The Great Lakes Practice Transformation Network (GLPTN) is a part of the Transforming Clinical Practices Initiative (TCPI), a 4-year, nationwide, federally-funded effort by Centers for Medicare and Medicaid Services (CMS).  GLPTN’s goal is to help doctors, nurses, pharmacists, and others advance their practices, lower healthcare costs, and improve the health of patients in Michigan, Indiana, Illinois, Kentucky, and Ohio.

Does your healthcare practice use an evidence-based process improvement methodology when making process changes?  As a large network with over 11,500 clinicians across 5 states since 2015, the Great Lakes Practice Transformation Network has taught us that there is usually no “one-size-fits-all” approach to quality improvement in healthcare.  Our Quality Improvement Advisors utilized LEAN, PDSA, Agile Implementation, and various other improvement methodologies to improve the health of our patients and the delivery and cost of care.  This article will expound upon several important benefits of using an agile approach when seeking to lead a practice towards value-based care. 

By first recognizing that “the process of delivering care is inherently variable and that the variability stems from multiple sources,” we can agree that each practice’s transformation journey towards value-based care is unique (Boustani, Azar, Solid, p. 65).  Feedback from our Great Lakes network on how improvements were made in practice was as different as the populations that each practice serves; however, the theme of agility as a fundamental element of change was undisputed.  This can be highlighted with a few real-world examples.

• Identifying the pain points within a practice is step 1 of the Agile Implementation process: Confirming Demand. If no demand currently exists for innovation and transformation in a practice, no opportunity will be perceived—and change is much more difficult to implement or sustain. Agile Implementation promotes process improvement in its beginning stages by helping to gain buy-in before a project even begins.
• Smaller practices may not have as many resources as a larger health system that has its own Quality Improvement department. This makes agility especially essential. Whether a small practice is pursuing a path towards an Alternative Payment Model, or solely aiming to improve the health outcomes of its patients, being able to manage change often requires innovative solutions in an environment where resources are limited.  When using Agile Implementation as a guide, solutions are selected in the minimally viable form—a form that can be adapted and sustained long-term if changes arise.  There is also room to innovate a new solution if no evidence-based solution currently exists—a common problem in a complex setting like healthcare.  Using innovation and minimum specifications is a bedrock of being agile.
• An agile approach also recognizes the human element of change. Incorporating motivational techniques when implementing process improvement can be helpful, because it allows you to apply intention to a person’s key drivers of change. Many of the Quality Improvement Advisors in the GLPTN carefully applied behavioral economics techniques to ultimately help their practices improve care delivery and engage QI teams.  Performance improvements were seen with success in medication adherence, patient portal use, and depression screening rates resulting from the use of motivational interviewing (M. Kaur, personal communication, Oct. 30, 2019). 
• Fostering a feedback culture is another strategic, evidence-based element of quality improvement methodology. When using Agile Implementation, especially, feedback is vital to monitor progress towards reaching metrics and adapting to dynamic environments. The Great Lakes team leverages valuable feedback as much as possible by using communication plans, staff and patient feedback, and data-informed decisions to make improvements in practice.  Not only does this help to identify obstacles, but it also keeps teams engaged and proactive in addressing their core quality metrics.  Without actionable feedback, a team cannot be agile.

While practices may vary in size and the amount of resources that they have for improvement initiatives, the Quality Improvement Advisors of the Great Lakes Practice Transformation Network benefited from the starting point of recognizing that change in non-linear.  It requires a multifaceted approach that draws upon the best aspects of every change methodology. 

Are you passionate about implementing evidence-based practices to improve the quality and value of the care that you provide?  Do you have clinical staff who would benefit from training in change management?  Learn more about the foundations of Agile Implementation (AI) so that you can apply them in your health system by visiting http://www.hii.iu.edu/.  Here you will be connected to resources and training from the IU School of Medicine’s Center for Health Innovation and Implementation Science, like our 3-day Agile Implementation Boot Camp and our professional certificate in Health Innovation & Implementation Science.

A big thank you to Quality Improvement Advisor with the Great Lakes Practice Transformation Network, Mandy Kaur, for sharing her insights into quality improvement in practice.  Many of the examples in this article were taken from an interview about her experiences as a QI Advisor.

References

• Boustani, M., Azar, J., & Solid, C. A. (2020). Agile Implementation. New York, NY: Morgan James Publishing.

An example that exemplifies the importance of identifying opportunities can be illustrated by the Healthy Aging Brain Center (HABC). The founders, Dr. Malaz Boustani, Dr. Callahan, and others at the Indiana University Center for Aging Research, opened the clinic at Eskenazi Health in January 2008. The Healthy Aging Brain Center is a model of care that addresses the gaps of care in patients with Alzheimer’s. Prior to the formation of HABC, Eskenazi leadership performed a cost analysis to determine the financial viability of this solution to Alzheimer’s. Shortly after confirming buy-in and demand, HABC was granted the go-ahead by Eskenazi CEO, Lisa Harris. By proactively identifying and confirming opportunities and demand, HABC was set up for success to address gaps in care for those suffering with Alzheimer’s.

If you would like to learn more about the eight-step Agile Implementation model, you can reserve your free copy of the Agile Implementation book at http://www.hii.iu.edu/. This book describes a proven, evidence-based methodology to leverage real-world practices to achieve sustainable change within the healthcare industry.