Closing the Referral Loop Conference Call July 11, Sustaining and Spreading the Referral Process Connie Sixta, PhD

Transcription

1 Closing the Referral Loop Conference Call July 11, 2014 Sustaining and Spreading the Referral Process Connie Sixta, PhD

2 Objectives Discuss centralized process for managing surveys related to patient satisfaction. Review aggregate data for past three months. Discuss the need for increased referral volume. Describe strategies used by leaders to sustain and spread changes with the practice. Describe next step as an individual dyad conference call to develop a strategic spread plan.

3 Problem: Low rate of patient satisfaction questionnaires Potential Solution: centralized questionnaire completion and tallying

4 Aggregate Data for April, May and June

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15 Average number of referrals per dyad = 5/mo.

16 We need to spread the referral process through the dyad. Low number of referrals identified as the largest challenge experienced by dyads (5) -- No Shows (another challenge) contributes to low referral rate In terms of QI, low referral numbers: Can be managed by a person do not require a sustainable process or system QI Work conflicts with the reality of the high volume PCP and/or Specialty practices.

17 So let s talk about spread..

18 Definitions Related to Change Testing: Trying and adapting existing knowledge on small scale. Learning what works in your system. Change is not permanent Failure very useful here, even expected Few people impacted than during implementation Implementing: Making this change a part of the routine day-to-day operation of the system in your pilot population Don t expect failure here More people impacted than during testing Increased resistance compared to testing Generally requires more time than testing Spread: adapting change to areas or populations other than your pilot populations

19 Creating an Improved Clinical System Improvement Hold Gains Spread BETTER Improvement Hold Gains Spread API Lloyd Provost

20 Some Theory on Spread Everett Rogers: Adopter categories; Attributes of an innovation; Different aspects of communication John Seely Brown: Content, context, community Malcolm Gladwell: Tipping point; Stickiness factor; Law of the few; Power of context Nancy Dixon: Explicit and tacit knowledge James Prochaska: Stages of Change Model Albert Bandura: Preconditions for change; Motivation; Modeling and guided enactment

21 The Tipping Point The name given to that one dramatic moment in an epidemic when everything can change all at once. - M. Gladwell The part of the diffusion curve from about 10 percent to 20 percent adoption is the heart of the diffusion process. After that point, it is often impossible to stop the further diffusion of a new idea, even if one wished to do so. - E. Rogers

22 Approaches to Spreading Change Natural Diffusion Breakthrough Series Collaborative Executive mandate or infrastructure changes Extension agents (field consultants) Marketing programs Campaigns Wave Sequence (roll-out) Emergency Mobilization Hybrid Models

23 The Science of Spread Key Reference: Diffusion of Innovations, Everett Rogers (1962, 1971, 1983, 1995, 2004) Diffusion: the process by which an innovation is communicated through certain channels over time, among the members of a social system Diffusion includes both spontaneous and planned spread Innovation: an idea, practice, or object that is perceived as new by an individual or other unit of adoption

24 Adopter Categories Innovators Early Adopters Early Majority Late Majority Laggards 2.5% 13.5% 34% 34% 16% from Rogers, 1995

25 Percent of clinics implementing CCM The Diffusion Curve Spread of Chronic Care Model Across Clinics Total of 80 Clinics in Organization Sep- 98 Oct Nov Dec Jan- 99 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan- 00 Feb

26 Are You Ready to Spread the Referral Process Within Your Practice? Spread of the referral process is necessary to create system sustainability and benefits. There has been a clear intent to spread referral improvement throughout the practice. Improved management of referrals is a key initiative for the practice. Leaders from the practice (MD and Manager) are positioned to lead and coordinate the spread of the referral process. Your dyad has implemented changes and is improving outcomes.

27 Spread of the Referral Process A S P D PCP Population Needing a Referral A S P D A S P D Patients Referred by Dyad PCP to Dyad Cardiologist (Population of Focus) A S P D A S P D S A Smallscale tests of change PCP Practice Patients Referred to Cardiology P D Total PCP Patient Panel Total Panel of Patients in the Cardiology Practice

28 What role is leadership playing in the support of spread?

29 Kotter s Change Model Key Principles Every step is necessary The process is dynamic Several of the steps can happen simultaneously and continuously Change is an iterative process

30 Kotter s Eight-step Change Model Act with urgency Develop a guiding coalition Develop a vision Sell the vision Empower broad-based action Generate short term wins Don t let up Make it stick

31 Kotter: three major phases in system transformation Creating the climate for change Engaging and enabling the whole organization Implementing and sustaining the change

32 Kotter s Model 1. Act with urgency Examine market and competitive realities Identify and discuss crises, potential crises or major opportunities

33 Act With Urgency or. Create a Desire for Change Use data or feelings to get the attention of the practice Often a negative story or negative data Elicit the desire for a different future A positive story Reinforce with reasons (who, what, when, how and why) Improve coordination of care Improve efficiency and effectiveness Improve satisfaction Meet MU Core Measure 15 Opportunity to lead the process nationally

34 Kotter s Model 2. Develop the Guiding Coalition Assemble a group with enough power to lead the change effort Encourage the group to work as a team

35 Kotter s Model 3. Develop a Change Vision Create a vision to help direct the change (spread) effort Develop strategies for achieving that vision

36 Kotter s Model 4. Sell the Vision Communicate the vision and get buyin Use every vehicle possible to communicate the new vision and strategies Teach new behaviors through Pilot example

37 Great leaders are great communicators Create a learning environment Take on the nay sayers Avoid useless meetings Need to leave with clear action steps Ensure action steps are completed

38 Kotter s Model 5: Empower Broad-based Action Bust barriers that hinder people who are trying to make the vision work Remove or alter systems or structures undermining the vision Identify and redesign processes that are ineffective Encourage risk taking and nontraditional ideas, activities, and actions Align new programs, designs and processes to the vision

39 Kotter s Model 6. Generate Short-term Wins Achieving visible, timely, and meaningful performance improvement to demonstrate that progress is occurring Keep it simple. Break the change into manageable units and pick the low hanging fruit first Distinguish between the urgent and the important. Important issues must be addressed Recognize and reward employees contributing to those improvements

40 Kotter s Model 7. Don't Let Up.. Leadership must Stay united while modeling change. Provide support, direction and structure with accountability. Delegate tasks to staff best able to do the task. Establish an improvement team who understand the referral processes, problems, and changes needed. Remember to talk with people and listen to your referral experts

41 Kotter s Model 8. Make It Stick Recognize, reward, and model the new behavior in order to embed it in the fabric of the organization and make the change the way we do business here Articulate the connections between the new behaviors and practice success

42 Questions that guide spread plan development Why does this work need to be done (what are the referral process gaps in care)? Who in your practice will help you spread the referral processes? What will the new referral process look like? What are the benefits related to improving referral processes? What data will indicate short term progress? What barriers require leadership action? What actions are needed to sustain referral improvements?

43 Next Steps We will be setting up individual conference call with each dyad to discuss: Spread strategy for PCP office Spread strategy for Specialty office

44 Questions??