Improvement Ramp, Process Mapping, PDSA, ORIC

1. Welcome!
Implementing Team Based Care (TBC)
Learning Collaborative
National Cooperative Agreement and Community Health Center, Inc.
Session Two
June 20, 2018
3:00 - 4:30 EST

2. We will begin shortly…
Welcome
2

3. Get the Most Out of Your Zoom Experience
• Please turn on your webcam!
• Remember to mute yourself
• If you have a question, you may un-mute yourself and
ask after each presentation, OR use the chat feature
• Use the chat feature to submit questions!
• Live tweet us at @CHCworkforceNCA
• View past webinars at www.chc1.com/nca

4. TBC Faculty, Collaborative Design,
Facilitation
AnnMarie R Hess NP, MS
 Consultant
 ahess@maine.rr.com
National Cooperative Agreement
Amanda Schiessl, MPP
 Project Director, NCA
 Schiesa@chc1.com
Nashwa Khalid, MA
 Project Coordinator, NCA
 khalidn@chc1.com
Kerry Bamrick, MBA
 PI, NCA & Program Director,
Postgraduate Residency Training
Programs
 Kerry@chc1.com
Margaret Flinter, APRN, PhD, FAAN
 PI, NCA & Senior Vice
President/Clinical Director
 Margaret@chc1.com
3:35
Mentors, Coaching Faculty
Deborah Ward, RN
 Senior Quality Improvement
Manager
 WardD@chc1.com
Kasey Harding, MPH
 Director of the Center for Key
Populations
 HardinK@chc1.com
Evaluation Faculty
Kathleen Thies, PhD, RN
 Consultant, Researcher
 ThiesK@chc1.com
Improvement Science Faculty
Patti Feeney, MS
 Manager of Quality Improvement
Education
 HardinK@chc1.com
Mark Splaine, MD, MS
 Director of Education
 SplainM@chc1.com

6. Name of FQHC Coach
Central Virginia Health Services, Inc. Lisa Dunkum
HealthRIGHT 360 Alan Hernandez Gutierrez
Lancaster Health Center Julie Hoffer
Western Maryland Healthcare (Mountain
Laurel)
Erica Healy, Autumn Rush
New Horizons Healthcare Angela Martin
Northwest Michigan Health Services Gwen Williams
OPTIMUS HEALTHCARE Nelly Angah
San Vicente Family Health Center Cara Johnson
Thunder Bay Community Health Service, Inc. Kayla Berry
Tri-Cities Community Health Whitney Garcia Fraga
Wellspace Health Jeremy Meis
Family Health Center of Worcester Anne Reeder
Ocean Health Jeremiah Walsh, Kim Tozzi

7.  Define Core and Extended
Team (structure, roles)
 Achieve multiple TBC specific
aims, data driven PDSAs
 Standardize (SDSAs) roles
and key processes (Playbook,
Spread Plan- another team)
 Improve team and coach skills
(improvement science, team
work, coaching)
 Move Practice Assessment
Data toward Level A
 Develop a post collaborative
team Improvement Plan
Structure and Expectations
Seven 90 min Zoom Learning Sessions
( 3:00-4:30 EST)
Between Session Action Periods (6 weeks)
Weekly Team Meetings, Daily Huddles
Complete Assignments
Upload Your Work Moodle Folders
Online Moodle Learning Network (Share Your Work , Resources)
Between Session
Coaches Meet with Mentors Weekly
Faculty Support
Discussion Board
7
May 9 June 20
Pre
Work
Aug 1 Sept 12 Oct 24 Dec 5 Jan 16

8.  Teaching Skills and Reviewing
Tools
 Clarifying Assignments and
Rationale
 Facilitating Learning : Best
Practices and Challenges
 Providing Resources : (Moodle)
Learning Network
Action Period 1
18 Mentor Sessions
Helping 13 Coaches
2 Sessions Weekly
(Deb and/or Kasey)
9-10 Coaches
Attending Weekly
All Coaches :
attending most sessions

