a failed step in process
 There is a communication plan to support correcting a process
defect to all areas
 Measures clearly indicate that the process is working
Ihi.org
Geisinger Quality Institute

20. Staff Reaction to Standardization
20
“We have heard so much about what was going on in the NB site and were
wondering when this would get around to us.” ~MA in Enfield
“I have a daughter who is transgender and I asked her about the training we
received and the process we are using. She was very interested in how we
would be using the data collected and not just the fact that we collected it. I
would like to know more about our long-term goals.” ~ RDH NB
“Everything gets put on the MA’s to do but this is something that feels right to
do as an agency. When I heard what the patient response was in the first sites I
couldn’t wait for it to move to our site.” ~ MA New London

21. Data, Data, Data!
21
Agency
Roll-Out
60% of patients seen
within last 12 months

22. SOGI Collection Rates by Site
22
Another way to visualize data
to prove the impact to leadership

23. It is never to early to
plan for spread
however certain things
should be in place
before actually carrying
out the plan.
Ihi.org
Geisinger Quality Institute

24. “4 Certain Things”
1. The improvement process is a key strategic initiative
of the organization
2. It has identified executive and local leadership
3. There exists successful sites that are the source of the
improvement process to be spread
4. There exists evidence that the improvement process
results in a desired outcome
A Framework for Spread: From Local Improvement to System-
wide Change. 2006 Institute for Improvement Ihi.org
Geisinger Quality Institute

25. Key Strategic Initiatives:
Performance Improvement Plan 2015-2016
UDS Reporting 2016
25

26. LGBTQ Resource Page & Site Champions
26

27. Broad Spread is a BIG deal
Owned by Leaders
and Managers
Extensive planning, timetables,
communication, leadership expectations,
possible infrastructure enhancements,
transition to operational responsibilities,
follow-up measurement, etc. (Whew!!)
Ihi.org
Geisinger Quality Institute

28. Communication is Key
28

29. Presentation to Agency Wide Performance Improvement Committee with
Key Action Items Outlined
29

30. Use positive patient feedback to sustain
momentum!

31. Lessons Learned
00/00/00 31
• Standardization is on-going and the process requires continuous attention.
• Prioritize a true change in agency culture not just process.
• Facilitate collaborations with internal departments early in the process (i.e.: data,
business intelligence)
• Be prepared for the “hoops” you need to jump through to get to an agency wide
initiative – committee presentations, BOD approval
• Patient feedback can invigorate enthusiasm in staff
• Training to all levels of staff is arduous but necessary in standardization –
remember to include administration, IT, billing, finance.
• Communication to the correct individuals is a key to success.
• Recognition for key staff (especially those with increased work load) is essential
• Leadership buy-in can make or break an initiative.
• Assign a key point of contact for questions, concerns and suggestions.
• Highlight successes often!

32. Questions/Comments

33. Contact Information
33
Kasey Harding-Wheeler, Director CKP
HardinK@chc1.com
Grace Capreol, Sr. EHR & Health Applications Analyst
CapreoG@chc1.com

34. Resources
34
You can access more playbook
documentation and resource guides
on the moodle!