Welcome to this Quality Improvement for Institutions Learning Center lesson titled Engaging the Clinical Team to Develop a Quality-Centered Program. This lesson is number three of a five-lesson series authored by NCDR participant expert Sheila Nichols, who is a Clinician System Analyst, HBTI, and Strategic Operations Administrator at the Cleveland Clinic. Sheila will be sharing her expertise from an academic system perspective, NCDR participant expert Andrea Price, who is from Indiana University Health System. Andrea will be sharing her expertise from a community hospital perspective, and Michelle Hare, MSRN LSSGB. Lesson number three focuses on how to establish a core quality team within your organization. Now you are ready to assemble the quality core team for an initial meeting. The core team will consist of five to eight individuals that will help guide the direction of the work. Let's begin by discussing the reason for the meeting, the roles they will assume as the core team, and the goals that leadership approved. Next, discuss and create the overarching program mission, goals, and objectives. If you like a more formal process, develop a program charter. Determine additional membership. Do you have all the right people at the table or do more need to participate in the core group? Determine frequency and time of the meeting. Is monthly, every other month, or quarterly meetings needed? Is there already an existing meeting the QI meeting could replace every other month while bringing in the additional members? Determine topics and content of these meetings. In other words, build an organizational framework for the meeting. Start with the why these objectives tactics were selected as being important to the organization. Remember, individuals on the teams may relate to different whys than others. Answer your team members questions. What's in it for me through education? Review the current data reporting structure. Let the data support your narrative by using comparisons and benchmarks behind the approved recommendations. Few people are happy being in the 50th percentile for any metric. Determine communication channels, both electronically and during the meeting. Who will speak to the data? Who will manage meetings logistics like meeting invites, drafting, and approved meeting minutes? You may need to develop incentives or motivators for participation. Think about both internal and external ways to recognize team members in the important work. For example, submit an abstract proposal at the next ACC Quality Summit could be a goal of your improvement work. Discuss data impacts. Challenge your core team to think globally about the impact of the improvement efforts you are selecting. Monitoring evidence-based patient care, patient and facility reimbursement, evidence-based metrics or pay for performance, reputation scores, public reporting. Once this team has had its initial meeting and the key components or the team objectives have been developed, it is time to review the initial gap analysis. This can be accomplished by working with the core team to review approved recommendations, prior gap analysis findings, add to them and then finish the last two steps of the process. The goal of this exercise is to identify the areas of opportunity that correlate with leadership's high-level recommendations. Identify the key team members and processes involved, and lastly, determine timing or prioritize initiatives. As a core team, you are likely to identify many things that need to begin or be refined. It can't all be done at once. Prioritize the project and set high-level timing goals. The goal of this exercise is not to fix the problem, but to identify all the improvement activities that need to occur in order to meet your programmatic goals. There are tools that can help facilitate this process. You can finish the last two steps in the process by simply discussing and capturing the conversation, or you can use a more formal approach. There are tools available to help keep the conversation on track. A SWOT analysis is a strategic planning technique used to help a person or organization identify strengths, weaknesses, opportunities, and threats related to the program planning. A fishbone diagram is especially valuable when examining your current situation. These six categories are commonly used in any category that makes sense for the central problem or effect you're examining. And they are Measurements, Materials, People, Machines, Methods, Environment. Detailed information on how to use these tools can be found online. The goal of this exercise is to identify the areas of opportunity, key teams or processes involved, determine priority, and assure your analysis is comprehensive. The goal of these tools is not to fix the problem. Andrea Price shares best practice from a community hospital in the Indiana University Health System. In the next best practice review, I will review the launch of a TAVR program. Launching a TAVR program takes a lot of effort. This is especially true for low-volume centers, which are often the case for community hospitals. The core triad of cardiology, cardiovascular surgery, and cardiovascular operations included the TBT Registrator Coordinator as part of the care team. Collectively, they work to identify operational throughput and competencies, which supporting best practice and registry data capture needs. The TAVR program core team finished the gap analysis by undergoing a SWOT. In this process, they identified one weakness as lack of understanding the comprehensive TBT registry requirements. They also identified dedicated RSM and program coordinators as strengths that could help address the weakness. In order to determine what were the barriers to and potential opportunities for improvement, the core team worked with these individuals to understand the current state and obtain knowledge on how to achieve the future state. Leading up to the months prior to the first procedure, the team sought to fully understand the TBT registry requirements, including KCCQ and 5-meter walk test, to ensure they were creating workflows that supported the accurate data collection of these items. There was bidirectional communication with the core clinical team to ensure the entire team was aware of the documentation requirements needed to support a successful and sustainable program. For six weeks following the initial procedure, weekly feedback was provided from the TBT registry coordinator to ensure documentation and patient outcomes were transparently shared in the early weeks of the program. After the initial six weeks, the team was provided performance updates on a monthly basis. Sheila Nichols shares her experience as a clinical system analyst, HVTI, and strategic operations administrator at the Cleveland Clinic. Develop your core team based on the results of the gap analysis. I will use the door-to-balloon example again. After you have worked with leadership to gain program alignment, you will need to build your core team. This will most likely consist of active and inactive members. You will need support of this core team to provide direction or guidance on operational strategy, outreach, education, and feedback with all partners, including the emergency department and EMS. This team owns the strategic direction and results of the program. After further program evaluation and process improvement opportunities are identified, this team will provide guidance on how to identify persons to help with each of the improvement initiatives. This may or may not actually participate in the events. In my academic hospital system, the CV section head will either function as the physician champion or assign another physician in the department to fulfill that function of the core team. The physician champion was a key person in helping analyze the door-to-balloon data to identify the specific areas that needed target for improvement. He was responsible for reviewing all the NCDR registry data on a periodic basis to further provide insight on next steps and initiative direction. Other active members of the team were boots-on-the-ground personnel such as mid-level providers, nurses, and technicians working in collaboration with the quality and registry team. This concludes Lesson 3, Engaging the Clinical Team to Develop a Quality-Centered Program, Establishing a Core Quality Team. Thank you for your participation.

Engaging the Clinical Team

Quality-Centered Program

Core Quality Team

Meeting Roles and Goals

Data Reporting