learning session ii - children's safety network (csn) · •increase the number of child...

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October 26th, 2016

Learning Session II

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Welcome!

Day 1Welcome Bethany Miller, Health Resources and

Services Administration

Rod McClure, Centers for Disease Control and Prevention

Where we are as a Collaborative

Jen Leonardo, CS CoIIN Improvement Advisor

Jenny Stern-Carusone, CS CoIIN Manager

Caretakers Learning to Improve Car Seat Knowledge

Lesha Peterson, Missouri, Child Passenger Safety

Carole Guzzetta, National Highway Traffic Safety Administration

Partnerships & Prioritization Susan Pollack, Kentucky, Teen Driver Safety

Katie Ballard, National Highway Traffic Safety Administration

Accelerating Improvement:

Moving from Developing to Testing, Implementing, and Spread

Jane Taylor, CS CoIIN Improvement Advisor


Opening Remarks from HRSA

Bethany MillerDirector of Injury and Violence Prevention Programs

HRSA

Working Together to Create a Systems Approach to Preventing Intentional and

Unintentional Injury

Presentation to

CS CoIIN Learning Session 2

October 26, 2016

Roderick McClure

Angela Marr

Sally ThigpenDivision of Analysis, Research, and Practice Integration

National Center for Injury Prevention and Control, CDC

Injury-related deaths are only apart of the problem

Injury Center Mission

To prevent injuries and violence and reduce their

consequences.

Injury Center Vision

To put injury and violence prevention on the map as the

premier public health achievement of the decade

DARPI

Integrating science and practice to prevent injuries and violence.

I N N O V A T I O N P A R T N E R S H I P

C O L L A B O R A T I O N

DARPI Framework for a Systems Approach to IVP

Systemic Approachto Population Level Injury and

Violence Prevention

KNOWScience & Methods

Cooperative Agreement funding

period: 2016-2022

23 BASE Awardees

5 Regional Network Coordinating

Organization (RNCO) Component

Awardees

4 Surveillance Quality Improvement

(SQI) Component Awardees

Focus Areas: motor vehicle crash

injury and death, child abuse and

neglect, intimate partner and sexual

violence and traumatic brain injury

Core State Violence and Injury Prevention Program (Core SVIPP) Overview

Core State Violence and Injury Prevention

Program (Core SVIPP) Overview

Support states in implementation, evaluation

and dissemination for violence and injury prevention activities

Implementation of IVP programs, practice, and

policy

Collect, analyze and use injury data

Support and Evaluate Program

and Policy interventions

Program Evaluation

Core SVIPP States

Base Component

23 funded states

Key activities:

Collect and analyze data

Implementation of injury and violence prevention

programs, practices and policy

Support and evaluate program and policy

interventions

Inform policy

Program evaluation

Funded states include: Arizona, Colorado, Georgia,

Hawaii, Illinois, Kentucky, Louisiana, Maryland,

Massachusetts, Michigan, Minnesota, Nebraska, New

York, North Carolina, Ohio, Oklahoma, Oregon, Rhode

Island, Tennessee, Utah, Virginia, Washington and

Wisconsin

BASE Component

Purpose: To

support funded

states in

implementation,

evaluation and

dissemination of

programs,

practices, and

policies with the

best available

evidence.

Regional Network Coordinating Organization

(RNCO)

• 5 funded states

• Key activities:

Enhance collaboration between state health

departments (SHDs) and Injury Control Research

Centers (ICRCs)

Conduct a basic needs assessment

Provide peer to peer coaching for SHDs

Facilitate regional and national learning

communities

• Funded states include: Colorado, Maryland,

Massachusetts, North Carolina, and Washington

Purpose: To

provide

coordination

across and

between

states(regardless

of funding status)

and collaborate

with injury and

violence

prevention

organizations to

share scientific

evidence and

programmatic

best practices.

