These slides are from the Weitzman Institute's 2nd Project ECHO QI Session on May 18, 2016

1. Welcome to Project ECHO Quality Improvement
We will begin momentarily.
Join the
Discussion!
Use #QIECHO on
Twitter
Send questions via
Zoom Q&A or
Chat.

2. Welcome!
Project ECHO Quality Improvement
Presented by the Weitzman Institute, a division of
Community Health Center, Inc.
Session 2: Managing Up – Enhancing Your Relationship
with Leaders
May 18, 2016

3. Faculty
• Presenters
– Daren Anderson, MD, Director, Chief Quality Officer
– Wanda Montalvo, PhD RN, Associate Director
• Panelists
– Patti Feeney, MS, QI Education Manager
– Tierney Giannotti, MPA, QI Data Analyst
– Mark Splaine, MD, MS, Director of Education
– Deb Ward, RN, Senior Quality Improvement Manager
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4. Community Health Center, Inc.
Foundational Pillars
 Clinical Excellence
 Research & Development
 Training the Next Generation
CHC Profile:
 Founding Year - 1972
 200+ delivery sites
 130k patients

5. Project ECHO QI Sessions
May 18, 2016
Managing Up – Enhancing Your Relationship with
Leaders
June 8, 2016
Buy-In – Gaining Support for Your Project
June 29, 2016
Communicating & Advocating Using Data
July 20, 2016
Plan-Do-Study-Act Cycles – Getting the Most from Your Tests of
Change
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To register visit:
http://weitzmaninstitute.org/clinics/qualityimprovement

6. • The Weitzman Institute Online Learning Network is free and
available to anyone interested in the session materials
• We have posted many resources and answered questions
from our session on April 28th on “Developing Your
Professional Presence”
• Recording and slides are available after each session by
clicking on the following link:
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Online Resources
http://moodle.weitzmaninstitute.org/course/view.php?id=16

7. • Functions we will use in this session
– Chat, polling, Q & A
• Live tweet us @CHCProjectECHO and #QIECHO
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Get the Most out of Zoom
Lower right hand corner of
screen

8. • A little bit more about Zoom functions we will
use
– Polling – we will ask you a specific multiple choice
question and you will answer on your screen
– Chat – you can use this function to offer comments
and send messages to us during the session
– Q & A – use this function for questions you would like
us to address
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Get the Most out of Zoom

9. Learning Objectives
• Understand common challenges when working
with leaders on a QI effort
• Review and discuss effective strategies when
communicating with leaders
• Consider approaches to developing yourself as a
leader

10. Managing Up: Five Tips for
Communicating with Leadership

11. The Leadership Perspective
• Leaders are very busy
• Leaders are balancing many competing
priorities
• Leaders are thinking strategically
• Leaders are responsible for financial as well as
clinical outcomes
• Leaders prefer data over anecdote to make
decisions

12. • Key Stakeholder in the dark
• Lost in the details
• Lack of alignment
• Unconvincing Results
Pitfalls when communicating
with leadership

13. Some examples of when working
with leaders didn’t go so well…

14. When communicating with leaders:
1. Be sure that you have evaluated the
impact of your project on various
stakeholders and communicated with
each of them

15. Know Your Stakeholders
• Projects often fail when key stakeholders are:
– unaware, unsupportive, unengaged
• Projects can fail when we don’t properly
anticipate the impact of a change

16. Identify all the key stakeholders
before initiating your project:
• Who will need to be actively involved?
• Who might be impacted?
• Who might be threatened by the changes
brought about by your project?
• Don’t forget IT, HR, Finance!

17. Stakeholder Analysis
Stakeholder Strongly
against
Moderately
against
Neutral Moderately
supportive
Strongly
supportive
Not all stakeholders need to be “strongly supportive” for
successful change

18. Communication Plan
Audience Objectives Message(s) Media &
Methods
Timing &
Frequency
Who/When
Where

19. When communicating with leaders:
2a. Establish a regular communication
process with the senior leaders/sponsor
2b. Know your topic: be able to speak
about it succinctly and clearly

20. Project / Program: Project XYZ Date: 5/5/2016
A. Key Project / Program Metrics
-Enroll xx patients into the program
A. Key Upcoming Event(s) or Milestone(s)
1. Continuation of weekly project touch base meetings
2. Testing of system
3. Staff training
4. Launch!- May 31st
C. Highlight / Lowlights / Risks / Opportunities
Lowlights Highlights
1. The training will likely have to take place on 2
or 3 different days to accommodate all of the
sites. It seems that a single training with all 6
intervention sites is not possible.
1. Teams worked together to devise a strategy that
will eventually eliminate the needs for individual
patient referrals
2. Integration is largely complete and testing has
begun
Risks Opportunities
1. Patient recruitment- how will our patient
population receive this intervention? Will they
engage at all?
2.
1. We will learn a lot about the potential of email to
engage patients. We will see how many have
email addresses shared with the agency as well as
how many are correct.
2.