9. Team Based Care and Quality Improvement
Core Concepts in Team Based Care Teamwork Gathering and Using Data

10. Developing Skills
Session 1 : May 9 2018
o Running effective team meetings using tools
o Developing and using a cause and effect diagram to inform PDSAs
o Writing a global and specific aim statement
Session 2 : June 20
o Developing a process map or current state workflow
o Applying PDSA methodology for improvement
Session 3 : Aug 1
o Using data for improvement (run charts, control charts)
Session 4 : Sept 12
o Standardizing (SDSAs) and Reliability Science
Session 5 : Oct 24
o Spreading Change
Session 6 : December 5
o Gantt Charting : 3-6 month Core Team improvement plan

11. Team Skills Assessment Summary (2018)

12. Objectives Session 2
 Summarize Action Period 1 Milestones (6 weeks)
 Provide TBC concept overview
 Learn from team assignments
→ Adjusting Core and Extended Team Structure
→ Practicing Effective Meeting Skills
→ Implementing Best Practice Daily Huddles
→ Global Aim and Specific Aim
→ Using Cycle Time
 Refresh QI Skills : Specific Aim , Process Mapping and PDSA
Methodology
 Action Period 2

13. Time Learning Session 2 Agenda Lead
3:00 Welcome and Introductions Amanda Schiessl
3:05 Objectives and Agenda
Action Period 1 Milestones
TBC Concepts and QI Overview
Ann Marie Hess
3:15 TBC Presentations (5 min team presentation, 2 min questions)
 Team Structure and Role Activity Assessment: Tri Cities
 Running Effective Team Meetings : Mt Laurel Medical Center
 Best Practice Daily Huddles: NW Michigan Health Services
Team Member
3:40 Key TBC Concept
 Pre Visit Planning (protocols, workflow, roles): Thunder Bay
Team Member
3:50 TBC Presentations (5 min team presentation, 2 min questions)
 Global Aim and Process Map : Health Right 360
 Cycle Time , Fishbone, Global Aim : Lancaster Health Center
Team Member
4: 05 Action Period 2
• Assignments
Deb Ward
4:10 QI Refresh
 Developing a process map or current state workflow
 Specific Aim (measurable, small)
 Applying PDSA methodology for improvement
Deb Ward
4: 25 Wrap Up Amanda Schiessl

14. Action Period 1 : Milestones

15. Progress Action Period 1 Assignments

16. Action Period 1 : Refining Your TBC Model
(webinar #1 2016, 2018)
→ Define your Core and Extended
Team Structure
→ Strategically redistribute work
among team members (reduce
waste, duplication, variation)
→ Create new responsibilities and
provide training
→ Improve efficiencies (wait
times, start times)
→ Standardize processes to reflect
new model
At the Center is The Teamlet

17. Role Activity Analysis (Lancaster): Waste, Duplication, Variation in Who is Doing
What
 Very surprised by the number and type of tasks that we ‘were NOT doing’
 Finding significant duplication of tasks we ARE doing across roles – we work in silos
 “When everyone is responsible, no one is responsible” (Accountability)

18. Standardizing Processes to Achieve TBC
Webinars 1-8, 2016

19. 0
1
2
3
4
5
6
1 2 3 4 5
CountofPollResults
Not Difficult at All
Polling Questions May 2018
How challenging or difficult has it been for your
practice to implement new roles and new ways of
caring for your patients? (N=12)
Extremely Difficult

20. ACTION Period 1: ORIC READINESS SURVEY: Implementing Change

21. Readiness Conversation: Implementing TBC
• 60% motivated to implement TBC
• 63% want to implement TBC
• 56% confident can coordinate the tasks
• 55% confident that they can keep the momentum going
• 54% confident they can keep track of progress
• 54% confident they can get people invested
• 49% confident organization can support people as
adjust to TBC
• 43% confident that they can manage the politics

