Integrating Best Practices Into Collaborative Learning Methods for Health Care Home Providers
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Integrating best practices into collaborative learning methods for Health Care Home providers A summary of findings and recommendations for the Minnesota Departments of Health and Human Services SEPTEMBER 2009 Integrating best practices into collaborative learning methods for Health Care Home providers A summary of findings and recommendations for the Minnesota Departments of Health and Human Services September 2009 Prepared by: Jane Taylor and Susanne Salem-Schatz Michelle Decker Gerrard, Consultants on Quality Improvement Rachel Hardeman, Jill Jim Wilder Research 451 Lexington Parkway North Saint Paul, Minnesota 55104 651-280-2700 www.wilderresearch.org Contents Summary ............................................................................................................................. 1 Introduction ......................................................................................................................... 9 Background: Health Care Home in Minnesota .............................................................. 9 Purpose of this report .................................................................................................... 11 Methods......................................................................................................................... 12 Findings from literature .................................................................................................... 14 Practice wisdom: themes from the literature about Learning Collaboratives ............... 14 Limitations identified in the literature about the success of collaborative learning in health care ..................................................................................................................... 18 Successful aspects of adult learning models ................................................................. 21 Findings from key informant interviews........................................................................... 23 Engaging participants and stakeholders ........................................................................ 24 Selecting a learning method .......................................................................................... 26 Other planning and logistical considerations ................................................................ 31 Evaluating progress ....................................................................................................... 32 Experiences with collaborative learning models in industry ........................................ 34 Critical components of adult learning ........................................................................... 35 Recommendations ............................................................................................................. 36 Hold fast to the principles and values of Health Care Homes ...................................... 36 Engaging participants and stakeholders ........................................................................ 37 Selecting a learning method .......................................................................................... 39 Other planning and logistical considerations ................................................................ 43 Evaluating progress ....................................................................................................... 44 Key mistakes made or lessons learned from others implementing collaborative learning ......................................................................................................................... 45 Study limitations ........................................................................................................... 46 Next steps ...................................................................................................................... 47 Integrating best practices in using Wilder Research, September 2009 collaborative learning Contents (continued) Appendix ........................................................................................................................... 49 Citations ........................................................................................................................ 51 List of key informants ................................................................................................... 54 Summary of web survey of key informants .................................................................. 56 Considerations if working with contracted partners ..................................................... 60 Literature scanned for this study ................................................................................... 61 Companion report: Potential methods for evaluating a Collaborative Learning Model designed to support the implementation of Health Care Homes in Minnesota ...................................................................................................................... 66 Integrating best practices in using Wilder Research, September 2009 collaborative learning Acknowledgments The authors would like to thank Marie Maes-Voreis and Carolyn Allshouse from the Minnesota Department of Health for their project oversight and review of report materials. Wilder Research staff contributors include: Marilyn Conrad Louann Graham Heather Johnson Greg Owen Kerry Walsh Finally, we would like to thank the 35 experts who shared their experiences and lessons learned by participating as key informants for this study. Without them and the knowledge gained from feedback from primary care providers, care coordinators, nurses, office staff, and patient and family partners – this study would not have been possible. Integrating best practices in using Wilder Research, September 2009 collaborative learning Summary In May 2009, the Minnesota Departments of Health and Human Services contracted with Wilder Research and two expert consultants in the field of quality improvement in health care settings to conduct a review of collaborative learning methods that incorporate quality improvement approaches that could be implemented statewide for initial ongoing clinical certification as a Health Care Home provider. These researchers reviewed literature and interviewed 33 nationally recognized experts on Health Care Home implementation and collaborative learning in others settings in order to develop recommendations related to best practices related to collaborative learning of Health Care Home concepts. Findings from review of literature It is commonly reflected that quality improvement collaboratives are, by their nature, complex and applied in many different ways. Although there is limited evidence about which elements contribute most to effective learning and implementation, a set of themes from the literature emerges that offer practice wisdom: a set of perspectives and components for designing a successful Learning Collaborative model. Value of preliminary work. Many authors suggest that planners and facilitators take the following details into consideration: team-forming and team-building, data collection, performing audit work, analyzing the organization’s infrastructure, developing baseline data, and planning future meetings. Shared and common purpose. The objectives should be clear, and there must be consistency among the aims. Use of data and technology. Learning Collaborative teams improve their information technology skills in order to support data collection during implementation and to improve efficiency in generating data reports necessary for a successful Learning Collaborative. Sponsorship considerations. Both Learning Collaboratives and sponsors assess priorities and establish harmony among one another. Development of appropriate team composition and collaborative staffing. A successful team is one that is interdisciplinary or multidisciplinary. Three essential roles of a Learning Collaborative include a clinician leader, data analyst, and project manager. Integrating best practices in using 1 Wilder Research, September 2009 collaborative learning Fostering relationships and team motivation. Social relationships established at the beginning of a collaborative can foster accountability, satisfaction with work, team unity, peer support within the collaborative, and opportunities to learn from others doing the same work. Collaborative meetings. To meet varied learning preferences, authors recommend meeting formats and activities that include facilitated discussions, sharing information, and problem solving. Use of quality improvement theory and evidence based practices. It is important for teams to both apply innovative quality improvement methods and incorporate evidence-based practices to improve care. Maximize strong leadership support. Learning Collaboratives need strong leadership – at the system’s level, clinical level, and team level – to support their missions, act on organizational and cultural changes, and make resources available. Plan for sustainability and purposeful spread. Steps for successful quality improvement spread include preparation and defining of purpose, collaborative learning meetings, and post-collaborative transition. Reliable measurements. Previous Learning Collaboratives recommend including realistic and time specific targets, measures that track progress toward achieving goals, and measures that give feedback to teams and clinical administration. Elevation of organizational culture. Teams need assistance in implementing changes that impact organizational culture. Varying approaches