Surveillance Quality Improvement (SQI)

Component

• 4 funded states

• Key activities:

Conduct injury data investigations

supportive of promoting and advancing

uniform injury case definitions and

improving data quality

Advance methodology

Explore emerging sources of injury data

• Funded states include: Colorado, Kentucky,

Maryland, and Massachusetts

Purpose: To

conduct injury data

investigations

supportive of

promoting and

advancing uniform

injury case

definitions,

improving data

quality, and

advancing

methodology and

exploring emerging

sources of injury

data.

Core SVIPP CS CoIIN

Integrated Approaches to IVP Prevention

through Partnerships and Collaboration

Data Quality

Addressing Shared Risk and Protective

Factors

Implementation and Evaluation of Evidence

Supported Strategies

Areas of Focus:

Child Abuse and Neglect

SV/IPV

Motor Vehicle Safety

Traumatic Brain Injury/Youth Sports

Concussion

Improve Partnerships Within and Between

States/Jurisdictions

Spread Evidence-Based Practices to

Vulnerable Populations that Are Not Yet

Receiving Services

Improve the Implementation of Evidence-

Based Practices

Boldly Focus on:

Teen Driver Safety

Child Passenger Safety

Suicide and Self-Harm

Interpersonal Violence

Falls

Core SVIPP – CS CoIIN

Alignment of Priorities

Core SVIPP:

www.cdc.gov/injury/stateprograms

CDC Injury Center:

www.cdc.gov/injury

For More Information


Where We Are as a Collaborative

Jen Leonardo,

CS CoIIN Improvement Advisor

Jenny Stern-Carusone,

CS CoIIN Technology Director


The Challenge

Less

RequiredFormality, documentation, methods, time, coalition

building, communication, measurementStraight Forward Very Difficult

More

Required

Cleaning

Hotel Rooms

On-time

Shipments

small

warehouse

Teaching of

Chemistry

local school

district

Infections in

Surgery

Sales to

global

accounts

Quality,

safety,

productivity

organization

wide

Multinational

Supply chain

optimization

Teaching of

science

nationwide in

elementary

school

Source: The Improvement

Guide pg. 238


Working in a Complex System

Project design

Engagement of frontline workers

Strategies for collecting real-

time data

Coping with data lags

Coordination within and

across agencies and

organizations

Outreach to non-traditional

partner

Requires Special Attention to and Strategies for


Quality Improvement Skills

The Model for

Improvement

Building

the System

of Improvement

• Aim Statements

• Systems Thinking

• Gathering Information for Improvement

• Driver Diagrams

• Plan-Do-Study-Act Cycles

• Run Charts


Content Knowledge & Skills

Teen Driver Safety

• Engaging Parents

• Innovative Data Collection System

Interpersonal Violence Prevention

• Creating & Expanding Partnerships

• Uptake of Evidence Based Programs


• Cultural Competency

• Technician Engagement & Retention

Suicide and Self-Harm Prevention

• The Power of Prevention

• Emergency Department Protocols

Falls Prevention

• Concussion Reporting Systems

• Training Coaches

ICD-9 & 10 Coding: Master Cross Walk

Finding Data: Outcome Data

Worksheet

State Updates & Sharing on Webinars

Stories of Success: Collecting Real-

Time Outcome Data


Progress MadeReal-Time Outcome Data Collection

Massachusetts

Suicide & Self-Harm Prevention

Tennessee

Falls Prevention

Indiana



Kentucky



2%2%2%

4% 9% 9% 7% 7%

14%22%

35% 30%28%

21%

2%2%

2%

2%16% 21%

26%

2%

0%

10%

20%

30%

40%

50%

60%

March April May June July August September

Improvement by the Teams

1: Forming 1.5: Planning 2: Activity

2.5: Testing 3: Modest Improvement 3.5: Improvement

4: Significant Improvement 4.5: Sustainable Improvement 5: Outstanding Sustainable Results