22.  Increase Staffing and Team Structure : 59% increase in staffing, to 4.25 FTE staff per physician, is
needed to achieve the patient-centered medical home. Panel size varies based on capacity and
demand.
 Co-Locate Teams : physicians working in the same space as their team members increases
efficiency and can save 30 minutes of physician time per day
 Standardize Team Documentation : associated with greater physician and staff satisfaction,
improved revenues, and the capacity of the team to manage a larger panel of patients while going
home earlier
 Standardize Pre-Visit Planning : reduces time wasted on review and follow-up of lab results , tests,
care plans
 Expand Roles : RNs and MAs to assume responsibility for preventive and chronic care using
standing orders, contributing to the health of their patients
 Unnecessary work is reengineered out of the practice , to make room for new
responsibilities
 Ensure that staff who assume new responsibilities are well-trained
 Standardize Workflows : med refill workflow can save physicians 5 hours per week while providing
better care
Team Based Care Model: Care of the Team
Source: From Triple Aim to Quadruple Aim. Bodenheimer and Sinsky . Ann Fam Med 2014

23. 3:15 – 3:40 TBC Presentations
(5 min team presentation, 2 min
questions)
 Team Structure and Role Activity
Assessment
Tri Cities
 Running Effective Team Meetings Mt
Laurel Medical Center
 Best Practice Daily Huddles
NW Michigan Health Services
Team
Member

24. Team Structure and Role Activity
(Action Period 1)
 9 Team Defined Team Structure
 8/9 Teams Changed Their Structure
 Replaced MA
 Changed Providers
 Added Receptionist
 Moved Managers to Extended
 Added Behavioral Health
 Moved Dental to Extended

25. 3:15 – 3:40 TBC Presentations
(5 min team presentation, 2 min
questions)
 Team Structure and Role Activity
Assessment
Tri Cities
 Running Effective Team Meetings Mt
Laurel Medical Center
 Best Practice Daily Huddles
NW Michigan Health Services
Team
Member

26. Tri-Cities Community Health
Meet Our Core Team Members
Whitney Garcia (Coach) – Quality & Accreditation Coordinator
Sara Dusky (Co-Coach) – Clinical Pharmacist
Spencer Crihfield, CPNP – Provider (New)
Noemi Tello – Medical Assistant (New)
Meet Our Extended Team Members
Jim Davis, CEO - Overseer
Veronica Gutierrez – Quality
Christina Rodriguez – Nursing & Care Coordination
Kristy Needham – Billing & Referrals
Aida Juarez – Support Services & BH Integration
Nelly Zarate – Customer Service

27. Role Activity Assessment
Fishbone Diagram
Areas of Improvement
& Standardization
Population Management
Planned Care
(Solidified Previously Identified)
Focus
Technology Support
Standardization (per Union)

28. Love
Patient care
Compassion
Multiple services
Patient Loyalty
Nuts
EMR
Patient Flow
Communication
Staffing
Access
Love & Nuts Trend Analysis

29. Specific Aim & PDSA Cycles
Specific Aim
 Baseline Data
 Fishbone Diagram
 Role Assessment Activity
 Love & Nuts
 Smallest Changes
 Core Team
Core Team PDSAs
 Care Guidelines (6 months)
 Checkout Template
 Rooming Access (Laptops)
 PAQ Closing the Loop (Referrals)
 Pre-Visit Planning (NextGen)
Extended Team PDSA (Idea Tree)
Idea Tree

30. 3:15 – 3:40 TBC Presentations
(5 min team presentation, 2 min
questions)
 Team Structure and Role Activity
Assessment
Tri Cities
 Running Effective Team Meetings Mt
Laurel Medical Center
 Best Practice Daily Huddles
NW Michigan Health Services
Team
Member

31. “Teams must
meet to
improve
care.”
“Teamwork is
a must.”
NCA, 2016

32. Running Effective Meetings
(Action Period 1)
Day and Time
 Tues 8:20 am
 Tues 10:00 am
 Tues 1:00 pm
 Tues 4:00 pm
 Wed 1:00 pm
 Wed 2:00 pm
 Wed 3:00 pm
 Thurs 9:00 am
 Thurs 12:00 pm
 Thurs 12:30 pm
 Friday 1:00 pm
# Meetings (6 weeks)
 1-2 (3 Teams)
 3-4 (5 Teams)
 5-6 (4 Teams)
 7 (1 Team)

