SPREADING AND
SUSTAINING STRATEGIES
FOR SENIOR LEADERS AND
TEAM MEMBERS
St. Anthony Amofah, MD, MBA
Medical Director,
Helen B. Bentley Family Health Center, Inc
Miami, Florida
WHY ARE WE HERE TODAY?
• Knowledge of burden of chronic diseases
• Desire to help to reduce health disparities
• Appreciation of value of Collaborative
Models
• BPHC Expectation
• Desire to share selflessly and steal
shamelessly on strategies to spread and
sustain gains
GOAL: TO ENGAGE GROUP IN A DISCUSSION AT
THE END OF WHICH EACH OF US WILL BE ABLE TO
TAKE SOMETHING BACK TO OUR CENTERS ON
HELPFUL STRATEGIES FOR SPREADING AND
SUSTAINING CHANGES.
OUTLINE
• Definition of Spread/Sustain
• Preparing for Spread
• Spreading
• Sustaining gains
• Take home messages
• Discussion (What else can
• we learn from each other?)
“SPREAD?”
Learning from changes that have resulted in
improvement in one area (provider panel,
site, disease, etc) and then implementing
them in other areas.
“SUSTAIN?”
• Holding gains
• Maintaining improvements
• “Cementing” positive changes into system of
care
PROCESS OF SPREADING
PREPARING FOR SPREAD
SPREADING
SUSTAINING
CHANGES
PREPARING FOR SPREAD
(Minimum Necessary Requirements)
(1) SELECT SPREAD TEAM
• Importance
• An effective team
– Serves as the coach, coordinator, etc
– Keeps plans moving forward
– Keeps everyone focused
– Serves as a reminder when
people get distracted
PREPARING FOR SPREAD
(Minimum Necessary Requirements)
(1) SELECT SPREAD TEAM
• Membership
–
–
–
–
Provider from Pilot Team
Senior Leader
Team Leader/Member of Pilot Team
New Members: New Provider, New Support
Staff, Office Manager
• Desirable New Member characteristics
– Enthusiastic, Open to new ideas, People skills,
Willing to work extra hours
PREPARING FOR SPREAD
(Minimum Necessary Requirements)
(2) PERFORM READINESS ASSESSMENT
– Should be done by New Team
– Must include Executive Director
– Assign primary responsibility for areas needing
work
Importance
Potential barriers to success are addressed
Process helps team to “bond”
READINESS ASSESSMENT ALGORITHM
Did Pilot Team
Succeed?
Measures of success
Outcomes measures
Process
Structure
Importance of pilot team success
Motivating to team, senior leader, other
staff
Lends credibility to changes made
Most likely reasons for failure
Lack of visible management support
Lack of effective team leadership
Team not empowered
READINESS ASSESSMENT ALGORITHM
Did Pilot Team
Succeed?
yes
Is Improvement in
Chronic Disease
Care in Strategic
Plan?
SOLUTIONS
no
Management must assume ownership
Go back to “drawing board’ and start
Over (You are not ready for spread).
READINESS ASSESSMENT ALGORITHM
For this to be a useful step in improving chronic disease care
-Center must have an effective strategic plan
-Improving chronic disease care must be included in it.
What is an “Effective” Strategic Plan
Is Improvement in
(A living, breathing strategic plan)
Chronic Disease
-Reflects Board/Management’s vision
Care in Strategic
-Is shared regularly with middle management
Plan?
-Is translated into a departmental work plan with line
staff involvement
-Is evaluated periodically
READINESS ASSESSMENT ALGORITHM
SOLUTIONS
Did Pilot Team
Succeed?
no
Management must assume ownership
Go back to “drawing board’ and start
over (You are not ready for spread).
yes
Is Improvement in
Chronic Disease no
Care in Strategic
Plan?
yes
Are measures
Included in PI
Plan?
yes
Develop effective Strategic Plan
Formal written proposal to Board/Mmt
-Emphasize importance
-Summarize goals/measures
Formal proposal to PI Committee
-Summarize importance
no -Give details of goals/objectives, evaluation
method
Include in PI calendar of activities
Standing agenda item
READINESS ASSESSMENT ALGORITHM
Can staff maintain
Registry?
Reasons for inability to maintain Registry
-No assigned primary responsibility for data entry
-No accommodating delivery system design
READINESS ASSESSMENT ALGORITHM
Can staff
maintain
Registry?
no Assign primary responsibility (?Admin. Clerk)
Define accommodating delivery system design
Recruit data entry clerk
yes
Is someone in
Leadership
Responsible for
Spread?
yes
You are ready
to spread
no
Assign responsibility
-Person must attend/have attended a
Learning session.
PREPARING FOR SPREAD
(Minimum Necessary Requirements)
(3) DEVELOP A WRITTEN PLAN
• Importance
– Serves as a roadmap
• Must include
– Defined aim statement/key measures/action steps
– Resources (Staffing, Equipment/Supplies, Funding)
– Discussion of potential barriers
– Support system
– Communication plan
– Responsible person for each objective and timelines.
