Anyone who has tried to implement any kind of improvement at their practice knows the challenges of getting those improvements to “stick” over the long term. What if your champion(s) left your practice? Would that improvement still be there, a year from now?
Last month, the Quality Improvement team hosted a webinar with ECC and DCM Collaborative alumni teams focused upon how to sustain important activities to continue to practicing a disease management philosophy. The webinar referenced the Sustaining Improved Outcomes: A Toolkit by Scott Thomas, PhD, and Deborah Zahn, MPH. This toolkit provides an introduction to twelve factors that influence sustainability, in order of importance: perceived value, monitoring and feedback, leadership, staff, shared models, organizational infrastructure, organizational fit, community fit, partners, spread, funding, and government policies.
What sustainability factors did the DCM and ECC Teams focus upon? Here is some of what they shared:
Organizational IT (information technology) Capacity is important when considering how to make changes last. Working with electronic records to build changes into the system can be time consuming and often frustrating, however, once completed, integrating caries risk assessments, self-management goals and smart codes has a lasting impact. Practices like Choptank Community Health System in Maryland emphasized that through the use of templates, they were able to hardwire disease management into their workflow for all providers. Even as new hires were trained on how to use the health record, they were simultaneously trained on how to use the templates.
Leadership buy-in is essential to both the implementation and sustainability of any quality improvement process. Having buy-in from senior leaders, Board of Directors, and practice champions helps create a supportive environment and maintains attention to the disease management work. Eastern Shore Rural Health System in Virginia shared that their Board is truly bought into the idea of improving access and lowering costs, but they understand the process to achieve these goals is not without barriers. The Board supports bringing patients back for more frequent recare appointments, even though these may not be paid by state Medicaid or private dental insurers.
Data is important! Jordan Valley Community Health Center in Missouri shared that frequently looking at data dashboards to see if gains are being held helps staff maintain attention to their disease management work. Data helps convince leadership, new staff or even resistors that the new way of providing care is worth continuing. Perfection with sustainability is not required; vigilance is.
Organizational infrastructure is a large factor in creating a culture of quality improvement and sustaining the changes made by the improvement process. Clinica Family Health Services in Colorado highlighted the importance of continuously training staff, creating robust onboarding processes, and making an effort to hire staff that are open to learning and to trying something new.
Need to focus on sustainability? All teams shared it was easiest to start with one or two sustainability factors, and then build upon their efforts. Continuously thinking about improvement, being persistent, and seeking feedback helped grow a culture of improvement at their practice that addresses and re-assesses their sustainability efforts.