J-6_Learning_and_Action_Networks.docx

Attachment J-6 Learning and Action Networks

Table of Contents

10 – Background

· This document will outline how the ESRD Network will support, convene, and report data for any Learning and Action Network (LAN) activities associated with the ESRD Network core contract Statement of Work (SOW).

A LAN is a mechanism for fostering large-scale rapid improvement in an “all teach, all learn” environment. A LAN is an improvement initiative that brings together health care professionals, patients, and other stakeholders around an evidence-based agenda to achieve rapid, wide-scale improvement. The LAN model includes collaborative projects, online interactions, and peer-to-peer education to facilitate shared commitment, energy, and knowledge that allows the LAN participants to learn from each other as well as from other entities including stakeholders, Networks, and Quality Improvement Organizations (QIOs).

The goal of a LAN is to bring providers and community partners together to:

Offer a forum for sharing of best practices Develop an action plan to assist providers in overcoming barriers and problems for improving quality measures Offer resources to providers to assist in improving quality measures (such as webinars, clinician tool kits, meetings, and best practice advice from successful clinics and experts) 0.

A key factor in closing the gap between best practice and common practice is the ability of health care providers and their organizations to rapidly spread innovations and new ideas.

Health care quality improvement works best when everyone teaches and everyone learns. LANs create an opportunity for building and harnessing the knowledge, skills, and abilities of peers and other vested partners.

A LAN should:

Connect organizations and individuals that have similar quality improvement goals and challenges and provide an opportunity for in-depth learning and problem solving

· Engage participants in an "all teach, all learn" environment

· Foster mentoring by high performers

· Share best practices as quickly as they are identified

· Collect and share free information and tools that support improvement

· Recognize participants meeting or exceeding improvement targets.

LANs are mechanisms by which large-scale improvement around a given aim is fostered, studied, adapted and rapidly spread regardless of the change methodology, tools, or time-bounded initiative that is used to achieve the aim. LANs consciously manage knowledge as a valuable resource. They engage leaders around an action based agenda. Such a network creates opportunities for in depth learning and problem solving, it accepts all offers of support seeking to catalyze interested parties, and it is transparent, flexible, interchangeable, and purposeful.

While all facilities, providers and stakeholders in a given ESRD Network may not receive direct intervention, LANs create an opportunity for communities, with assistance and guidance from the Network, to harness the knowledge, skills, and abilities of their peers and vested partners to reach a critical mass of the appropriate factions in their Network service area around a common aim(s). It is expected that the ESRD Networks will develop and facilitate sustainable LANs within their respective service areas, as well as participate in NCC and other CMS supported and facilitated LANs which will function to support Network activities at the local level through spreading knowledge gained from counterparts across the country which may provide additional information for improving local quality of care for the ESRD population

30 – Definitions

Learning and Action Network (LAN): An improvement initiative that brings together health care professionals, patients, and other stakeholders to achieve rapid, wide-scale improvement.

Local: Related to the geographic service area in which a Network operates. Local activities may be Network-wide or aimed at certain communities or providers in the Network service area.

Affinity Group: A sub-group that develops within a LAN to work in a specialized area(s). These groups may form because a subset of the LAN membership shares commonalities and finds that it would be advantageous to work together. Affinity groups may work to remove specific barriers or promote specific goals. Members can address specific interests such as, but not limited to, increasing transplant referrals among eligible candidates or exploring home dialysis for qualified candidates.

Collaborative: A short term (usually 12–18 months) initiative that brings together a large number of teams from health care facilities to seek improvement on a specific topic. A collaborative is one of many tools available to a LAN to drive change. This improvement method relies on the practices of high performers and the rapid adaptation of those practices across the system being changed. Collaboratives are designed to accelerate improvement, achieve results, disseminate good ideas to community stakeholders, and build clinical change leaders.

Disparate Care: Unequal treatment of patients on the basis of race/ethnicity, gender, socioeconomic status, locale, or other patient factors when the difference in care is not justified by the underlying health conditions or treatment preferences of patients.

Subject Matter Expert: An expert in a given field who has specific insight into how his/her facility is achieving certain aims, such as the lowest infection rates in the state or the highest utilization of universal precautions.

High Performing Organization: An organization that has a high rate of success on a given measure and has specific insight as to the processes and practices that are in place that allow for the desired outcome.

Best Practice: A repeatable technique or methodology that, through experience and/or research, has been proven to be one of the most efficient (least amount of effort) and effective (best results) way of accomplishing a task or achieving an outcome.

Spread: The act of expanding an improvement from one area of success to another area within a system to accelerate the rate at which proven interventions are implemented.

Sustainability: The probability that quality improvements attained through the Network’s work will be maintained or improved upon after the Network has completed its formal work with participants.

40 – Specific Requirements for Supporting and Convening LANs

The Network will develop, lead, and sustain local LANs. The Network will work with the NCC, which will support the ESRD Networks in their effort to lead local efforts driving toward achievement of national goals.

40.1 – Develop and Implement Local LANs

The Network will develop a team(s) (number and composition to be determined by the Network) that is responsible for supporting and facilitating the LANs identified in the ESRD Network core contract SOW.

