Report #2: Louisiana Health Care Quality Forum
Contents
Introduction
About the Louisiana Health Care Quality Forum
Leading Practices
Part I: Determining Where to Focus
Question #1: Where are we? What can we learn from a fresh look at the organization and its approach?
Question #2: Where do we need to focus our efforts? (What are our strengths and weaknesses?)
Part II: Applying Leading Practices
Question #3: How do our stakeholders think we are doing as an organization?
Question #4: Are we on the right track with our programs?
Question #5: What results are the most meaningful?
Part III: Delivering on Our Promises
Question #6: How will we expand and diversify our funding?
Question #7: What other resources are needed to deliver on our commitments?
Question #8: Do we have the right governance structure to be nimble and effective?
Question #9: Who is responsible for driving development and sustainability?
Question #10: How will we monitor our progress?
Conclusion
Acknowledgments
Introduction
Based on the real life experience of the Louisiana Community Quality Collaborative
(Community Quality Collaborative), this report provides guidance to assist
a Community Quality Collaborative in developing its sustainability plan. For
six months in 2008, the Agency for Healthcare Research and Quality (AHRQ) funded
a sustainability planning project for the Louisiana Health Care Quality Forum
(LHCQF). Tools and templates, based on the work in Louisiana, are provided
in the Sustainability Toolbox (see Web link below).
This report is one component in a technical assistance program on sustainability
developed by AHRQ for its Learning Network for Community Quality Collaboratives.
The program toolbox includes two reports based on real life experience in the
pilot projects: one in Oregon and one in Louisiana. The goal of this sustainability
program is to support Community Quality Collaboratives in defining strategies
that will lead to productive and financially sound collaboratives that grow,
thrive, and deliver significant value over time.
For more information about this program and to access the electronic documents
in the Sustainability Toolbox, go to http://www.cvelearningnetwork.org/doc.asp?id=50.
About the Louisiana Health Care Quality Forum
(Louisiana Community Quality Collaborative)
The Louisiana Community Quality Collaborative, launched in 2007, had been
in operation for about one year when the sustainability planning project began.
In the aftermath of Hurricane Katrina, the Louisiana Health Care Redesign Collaborative
put forth recommendations for redesigning and rebuilding the health care delivery
system in Louisiana. More than 40 organizations came together in a truly collaborative
effort to envision and build a much stronger system for all Louisiana residents.
As a result of these efforts, the LHCQF (which also became the Louisiana Community
Quality Collaborative) was incorporated as a non-profit 501(c)3 entity and
secured a 3-year contract with the State of Louisiana. This contract defined
specific outcomes, while delegating the detailed shaping of the work to the
LHCQF.
The remainder of this report summarizes the sustainability planning efforts
in Louisiana.
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Leading Practices
As part of the sustainability program, seven leading practices were identified
in three case studies of successful collaborative organizations. A key component
of the recommended sustainability planning approach involves evaluating the
application of these practices and targeting the biggest gaps for immediate
attention.
The seven leading practices are:
- Responding to Compelling Market Circumstances.
- Maintaining Effective Leadership.
- Achieving Balance Among Stakeholders.
- Delivering Tangible Value.
- Communicating Proactively.
- Establishing a Transparent Management Style.
- Employing Rigorous Prioritization.
Each leading practice is described in detail in the Sustainability Program
Overview.
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Part I: Determining Where to Focus
This section provides insight into how to assess the current state of the
collaborative and its environment. This assessment is critically important
in determining if the Community Quality Collaborative is on track and where
it should focus future efforts. Ideally, this portion of the planning should
be conducted by a neutral party with "fresh eyes" to gain the most
insight.
Question #1: Where are we? What can we learn
from a fresh look at the organization and its approach?
With each of the sustainability pilot projects, the work began with a review
of the current state, recent history, infrastructure, and programs. A checklist
of items to review is included in the Toolbox. This review, along with initial
discussions with the Executive Director, helped to narrow the focus for the
Louisiana project.
Question #2: Where do we need to focus our
efforts? (What are our strengths and weaknesses?)
In each of the two pilot projects, the consultant and executive leadership
narrowed the focus to two or three of the leading practices (as listed above).
In Louisiana, prioritization was identified as an existing strength. The organization
had created an effective structure based on four working Committees:
- Quality Measurement
- Medical Home
- Health Information Technology
- Outreach and Education
Each of the Committees was chaired and populated by volunteer stakeholders,
and supported by the Executive Director as well as a part-time staff project
manager. Priorities and goals had been clearly defined within each Committee.
Therefore, the sustainability pilot project was designed to focus on the following
objectives:
- Applying the seven Leading Practices (listed on Page 2) effectively.
- Refining the balance of staff work to volunteer stakeholder involvement
(an aspect of Leading Practice #3).
- Ensuring that the organization as a whole was demonstrating value (Leading
Practice #4).
- Sustaining momentum.
- Identifying additional funding opportunities and potential barriers to
success.
