Practice Key Driver Diagram
Team Meeting 1, Part 1:
Running Effective QI Team Meetings
Accelerating Improved Care for Children with ADHD
Chapter Quality Network ADHD Project
Jen Powell, MPH, MBA
Commercial Interests Disclosure
Jen Powell
I have no relevant financial relationships with the
manufacturer(s) of any commercial product(s) and/or
provider of commercial services discussed in this CME
activity.
I do not intend to discuss an unapproved or investigative
use of a commercial product/device in my presentation.
Objectives
Understand the basics of using effective meeting skills
Highlight the key components of a good quality
improvement meeting
Review ways to discuss measurement and data
Effective QI Team Meetings
Get the job done:
 Keep the momentum going for QI efforts
Increase efficiency:
 Provide a time and space for regular shared learning and review of data
Engage everyone & improve communication:
 Encourage participation by all on the team; all participate in testing
 Provides a venue for building trust and collaboration among the team
Meeting Skills
The First Meeting
 Collaboratively set ground rules or “norms” for the team.
 Start with some examples to get the conversation started
 Invite everyone’s input
 Keep the list to 5 or 10
 Post during future meetings or include on meeting agendas
 Establish roles
 These can be changed at regular intervals if the team prefers
Example Ground Rules:
Start and end on time
No sidebar conversations
Come prepared and ready to contribute
Don’t interrupt the person speaking
Be open to hearing other people’s perspectives
Question assumptions
Speak only for yourself
Honor the group
Be honest
Be respectful
Create a safe environment
Share all relevant information.
Everyone has a chance to speak without
interruption.
 No idea is a bad idea. All ideas and opinions will
be respected.
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 Individuals’ personal comments remain
confidential
 Give specific example
 Speak about interests not positions
 Capture decisions and action items
 Silence means agreement
 Consensus, majority vote, or unanimous
agreement are the way to make decisions
 Raise hands when you want to speak
 Make decisions based on clear information.
 Accept the fact that there will be differences of
opinion.
 Attack the problem, not the person- "no blame
game"
 Share time so that all can participate
 End meeting with a list of follow-up items and the
person responsible for each
Example Roles:
Meeting Management
 Always start and end on time.
 Use an agenda that includes standing items such as:
 Status report on completed tests
 Review of previous action items and status
 Highlight of decisions that need to be made during the meeting
 Discussion of measures and data
 New PDSA cycle ideas
 Update list of action items with due date and person responsible
 Brief evaluation of meeting
Discussion of Data
Example questions to guide discussion of measures and
data:
 What do you notice about your measures?
 Are they moving?
 Is there a sudden dip or a big jump? Can you indicate what the
change is with an annotation?
 Is the information what you need? Could you stratify any of the
measures to give you a more granular picture of what is
happening?
 Are there things you aren’t measuring that might we helpful to
measure?
Evaluation of Meeting
Plus/Delta is a simple, quick (5–10 min), and effective evaluation tool that works
very well for this. To use, draw a vertical line down the center of an easel pad. At
the top of the left column put a plus sign; at the top of the right put a triangle or
delta sign. Under the plus write comments from meeting attendees about what
went well during the meeting or what should be continued or brought forward for
the next meeting. Under the delta write comments about what could be improved
or done differently.
Other Suggestions
 Ask for input from others on agenda items ahead of time.
 Keep leadership informed of what is happening; ask for help and
support as needed.
 Communicate work with the broader staff.
 Make it fun! What would motivate the folks at your site to get or stay
involved? Remember, this is hard work that can take time!
Sample Agenda
Date:
Time:
Attendees:
 Review current agenda – add/remove items as needed (3 min)
 Highlight decisions that need to be made during the meeting (2 min)
 Review previous action items and discuss status (5 min)
 Review PDSA cycles run since last meeting and status (8 min)
 Review and discuss dashboard of data or monthly measures (10 min)
 Discuss new PDSA cycle ideas and make plans for tests (10 min)
 Update list of action items with due dates and person responsible (5 min)
 Evaluate meeting (2 min)
Objectives
 Understand the basics of using effective meeting skills
 Highlight the key components of a good quality improvement
meeting
 Review ways to discuss measurement and data
Team Meeting 1, Part 2:
Using Flowcharts
Accelerating Improved Care for Children with ADHD
Chapter Quality Network ADHD Project
Jen Powell, MPH, MBA
Commercial Interests Disclosure
Jen Powell
I have no relevant financial relationships with the
manufacturer(s) of any commercial product(s) and/or
provider of commercial services discussed in this CME
activity.
