Orientation to IHI's Breakthrough Series

Report
The Olympic Team Trials:
An Orientation to the
Institute for Healthcare
Improvement Breakthrough
Series*
Joe Kyle, MPH
Kim McCoy, MPH, MS
*some adaptations for MLC collaboratives
Objectives
By the end of this session, you should be
able to—
 Describe the elements of a successful
Breakthrough Series collaborative
 Recognize and define the phases of the
Breakthrough Series model
 Understand how this applies to the MLC-3
collaboratives
Who is IHI?
The Institute for Healthcare Improvement
(IHI) is an independent, not-for-profit
organization whose work is to help lead
the improvement of health care around the
world.
What is the IHI Breakthrough
Series?
IHI’s Breakthrough Series (BTS) is an
improvement method that relies on
spread and adaptation of existing
knowledge to multiple settings to
accomplish a common aim.
IHI Breakthrough Series
(6 to 18 months time frame)
Select
Topic
Participants (10-100 teams)
(develop
mission)
Expert
Meeting
Prework
Develop
Framework
& Changes
Planning
Group
P
Dissemination
P
A
D
A
S
P
D
A
S
LS 1
LS 2
AP1
AP2
D
S
LS 3
Supports
LS – Learning Session
AP – Action Period
Email (listserv)
Visits
Phone Conferences
Assessments
Monthly Team Reports
Publications,
Congress. etc.
AP3*
Holding
the Gains
*AP3 –continue
reporting data as
needed to
document success
Goals for a BTS Collaborative
 Achieve
results
 Accelerate improvement– get results
faster!
 Define, document, and disseminate good
ideas
 Develop leaders of change
Example of BTS Model*
Applied to Public Health
ISSUE 1: Implementing Clinical Practice
Guidelines for Smoking Cessation in all
Public Health Clinical Settings
ISSUE 2: Improving capacity for Health
Improvement Planning at local health
departments
*some adaptations for MLC collaboratives
BTS Phase 1
Topic Selection
IHI Breakthrough Series
(6 to 18 months time frame)
Select
Topic
Participants (10-100 teams)
(develop
mission)
Expert
Meeting
Prework
Develop
Framework
& Changes
Planning
Group
P
Dissemination
P
A
D
A
S
P
D
A
S
LS 1
LS 2
AP1
AP2
D
S
LS 3
Supports
LS – Learning Session
AP – Action Period
Email (listserv)
Visits
Phone Conferences
Assessments
Monthly Team Reports
Publications,
Congress. etc.
AP3*
Holding
the Gains
*AP3 –continue
reporting data as
needed to
document success
Topic Selection
1.
There is a gap between science
(evidence) and practice
2.
Examples of better performance exist
3.
A good “Business Case” exists for the
topic
Topic Selection for BTS
Public Health Example
Smoking Cessation
HIP – Community
Engagement
Gap btw
science
and
practice
Clinical practice guidelines
are proven to be effective
AND guidelines implemented
unevenly across programs
Community engagement
guidelines exist AND
practice varies by local
health department
Examples
of better
practice
Fully implemented in one
large FP program in X state;
One large WIC site in our
state
MAPP, ACHI, state and
local work (e.g. Assess
Now – Washington)
Business
Case
Proven impact on reducing
Legally mandated to do it,
smoking, a critical health
lack of resources to do
status issue for public health everything, evidence of
significant disparities
BTS Phase 2
Developing the Technical Content
IHI Breakthrough Series
(6 to 18 months time frame)
Select
Topic
Participants (10-100 teams)
(develop
mission)
Expert
Meeting
Prework
Develop
Framework
& Changes
Planning
Group
P
Dissemination
P
A
D
A
S
P
D
A
S
LS 1
LS 2
AP1
AP2
D
S
LS 3
Supports
LS – Learning Session
AP – Action Period
Email (listserv)
Visits
Phone Conferences
Assessments
Monthly Team Reports
Publications,
Congress. etc.
AP3*
Holding
the Gains
*AP3 –continue
reporting data as
needed to
document success
Content Development
Collaborative Charter
2. Change Package
3. Measurement Strategy
1.
Collaborative Charter
 Establishes






a common vision for the work
Problem statement
Gap between science and practice
Mission statement
Business case for improvement
Specific goals
Expectations
Change Package
 The
essential changes needed to
accomplish the mission



Evidence-based strategies
Model practices
Credible expert opinion
Measurement Strategy
 Key
measures that will be used to track
improvement
 Definitions of data elements
 Data collection methods
How is technical content
developed?