In hindsight, this list proved to be too ambitious for the timeframe and structure
of the project. In this case, the focal point of the planning effort was an
all-day annual retreat. While progress was made on all fronts, the process
did not produce the desired comprehensive plan with succinct actionable strategies.
Therefore, Community Quality Collaborative leaders are encouraged to be very
focused and realistic when tackling sustainability questions.
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Part II: Applying Leading Practices
This section provides insight into how to evaluate the application of leading
practices, to ensure that the organization can deliver on its promises.
Question #3: How do our stakeholders think
we are doing as an organization?
A key component of the Louisiana pilot project involved surveying key stakeholders
about the effectiveness of the organization. In this process, survey forms
in MS Word format were emailed to 65 participants. Each survey contained the
same 30 questions organized around the seven leading practices and requested
numerical rankings as well as written comments.
A template for this type of survey is included in the Toolbox. However, it
is recommended that Community Quality Collaboratives shorten the length of
the survey and use an online survey tool to streamline the process.
The response rate was good, considering the length of the survey, which showed
a high degree of interest and engagement. Twenty-three respondents (35%) returned
the survey, including a good cross-section from the four stakeholder groups.
There were 348 written comments, which provided deeper insights for the planning
process.
Following are some key findings from the survey:
- Respondents gave the organization high ratings for Overall Effectiveness.
- Multiple ratings and comments provided praise for the group's leadership
and respect for the participants.
- Respondents believed the Louisiana collaborative was on the right track
and supported the planned activities and deliverables.
- Several areas were highlighted for focus and attention:
- Need for diversified funding.
- Importance of stakeholder engagement and balance (Stakeholder balance
received the lowest average rating, although the overall rating was still
high.)
- Individual comments pointed to needing more involvement from nearly
every stakeholder type (consumers, health plans, purchasers, individual
providers), as well as from different geographic areas.
- Perceived lack of public awareness of the organization and its mission,
including several suggestions to engage more press coverage.
- Importance of openness and communication within the Louisiana Community
Quality Collaborative.
Question #4: Are we on the right track with
our programs?
As a key component of the retreat agenda, each Committee presented its current
plan and a progress update. There was lively discussion about the goals and
needs in each program or subject area. As noted above, the priorities previously
had been defined and were progressing under the Committee structure. However,
the Board discussion revealed that some Committee participants were more informed,
engaged, and effective than others.
Ultimately, the Board concluded that the right priorities were defined in
the Committee plans, but that adjustments were needed in some cases to ensure
consistent progress. For example, one Committee had experienced turnover in
leadership. This Committee's work was less clearly defined and generated more
discussion. At the retreat, a new leader was confirmed for that Committee.
Each Community Quality Collaborative will structure its programs differently.
However, the experience in Louisiana points to the need for consistent tracking,
information sharing, and coaching across all program areas. Community Quality
Collaboratives should use clear and simple documents to track and report program
status to leaders and stakeholders. Several examples of models, plans, and
tools are included in the Toolbox.
Question #5: What results are the most meaningful?
A critical component in planning for sustainability is having a current, neutral
understanding of what stakeholders value and will support. This was addressed
at the Louisiana Board retreat. Following a detailed review of program priorities
and Committee workplans, a group discussion was planned to address this question.
While there was lively discussion, the process employed was not entirely effective
and yielded more "lessons learned" than firm conclusions. More data
gathering and preview discussions would have helped to shape and focus the
discussion.
The discussion did yield a working list of high value assets, including:
- Award of CMS EMR demo.
- Community Quality Collaborative designation.
- Medical Home model
- Summit(s).
- Exploration/advancement of medical home concept.
- Thought leadership
- Information about national and state/local best practices.
- Participants on key advisory groups in the state.
- New fresh ideas.
- Education as to the current state of health care in Louisiana.
- Papers released by the Quality Measurement Committee.
- Dissemination of the Health Dialog Report.
- Increased visibility to physician use of HIT.
- Resource Guide.
- Health Plan Database.
A key component of the discussion centered around the concept of providing "nutrition" to
interested stakeholders as the organization develops and grows. Several participants
emphasized that the Louisiana Community Quality Collaborative may lose the
interest and support of key stakeholders, such as employer/purchasers, if those
stakeholders do not see tangible results.
For more information about effectively evaluating stakeholders' perspectives,
see the Sustainability Toolbox and Sustainability Planning for Community
Quality Collaboratives: Ten Key Questions to Guide Your Planning Efforts, Report
#1: Oregon Health Care Quality Corporation.
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Part III: Delivering on Our Promises
The most important part of a sustainability plan is the execution. This section
describes how the Louisiana Community Quality Collaborative identified needs
and strategies to ensure that the collaborative delivers value.
Question #6: How will we expand and diversify
our funding?
Because the organization had a 3-year contract with the State of Louisiana,
the timing for a strategic planning process was good. Before the end of the
contract in 2010, the group needs to establish a more diversified and sustainable
funding portfolio.