33. Running Effective Meetings
(Action Period 1)
 It has been difficult to coordinate meeting times
 We are working on problems with individual engagement
 We learned that we need to adjust provider schedules to attend, be on
time
 We invited leaders to a recent meeting as part of our communication
plan
 In spite of time challenges, we have been working really well together
 We are doing a type of evaluation of meeting to improve them
 Our meetings are going very well, but need to lock in a time and day
 We have had ‘big moments of frustration’ using tools
 Everyone comes to our meeting wanting to do different things

34. Running Effective Meetings
Mount Laurel Medical Center

35. • Decide the best time to meet
• Recognize and deal with problems during the meeting
• Follow up on decisions
• Set ground rules for success
• Manage time to get effective results
• All team members participate in meetings
• Stay on topic

36. • Meeting time: Fridays at 1:00 pm (CoreTeam)
• First meeting: April 27th, 2018
• Ground rules set during first meeting
• Team members respect others opinions
• All team members are expected to participate
• Schedules are not blocked; providers on core team see patients part time
• Encourage team work as well as individual if assignments are not
completed during meeting time
• Relationships have improved within core team because we respect and
count on each other for effective results in moving toward a model of team
based care
• Having staff roles helps with the flow for meetings
• Our current challenges include staying on track, working toward our global
aim goal, and narrowing down the goal to a specific aim
• Our core team consists of leadership and director level employees that gives
us extended options
• We aim to stay focused on assignment at hand and to work toward our goal
with the help of core and extended team

38. 3:15 – 3:40 TBC Presentations
(5 min team presentation, 2 min
questions)
 Team Structure and Role Activity
Assessment
Tri Cities
 Running Effective Team Meetings Mt
Laurel Medical Center
 Best Practice Daily Huddles NW
Michigan Health Services
Team
Member

39. Feedback Daily Huddles (All Teams)
From ‘Just Started’ to ‘Years of Experience’
 A lot we would change
 Not robust enough after a few years
 Revamping our huddles now
 Increased to 15 min , not robust if 5-7 min
 First 20 minutes of schedule is blocked for huddle time
 Print out the appointments for the day
 Share notes during the huddle
 Document in the EHR during huddle
 Huddles improve efficiencies

40. NMHSI-Shelby
Huddles

41. When are your huddles, who attends, how
long have you been implementing, who
prepares, how much time?
 Our huddles start around 7:55 and last 10 minutes
 All staff attend the huddles.
 Medical, Dental, BH staff and providers, along with reception,
CHW, referral specialists, etc.
 We have been holding daily huddles for well over a year.
 The Clinic Coordinator runs the huddle when she is on site.
When she is off site, any other staff member can and will
run the huddle.
 MA’s and Dental Hygienists, print the AZARA huddle sheets
in preparation for the huddle. Reception also prints the
AZARA huddle sheets in preparation for the huddle.
 These huddle sheets allow reception to see who needs
to be signed up for the portal and any self-pay
patients that may need assistance with insurances.

42. Huddle time blocked in everyone’s schedule?
 Medical provider time is not actually blocked in the
schedule; however, their first patient is scheduled for 8:20.
 After the all staff huddle, the medical providers and
respective MA’s hold their own huddle in their office. They
use the AZARA huddle sheet to guide any alerts, quality
measures, etc.
What specific impact are your huddles having on
efficiency and care? (e.g. cycle time and other
efficiencies, access, closing health maintenance
gaps, team communication, rooming standards,
care management, value added time with patient)
 Our huddles have helped with integrated visits involving
BH, Medical and the CHW.
 Team communication has improved as huddles allow for
easy interaction and access to one another before the day
becomes busy.
 The referral specialists and CHW can alert reception of
patients they would like to speak with that day.
 Huddles have helped address staffing issues, allowing staff
to see where coverage may be needed.