In Your Words

“Will share resource information with

providers - there are actually vast

applications beyond just CoIIN programs.” -

Anonymous

“Most individuals

entering the ED with a suicide attempt (70%) never attend

their outpatient appointment -

key to determine ways to link services!” -Anonymous

“Developing and working with

partners is critical to getting work done.” -

Anonymous

“The insights from other

states made the session even

more valuable.” -Anonymous

“In public health you don’t see the reward of your work for years – sometimes 10.

it’s nice to have the gratification of the work you

are doing now and see ‘man, parents really need this

information.’ It’s great that the CoIIN provided evidence

based strategies to help focus on the direction one should go with a particular

topic.” -Jeanne Bietz, Nebraska

“Starting small and that some

data is better than no data.” -

Anonymous

“Will try to retool everything to be smaller and more measurable, still

building a coalition . . . will try to include passionate family, also PTA and others from community. Better

understanding of the CoIIN process- something just clicked

better finally.” -Anonymous

“It's important to

be able to identify and understand

your system.” -Anonymous

“Refine my process

measures and keeping

track of data.” -

Anonymous

“Got me thinking more

about processes and approaches for measuring & changing them.”

-Anonymous

“How powerful the visual

presentation of data can be. It

shows how useful the data can be.

Great!” -Anonymous

25Missouri CLICK


Missouri CLICKCaretakers Learning to Improve

Car Seat Knowledge

Team Members:

Martha Smith – Center for Local Public Health, DHSS

Lori Winkler – Safe Kids St. Louis

Carrie Wolken – Missouri Department of Transportation

Ginny VanAusdall – Safe Kids Bootheel

Rebecca Chitima-Matsiga – Office of Epidemiology, DHSS

Julie Lueckenhoff – Missouri Department of Heath and Senior Services

Lesha Peterson – Missouri Department of Health and Senior Services

Pat Simmons –Missouri Department of Health and Senior Services

26Missouri CLICK


Aim Statement

By June 2017, we will reduce child (ages 0-8) passenger deaths, hospitalizations, and emergency department (ED)

visits resulting from a motor vehicle crash in which the victim was an occupant of a vehicle.

Our goals are to:

• Decrease the child passenger mortality rate by 2% relative to the state/jurisdiction baseline.

• Decrease the rate of child passenger hospitalizations by 2% relative to the state/jurisdiction baseline.

• Decrease the rate of child passenger emergency department (ED) visits by 2% relative to the state/jurisdiction baseline.

27Missouri CLICK


Process Measures & Goals

• Increased access and learning opportunities for caretakers for child safety seat fitting, installation, and distribution.

• Increase the number of Child Passenger Safety Technicians (CPST) with up-to-date certification.

• Increase the number of mobile inspection stations and car seat inspection stations.

• Increase Child Passenger Safety Technicians/educators teaching caretakers how to adjust seat, buckle harness, install, and protect their children.

28Missouri CLICK



Example where some data is availableProcess Measure Goal

Increase the number of Child Passenger Safety

Technicians (CPST) with up-to-date certifications.

Have at least one certified Child

Passenger Safety Technicians (CPST) in

every county in the state.

Tip: Use as many slides as you need

Delete this slide before submitting

.

29Missouri CLICK



Process Measure Goal Progress

Increased access and

learning opportunities

for families for child

safety seat fitting,

installation, and

distribution.

Expanded network of

CPSTs, inspection

stations, and sites for

distributing child

safety seats.

DHSS offering to assist

agencies in covering costs for

one staff member to attend a

nationally certified CPST

training course.

30Missouri CLICK


Organizing Your Work

The Missouri CLICK strategy team is comprised of members of different organizations and agencies located throughout the state that have expertise in child passenger safety.

31Missouri CLICK


Organizing Your Work

Can you find

all the

“wrongs” in

this picture?

32Missouri CLICK


Lessons Learned

• Have flexibility to change

directions mid-course.

