Attachment_J-24A_Integrated_Innovation_Spread_Strategy_Frequently_Asked_Questions.pdf

Updated October 15, 2012

Integrated Innovation Spread Strategy (IISS) Deliverable:

Frequently Asked Questions

NOTE: New text for this update is shown in red, below.

What is the Integrated Innovation Spread Strategy?

The Integrated Innovation Spread Strategy (IISS) is a deliverable required of all QIOs under section C.10.3.

(“CRISP Model”) of the 10th SOW. The IISS outlines the communications/social marketing strategies and tactics each QIO uses to approach its work under the Aims of the SOW for CRISP activities with a goal of giving access to the right information and services, in the right form, at the right time, to the right people in the right place.

CMS expects that QIOs will incorporate the CRISP model and corresponding activities into their Aim approaches as part of their efforts to stimulate widespread positive changes in the attitudes and behaviors of those audiences who are critical to the success of the 10th SOW, including providers, stakeholder organizations, community groups, beneficiaries, and others.

The IISS provides CMS with an opportunity to collect data about these activities at a national level to spot trends among QIOs, assess the progress of CRISP activities under the 10th SOW, and determine the future direction of CRISP work for the QIO Program. The IISS is also intended to be a helpful planning tool that can help maximize QIO success in achieving the bold goals of the 10th SOW.

What is the scope of my QIO’s IISS, due August 31, 2011, and every three months thereafter?

Each IISS consists of an audience analysis, tactical planning and evaluation worksheet, and situational analysis;

all components should include as much detail as possible:

The audience analysis captures the primary audience(s) for each of your Aims or initiatives (e.g., topics within an Aim); their preferred methods of communication; their influencers or secondary audiences; an assessment of the knowledge, attitude, beliefs and behaviors your audience(s) currently exhibit related to the Aim/initiative; the knowledge, attitude, beliefs and behaviors that the audience(s) must demonstrate in order to improve and sustain performance; and the messages you plan to use to move your audiences from their current state to the desired future state. We encourage you to use the audience analysis as a tool for engaging your QIO’s improvement teams in CRISP.

In order for CMS to accept your deliverable as complete, you must fill in all of the columns of the analysis for each primary audience. Note that the audience analysis is organized by audience, not by

Aim/initiative. Your completed IISS should encompass all four Aims of the 10th SOW; however, it is not likely that you will need to target every audience for every Aim.

The tactical planning and evaluation worksheet captures the tactics you are using or plan to use, the timeframe during which the activity will be conducted, your evaluation metrics, and results. If you are planning to implement a tactic, you must fill in the tactic, audience, timeframe, and measurement columns.

The situational analysis consists of narrative descriptions of your experience conducting CRISP activities during the reporting period. In order for CMS to accept your deliverable as complete, you must respond to all of the questions in this section unless they are marked otherwise.

Attachment J-24A Integrated Innovation Spread Strategy (IISS) Frequently Asked Questions

What format should I use to develop my IISS?

Use the CMS-issued Microsoft Word template, which is available on the “Deliverable Help” folder of the

“CRISP Reference Shelf” section of the Collaborative Tool. Visit the Collaboration Tool online at http://www.healthcarecommunities.org/Comm_Docs.aspx?groupid=33&id=0&fid=47399&tnid=TREE1_2_473

94_47399.

The Word template contains three sections; each will be used to capture one of the three components of your

IISS as described in the bulleted list above. Duplicate the audience analysis or tactical planning and evaluation worksheet as necessary to capture all of your work. You only need to complete one situational analysis for each quarterly IISS. Directions on how to complete the sections follow.

What should I include in my QIO’s IISS?

Your plan should provide CMS with your strategies and intended approaches for conducting CRISP activities for each of your QIO’s Aims in the 10th SOW. Should your provider recruitment efforts require you to conduct outreach activities, please include them in your plan.

What type of evaluation/measurement is expected?

First, it is important for all evaluation methods to comply with CMS requirements for information collection outlined in the QIO Manual, Chapter 12, Sections 12600-12670. It is equally important to understand that a practical approach to evaluation is desired. The intent is to conduct some form of measurement that helps determine whether a tactic is effective and worth repeating (Did the tactic help remove a barrier to behavior change?). Evaluation is NOT expected to be based on a formal or complex design.

