SPREADING AND SUSTAINING STRATEGIES FOR SENIOR LEADERS AND TEAM MEMBERS St. Anthony Amofah, MD, MBA Medical Director, Helen B. Bentley Family Health Center,

SPREADING AND SUSTAINING STRATEGIES

FOR SENIOR LEADERS AND TEAM MEMBERS

St. Anthony Amofah, MD, MBAMedical Director,

Helen B. Bentley Family Health Center, Inc

Miami, Florida

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

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

GOAL: TO ENGAGE GROUP IN A DISCUSSION ATTHE END OF WHICH EACH OF US WILL BE ABLE TO

TAKE SOMETHING BACK TO OUR CENTERS ON HELPFUL STRATEGIES FOR SPREADING AND

SUSTAINING CHANGES.

“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

PROCESS OF SPREADINGPREPARING FOR SPREAD

SPREADING

SUSTAININGCHANGES

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

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

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

ImportancePotential barriers to success are addressed

Process helps team to “bond”

READINESS ASSESSMENT ALGORITHM

Did Pilot Team Succeed?

Importance of pilot team success

Motivating to team, senior leader, other staff

Lends credibility to changes made

Measures of successOutcomes measures

ProcessStructure

Most likely reasons for failure Lack of visible management support

Lack of effective team leadershipTeam not empowered

READINESS ASSESSMENT ALGORITHM

Did Pilot Team Succeed?

Is Improvement inChronic DiseaseCare in Strategic

Plan?

yes

noManagement must assume ownershipGo back to “drawing board’ and start Over (You are not ready for spread).

SOLUTIONS

READINESS ASSESSMENT ALGORITHM

Is Improvement inChronic DiseaseCare in Strategic

Plan?

What is an “Effective” Strategic Plan(A living, breathing strategic plan)

-Reflects Board/Management’s vision-Is shared regularly with middle management

-Is translated into a departmental work plan with line staff involvement

-Is evaluated periodically

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.

READINESS ASSESSMENT ALGORITHM

Did Pilot Team Succeed?

Is Improvement inChronic DiseaseCare in Strategic

Plan?

Are measuresIncluded in PI

Plan?

Develop effective Strategic PlanFormal written proposal to Board/Mmt-Emphasize importance-Summarize goals/measures

Formal proposal to PI Committee-Summarize importance-Give details of goals/objectives, evaluationmethodInclude in PI calendar of activitiesStanding agenda item

yes

yes

yes

no

no

no

Management must assume ownershipGo back to “drawing board’ and start over (You are not ready for spread).

SOLUTIONS

READINESS ASSESSMENT ALGORITHM

Can staff maintainRegistry?

Reasons for inability to maintain Registry-No assigned primary responsibility for data entry

-No accommodating delivery system design

READINESS ASSESSMENT ALGORITHM

Is someone in Leadership

Responsible forSpread?

You are readyto spread

yes

no Assign responsibility-Person must attend/have attended a Learning session.

Can staff maintainRegistry?

yes

noAssign primary responsibility (?Admin. Clerk)Define accommodating delivery system designRecruit data entry clerk

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)

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

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

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

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

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)

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

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

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)

(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

• 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

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).

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

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

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

GENERAL DISCUSSION

• WHAT ELSE CAN WE LEARN FROM EACH OTHER?