21. Elevator speech

22. Elevator Speech
(at the Wall)

23. Imagine a chance meeting of a project team member and a
key stakeholder in an empty elevator with 90 seconds to ride
Describe the need for change and the vision of the new state,
as one might respond to the question, “Why are we doing
this project?” by addressing the following elements:
Problem / issue
Benefit
Where we are
What others can do
Team members practice this “speech” so they can convey
a uniform message to others
Communicate Clearly and
Succinctly

24. When communicating with leaders:
3. Be able to
demonstrate how
your project aligns
with core agency
goals and objectives

25. When communicating with leaders:
4. Understand the impact on finance as
well as on staff and patients

26. When communicating with leaders:
5. Use data to make your case
70
75
80
85
90
95
100
Q42012
Q12013
Q22013
Q32013
4Q2013
1Q2014
2Q2014
3Q2014
4Q2014
1Q2015
2Q2015
3Q2015
4Q2015
1Q2016
PercentofPatientsRespondingYES

28. Example: Same Day Access Clinic

29. The Problem:
• Too many patients being diverted to urgent
care due to filled schedules

30. The solution:
• Test an in-house urgent care clinic

31. Strategic alignment:
• The team aligned their project with key
agency goals:
– improve patient satisfaction
– reduce ER utilization

32. The Team Used Data to Demonstrate Results
4 5 4 4 5
2
5 4 5 5 5 5 5 5 4 5
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55
50
38
46
27
69
29
51
41
63
57
49
58
62 62
0
10
20
30
40
50
60
70
80
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Week
Number of Days worked and patients seen by week
Days worked
Patients seen

33. Top Diagnoses
Diagnoses Total
URI 110
Pain 66
Rash 53
Allergic rhinitis 43
Dysuria 37
Diarrhea 29
Asthma 29
Hypertension 9
Depression 5
Diabetes 8
Alcoholism & Other Drug Abuse 5
COPD 2
Tobacco Abuse 2
Well Child Visit 1

34. 6
8
6
88
14
10
12
11
18
9
12
11
15
8
7
8
6
11
7
1111
16
11
16
1515
13
1010
7
4
8
6
15
7
8
15
10
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14
9
15
6
12
1515
18
8
5
12
14
8
14
8
12
7
21
16
10
4
7
10
22
17
13
12
19
13
11
7
0
5
10
15
20
25
Tue,May12
Fri,May15
Wed,May20
Tue,May26
Fri,May29
Wed,June03
Tue,June09
Fri,June12
Mon,June22
Thur,June25
Tue,June30
Mon,Jul6
Thu,Jul9
Tue,Jul14
Fri,Jul17
Wed,Jul22
Mon,Jul27
Thu,Jul30
Tue,Aug4
Fri,Aug7
Wed,Aug19
Mon,Aug24
Fri,Aug28
Wed,Sep2
Completed Sick Visit Provider Appointments May 12-September 4, 2015
Completed Appts
Break Even
Rolling Average
Attention to ROI:

35. Developing as a Leader

36. Survey Results (n=52)
Question Disagree Neutral Agree
I spend a lot of time at work
developing connections with
others
8% 19% 73%
I always seem to instinctively
know the right thing to say or
do to influence others
21% 52% 27%
I have a large network of
colleagues, able to call on for
support to get things done
23% 38% 39%

37. Map it Out
• Set your goals
– Be clear about whom you need to influence
and what you want to accomplish
• Identify benefits and challenges
– Find common ground and anticipate the
challenge, should you tap relationships ?

38. Make it Happen
• Pick the right time and place
• Establish Rapport
– Connect with the person you are attempting to
influence
• Set the Stage
– Describe situation, be factual, watch for
reactions as you share
• Leverage Agreement
– Capitalize on something you agree on, next steps
might as simple as a PDSA CYCLE

39. Developing Political Skill
• Think before you speak
• Practice influence
• Socially astute
• Be sincere, professional integrity and
authenticity are crucial
• Knowledge expert has authority
– Messenger is the persuader and not necessarily
the message
• Network, network, network

40. Let’s Answer Your Questions

41. Bibliography
• Some references that have been helpful
to us….
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42. Additional Resources
Weitzman Institute offers a range of additional
QI training resources and opportunities. If
you’d like to learn more, please contact
QIecho@chc1.com
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Slides and recording of today’s session:
http://moodle.weitzmaninstitute.org/course/view.php?id=16

43. Project ECHO Clinics

44. Reminders
Sign up for our next session in this series:
Buy-In – Gaining Support for Your Project
Wednesday, June 8th from 12-1p.m. EDT
Complete our post-session survey!
Sign up at
http://weitzmaninstitute.org/clinics/qualityimprovement
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