Actions Set a clear aim for the performance of your eligibility system Define why your key audiences (governor, legislature, public) should support it.

Actions

• Set a clear aim for the performance of your eligibility system

• Define why your key audiences (governor, legislature, public) should support it given their interests

• Establish specific actions steps to get there in the next year

Sustainability and Spread

Learning Session 3April 24, 2003

Ron Moen

Sustain Improvement

Spread Improvement

Improvement

Creating a New System

Sustainability: “Hold the Gains”

Sustainability means continuing to profit from gains rather than experiencing a one-time effect of your efforts

(You have achieved something that you wish to sustain)

Old System New System

Some Inhibitors:“We met our goals”“We assumed the improvement would hold”Other priorities took all resources away

(not on senior management’s radar screen)Did not learn how to hold the gainsNo infrastructures are in place

Hold the Gains:

Readiness for “Hold the Gains”

Success of collaborative team Intention Organizational priority Leadership responsibility

Three Key Components of a Strategy to Hold the Gains

1. Communication

2. Infrastructure

3. Design Effective Control System

Hold the Gains: 1. Communication

Aim, successes, learning's, and

benefits to all stakeholdersDocument the new processKeep in contact with your team

and other teams

Training and development of new skillsChanges to job descriptions, policies, and

proceduresAssign ownership for improvement and

maintenance work of the new processInvolvement of senior leaders in taking

responsibility for the efforts to sustain the change and remove inhibitors that might allow slippage back to the old system

Hold the Gains: 2. Infrastructure

Hold the Gains: 3. Design Effective Control System

Design using the Model for Improvement

• Use the 3 questions• PDSA Cycles

1. What are we trying to accomplish? Hold

the gains after successful improvement 2. How do we know a change is an

improvement? Performance/outcome measures will remain at the improved level

3. What changes can we make that will result in improvement? Standardization Identify and remove any special

causes

3. Design Effective Control System

Some PDSA Cycles:

Plan to standardize and verify conformance to the standard

Sustain the change by using run charts or control charts to monitor outcome measures

3. Design Effective Control System

Sustain Improvement

Spread Improvement

Improvement

Creating a New System

Target Population for Spread

Population of Focus for your BTS Aim

Spread

- Other offices - Other departments

- Other counties - Other key systems

Spread:

Spread means making improvements

beyond the scope of the Collaborative

Team

Readiness for Spread

Success of collaborative teamIntentionOrganizational priorityLeadership responsibility

Five Key Components of a Strategy for Spread

1. Infrastructure

2.Communication

3.Social System

4.Schedule for spread

5.Measurement and Feedback

Spread: 1. Infrastructure

Topic a key strategic initiativeSet up the project

Executive sponsor: sets the agenda Day-to-day leader: the driver Target population: who will be the adopters of

the changes Communication plan: start early Measurement strategy: system wide

Staging plan - The plan to reach all units in the target population over time with all of the changes

Spread: 2. Communication

Distinguish between communicating awareness and technical knowledge

Use multiple communication channels

Identify and train your key messengers (Change agents, content expert, opinion leaders)

Adapted from Ashkenas, 1995

SHAREINFORMATION

SHAPE BEHAVIOUR

GeneralPublicationsflyersnewslettersvideosarticlesposters

PersonalInvitationlettersreportspostcards

InteractiveActivitiestelephoneemailvisitsseminarslearning setsmodeling

Face-to-faceone-to-onementoringsecondingshadowing

The WAY in which we communicate is

important

Spread: 3. Social System

Content, context, and community Understand the relevant circumstances

affecting peoples’ ability/willingness to adopt the changes

Take advantage of the existing relationships within the system

Develop “communities of practice” among those with similar roles

Don’t forget improvement knowledge

Spread: 4. Schedule for Spread

Consider completeness and coverage as a way to direct the spreadCompleteness: all changes, limited

officesCoverage: all offices, limited changes

Design a flexible spread program

Offices

Par

ts o

f th

e S

yste

m

100%

100%Coverage

Co

mp

lete

nes

s

Spread: 5. Measurement and Feedback

Data collected on: -Outcome measures -Measures to track spread of specific changes

Reporting to provide feedback Data and reporting at different levels

within the organization