45. Time Learning Session 2 Agenda Lead
3:00 Welcome and Introductions Amanda Schiessl
3:05 Objectives and Agenda
Action Period 1 Milestones
TBC Concepts and QI Overview
Ann Marie Hess
3:15 TBC Presentations (5 min team presentation, 2 min questions)
 Team Structure and Role Activity Assessment: Tri Cities
 Running Effective Team Meetings : Mt Laurel Medical Center
 Best Practice Daily Huddles: NW Michigan Health Services
Team Member
3:40 Key TBC Concept
 Pre Visit Planning (protocols, workflow, roles): Thunder Bay
Team Member
3:50 TBC Presentations (5 min team presentation, 2 min questions)
 Global Aim and Process Map : Health Right 360
 Cycle Time , Fishbone, Global Aim : Lancaster Health Center
Team Member
4: 05 Action Period 2
• Assignments, Syllabus
Deb W
4:10 QI Refresh
 Developing a process map or current state workflow
 Specific Aim (measurable, small)
 Applying PDSA methodology for improvement
Deb Ward
4: 25 Wrap Up Amanda Schiessl

46. Pre Visit Planning (Action Period 1)
Lancaster

47. Pre Visit Planning
Best Practices
Thunder Bay Community Heath Services,
Inc.

48. Time Learning Session 2 Agenda Lead
3:50 – 4:05 TBC Presentations
(5 min team presentation, 2 min
questions)
 Global Aim and Process Map
Health Right 360
 Cycle Time , Fishbone, Global Aim
Lancaster Health Center
Team
Member

49. HealthRIGHT
360
Haight-Ashbury Clinics

50. Core Team
Adam Corona Registered Nurse
Leticia Gonzalez,
NP
Nurse Practitioner
Alan Hernandez
Gutierrez
Clinic Operations
Manager
Racquel Kraft Access Coordinator
Extended Team
Nina Soares Director of Clinic
Operations
Amber Ugarte Health Education
Intern

53. Time Learning Session 2 Agenda Lead
3:50 – 4:05 TBC Presentations
(5 min team presentation, 2 min
questions)
 Global Aim and Process Map
Health Right 360
 Cycle Time , Fishbone, Global Aim
Lancaster Health Center
Team
Member

54. Lancaster Health
Center
Lancaster, PA
Global Aim, Fishbone Diagram
Mark Sprunger, Julie Hoffer, Matthew Weitzel,
Virginia Rodriguez, Jamie Ocasio

55. Global Aim: Decreasing Patient
Cycle Time
We arrived at this global aim after doing some solution
storming and recognizing that cycle time is a theme of many of
the issues that we see as an organization

56. Time Studies:
 We ran reports from our EHR (Athenahealth) and compared
them to patient-reported time sheets to validate the system
report (pink lines are patient-reported, and white are
system-reported)

57. Cycle Time Averages
We then averaged the cycle
time for each provider in
February, March and April to
use as our baseline data

58. Fishbone
Diagram
Problem:
Lengthy cycle
time

60. Next Steps:
 Use the fishbone diagram to identify a
specific aim
 Draft a specific aim statement
 Process map
 PDSA cycle(s)

61. Time Learning Session 2 Agenda Lead
3:00 Welcome and Introductions Amanda Schiessl
3:05 Objectives and Agenda
Action Period 1 Milestones
TBC Concepts and QI Overview
Ann Marie Hess
3:15 TBC Presentations (5 min team presentation, 2 min questions)
 Team Structure and Role Activity Assessment: Tri Cities
 Running Effective Team Meetings : Mt Laurel Medical Center
 Best Practice Daily Huddles: NW Michigan Health Services
Team Member
3:40 Key TBC Concept
 Pre Visit Planning (protocols, workflow, roles): Thunder Bay
Team Member
3:50 TBC Presentations (5 min team presentation, 2 min questions)
 Global Aim and Process Map : Health Right 360
 Cycle Time , Fishbone, Global Aim : Lancaster Health Center
Team Member
4: 05 Action Period 2
• Assignments
Deb Ward
4:10 QI Refresh
 Developing a process map or current state workflow
 Specific Aim (measurable, small)
 Applying PDSA methodology for improvement
Deb Ward
4: 25 Wrap Up Amanda Schiessl