Specific funding opportunities were discussed at the Board Retreat, which
generated a working list. The most important outcome was the recognition that
more attention from the Board, and possibly outside expertise, was needed.
The Board agreed to create a Development Committee to focus on critical development
and funding issues.
Each Community Quality Collaborative should clearly define roles and responsibilities
with respect to funding. In most cases, it is advisable to designate a small
group to focus on development and funding. This activity may be assigned to
a standing Committee, such as an Executive Committee, or a new Committee convened
for this purpose. Examples of a strategic plan and dashboard for the Development
Committee are included in the Toolbox.
Question #7: What other resources are needed
to deliver on our commitments?
In addition to funding needs, the consolidated review of all of the programs
identified other resource requirements such as needs for technical assistance,
information, and partnerships. From each of the Committee plans, the resource
requirements were summarized into one master list to guide the Executive Director
and Development Committee in focusing requests and securing support. This list
highlighted that the four programs had related needs for certain types of support
such as research, technology, and communications expertise.
It also is important to have a clear, well-documented picture of what it will
take to achieve the stated goals. The organization already employed two professional
project managers to support the Committees. This approach was recommended for
the new Development Committee as well— to track goals, tasks, and projects
in a similar fashion.
Question #8: Do we have the right governance
structure to be nimble and effective?
Both the stakeholder survey and the Board retreat highlighted variations in
Committee effectiveness and perceptions of the Board's role. This was caused,
in part, by different levels of engagement by individuals as well as the maturity
of the respective Committees and their work. This variation affected the strategic
discussions at the retreat, because not all participants were starting from
the same place.
This is a common challenge for Community Quality Collaboratives, because time
with the Board is very limited and must be carefully organized without becoming
too orchestrated. In Louisiana, adjustments have been made to the Board and
Committee assignments to achieve the desired balance and level of activity.
Question #9: Who is responsible for driving
development and sustainability?
As discussed above, the solution for the Louisiana Community Quality Collaborative
was to leverage a smaller group to work closely with the Executive Director
on development issues.
For more information about governance models of other Community Quality Collaboratives,
including Board sizes and Committee structures, see the individual Community
Quality Collaborative profiles on AHRQ's Learning Network for Community Quality
Collaboratives Web site: http://www.cvelearningnetwork.org/doc.asp?id=22.
Question #10: How will we monitor our progress?
Through its professional project management team, the Louisiana Community
Quality Collaborative was already using workplans and dashboards with its program
committees. These documents were created for the Development Committee as well,
recognizing that the development effort requires as much attention and focus
as program work.
Community Quality Collaboratives also should consider building an overarching
resource plan that recognizes potential opportunities and/or conflicts between
programs and committees.
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Conclusion
In summary, the chart below illustrates the strategic planning process, which
was applied in Louisiana as follows:
- The Vision and Universe of Possibilities had already
been well defined.
- Four working Committees had clearly defined Priorities, which
were affirmed at the Board Retreat.
- The planning activities at the Board Retreat were designed to focus on
the intersection of Capabilities, Priorities, and Funding.
As with many organizations, the biggest challenge of sustainability was in
balancing these three factors.
- The process and retreat produced new insights and motivation to refine
the Strategies, Execution Plan, and Monitoring approach.
This process yielded the following lessons learned for the Louisiana group,
which also may apply to other Community Quality Collaboratives in their sustainability
planning efforts:
- Breaking down the process is critical.
- Maintain a sharp focus: don't try to cover too much ground in one meeting.
- Select and tailor tools to your organization.
- Plan multiple sessions; include several in-person meetings.
- Acknowledge differences in style.
- Style of engagement.
- Preferred levels of detail.
- Types of documentation.
For more information, tools, and templates, please see the Sustainability
Toolbox.
Acknowledgments
Contributors
The author would like to thank the following people from the Louisiana Health Care Quality Forum (LHCQF) for contributing to this document: Shannon Robshaw, Executive Director, and the Board of Directors and staff.
Reviewers
The author wishes to thank the following people for reviewing this report: Jan De La Mare, MPAff, Agency for Healthcare Research and Quality; Karen Shore, PhD, Center for Health Improvement; Shannon Robshaw, Louisiana Health Care Quality Forum; and Peggy McNamara, MSPH, Agency for Healthcare Research and Quality.
AHRQ appreciates citation as to source. Suggested format follows: Lejnieks, L. Sustainability Planning for Community Quality Collaboratives: Ten Key Questions to Guide Your Planning Efforts; Report #2: Louisiana Health Care Quality Forum. Rockville, MD: Agency for Healthcare Research and Quality, December 2008.
We consider our Learning Network tools to be works in progress and always welcome your comments. Please forward suggestions to AHRQ's Peggy McNamara at peggy.mcnamara@ahrq.hhs.gov.
AHRQ Contract No: HHSA290200710022T
Current as of March 2009
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