Effective evaluation should be matched to tactics, and can include: website traffic analysis, media measurement, conference evaluation forms, reader surveys with open-ended questions, and focus groups that meet CMS requirements. Another evaluation option is to set a goal for response to your “call for action,” such as a targeted attendance for a provider workshop that you are promoting. Please refer to QIO Manual Section 12620 and your

Contracting Officer’s Representative (COR) for specific guidance about allowable evaluation methods.

AUDIENCE ANALYSIS

The audience analysis includes a table for capturing information about your target audience(s). Use a separate row for each audience you plan to target. You may want to use additional rows for the same audience if you are targeting it for more than one initiative. Important note: Audiences are human beings with shared perspectives

(e.g., hospital infection control practitioners, hospital administrators), not buildings (e.g., hospitals). See the example on the next page.

The audience analysis should be updated regularly. With the exception of new audiences being recruited for

Learning and Action Networks, current audiences should now be familiar with your QIO and have some knowledge of the Aim or initiative they are associated with. Documentation in the “Current State” would provide the level of their understanding as they have moved from being unfamiliar with your QIO, the QIO

Program or the initiative.

Additionally, the messages you plan to use to move your audience to the desired future state should be written as your QIO would actually express them in a letter, PowerPoint presentation, or other CRISP tactic.

http://www.healthcarecommunities.org/Comm_Docs.aspx?groupid=33&id=0&fid=47399&tnid=TREE1_2_47394_47399 http://www.healthcarecommunities.org/Comm_Docs.aspx?groupid=33&id=0&fid=47399&tnid=TREE1_2_47394_47399

If you are making changes or updates to any existing information in this section, please use the strike-through feature available in Microsoft Word. The strike through feature is located on the home tab just below the font and text size drop-down menus.

To indicate new information, please use red, bolded font. DO NOT use track changes. As you continue to make updates in future deliverables, remove any information that has previously been struck-through and change the red, bolded font from the previously new information to plain black text. See the example below.

What do you mean by current state?

o An audiences’ current state is the knowledge, attitude, beliefs and behaviors they exhibit toward a particular Aim or initiative.

What do you mean by future state?

o An audiences’ future state is the knowledge, attitude, beliefs and behaviors you want them to demonstrate in order to improve and sustain performance.

What is a message?

o A message is an overarching statement customized for each audience that is easy to understand, responds to an audience’s interests or concerns and empowers the audience to act.

What about brand messages?

o Brand messages are designed to encapsulate the general impressions that audiences should take away from any QIO Program stakeholder interaction. Messages for specific audiences can be found on page 30 of the QIO Program Brand Guidelines Manual.

Example: Audience Analysis Illustrating How to Make Updates to Existing Information

Primary

Audience(s)

Aim/Initiative

Preferred Methods of

Communication

Influencers

(Secondary

Audiences)

Current State Future State Messages to Move Audience to Future State

CNAs IIPC/Reduce HAIs

(pressure ulcers)

Face-to-face meetings;

webinars; hard copy newsletters

DONs, NH administrator

What does your audience know?

CNAs know that pressure ulcer prevention is important.

What is your audience’s attitude toward this project? CNAs care

What do you want your audience to know? There are simple steps they can take to prevent pressure ulcers that won’t take too much time.

Here are three simple steps you can take to prevent pressure ulcers.

Use the PUP

Checklist when checking residents for about their residents and want them to be healthy but some don’t feel there’s time.

What does your audience believe?

CNAs believe preventing pressure ulcers is important but they have other things to do.

How does your audience behave?

Some CNAs are actively checking resident’s pressure points for ulcers.

Others have not yet begun to engage in this behavior.

What attitude do you want your audience to have toward this project? I can prevent pressure ulcers.

What do you want your audience to believe? It’s my duty to help prevent pressures and I can with a few simple steps.

How do you want your audience to behave? Actively check resident’s pressure points for ulcers each day.

pressure ulcers.

When you visit a patient, make it your priority to check their pressure points for ulcers right away.

You are an important part of your resident’s care team. Let them know you care, check for pressure ulcers on every visit.

TACTICAL PLANNING & EVALUATION WORKSHEET

The tactical planning and evaluation worksheet has two sections: a planning section that includes the tactics you have implemented and plan to implement, your target audience(s) and the timeframe for deploying the tactic;

and an evaluation section that includes metrics and results. If a single general tactic addresses multiple audiences (e.g., your QIO website), you only need to list the tactic one time. If you use the same tactic with different audiences for different purposes (e.g., video to train nursing home staff on skin care, video to train hospital staff on catheter checklist), you need to list the tactics separately.

