OneCF LLC2TeamAdobe Connect Session

January 25, 20163:30-5:00pm ET

OneCF LLC2

Exacerbations?

Hospitalization

Baby Care

Lung Transplant

Mental Health

ReproductionCFRD Pedi-Adult Transition

Aim: Assess and develop a CF care center that provides seamless care from the time of diagnosis through advanced care. This includes a focus on integrated care, smooth transitions (pediatric to adult), warm handoffs and transfers, and improvement of mesosystem care such as referral to specialists (e.g. Endo, GI, ENT, Psych) and inpatient care.

1. Baseline assessments2. Improvement

fundamentals3. Everyone’s first focus:

Pedi to adult transition4. All teach, all learn

Diagnoses Advanced Care

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OneCF LLC2 Teams, Coaches & LeadersTeam & Coach Leaders

Boston Children’s Hospital/Judy Kate, Leah, Greg, Ahmet

Columbia NYC/LaCrecia Emily ,Claire, Hossein, Shirley

Nationwide Columbus Ohio/Suzanne

John, Terri, Karen, Deanne, Judy

RushChicago Illinois/Staci

Robert, Jenifer, Girish, Kathryn

University of MissouriColumbia/Bob

Jim, Connie, Natalie, Joe

University of North Carolina/Randy

Sheree, Jennifer, Magee, James

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Agenda3:30 Welcome and sign-ons

3:40     Pediatric to Adult Best Practices review and discussion

3:45     Pediatric to Adult Best Practices-Compare and Contrast with Got Transitions and CF R.I.S.E

4:00     Break out rooms Aim: Discuss new improvement focus & DMIC status

Group 1: Boston & U of Missouri (coaches Judy & Bob)Group 2: Columbia & Nationwide (coaches LaCrecia & Suzanne)Group 3: Rush & UNC (coaches Staci & Randy)

4:30      3 minute report outs to larger group (Group 1, 2, 3)

4:40 Improvement isn’t done until it’s published!

4:50 Update on Relational Coordination and Focus Groups at Boston 

Action Items and preparation for February 29th Adobe Connect session

4:55 Final Questions and Adjourn -4-

Develop a CF Center central policy

Involve the Patient and PFAB

Communicate, communicate, communicate!

Introduce topics of transition early (age 8)

CF R.I.S.E rollout and questionnaires

Adult providers meeting with transitioning patients repeatedly

Standardize task sheets (processes) used in clinic

Pedi & Adult

Weekly team meetings

Educational milestones

Ensure full team participation

iPADsReadinessGoal SheetSelf Care

Pedi to Adult Best Practices (Submitted)

Survey and Re-assess processes, policies, practices

Best Practices Summary Tips

• Pediatric to Adult Transition/Transfer diagram helpful• Important to remember to communicate with the CF Clinics and between

pediatrics and adult clinics.– Holding joint pedi/adult meetings are often better than paper

communication• Involving the patient is key

– To create surveys about transition – Survey patients and families throughout the transition process including

transition completion– To create documents that will help support the patient/ family in the

transition process• Introducing topics early to patients and families and having adult

providers meet patients and families repeatedly have shown some early results (verbal feedback)

• Reassess, review and revise improvement work periodically to see how things are working

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Pedi to Adult Transition Models

For Care Team

For Patients

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Current and Future Focus of Improvement (recorded 12/22)

CF Center Current Improvement Future ImprovementBoston Children’s Hospital

Transition Mental health; nutritional guideline for younger kids (inpatient)

Columbia Transition; pediatric milestones

Depression and anxiety screening

Nationwide Transition Mental health; OGTT timeliness

Missouri Transition Clinic efficiency; mental health; newborn screening and education; standardize teaching protocol for newly diagnosed

Rush Transition Depression and anxiety screening

UNC Transition Mental health screening; CFRD screening for pedi and adult

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Break Out DiscussionsAim: Discuss new improvement focus and DMIC progress

Group1: Boston & U of Missouri (coaches Judy & Bob)Group 2: Columbia & Nationwide (coaches LaCrecia &

Suzanne)Group 3: Rush & UNC (coaches Staci & Randy)

The coaches will share the role of facilitator & recorder to report on the group discussion. Each OneCF LLC2 team will have 10 minutes to discuss the new improvement focus if moving beyond transition. Coaches will offer guidance and answer questions. Group will help. Coach will prepare a 3-minute report out of the group themes.

