Efficiently Implementing Protocols and Bundles:Engaging Stakeholders

December 9 from 2 – 3 pm

Hosted by: Stephanie Sobczak

Courtesy Reminders: •During the webinar, you may select *7 on your phone to speak, and use *6 to mute. •Please refrain from placing the phone on HOLD during the presentation.

Welcome to IPAB!(“Fix it in 6”)

This is a new approach to rapid cycle improvement.

This design intentionally involves multiple stakeholders in a series of meetings to transparently discuss barriers, then use QI practices between meetings to close any gaps and achieve aims.

Our goal is to determine gaps and issues and achieve implementation of the solutions using 6 one-hour meetings as the base structure, plus specific tasks to be completed between those meetings.

Meetings you will schedule are:

1)Stakeholder Meeting2)Action Planning Meeting3)Change Planning Meeting (Pilot and Small Test Design)4)Progress Check Meeting5)Implementation Planning Meeting6)Implementation Follow-up Meeting

“Fix it in 6”

Universal Design

Any Partners for Patients topic you are working on will work in this model.As long as: You aren’t taking on a brand new topic You have a good idea what the gaps are, just

need a method to solve the issues.

Meeting PurposePre-work Huddle Identify participants

Gather information needed for stakeholders 1 – Stakeholders Meeting Identify gaps in best practices

Determine other key stakeholders 2 – Action Planning Meeting Discuss priorities

Identify low hanging fruitIdentify processes to test

3 – Change Planning Meeting Involve staff doing the workPlan for just in time trials/tests

4 – Progress Check Meeting Reports on pilots and testsDecision to continue, or adopt the change

5 – Implementation Planning Meeting Discuss the implementation checklistDetermine next steps

6 – Implementation Follow-up Meeting Monitor progress with implementationDetermine accountable staff

Our Process

Webinars will introduce the purpose of each stakeholder meeting and outline best practices for implementation and troubleshooting. Tools will be provided related to each of the meetings.

The intention is hospital staff (team leads, etc.) should hold the meetings and implement best practices between webinars

Coaching calls will be held to support your efforts

Meeting PurposeWebinar 1Engaging StakeholdersDec 9, 2 pmOptional Coaching callDec 16, 2pm

Pre-work Huddle Identify participantsGather information needed for stakeholders

1 – Stakeholders Meeting Identify gaps in best practicesDetermine other key stakeholders

Webinar 2Action PlanningJanuary 13, 2pmOptional Coaching callJan 27, 2pm

2 – Action Planning Meeting Discuss prioritiesIdentify low hanging fruitIdentify processes to test

Webinar 3Change PlanningFebruary 10, 2 pm

3 – Change Planning Meeting Involve staff doing the workPlan for just in time trials/tests

4 – Progress Check Meeting Reports on pilots and testsDecision to continue, or adopt

Webinar 4Making ProgressMarch 9, 2 pm

5 – Implementation Planning Meeting

Discuss the implementation checklistDetermine next steps

Coaching Call onImplementationMarch 30 2pm

6 – Implementation Follow-up Meeting

Monitor progress with implementationDetermine accountable staff

Orientation to Topic Web Resources

Best Practice

Mindset Shift

Culture

Tools

Four Elements to Change Management

Shifting the MindsetTwo big shifts in mindset are necessary in this approach:

1. Must move the action steps out of the meeting room and into the clinical areas.

2. Not working on action steps between meetings is unacceptable.

Meeting and planning alone don’t change outcomes….only making changes to actual practice will.

Think aheadHow will the lead and senior leader champion address stakeholders who do not engage in the work between meetings? Is there a good reason for lack of follow-up? Is the right person involved in the task? Is there a ‘resourcing’ problem making

progress difficult or slow? What is the plan if there are barriers?