I do not intend to discuss an unapproved or investigative
use of a commercial product/device in my presentation.
Objectives
 Review the purpose and benefits of using flowcharts
 Discuss and analyze mehealth workflows
 Practice effective meeting skills
The Purpose of Flowcharts
 Creates a picture of the sequence of steps in a process
The Benefits of Flow Charts
 Engages all members of the practice
 Replaces pages of written word with a picture
 Illustrates waste, delays, missteps and duplication in the process
being studied
 Builds consensus within the practice
 Corrects misunderstandings about a process
 Builds common understanding of the process
Simple Flow Chart Example
Shapes Used in Flow Charts
Shapes Used in Flow Charts
During office visit
Office Visit - Prework
Clinical Assessment Process Map – Paper Chart System
Asthma patients
identified at the
front desk
Once parent input
is completed the
form is returned to
the top of the chart
At time of parent check in,
encounter form is
removed from top of
folder, given to parent and
parent is asked to fill out
their part of the encounter
form Questions 1-10
Patient is ready to
be seen by
Physician
During the visit the
physician fills out the
remainder of form while
having informed clinical
discussion
Questions 11-27
Patient with new
diagnosis of
Asthma, form is
pulled and filled
out concurrently
YES
Completed form
returned to chart,
then chart to
‘finished chart’ box
Physician
completes the
form immediately
after the visit
Is there an opportunity for
completeness check at this
point in the process
Post visit Activities
NO
YES
Nurse Leader removes
encounter form and verifies
for completeness
If necessary circle
back with
Physician or
patient family by
phone to obtain
missing
information
All necessary
information on the
form is entered
into EQIPP and
Registry (if you
have one), no
incomplete entry,
no batching
List of active
patients without
forms is regularly
generated
reviewed and
updated
Any patients with missing forms are
targeted for pro-active communication
during FluShot Season: Post-card, Phone
call and letters
NO
This form was developed specifically for the AAP Chapter Quality Network Asthma Pilot Project and originally developed by the Physicians Hospital Organization at Cincinnati Children’s Hospital Medical Center
Tips for Useful Flow Charts
Do’s
Draft the current process before the ideal process
Ask for input of all members of the practice, including patients
Observe the process directly or ask a patient to give their
perspective
Draft the flow chart with post-it notes with all members
involved
Place the draft in a public place before finalizing
Don’ts
Have one person or discipline complete the chart
Use a pre-determined template
Time for Action:
Review and Modify your Flow Chart
First, plan for your meeting!
 Identify roles for this team meeting
 Clarify aim: modify flowchart
 Determine how much time you will spend discussing each question
 Capture notes on the discussion to use in Team Meeting 2
 List next steps and action items for follow-up
 Save time at the end to evaluate your meeting
Time for Action:
Review and Modify your Flowchart
Questions for your discussion:
 Is the right person completing the appropriate tasks?
 Are there any missing steps?
 Are there steps that should be more detailed or broken into
smaller pieces?
 Are there places in your workflow where you are unclear HOW
they will work in your practice?
Debrief your Meeting
Use the
Or, ask everyone to score the meeting on a 1-10 scale
(higher number = more effective and efficient). Discuss
results.
Evaluation of Meeting
Plus/Delta is a simple, quick (5–10 min), and effective evaluation tool that works
very well for this. To use, draw a vertical line down the center of an easel pad. At
the top of the left column put a plus sign; at the top of the right put a triangle or
delta sign. Under the plus write comments from meeting attendees about what
went well during the meeting or what should be continued or brought forward for
the next meeting. Under the delta write comments about what could be improved
or done differently.
Objectives
Review the purpose and benefits of using flowcharts
Discuss and analyze mehealth workflows
Practice effective meeting skills