– (Consider plan for each model component)
PREPARING FOR SPREAD
(4) INTENSIVE EDUCATION PROCESS
• WHO?
– Educate new team members, target staff,
support staff, and then entire staff
• WHAT?
– Provide education on: What changes are being
made, why the changes are being made and how
the changes will affect them
• HOW?
– Review new Delivery System Design and how it
differs from old.
– Role Play
– Then Review Model Components
PREPARING FOR SPREAD
(Minimum Necessary Requirements)
SUMMARY
(1) SELECT A SPREAD TEAM
(2) PERFORM READINESS ASSESSMENT
(3) DEVELOP A WRITTEN PLAN
(4) INTENSIVE EDUCATION PROCESS
SPREAD
• Commence changes
– Target staff must huddle to clarify roles and
patient flow on day of spread
– Senior Leader/Management should be visible,
troubleshoot and exude support on day 1
– End of day session to review issues and prepare
for day 2
• Identify overlapping functions and
integrate
• Monitor adherence to written spread plan
• Use feedback (PDSAs) to fine tune process
SUSTAINING CHANGES
4 CRITICAL FACTORS FOR SENIOR
LEADERS AND TEAM MEMBERS
–
–
–
–
(1) AN EMPOWERED, ENTHUSIASTIC TEAM
(2) A DYNAMIC KNOWLEDGE BASE
(3) STAFF BUY-IN
(4) VISIBLE MANAGEMENT SUPPORT
• HOW CAN AN ORGANIZATION EFFECTIVELY
ACHIEVE THESE CRITICAL FACTORS
SUSTAINING CHANGES
(1) EMPOWERED TEAM
WHAT CAN AN EMPOWERED TEAM DO TO HELP
TO SUSTAIN CHANGES?
– Monitor written plan (provide feedback to
stakeholders)
– Keep changes in front of all
– Facilitate on-going education process
– Exude and infect others with enthusiasm
– Share success stories (at staff meetings, on
storyboards, in memos)
SUSTAINING CHANGES
(1) EMPOWERED TEAM
HOW CAN A CENTER DEVELOP AN EMPOWERED
TEAM?
– Support by management
– Decision-making capability
– Allowed room for errors
– Mandated meeting time
SUSTAINING CHANGES
(2)DYNAMIC KNOWLEDGE BASE
ON WHAT?
– Overall purpose of Collaboratives
– Models utilized
– How implementation of the models helps to achieve
goals
– Changes made in organization as a result of
application of models
– Supporting policies and procedures
SUSTAINING CHANGES
(2)DYNAMIC KNOWLEDGE BASE
HOW CAN A CENTER MAINTAIN SUCH A KNOWLEDGE
BASE?
– Quarterly General Staff In-service
– On-going Provider education by local specialists, etc
– Develop Clinical Pearls (Post in exam rooms)
– Pop Quizzes
– Story board posters
– Role play
– E mails
– Newsletters, Peer-to peer, Shadowing, etc.
(Consider Calendar of Educational Activities to improve
chronic disease care)
(3) STAFF BUY-IN
• A major challenge
• Importance
– Responsible for implementing most changes
made..
– Necessary for sustaining this change
– Necessary for initiating and sustaining other
changes (re management credibility).
• 3 staff groups to address
– Providers
– Clinical Support Staff
– Non-clinical Support Staff
• CLINICAL SUPPORT STAFF BUY-IN
– Typical problems
• Work Overload
• Apathy
– Helpful Solutions
• Educate
• Embed in daily routine
• Feedback
• PROVIDER BUY-IN
– Typical problems
• Work overload
• Perception of value of changes made
• Knowledge base
– Helpful Solutions
• Increase knowledge base
• Optimize workload
• Feedback
• Compensation Plan
• Senior Management Support
SUSTAINING CHANGES
(4) VISIBLE MANAGEMENT SUPPORT
– Standing agenda item in meetings
• (Management, Board, PI meetings)
–
–
–
–
Policies and Procedures
Inclusion of roles in Job Descriptions
Staff Compensation Plan
Removal of barriers (staff resistance,
equipment/supply needs, etc).
SUMMARY OF DISCUSSION
• Why Spread and Sustain Changes?
• Preparing for Spread
–
–
–
–
Select a Spread Team
Assess Readiness
Create a plan
Educate
• Spreading
– Monitor adherence to plan
– Remember PDSAs
• Sustaining changes
– Enthusiastic team
– Knowledge base
– Management support
TAKE HOME MESSAGES
HOW CAN TEAM MEMBERS ENGAGE
SENIOR LEADERS TO MAINTAIN
SUPPORT
– Keep them informed
– Involve in discussions, recommendations and
decision-making
– Give them assignments
– Infect enthusiasm
– Celebrate success together (Share success
stories)
– Share patient feedback
TAKE HOME MESSAGES
WHAT CAN YOU DO AS A SENIOR
LEADER TO SUSTAIN SPREAD?
– Demonstrate your support
– Demonstrate your support some more!
– Do not stop Demonstrating your support
GENERAL DISCUSSION
• WHAT ELSE CAN WE LEARN FROM
EACH OTHER?