62. Action Period 2 Assignments
1. Work on weekly meeting challenges : scheduling, evaluating , using skills
2. Improve Your Daily Huddles and Standardize
3. Revisit Your Communication Plan
4. Continue with Action Period 1 Assignments
5. Write a Specific Aim (small, actionable, measurable, achievable in 90 days)
aligned with Global Aim
6. Complete a Process Map of the workflow you want to improve
7. Brainstorm solutions and ideas for achieving your aim , do some Benchmarking
8. Plan your PDSAs , Implement Some Tests of Change

63. https://www.weitzmaninstitute.org/NCA
Brainstorming Solutions and Ideas
2016 TBC Webinars
Webinar #1: Advancing Team Based Care : Building
Your Primary Care Team to Transform Your
Practice
Webinar #2: Enhancing the Role of the Medical
Assistant
Webinar #3: The Emerging Role of Nurses in
Primary Care
Webinar #4: Data Driven Dashboards to Support
Team Based Care
Webinar #5: A Team Approach to Prevention and
Chronic Illness Management
Webinar #6: Complex Care Management in Primary
Care
Webinar #7: Achieving Full Integration of
Behavioral Health and Primary Care
Webinar #8: Dissolving the Walls: Clinic
Community Connections
2018 TBC Webinars
Webinar #1: Taking Team Based Care to
the Next Level
Webinar #2: Advancing the Practice of
RNs and Behavioral Health Providers
Webinar #3: Beyond the Walls: Effectively
Utilizing Community Health Workers and
Clinical Home Visitors as Part of the Team
Webinar #4: Caring for Patients with Pain
is a Team Sport
*LEAP Project
Improvingprimarycare.org

64. NCA Online Learning Network
Find best practice material for download
Find TBC webinars , and QI Tools
Find Team folders for sharing work ...
Discussion Board
Ask questions or make
requests of
teams, faculty….

65.  Continue Weekly Mentor Calls
(individual coaching support as needed)
 Facilitate Participation Online Learning
Network
 Plan Session 3 : Team’s Sharing Work
Faculty Action Period 2

66. Time Learning Session 2 Agenda Lead
3:00 Welcome and Introductions Amanda Schiessl
3:05 Objectives and Agenda
Action Period 1 Milestones
TBC Concepts and QI Overview
Ann Marie Hess
3:15 TBC Presentations (5 min team presentation, 2 min questions)
 Team Structure and Role Activity Assessment: Tri Cities
 Running Effective Team Meetings : Mt Laurel Medical Center
 Best Practice Daily Huddles: NW Michigan Health Services
Team Member
3:40 Key TBC Concept
 Pre Visit Planning (protocols, workflow, roles): Thunder Bay
Team Member
3:50 TBC Presentations (5 min team presentation, 2 min questions)
 Global Aim and Process Map : Health Right 360
 Cycle Time , Fishbone, Global Aim : Lancaster Health Center
Team Member
4: 05 Action Period 2
• Assignments
Deb Ward
4:10 QI Refresh
 Developing a process map or current state workflow
 Specific Aim (measurable, small)
 Applying PDSA methodology for improvement
Deb Ward
4: 25 Wrap Up Amanda Schiessl

67. Team &
Roles Defined
Assessment
And
Baseline Data
Global Aim
Problem
Statement
Specific
Aims
And
Measures
Change Idea
Solution-
Storming
PDSA
SDSA
Spread
Measure
and
Monitor
The Stages of Improvement
QI REFRESH

68. What is a Process Map?
A sequence of detailed steps with a specific process

69. • Teamwork
• View of current work
• Identifies unwanted
variation, waste, delays, and
rework
• Generate ideas for
improvement
Importance
“You don’t learn to Process Map. You Process Map to learn.” - Dr. Myron Tribus
• Document Processes
• Describe and understand the
work
• Analyze and improve on
processes

70.  Identify the people with “tribal knowledge”
 Choose a process
 Identify purpose
 Start and end points
 Detail!
Prepare