• Multiple barriers for Child

Passenger Safety

Technician(CPST) training such

as funding and availability of

car seats.

33Missouri CLICK


We Wonder If Next We Should . . .

• Offer money to purchase car seats and how to accomplish that task.

• Make more direct contact with counties and identify barriers.

◦ Partner with the Maternal Child Health Program staff to do this outreach.


Questions & Comments

We’re

listening.

Carole Guzzetta

Highway Safety Specialist

Office of Impaired Driving and Occupant Protection

National Highway Traffic Safety Administration

Kentucky Teen Driver Safety Strategy Team 35

Teen Driving Kentucky

Our team is working to make sure that

every teen comes home safely, through

parent and teen knowledge of graduated

drivers licensing (GDL) and the risks of

inexperience, speed, excessive

passengers, no seat belt, rural roads and

all types of distraction and impairment.


Teen Driving KentuckyRuth Ann Shepherd

MCH Director

KY Department for Public Health

MCH Director

(502) 564-4830

[email protected]

Susan Pollack

IVP Director Desginee

Pediatric and Adolescent Injury Prevention

Program

(859) 421-5881

[email protected]

Tammy Barrett

Primary Point of Contact

Contact

KY Department for Public Health, Division of

Maternal and Child Health

Pediatric Section Supervisor

(502) 564-2154 ext 4409

[email protected]

Monica Clouse

KY Department for Public Health,

Epidemiologist

(508) 564-4830 ext 4394

[email protected]

Ty Collins

KY Office of Highway Safety

Program Coordinator

502-782-3996

[email protected]

Louan Cottrell

Kentucky Department for Public Health

Infant Mortality Nurse

502-564-2154 ext 4410

[email protected]

Sherri Hannan

Safe Kids Fayette County

Program Coordinator

859-323-1153

[email protected]

DeShaun Bailey

Office of Highway Safety

502-229-7004

[email protected]

Steve Sparrow

Kentucky Injury Prevention and Research

Center

Program Coordinator

(859) 257-9484

[email protected]

Robert McCool

Prevention and Research Center

Program Manager

(859) 257-4954

[email protected]

Jon Akers

Ky Center for School Safety

Executive Director

877-805-4277

[email protected]

Sharon Rengers

Kosair Children's Hospital

RN, Manager

502-629-7337

[email protected]

Michael Schwendau

Office of Highway Safety

Assistant Director

502-782-3985

[email protected]

Michael Singleton

Child Passenger Safety, Teen Driver Safety

[email protected]

mailto:[email protected]













Aim Statement

• By June 2017, we will reduce deaths, hospitalizations, and emergency department (ED) visits resulting from a crash in which the victim was a driver or occupant of a motor vehicle and between the ages of 15 and 19. Our goals are to:

• Decrease the teen motor vehicle mortality rate by 13.33% relative to the state/jurisdiction baseline;

• Decrease the rate of teen motor vehicle-related hospitalizations by 13.33% relative to the state/jurisdiction baseline; and

• Decrease the rate of teen motor vehicle-related ED visits by 13.33% relative to state/jurisdiction baseline.


Drivers and Change Ideas


Drivers and Change Ideas continued


Possible Process Measures

• 9. % of teens reporting understanding of GDL requirements

• 10. % of teens reporting compliance with GDL

• 11. % of parents reporting understanding of GDL requirements

• 12. % of parents reporting enforcement of GDL with their teen driver.

• 13. % of signed parent-teen driving agreements among teens participating in an evidence-based teen driver safety program

• 16. % of parents educated on GDL

• 18. % of active stakeholders in the state/jurisdiction teen driver safety coalition

• Add: % of county/District health departments choosing GDL teen driving package for 2016-17 MCH CFR activities.


Example 2: Process Measures & Goals

Process Measure Add1 Goal Progress

% of county/District

health departments

choosing GDL teen

driving package for

2016-17 MCH CFR

activities. (There are

120 counties in KY.)