Staff do initial research with one or two experts
 Panel of experts broadens and deepens the
content
 Staff work with other experts to enhance and
“package” the content for the Collaborative
 During the Collaborative the content is tested
and developed further; package is revised.
Expert Meeting- A Key Step
 Invite




12-15 experts in topic area
Multidisciplinary
Mix of research and applications expertise
Practitioners necessary
Best thinkers and doers on the topic
 Develop
the technical content
 Identify faculty for Learning Sessions
Development of Technical Content
Public Health Examples
Smoking Cessation
HIP – Community
Engagement
Problem
Statement
Clinical practice guidelines
not implemented in all public
health clinics
Community involvement in
local public health planning
is insufficient
Mission
Statement
Clinical practice guidelines
implemented consistently in
all public health clinics
All community groups
actively engaged in local
public health planning
Goal
WIC, FP, and STD clinics
implementing the guidelines
Participation by historically
disenfranchised groups
BTS Phase 3
Prework
IHI Breakthrough Series
(6 to 18 months time frame)
Select
Topic
Participants (10-100 teams)
(develop
mission)
Expert
Meeting
Prework
Develop
Framework
& Changes
Planning
Group
P
Dissemination
P
A
D
A
S
P
D
A
S
LS 1
LS 2
AP1
AP2
D
S
LS 3
Supports
LS – Learning Session
AP – Action Period
Email (listserv)
Visits
Phone Conferences
Assessments
Monthly Team Reports
Publications,
Congress. etc.
AP3*
Holding
the Gains
*AP3 –continue
reporting data as
needed to
document success
Why Prework?
 Establish
an action-oriented culture
 The teams come ready to work
 Engage others– lay foundation for the
improvement back home
Prework for the Planning Group
Planning Group- Collaborative staff, small group of
experts





Completing first iteration of the Change Package
Selecting and enrolling teams
Creating and testing Prework materials
Preparing teams
Assessing resources
Prework for Collaborative Teams
Collaborative Teams- Local staff, community
partners, other stakeholders
 Discuss aims and focus work
 Engage the senior leader
 Initiate measurement and other information
gathering
 Identify resources and develop a budget
 Storyboard
This is a different type of learning experience
BTS Phase 4
Learning Sessions and
Action Periods
IHI Breakthrough Series
(6 to 18 months time frame)
Select
Topic
Participants (10-100 teams)
(develop
mission)
Expert
Meeting
Prework
Develop
Framework
& Changes
Planning
Group
P
Dissemination
P
A
D
A
S
P
D
A
S
LS 1
LS 2
AP1
AP2
D
S
LS 3
Supports
LS – Learning Session
AP – Action Period
Email (listserv)
Visits
Phone Conferences
Assessments
Monthly Team Reports
Publications,
Congress. etc.
AP3*
Holding
the Gains
*AP3 –continue
reporting data as
needed to
document success
Learning Session Objectives
Learning Session 1
Get Ideas
Get Methods
Get Started
Learning Session 2
Get More Ideas
Get Better at
Methods
Get a “Stride”
Learning Session 3
Celebrate Successes
Get ready to Sustain
and Spread
Test all
changes on
small scale
Action Period 1
Test &
implement
all changes
Action Period 2
Action Periods–
Where the Rubber Meets the Road
Opportunity for the teams to
 Test changes
 Measure results
 Get help from colleagues
Action Periods
Opportunity for staff to
 Support teams in their improvement work
 Build collaboration and shared learning
 Assess collaboration and progress
This is the time of maximal learning
Model for Improvement
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?
From: Associates in Process
Improvement
Act
Plan
Study
Do
Plan, Do, Study, Act
– who, what, when, where
 Do – implement change, collect data
 Study – analyze results – if test was
successful, then Act, if not, then Plan
again
 Act – Implement on a broad scale and
move to next cycle
 Plan
PDSA Cycle
A P
S D
Changes That
Result in
Improvement
Implementation of
Change
A P
Ideas
S D
Follow-up
Tests
Small Scale
Test
Wide-Scale
Tests
PDSA Cycle
Public Health Examples
Smoking Cessation
HIP – Community
Engagement
1
Test clinical practice guidelines Test engagement strategy with
with 1 provider in 1 clinic for 1 1 population group in 1
week
neighborhood
2
Test clinical practice
guidelines with 1 provider in 1
clinic for 2 weeks
Test engagement strategy with
1 population group in multiple
neighborhoods
3
Test clinic practice guidelines
with all providers in 1 clinic for
1 month
Test engagement strategy with
multiple population groups in 1
neighborhood
BTS Phase 5
Holding the Gains and Spread
Holding the Gains
 Continued
tracking of improvements
 Part of the BTS Design!
Spread
Definition-- Adapting change to areas or
populations other than your pilot
populations
Why Think About Spread Early in
Your Collaborative Planning?
 For

Helps identify which organizations or persons
to invite to collaborative
 For


those planning a collaborative:
the collaborative’s teams:
Aids in team’s selection of their pilot
population
Can think about who to involve and cultivate
relationships for spread
Examples of Spread
 One
county clinic site to all county clinic
sites
 One population group to multiple
population groups
 One preventable chronic disease program
to multiple chronic disease programs
 One neighborhood to an entire city
Holding the Gains and Spread
Public Health Examples
Smoking Cessation
HIP – Community
Engagement
1
Implementation of clinical
guidelines in all public health
clinics
Implementation of engagement
strategies by all local health
departments
2
Incorporate measure of clinical Annual reporting on community
guidelines in performance
engagement – by population
measurement system
group - in performance
measurement system
3
Monitor smoking rates among
clinic clients
Monitor community satisfaction
Lessons Learned/Tips
 Flexibility
 Focus
 Short-term
process improvement vs. longterm outcome improvement
 Incentives
 Failure as valuable as success
(sometimes more so)

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