As any prepared traveler knows, a roadmap is a key element of a successful journey. Even though we are sure to come across unexpected obstacles and adventures, one must prepare properly and establish some guiding milestones for reference along the way.
As a partner in CMS’ Transforming Clinical Practice initiative (or as we call it, Practice Transformation Initiative or PTI), CCI is supporting participating organizations in building an “improvement infrastructure” and developing a Practice Coach program. We have created this roadmap as a guide for coaches or improvement advisors as they engage with practices to transform care delivery. Regardless of whether you are building a program or providing ad hoc improvement support to one of your practices, this tool provides important steps that will contribute to your success. We also hope that this map will help those being coached better understand how their coaches think and plan.
Roadmap to Guiding Improvement
Prerequisite Steps: Before engaging with a practice, you want to make sure you have the right people in place (with QI experience), the support of your senior leadership, clarity on “what you are trying to accomplish,” and alignment with your organizational strategy and vision.
“Warm” Introduction to Practices: This step is particularly important when you are embarking on this journey with a practice you don’t know well. Be sure to leverage existing relationships (perhaps one of your leaders has a connection with one of the clinicians), identify key partners and potential champions in the practice, and anticipate their questions before setting up an initial meeting.
Kickoff Meeting / Launch: You always want to engage a practice in a discussion about what matters to them, and involve them in setting goals that will not only align with higher level organizational aims, but that are meaningful to them. Getting them onboard with a “kickoff meeting” gives you a chance to get to know one another, look at data that you already have, and establish a direction that those who deliver the care can really get behind.
Opportunities Assessment: While you might already have some data going into this project (likely the impetus for the work in the first place), your team has an important task to better understand what is driving current performance. Conduct a brainstorming session, leverage the expertise of the team (what do THEY think is happening?), get the “hunches” out on the table! And talk to patients… ask questions with curiosity and an open mind and you will strike a gold mine of valuable information!
ID Changes: Once you have a better understanding of what is contributing to your current state, it’s time to test out some changes! Again, leverage team members from the practice – as well as patients! – to brainstorm some ideas that might make a difference.
Test: Keep the changes small – test them out on one patient or for one shift, then get feedback… What went well? What could you tweak for the next round of testing? Be agile and adapt promising changes, adopt those that work, and don’t be afraid to abandon those changes that didn’t measure up.
While these steps are sequential to start, you’ll find that they become cyclical. When you have adopted a new change or addressed one problem, you might be ready to go back to your “opportunities assessment” to determine what to tackle next. Or, when you have gotten one practice up and running, speaking the “language” of improvement, you might go back to the beginning and engage with a new practice!
Be flexible, be sure to plan ahead, ask lots of questions, and have fun! You are making an important difference in your practices, with significant results for patients! If you’d like to continue this conversation, feel free to contact me at [email protected]
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