Value Champions TRAINING CURRICULUM © 2016 MacColl Center for Health Care Innovation Supported by the Robert Wood Johnson Foundation, grant # 72546 www.takingactiononoveruse.org / [email protected] Welcome & How to Use this Curriculum What is the Problem? In every health care setting you will find at least some overuse of health care services. These unnecessary or low-value care services are those for which the potential for patient harm is greater than benefit, harm that can be physical, financial, or emotional. Taking action to address these overused services is also a health equity issue because of the greater potential for harm among more vulnerable patients. (See Learning Module 1.) What Changes Are Needed? The Taking Action on Overuse action planning framework provides a roadmap about how to address overused services. (See Learning Module 5.) It provides a set of ‘high leverage changes’ along with a change package with key activities that can be used to address overuse. However, these changes require the use of specific strategies to engage providers, staff, and patients in efforts to reduce an overused service. One promising strategy to engage others in this change effort is that of a clinical value champion. What is a Clinical Value Champion? Clinical champions have long been regarded as key facilitators for successful change efforts in healthcare. Clinicians have the potential to be especially effective in efforts to engage their fellow colleagues in improving value by reducing overuse because of their role as a change agent or opinion leader. These “value champions” can be trusted sources of knowledge about the potential for harm from overuse. They can provide feedback and facilitate conversations, and they can serve as role models for how to relinquish an overused service. But how does one become an effective clinical value champion? What core knowledge and competencies does a clinical value champion need to be effective? p. 2 www.takingactiononoveruse.org / [email protected] The Clinical Value Champion Training Program: Here we present a training program comprising these 10 Learning Modules and the Project Workbook. It is intended to guide future clinical value champions through a learning experience that will prepare them for this role in their organization/setting. These materials were developed by faculty and fellows who participated in a one-year training program for Clinical Value Champions in the Safety Net supported by the Robert Wood Johnson Foundation. They are a product of a formative and summative evaluation of the training experience by all who participated. How to Use These Materials: The Learning Modules are intended to be used in regular meetings of a group of clinicians who will become value champions for their clinical setting. They are sequenced so that one builds on another but could be used individually as a stand-alone learning experience. Each Learning Module is intended to be used in a “seminar” format, one that ‘flips the classroom” so that learners have assigned readings, but then convene as a group for a facilitated discussion of the learnings and their application to their work as a value champion. Who Should Lead the Training Sessions? It is important to note that the facilitator for these meetings is not expected to be an expert in addressing low-value or overused services. They are responsible for convening the group and using basic facilitation skills to guide a discussion using the questions provided about the required readings. Each module has a “Facilitator Guide” for that session, including a suggested agenda for that session. p. 3 www.takingactiononoveruse.org / [email protected] Project Workbook: The accompanying Project Workbook is designed to be used in conjunction with the Learning Modules to guide the value champion through an overuse reduction initiative. Think of the learning modules as the curriculum for a “class” and the Project Workbook as a guide to the “laboratory” experience, guiding learners through the launch and implementation of an overuse reduction initiative. The teachings from each learning module can be applied to multiple aspects of an overuse reduction project and each module points out where that overlap exists. In addition, within the project workbook there are suggestions about which learning modules are relevant for that phase of their overuse reduction project. This workbook is broken into sections based on phases of the work, with tools and journal reflections throughout and in their own sections at the end. While the phases are presented and numbered in a linear fashion, in reality you may need to work on multiple phases at one time or go back to phases previously addressed. The phases of the work are presented in this workbook as follows: Select an Understand Build an Plan for Overuse the Project Improvement Sustainability Topic Landscape Team Write a Obtain Data Test the Project and Select Intervention Charter Measures p. 4 www.takingactiononoveruse.org / [email protected] Learning Modules: Each learning module is organized into sections: Overview: The background and rationale for this module. Learning Objectives: “By the end of the session, learners should be able to…” Readings: Learners are expected to complete these readings, or videos, and come to the session prepared to discuss them. Resources: Some of the small group exercises require the use of additional materials, those are provided here. Discussion Questions: What learners should be prepared to discuss during the session. Project Application: Describes how and where to apply what they learn from this module within their project. Facilitator Guide: Provides a rationale for the topic, a suggested agenda for the one-hour session, probes for discussion questions, and instructions for a small group exercise for the class. What is the Time Commitment? Learners/Students should expect to spend at least one-hour between classes to complete the readings before the class and come prepared to discuss. The time commitment for their project is a bit more difficult to estimate. Most of the RWJF Clinical Value Champion Fellows spent 2-3 hours each week preparing for the launch of their overuse reduction projects and then 2-3 hours each week supporting the activities intended to reduce the use of a service. However, most projects required a minimum of 6 months preparation before launch. p. 5 www.takingactiononoveruse.org / [email protected] Use of these materials: Finally, we encourage the broad and free use of these materials, no permissions are needed. They are covered by a Creative Commons License that only requires you to provide attribution to these original materials if you modify them and forbids anyone from charging or profiting financially from their use. Have Fun! And remember that “Less is often More” when it comes to health care services we provide. Take Care! – Michael Parchman and the RWJF Clinical Value Champions in the Safety Net Team. p. 6 www.takingactiononoveruse.org / [email protected] Table of Contents Module 1: High Value Care and Health Equity 9 Understanding the intersection between “value” and “equity” can inform conversations between value champions, leadership and stakeholders and inform early project planning activities. Module 2: Engaging Leadership for High Value Care 18 This module provides participants with an overview of how to engage leadership throughout the project and provides practical tips on how to create and sustain this engagement. Module 3: So Many to Consider: Choosing an Overused Service 26 Overuse of low-value care is common and selecting a target area of overuse requires careful consideration of multiple factors that will impact subsequent success. Module 4: How to Conduct a Stakeholder Assessment and Why it 36 Is Important As a value champion it is important to identify stakeholders who will be impacted by efforts to reduce the use of a service and approaches to engage them. Module 5: The patient voice: engaging patient participation in 48 your project This module helps participants understand why incorporating the patient voice is important and provides examples of how to do so when addressing an overused service. p. 7 www.takingactiononoveruse.org / [email protected] Module 6: Measurement, data and trust: Supporting change with data 56 This module discusses common challenges and a range of solutions for collecting and reporting overuse data when taking action on overuse. Module 7: Engaging health care professionals: the Taking Action on 64 Overuse Change Package The Taking Action on Overuse framework provides a roadmap for action and is accompanied by a change package with suggested key activities to select from when designing an intervention. Module 8: Strategies Employed by Value Champions 72 This module provides examples of intervention strategies used by other clinical value champions in their setting to engage providers, staff, and patients in changing their behaviors. Module 9: Choice Architecture and Overuse Reduction 80 This module helps participants understand how concepts from the field of behavioral economics can be applied to their overuse reduction initiative. Module 10: Planning for Sustainment An understanding of how value champions they can incorporate plans 88 for sustainment into every aspect of their overuse reduction initiative is provided in this module. This curriculum is also available online through the Kaiser Permanente School of Allied