Detecting Your GapsA. You know what the gap is (usually a “hard-

coding” issue) – Great! Ready to move on…

B. You think you know but are not certain Go through a detailed gap analysis

C. You have no idea what the gap is; just are not moving the dial. Select one of these: Detailed gap analysis Chart audits? Stratify your data and look for patterns? Gather patient and staff feedback? Do an FMEA or RCA?

Adopted Minnesota’s Roadmaps(with permission)

Review of Assessment Tools

For your clinical topic, select a method to do an assessment: Improvement Workbook – Sec 1, Worksheet Top Ten Checklist Topic Gap Analysis Documents Any other resources you may have

Who should organize this effort?

Preferably someone with skills in leading meetingsSomeone with the time to coordinate meetingsSomeone with knowledge of the clinical issue

Stakeholder

Meeting

Action Plannin

g

Change Plannin

g Meeting for Pilot or Small

Test Design

Progress Check

Implemen-

tation Plannin

g

Implemen-

tation Follow-

up

Day 1 Day 7 1 week later

Day 103 days later

Day 171 weeks later

Day 312 weeks later

Day 604 weeks later

Within 2 months to implementation

Example plan – schedule meetings in advance

Stake-holder

Meeting

Action Planning

Change Planning Meeting

Progress Check

Implemen-tation

Planning

Imple-men-tation

Follow-up

Day 1 Day 14 2 weeks later

Day 211 week later

Day 352 weeks later

Day 603+ weeks later

Day 904 weeks later

3 month plan of scheduled meetings

Jan 12 Jan 25 Feb 1 Feb 13 Mar 5 Apr 5

Pre-schedule all meetings – get them on the participants calendars

Before the First MeetingGeneral Pre-Work for the Team Lead: Schedule six 1 hour meetings at specific intervals Determine who will be included and invite them Clearly state what the gap is in the invitation Gather evidence about the bundle or protocol,

including “current state” outcome or process measure data

Summarize, document, and share any work done to-date before the meeting

Scheduling problemsQ: Do we schedule the meeting based on who can attend, and what if people cancel?

A: Identify 3 key people that need to be present and schedule the first 2 meetings according to their availability.Reschedule only if more than 1 of the 3 key people cancel(Or ask for a substitute to attend)

Remember

The purpose of these meetings is to preventpatient harm What is more important than that?

Not easily accommodating cancellations sends a strong initial message where harm prevention priority is in your hospital – leaders must lead this as a culture change

Why a 1 Hour meeting?

Why only a 1 hour meeting? Sets the tone to efficiently address the topic

– keep focus narrow; limit side conversations and tangents

Stick to the agenda – designed for one hour Avoid going over 60 minutes Add issues to the Parking Lot

1 – Stakeholders MeetingTask List 1: Identify who will be impacted by the change Invite them to a 1 hour meeting Explain the purpose and provide any

evidence or background material in advance Send an agenda

1 – Stakeholders Meeting

Hour 1 – Stakeholder Meeting Agenda Brief introductions (if needed) & Review agenda Review purpose of the meeting Identify gaps in best practices – use existing

checklist/assessment or brainstorm. Determine any issues that can be easily resolved:

“Why aren’t we doing _____?” Set assignments for follow-up

Stakeholders Meeting Agenda

1 – Stakeholders Meeting

Stakeholder Assignments - 1 Fix the “quick fixes” Discuss gaps in practice with other stakeholders Get feedback about barriers or opportunities for

improvement Determine readiness for change through dialogue

with others

Those who attended this meeting should do these action items before the next meeting.

Talking outside of the meeting

In some work cultures, “what is discussed in a meeting stays in the meeting”.In this case, discussion with others between meetings is vitally important because:1) Learning is improved by hearing other’s

perspectives on the challenge2) “Sets the tone” in the hospital that this is

important and will be resolved

WHA Quality Resources

• Recorded webinars• Improvement Workbook• Implementing a Protocol

webpage on the Quality Center

• On-Site Resources

Questions?

Please complete the brief post-webinar survey

We value your feedback and will follow-up with you if requested

Thank you!Stephanie Sobczak ssobczak@wha.org