12 counties (10%) of

counties would choose

Teen Driving as one of

their MCH/CFR

packages for the year.

Currently 1 District (5 counties) and

1 county have chosen Teen Driving.

(5%) Another is considering, and at

least one more county has Teen

Driving efforts going on through the

Safe Kids Coalition, and the list is

not yet complete.

Example where no data is available yet


Concept 1: Organizing Our Work

• Steps we have taken to:◦ Develop our team/coalition: invited relevant people/agencies to

meet through the state CDC injury planning and implementation process (KSPAN). Met quarterly there and with some additional times through Office of Highway Safety (OHS). Invited all team members to participate on monthly calls, first together and then individually since being at one’s own desk makes it easier to fully participate in both the visual and auditory parts of the call. Conducted informational phone call, visit and letter recruitment of stakeholders we felt were needed to accomplish the aims.

◦ Work with stakeholders individually to ensure leadership knows their contributions/experience and goals for teen driving safety.

◦ Aligned with ongoing work of OHS and the Injury Center (KIPRC) through KSPAN, running each of the 3 CoIIN pieces through an existing KSPAN committee with existing committee Chairs.


Lessons Learned

We planned We found We predict. . .

To rapidly gather a

multi-disciplinary,

multiagency group

of partners into a

stable, ongoing

State Teen Driving

Coalition, with all

contributing to

forward progress.

Having long time occupant protection

people involved who know about teen

driving too is a gift. But when those

people are the same people in the

state who are also the major players in

child passenger safety, there are

inadequate resources to move both

parts of CoIIN forward equally. So we

had to first emphasize teen driving to

gather a group, but were then needed

to respond to a large CPS effort, and

that need continues, forcing a revision

of teen driving timelines. Teen driving

/CPS stakeholders are often teaching

CPS classes at the time we had hoped

to meet before monthly CoIIN calls.

With steady, slower work, we

will be able to accomplish this

goal, it will just take longer

than we had originally

planned with great optimism.

Based on what we have heard

on the monthly CoIIN calls, if

we were able to add a half-

time dedicated coordinator to

this effort (shared with CPS

possibly) it would move faster

than if we continue to have

only the current CoIIN

leadership to drive this

process of finding and

maintaining the group.


Lessons Learned


That the process would

flow from that state level

out

That the new year (2016-17)

MCHB options for local health

departments including the

choice of teen driving activities,

and our need to support those,

presented new opportunities to

enlarge our partnership with

the addition of some very

enthusiastic local public health

people who already have some

experience with teen driving

programs/activities in their

counties.

Because leadership for CoIIN

came first from our state-level

team, we envisioned a process

that spread out from there, but

after gathering the group from

that direction, our progress will

now be greater if we can both

leverage and strongly support

county/community efforts as

pilots and use the knowledge

and experience learned from

the local level to inform the

state level.


Lessons Learned


To reach out to school

administrators during the

early summer months, so we

could implement at least a

pilot educational program for

parents of teen drivers at one

school in August before

school started.

This process can take

much longer than

anticipated, though it may

take less time in counties

where the health

department or OHS

already have a strong

presence in the schools.

If we start the process of

creating relationships and links

with schools now, we should be

in a good position to implement

a teed driving/GDL awareness

class for parents of youth

wanting school parking permits

for next year. In addition, we

might be ready in time to offer

the program to youth whose

birthdays leave them just

becoming independent licensed

drivers during this year.


We plan next to . . .

• Brief additional people from Fayette County Safe Kids, the Pennyrile District (District and 5 counties) and Knox County Health Departments on CoINN thus far and ensure that they are invited to become partners in the teen driving team. (Knox County and some of the Fayette County people have already been on one monthly call). These are the 7 Kycounties known thus far that plan to do teen driving as part of their CFR/MCH activities for the 2016-17 year or are already doing teen driving programs. (Any additional counties will be added as we hear of them, this process has already begun with those we know of.) Have new stakeholders brief the existing teen driving partners on what they have done (Pennyrile and Fayette each have experience in schools) and plan to do (Knox). These counties are located in the center, SW and SE of the state, and will serve as pilots from which we hope to expand.


