Module #1: High Value Care and Health Equity
Understanding the intersection between “value” and “equity” can inform conversations between value champions, leadership and stakeholders and inform early project planning activities.
Learning Module #2: Engaging Leadership for High Value Care
Authors: Elizabeth Vossenkemper & Kathy Reims
“So, an early critical step for our project was leadership engagement. And I remember having multiple meetings. In every meeting that I used to go…in the context of substance use disorder, … I would say, “Okay, so we’re doing this, it’s great, but what are we doing to safely prescribe opioids?”
-Roberto Diaz del Carpio, MD
“The success of this project was crucially dependent on institutional support, and, in fact, it really came out of institutional priorities.”
-George Hoke, MD
Overview: Engaging leadership in today’s chaotic healthcare environment is a challenge. And for the Clinical Value Champion, it is critical! Your project needs a “sponsor,” a respected leader who will publicly endorse your work, help you find the resources you need, and connect you to others in your organization. There are books, articles and ample resources about engaging leadership and this module is not intended to be comprehensive. Rather 6 tips used by clinical champions to engage leadership to provide high value care will be summarized. The first four tips pertain to Project sponsors or senior leaders, the fifth takes a broader view of leadership, and the sixth turns the spotlight on you as a leader. Some favorite leadership resources are listed as well.
- Describe how the health care leaders in your setting think about organizational strategies and priorities.
- Plan a strategy for eliciting sustained leadership support in your setting.
- Execute your strategy to engage with leadership about your overuse reduction project.
Learning Module #3: So many to consider: Choosing an Overused Service
Authors: Reshma Gupta and Leslie Dunlap
“Choosing the project is key. Make sure it’s aligned with your system and your community…”
-Roberto Diaz del Carpio, MD
“I wanted to choose something that was really black and white to start the process of even opening up a conversation about overuse….I have three other pediatric providers that kind of worked with me to say, “Yes, this is a problem, we want to address it,” and so we went forward.”
Overview: Overuse of health care services is widespread in most health care settings. Selecting a target area of overuse as a value champion requires careful consideration of multiple factors that will impact success. Identifying a high value care initiative is more successful when incorporating engagement, technical merit and cultural compatibility.
- Identify at least 3 key ingredients in your setting that should be considered when selecting a target area of overuse for a reduction initiative.
- Incorporate input from key stakeholders (leaders, clinicians and patients) to identify relevant overuse topics in your setting.
- Provide two examples of a target area of overuse in your setting that would be considered “low hanging fruit” as defined by the Newman-Toker article.
Learning Module #4: How to Conduct a Stakeholder Assessment and Why it is Important
Authors: Robert Fogerty & George Hoke
“Another key was a very detailed stakeholder analysis…We learned that we needed to include both nurses and patients in this conversation.”
-George Hoke, MD, University of Virginia, Charlottesville
“The number of different departments that I’ve engaged with over this fellowship is actually really incredible and has opened up a lot of opportunity for other relationships for other types of projects.”
-Elizabeth Vossenkemper, PNP, Tricities Community Health Center, Pasco, WA
Overview: The purpose of this module is to introduce the concept of a stakeholder, explain why identifying and engaging them is important, and present approaches for doing so. Any effort to reduce the use of a service impacts multiple stakeholders across an organization. Stakeholders can impede or facilitate your work as a value champion, therefore it is important to understand who those stakeholders are, how efforts to reduce a service will impact them, and approaches to engaging them in your work to increase the likelihood of reducing the use of an overused service.
Learning Objectives: “At the conclusion of this learning activity, value champion fellows should be able to…”
- Describe the reasons why a stakeholder analysis is beneficial when considering a project in high value healthcare
- Describe some common stakeholder positions
- Develop a strategy to identify stakeholders in the planning stage of a project
Lesson #5: The Patient Voice: Engaging Patient Participation in Your Project
Author: Kelly Rand
“So, before I started, or as I was going through this, one of the pushbacks [from physicians] was that patients would not be able to do this. So, I did a qualitative interview informally with patients… And in the entire group that I spoke with, they were all in favor of doing this and said they had unlimited text messaging capability and would like to do this.”
-Lauren Demosthenes, MD
Overview: Incorporating the patient's perspective and voice in efforts to decrease the use of services has proven to be extremely important for overuse reduction efforts. This Module aims to help participants understand why that is so and provide examples of how value champion fellows might incorporate the patient's perspective in their overuse reduction initiative.
- Understand the spectrum of patient engagement and the benefits to each level.
- Experience conversations about overuse from both clinical and patient perspectives through role play and become better attuned to the patient perspective on overuse and what communication levers elicit meaningful stories.
- Give examples of three types of ways to engage patients in the project and in sharing their stories.
Lesson #6: Measurement, Data & Trust: Supporting Change with Data
Authors: Roberto O. Diaz Del Carpio, MD and John N. Mafi, MD, MPH
“[A challenge] is the lack of… knowing …How many providers are actually prescribing these medications? What’s the volume? They need the data to help them with that black and white on paper to indicate there might be a problem.”
-Roberto Diaz del Carpio, MD
Overview: To build a culture of trust, innovation, and improvement; it is essential to share transparent, meaningful and actionable data about the targeted overused service with stakeholders. Pre-defined measures of overuse are often not readily available and reliable sources of data can take time to identify and even longer to extract into actionable measures within a report or dashboard for providers. Reliable and valid data translated into measures that are clinically meaningful are often critical to getting provider to the table for a discussion about your targeted area of overuse. In addition, it is also extremely important to confirm impressions about the rate of overuse in your setting when selecting your overuse topic/service for your project. Some projects have been derailed because initial anecdotal impressions about a service being frequently overused are not supported by the data.
- Describe the differences among outcome, process and balancing measures for an overuse initiative
- Understand the steps needed to identify your data source, method of collection, measure specification and how these measures will be reported.
- Discuss how to effectively present data that reveals variation in rates of overuse across settings and providers.