To better define tactics, the following new header sections have been added to the worksheet: Tactics with

Measurement Results, Tactics without Measurement Results and New Tactics for Next Quarter. When you have results, move the tactic under the “Tactics with Measurement Results” heading and fill in the results column. If you don’t have results for a tactic during the quarter in which you are reporting, move the tactic under the

“Tactics without Measurement Results” heading. When you have new tactics that you plan to implement, insert new rows at the bottom of the worksheet under the “New Tactics for Next Quarter” heading.

If you are making changes or updates to any existing information in this section, please use the strike-through feature available in Microsoft Word. The strike through feature is located on the home tab just below the font and text size drop-down menus.

To indicate new information, please use red, bolded font. DO NOT use track changes. As you continue to make updates in future deliverables, remove any information that has previously been struck-through and change the red, bolded font from the previously new information to plain black text.

See sample worksheet at the end of this section.

What is a tactic?

o A tactic is the method you will use to carry out your QIO’s CRISP strategy. Examples of tactics include e-newsletters, learning sessions and webinars.

o A tactic is NOT an action (“recruit providers”) or an explanation of what you plan to do

(continue to develop Cardiac LAN).

What are some examples of how I might measure a tactic?

o To measure an e-newsletter you might use email statistics; to measure the effectiveness of a webinar you might use an evaluation form; to measure website activity you might use Google

Analytics. Most importantly, evaluation methods must comply with CMS requirements for information collection outlined in the QIO Manual, Chapter 12, Sections 12600-12670.

o The measurement methods you choose should tie directly to your tactics. Since you are measuring the effectiveness of the CRISP tactic, placing the SOW evaluation criteria in this section is not what is indicated.

What are some examples of data I might use to measure?

o For an e-newsletter you might look at the open rate; for a webinar you might consider the percentage of participants who indicated they can use what they learned right away; for a website you might look at the number of visits to a particular page on your site.

o The data and goal you choose should be expressed as a percentage or number but not both. For example, if you’ve chosen the number of visits to your website as your data, your goal should also be expressed as a number. If you’ve chosen the percentage of opens for your newsletter, your goal should be expressed as a percentage.

How should I report my results?

o Be sure to report what you achieved. If you met or exceeded your goal, do not simply write “goal met.” Include what you actually achieved.

o If you did not achieve your goal, indicate what you did achieve. You will not be penalized for tactics that did not meet the goal. You may consider applying the PDSA cycle to these tactics.

o If you do not have results for a tactic, briefly (2 sentences or less) explain why (e-newsletter not sent this quarter; delayed tactic until next quarter; no results available as tactic implemented late in quarter).

o If your goal is to increase website hits or subscribers to your newsletter by a certain percentage, be sure to indicate your baseline measure.

Examples of effective results reporting:

Measurement Results*

How will you measure this tactic?

Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 30%

35%

Measurement Results*

How will you measure this tactic?

Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 30%

20% - Did not meet goal. See question 2 in

Situational

Analysis.

Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 30%

No results available this quarter.

Constant Contact

What data will you use to measure? List of new subscribers

Goal: 10% increase

Baseline: 180 subscribers. We had 20 new subscribers this quarter for an increase of 11%.

Goal exceeded.

Examples of ineffective results reporting, include the following. Be sure that your results map back to what you said you would measure and what data you would use to measure it.

Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 30%

Sent to 385 subscribers. We have seen an increase in subscribers since last quarter.

Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 30%

Our subscriber list has grown substantially since last quarter and subscribers indicate they are very satisfied with content.

Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 30%

Goal met.

Quarterly email sent by QI team.

Topics promote clinical measures and best practices.

Example: Tactical Planning & Evaluation Worksheet

PLANNING EVALUATION

Tactic Audience(s) Aim/Initiative Timeframe Measurement Results*

TACTICS WITH MEASUREMENT RESULTS

E-newsletter ALL ALL Ongoing How will you measure this tactic? Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 30%

35%

TACTICS WITHOUT MEASUREMENT RESULTS

Steering committee meetings

All ICPC, IHPC Ongoing How will you measure this tactic? Event evaluation

What data will you use to measure? Percentage of respondents who indicate they find collaboration beneficial for

No meetings held this quarter due to scheduling conflicts.

improvement activities.