We plan next to…

• Resume recruitment of additional partners foreseen but not yet brought to the table or there in an on-going way: School Health (from MCH, already involved in Pennyrile), insurance people (sometimes local and sometimes regional US), high school athletic association representative, Ky State Police, Ky Transportation Center,

• Support school and community safe teen driving events/programs conducted by these partners. Where possible, incorporate evaluation into the planning.

• Participate with Fayette County Safe Kids in their October 2016 Teen Driver Safety week program at Dunbar High School.

• Continue work to create routine access to information on GDL stage of driver in all motor vehicle crash deaths of youth under age 18. (Office of Highway Safety is leading this effort at present.) Work to ensure that local county review of all teen crash deaths includes or seeks this information.

• Work with the Office of Highway Safety and the legislature to provide education and data for any 2016-17 new GDL legislation proposed.



We’re

listening.

Katie Ballard

Highway Safety Specialist

National Highway Traffic Safety Administration


Accelerating Improvement:

Planning for Scale Up and SpreadChild Safety CoIIN

Jane Taylor, Ed.D.


Objectives of this Session

• Participants will be able to:

• State a key strategy for accelerating improvement

• State criteria for moving to scale up

• Value need for social systems change in spread

50


Topic Teams

Teen Driver Safety

Child Passenger

Safety

Suicide and Self-

Harm

Inter-personal Violence•Child Maltreatment

•Bullying

•Sexual Assault

•Assault

•Homicide

Falls


Strategy:

• Test

• Implement and accelerate

• Sustain

• Scale up and spread


What are we trying

to accomplish?

How will we know that a

change is an improvement?

What change can we make that

will result in improvement?

Act Plan

Study Do

Model

for

Improvement

Charter or Aim

Measures

Changes

API / IHI.org


• Consider stakeholders

• Designate leadership and group with oversight responsibility

• Designate a day to day team with clear roles and responsibilities to execute changes

• Communication plan to constituents and publics

• Recognize the lag between cause and effect and moving the outcome measure

• Develop a strategy to engage pilot group(s) and scale up/spread

• Many replicate CoIINs or Learning Networks as spread vehicle

Complex Change Reminder


Accelerating Testing to Move to Implementation and Then Scale Up and

Spread Change

Be the change you want to see in the world.

Mohandas Gandhi


The Sequence for Improvement

Sustaining and

Spreading a change

to other locations

Developing a

change

Implementing a

change

Testing a

change

Act Plan

Study Do

Theory and

Prediction

Test under a

variety of

conditions

Make part of

routine

operations


Testing v. Implementation

• Testing – Trying and adapting existing knowledge on small scale. Learning what works in your system.

• Implementation – Making this change a part of the day-to-day operation of the system

• Would the change persist even if its champion were to leave?


First Focus

- Select ONE focus area

- Use small scale tests

Ideas and Hunches

Study

Act

Do

Plan

Improvement

Courtesy of IHI IMPACT Program

Test in One Process


• Key Principles

• Test small to go faster

• Test changes in Parallel

• Staging change with pilot sites and communities

• Considering extremes

• Orchestrating testing

Accelerating Improvement


Primary DriverChanges


Secondary Drivers

Test multiple ideas simultaneously

Testing in Parallel


Primary Drivers or Expanding a Driver

Ramps or Categories of Change: work in parallel


• Test with volunteers

• Don’t wait to get buy-in, consensus, etc.

• Be innovative to make test feasible

• Collect useful data during each test

• Test over a wide range of conditions

• Think several cycles ahead

• Use simulation

Accelerating Change



• Do more testing

• Smaller scale tests-but more of them!