4:00-4:30-10-

3 Minute Progress Reports

Coach to prepare a 3-minute progress report on the new improvement focus

4:30-4:40

Group1: Boston & U of Missouri (Judy & Bob)

Group 2: Columbia & Nationwide U of Missouri (LaCrecia & Suzanne)

Group 3: Rush & UNC (Staci & Randy)

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Improvement isn’t Done until it is Published…

Aim: Improve and increase writing and quality of writing about CF improvement activities•SQUIRE Guidelines http://www.squire-statement.org/•Write regularly•Abstract, poster, manuscript•CF improvement teams, coaches, individuals•Support to write between now and April Boston meeting

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Why is it Important to Write about Quality Improvement Work?• Get credit for what you do• Share new ideas• Network• Increase transparency and accountability• Disseminate proven interventions• Allow others to learn from your mistakes• Avoid duplicating efforts• Build a body of knowledge that advances the field

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Why is it Different to Write about Improvement?• Not like writing about a set research protocol• Often different statistical methods (such as SPC)• Role of context – not “controlled out”• Iterative change – intervention is affected by the

environment and environment affects changes tested• Importance of “field notes”

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SQUIRE

• Publication guidelines for improvement• Provide a helpful roadmap for writing about

improvement• Calls out important and distinctive elements

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The Request• Prepare a poster or abstract (or if you are ambitious a

manuscript draft) to bring to Boston• Celebrate your work• Expert (and kind!) commentary and assistance from

David Stevens

• We will work together over the next months to achieve this

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Sharing Your Work

• Important to share your results others• Important to share your learning with others – how

did you get those results and what you learned• Can help you understand what you did/what

happened

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Prepare for February 29th Adobe Connect• Review the Squire Website• Decide what you want to write about• Consider the Introduction:

– Problem– Available Knowledge– Rationale– Specific Aim

• Post something (a beautifully written intro, a few sentences to get started….) in advance of our next session.

• Email to maria.scopelliti@gmail.com by February 26 5pm ET to be reviewed

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Thanks!

Update on Relational Coordination and Focus Groups

• Prepare for the 2nd round of Relational Coordination Surveys:– Early February: coordinator to confirm team

participants– Mid February: leaders to campaign for participation;

survey sent out– End of February: survey responses due– March: reports compiles; results circulated to leaders

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Action Items and Preparation

• Task book will be posted Friday January 29th and will cover the action period up to the Boston April meeting.

• Work through the task book at a pace that works for you. We will be asking for updates each month to hear about your progress and for you to share lessons learned. Measurement and Writing tasks will be due February 26th 5pm ET.

• Continue working on your improvement measurement tracking and displays-Brant will discuss dashboards, driver diagrams and registries in February

• Complete the following readings by February 26th 5pm ET:– The Problem with Plan-Do-Study-Act cycles (Reed, Card)– How Measurement Fails Doctors and Teachers (Wachter)

• Consider WRITING! Tina will provide feedback in February• Keep working on the Dartmouth Microsystem Improvement Ramp…please post

PDSA cycles, measurement and “Playbooks” if you have reached that step. Use the DMIC template.

• Follow and modify your team Gantt chart of improvement work• We will want to hear how the Obeya room is working to bring Pedi and Adult CF

clinics together as OneCF!• Be prepared to share stories about using effective communication

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Next Adobe Connect Session: February 29, 2016 at 3:30pm ET

Links available on Canvas

Benchmarking Site Visit

Save the Dates! April 6 – 8, 2016Wednesday, April 612:00pm – 2:30pm ET Working Lunch CF Fundamentals LLC overlap

with OneCF LLC23:00pm - 5:00pm ET OneCF LLC2 Relational Coordination Results6:30pm - 9pm ET Dinner Program

Thursday, April 78:00am – 3pm Site Visits and Concurrent Learning Sessions3:30pm – 5:00pm Focus Groups: Leaders and team members6:30pm - 9pm ET Dinner Program

Friday, April 87am – 8:30am Focus Group: OneCF LLC2 Quality Coaches8:30am – 1pm OneCF LLC2 Learning Session

Boston, Massachusetts - Boston Children’s Hospital

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Boston Benchmarking Site VisitApril 6-8, 2016 in Boston, Massachusetts

23 people registered

5 of 6 teams have participants registered!

2 special events during the evenings…

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Special Evening Events

• Wednesday, April 6, 2016 – 5:45pm– Fenway Tour and Dinner

• Tour starts at 6pm ET, dinner to follow• Tour costs $20 per person

• Thursday, April 7, 2016 – 5:45pm ET– Duck Tour and Dinner

• Tour starts at 6pm ET, dinner at Legal Seafood to follow

• Tour costs $29 per person-26-

Benchmarking Site Visit

Links to complete for the Benchmarking Site Visit

Register for the event:https://www.surveymonkey.com/r/CT6D36Q

Make your hotel reservation:https://gc.synxis.com/rez.aspx?Hotel=58219&Chain=56&arrive=4/3/2016&depart=4/8/2-16&adult=1&child=0&group=DART2016

Special evening events (approximately $80 per guest):

• 4/6 Dinner at Fenway Park • 4/7 Duck Tour with Dinner at Legal Seafood

Boston, Massachusetts - Boston Children’s Hospital

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www.clinicalmicrosystem.org

Thank you for your continued dedication and hard work to improve care for people with CF