71. Current process
Not what you WANT the process to be
Ask:
“What happens first”, and “what happens next”
Use:
Post-it notes (full sticky backing)
Dry erase markers
Super sticky flip chart paper
Blue painters tape
Important

72. • Start & End: An oval is used to show the materials, information or action
(inputs) to start the process or to show the results at the end (output) of
the process.
• Activity: A box or rectangle is used to show a task or activity performed in
the process. Although multiple arrows may come into each box, usually
only one arrow leaves each box.
• Decision: A diamond shows those points in the process where a yes/no
question is being asked or a decision is required.
• Connector/Break: A circle with either a letter or a number identifies a
break in the process map and is continued elsewhere on the same page or
another page.
• Cloud – represents the “Don’t know”
• Arrow – Process flow direction
Shapes

73. The Big Picture – 30,000 feet
A high level flowchart is a good place to start process
mapping

75. What to look at to write a Specific Aim
• Current process flow map “as is state”
• Cause and Effect analysis (Fishbone)
• Direct observation of the actual work process
• Evidence-based practice

76. Specific Aim Statement Template
We will: Improve, Increase, Decrease (select one)
The: Quality, Number/Amount ,Percentage (select one)
of___________________ (name the process)
By:_____Percent
OR
From________(baseline data, number/amount, percentage)
To_____________
By _______ (Date)

78. Diagram for Improvement Process
Specific
Aim
1
PDSA with
Measurement
PDSA with
Measurement
PDSA with
Measurement
Global AIM
Specific
Aim
2
PDSA with
Measurement
PDSA with
Measurement

79. PDSA Cycles
Plan
Do
Check/
Study
Act

81. PLAN
Collect data on the current
process
Identify all possible causes
Identify potential
improvements
Develop an improvement
theory
Develop an action plan

82. DO
 Implement the improvement
 Collect and document the data
 Document the problems, unexpected
observations, lessons learned, and knowledge
gained

83. STUDY
 Analyze the results:
was an improvement
achieved?
 Document lessons
learned, knowledge
gained, and any
surprising results
that emerged.

84. ACT
Take action:
•Adopt - standardize
•Adapt – change and repeat
•Abandon – start over

85. Once you’ve adopted
• Monitor
(reports, dashboards, quarterly meetings)
• Maintain
(who is the owner, process for looking into measures when they fall below?)
• Check In
(conversations, connections, accountability, transparency, trust)
SUSTAIN

87. Time Learning Session 2 Agenda Lead
3:00 Welcome and Introductions Amanda Schiessl
3:05 Objectives and Agenda
Action Period 1 Milestones
TBC Concepts and QI Overview
Ann Marie Hess
3:15 TBC Presentations (5 min team presentation, 2 min questions)
 Team Structure and Role Activity Assessment: Tri Cities
 Running Effective Team Meetings : Mt Laurel Medical Center
 Best Practice Daily Huddles: NW Michigan Health Services
Team Member
3:40 Key TBC Concept
 Pre Visit Planning (protocols, workflow, roles): Thunder Bay
Team Member
3:50 TBC Presentations (5 min team presentation, 2 min questions)
 Global Aim and Process Map : Health Right 360
 Cycle Time , Fishbone, Global Aim : Lancaster Health Center
Team Member
4: 05 Action Period 2
• Assignments, Syllabus
Kasey Harding
4:10 QI Refresh
 Developing a process map or current state workflow
 Specific Aim (measurable, small)
 Applying PDSA methodology for improvement
Deb Ward
4: 25 Wrap Up Amanda Schiessl

88. Looking Ahead
Session 3
 Advanced Team Based
Care Concepts and QI
Refresh (Data)
 Teams Sharing Their
Work
Action Period 2
Assignments
Level A Best Practices
Team Practice Assessment
Category
Number Teams
Level A
Behavioral Health Integration 8
Enhancing Access 7
Clinic-Community Connections 6
MA Role 4
Medication Management 4
Communication Management 3
Care Management 4
Layperson (CHW, Navigator) 3
Pharmacist 3
Referral Management 2
RN Role 2
Self Management Support 1
Population Management 1

89. Thank You All!
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