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. 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