The duties of this Network team(s) include, but are not limited to, the following:

The Network will connect the local LANs to the other improvement initiatives conducted by the Network under the core contract SOW.

The Network will actively and consistently recruit LAN to work with LAN leaders in achieving change.

The Network, with the support of the NCC, will closely monitor relevant Network data for the purpose of strategizing areas in which significant gains can be made, problem solving can occur, and barriers to rapid improvement can be removed.

The Network will ensure that each LAN has a specific and intentional focus on desired outcomes in a given topic area.

The Network will reach out to groups or organizations that may not be specified in the SOW, such as LDOs, NRAA, state and local health departments, CMS grantees or contractors, grantees or contractors of other federal agencies, and private sector quality improvement groups for purposes of collaboration and reducing duplication in effort.

The Network will arrange for learning and sharing opportunities with peers of the participants in the LAN who have achieved or nearly achieved the desired goal of the LAN. The Network will convene higher performers and lower performers to participate in “all teach, all learn” activities to share the best practices of the high performing organizations.

The Network will work to consistently identify best practices, improve and rapidly spread the practice to its constituents.

40.2 – Cultivating Leaders in the Local Area

In convening a LAN, the Network will convene health care leaders (including clinicians, administrators, members of boards of directors, and patients) around an actionable agenda that promotes the goals of the LAN. This will also include identifying the high performing organizations for leaders to form affinity groups as needed to enhance opportunities for learning, or problem solve around important topics that are applicable to the state or issue such as persons that have dual eligibility, rural concerns, and any populations where disparate care may be occurring.

The Network will identify those local leaders that have achieved outstanding results in the designated topic area to serve as quality advisors to the LANs.

The Network identified quality advisors will work to cultivate leadership among other identified leaders for the specified aim. The goal is to catalyze change among the leadership that can then transform the remainder of the staff from the specified settings such as dialysis facilities, nursing homes, VHA hospitals, etc.

40.3 – Plan and Coordinate Local LAN Meetings and Conferences

First, the Network will plan, organize and facilitate local LAN meetings for each of the identified priorities. It may be possible and is desirable to address several priorities at the same meeting for purposes of efficiency. Learning and Action team members will participate in one (1) to three (3) local meeting/s per contract year. These meetings will form the LANs of the QIO community. These meetings may occur through webcast, and conference calls.

Team members will be asked to prepare in advance of each of these local meetings, their current progress, effective practices and most recent results. During these meetings, CMS may direct the Network to roll out through their LANs new information that is derived from the most up to date practices in the field, patient stories, and business case development information as examples.

40.3 – Facilitating Collaborative Teams

The Network will lead, manage and direct the work of collaborative teams by providing the following supports: Introducing the Model for Improvement, providing the collaborative teams with effective Plan, Do, Study, Act (PDSA) cycles to test the effectiveness of the chosen intervention, creating a feedback mechanism for understanding individual team progress, utilize the NCC and ESRD Network information system for real-time communication, leading conference calls and webinars. Utilizing appropriate media outlets to promote the work of collaborative teams and share effective practices, develop vignettes to highlight the work of high performers in the Network service area or bring to light areas that require additional focus.

40.4 – Participate in National Meetings Convened by CMS or the NCC.

The Network will be expected to participate in national meetings aimed at coordinating LANs activities. These meetings may occur through webcast, conference calls, etc.

40.5 – Feedback Mechanisms and Sharing Best Practices

The Network in conjunction with its LANs and the NCC will develop a feedback mechanism that identifies areas of excellence for the purpose of spread, and areas where additional focus must be placed for the purpose of impacting the goals as outlined by the aim statement. The Network will collect and share best practices and learning from the LANs, the NCC, CMS, and other partners on an ongoing basis.

40.6 – Sharing Data

The Network will share improvement information such as aggregate data findings, intervention results, observation, or patient feedback (non-confidential data) collected through the LANs and develop a plan of action based on findings.

40.7 – Recognition

The Network will develop methods of recognition and awards (non-monetary) for LANs participants who meet or exceed targets. This recognition could be in the form of highlighting an intervention in a newsletter, awarding a certificate, highlighting an activity on a webcast. Please note that the Network will not sponsor an activity or awards ceremony solely for the purpose of providing an award.

40.8 – Reporting

The Network will report findings to CMS through the NCC unless otherwise specified in the SOW.

50 – ESRD Network Participant Assessment

In addition to the formal monitoring and evaluation metrics, the Network will periodically assess the effectiveness of its collaborative efforts as viewed by the participants. An informal assessment must be performed on an ongoing basis by asking the participants if the support they are receiving is of value. The assessment will include the Network’s effectiveness in areas such as leadership, member engagement, communication, formal structures and procedures, and the likely impact in improving the health of their community.

60 – Data Reporting

The Network will assist collaborative partners in generating data as frequently as needed but not less than monthly to ensure improvement efforts are on target. Collaborative members will generally use data sources identified by the SOW and/or provided by the NCC, other data sources must be approved by the COR for use to monitor improvement efforts.

The Network will report data to the NCC quarterly.