• At least 100 cycles per month. What????

• Teams who run more cycles have more success

• Understand the difference between testing and

implementation

• Use measurement and PDSA for learning

Accelerating Change


A Word about Moving to Implementation

• Developed a high degree of belief in the change

• Failures in process no longer occur

• WIFM and rationale must be provided

• Expect resistance because more are effected

• Still think PDSA• Many activities need to be done to make a change

permanent• Training, new hire training

• Job descriptions

• Policy and Procedure

• Communication

• Equipment

• Standard work and work flow


Implementation Checklist

Continue to use PDSA cycles as you manage the system changes necessary to make your changes permanent.

Element Owner Comments

Buy-in

Think about the people that will need to agree to adopt this change. How will you ensure their support?

Policies and documentation

Does this change requires changes in SOPs, standard policy, or other organizational standards?

Hiring procedures and requirements

Does this change entail changes in job descriptions or skill sets for new employees?

Staff education/training

Existing staff and new hires will need to be trained on the new process

Job descriptions, evaluation, compensation

Will this revised process become the basis for employee evaluations?

Information flow

Does this change require changes in IT systems, reports, or routing of operational information?

Equipment, supplies purchasing

Make sure that items needed to support the change are on hand, and that equipment purchases are compatible witn the new process.

On-going measurement and control

How will you track the performance of the new process over time, in order to sustain improvement?

Other:


Current Situation Resistant Indifferent Ready

Low

Confidence that

current change

idea will lead to

Improvement

Cost of

failure

large

Very Small

Scale Test

Very Small

Scale Test

Very Small

Scale Test

Cost of

failure

small

Very Small

Scale Test

Very Small

Scale Test Small Scale

Test

High

Confidence that

current change

idea will lead to

Improvement

Cost of

failure

large

Very Small

Scale Test Small Scale

Test

Large Scale

Test

Cost of

failure

smallSmall Scale

Test

Large Scale

TestImplement

Think About the Size and Scope of a Test


The Sequence of Improvement

Sustaining and

Spreading a change

to other locations

Developing a

change

Implementing a

change

Testing a

change

Act Plan

Study Do

Theory and

Prediction

Test under a

variety of

conditions

Make part of

routine

operations


Use Measurement

• Measurement• Visible, viewed over time

• Measurement of crucial support processes (early warning system)

• Used for understanding improvement

• Used to verify sustaining change

• Used for Scale up and Spread

IG 2nd ed., p. 182Courtesy of IHI IMPACT Program


Collect Data Over Time

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Testing

Evidence of improvement

during implementation

Sustaining Gains



HC Data Guide p. 121

70


Teams Who Hold the Gains

• Use data and continue with run charts

• Continue to report and create accountability

• Have leadership’s support

• Meet periodically

• Train and orient, make policy

• Assign responsibility for key tasks


A Word about Scale Up and Spread

• After successful implementation – consider scale up and spread or some might say implementation is a type of scale up

• Useful to proceed in increments of 5

1: 5: 25: 125, etc.

• This will allow most system barriers to be uncovered in small enough “bites” that they can be overcome

• If not overcome your spread will be incomplete


Scale Up in a Complex System Demand

• Cooperation to achieve a common purpose.

• Time and attention to set up and management of project

• A system designed to learn about how strategies work


Diffusion of Innovations

Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.


Characteristics of Ideas the Spread

• Relative Advantage: Does the innovation work better than the status quo?

• Compatibility: Can the innovation be easily adapted to current work patterns?

• Complexity: How difficult is it to understand and apply?

• Trialability: Can you try it out at low risk?

• Observability: Are differential effects of the innovation visible to other potential adopters?



Spread Criteria from Everett Rogers, Diffusion of Innovation

• Tip: take your change idea, evaluate it compared to these criteria. Shore up weak areas prior to beginning spread


Adoption Curve/Tipping Point Illustration

0

10

20

30

40

50

60

70

80

90

100

1950

1952

1954

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

Percent of US Households with TV


Adopter Categories


‘Traditionalists’


How Adopters

Adopt

1. Awareness

2. Persuasion

3. Decision

4. Implementation

5. Confirmation


Match Spread Activities to Need

• Awareness - Broad marketing and communication

• Persuasion - Data feedback

• Decision - Case studies, individualized communication

• Implementation - Tools and resources, Access to technical expertise

• Confirmation - Feedback, Leadership


Adoption is a SOCIAL thing!

A better

idea…

…communicated through a

social network…

…over

time


Set-upSuccess-

ful Sites

Social

SystemBetter Ideas

Knowledge Management

Measurement and Feedback

Leadership

A Framework for Spread


Adapted from Ashkenas, 1995

SHARE

INFORMATION

SHAPE

BEHAVIOUR−

General

Publicationsflyers

newsletters

videos

articles

posters

Personal

Touchletters

cards

postcards

Interactive

Activitiestelephone

email

visits

seminars

learning sets

modeling

Face-to-faceone-to-one

mentoring

seconding

shadowing

The WAY in which we

communicate is important

(C) 2001, Sarah W. Fraser

Public

EventsRoad shows

Fairs

Conferences

Exhibitions

Mass mtgs


The Seven Spreadly Sins

Step #1 Start with large pilots

Step #2 Find one person willing to do it all

Step #3 Use vigilance and hard work

Step #4 If a pilot works then spread the pilot unchanged

Step #5 Require the person and team who drove the pilot to be responsible for system-wide spread

Step #6 Look at process and outcome measures on a quarterly basis

Step #7 Early on expect marked improvement in outcomes without attention to process reliability


Managing Spread

• Create plan• Completeness vs. coverage

• Set schedule

• Anticipate needed support services• IT

• Case management/community liaison

• Technical expertise

• Eliminate barriers• Accessible knowledge

• Measurement and feedback


+

-

- +

$

Level of Ease

Spread Evaluation Matrix


Spread Strategy Matrix

County Jan Feb Mar Apr May

Fulton A B C

Troop A B C

Cherokee A B C

Forsyth A B C

Gainsworth A B C

A=teen driver agreements B=Insurers Distribute Cards with Discount

C=Pediatric Anticipatory Guidance at 14, 15, 16, 16, 18


Repeated Use of the PDSA Cycle for Testing

Hunches

Theories

Ideas

Changes That

Result in

Improvement

Very Small

Scale Test

Follow-up

Tests

Wide-Scale Tests of Change

Implementation of Change

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Sequential building of

knowledge under a wide range

of conditions

Spreading

Sustaining the Gains


“There is nothing more difficult to plan, more

doubtful of success, nor more dangerous to

manage than the creation of a new order of

things….”

-Nicolo Machiavelli, The Prince



We’re

listening.


See You Tomorrow!

Day 2 Same Place, Same Time

Welcome Back! Jennifer Allison, CSN Director

Developing a Learning Collaborative

Alan Holmlund, Danielle Bolduc, Kimona Cameron Massachusetts, Suicide and Self-Harm Prevention

Kerri Nickerson, Suicide Prevention Resource Center

How to Establish or Connect to an Improvement Partnerships

Wendy Davis, National Improvement Partnership Network (NIPN)

Testing and Spreading Coaching Boys to Men

Shaquallah Shanks, Tennessee, Interpersonal Violence Prevention

Malia Richmond-Crum, Centers for Disease Control and Prevention

Testing and Implementing GDL Communication

Jeanne Bietz, Nebraska, Teen Driver Safety

Jen Leonardo & Jane Taylor, CS CoIIN Improvement Advisors

Where the CS CoIIN is Going Next

Bekah Thomas, CS CoIIN Director

learning session ii - children's safety network (csn) · •increase the number of child...

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