Goal: 80%

NEW TACTICS FOR NEXT QUARTER

Annual LAN event All All November 12-13, 2012

How will you measure this tactic? Event evaluation

What data will you use to measure? Percentage of respondents who indicate they will take action.

Goal: 80%

SITUATIONAL ANALYSIS

Please include narrative responses to all of the questions provided in the situational analysis unless otherwise noted. You only need to complete one situational analysis for each quarterly IISS. Tables have been added to question one regarding stakeholder relationships and question two regarding QIOs’ use of the PDSA cycle.

To complete question one about stakeholder relationships:

1. In the first column, indicate the issue that is affecting your stakeholder relationships.

2. Indicate if the issue has helped or hindered your stakeholder relationships by placing an X in the appropriate column.

3. Provide a brief explanation in the comments/explanation column describing how the issue is affecting your relationships with your stakeholders/partners.

*IMPORTANT: List only THREE issues covering ALL Aims. You are not required to include issues affecting every Aim and sub-Aim. See the example below:

Issue Helped Hindered Comments/Explanation

Turnover X Turnover in participating nursing homes is making it difficult to improve our pressure ulcer rates as new staff need to be trained.

Partnership with state

REC

X The State Hospital Association, which is also the REC for our state, has been a solid partner for us and has helped us greatly in our recruiting effort for the REC LAN.

Competing initiatives X Some of our partners have expressed confusion over where to align resources due to competing initiatives in our state (i.e., HENS, QIO contract, health homes, etc.)

To complete question two about the PDSA cycle:

1. In the first column, briefly explain the problem identified in your PDSA cycle.

2. In the second column, indicate the plan you developed and implemented.

3. In the third column, briefly explain how you executed your plan.

4. Provide a brief explanation in the fourth column about how you reviewed the results of your plan and what you discovered.

5. In the last column, describe how you changed your plan to improve your results.

For the question about stakeholder relationships, should we complete a separate table for each Aim that lists three issues?

o You should only complete one table that lists all three issues. You are not required to complete a table listing issues for every Aim and sub-Aim.

What do you mean by “issues?”

o Issues are policies, organizations, people, etc. that are positively or negatively affecting you or your audiences’ ability to improve or sustain performance.

Do we need to complete a PDSA cycle for each Aim or each tactic that has not been successful?

o You are only required to report on one CRISP activity/tactic representing any Aim.

What will CMS do with my QIO’s IISS?

CMS will review each QIO’s IISS to ensure that it conforms to the requirements of Section C.10.3. of the 10 th

SOW. CMS will also condense all IISS into a roll-up report that will serve several purposes, including: 1) developing a QIO Program-wide CRISP strategy (i.e., the National QIO Program Integrated Innovation Spread

Strategy) that aligns with efforts at the local QIO level; 2) assessing the needs of the QIO Program as a whole for communications support throughout the SOW; 3) sharing trends with CMS Contracting Officer

Representatives, Aim leads, and leadership; and 4) sharing best practices with QIOs to foster inter-QIO learning and development on CRISP.

In the event CMS needs more detail to support the objectives above, requests may be made for additional information.

How will I get feedback about my QIO’s IISS?

You may contact the CRISP GTL, Kelly Anderson, at Kelly.Anderson@cms.hhs.gov or at 410-786-5673 or your Contracting Officer’s Representative (COR) for feedback specific to your IISS submission. You may also participate in the CRISP NCC’s Office Hours which are held on the first Thursday of each month at 2:00 p.m.

Eastern. A summary of all 53 QIO IISS will be presented on a national CRISP teleconference and will be posted on the CRISP section of the Collaboration Tool.

How can I learn more about the IISS deliverable?

The CRISP National Coordinating Center and CMS are available to support you. Please contact your QIO’s

CRISP NCC account manager to learn more. A directory is posted on the Collaboration Tool at:

http://healthcarecommunities.org/Comm_DocsDetails.aspx?id=4294972825. You can also contact the CRISP

GTL, Kelly Anderson, at Kelly.Anderson@cms.hhs.gov or at 410-786-5673.

mailto:Kelly.Anderson@cms.hhs.gov http://healthcarecommunities.org/Comm_DocsDetails.aspx?id=4294972825 mailto:kelly.anderson@cms.hhs.gov

SAMPLE COMPLETED TEMPLATE

AUDIENCE ANALYSIS/Integrated Innovation Spread Strategy

QIO Name, State/Territory: Please remember to include your state/territory here.

Time Period: November 30, 2012 – February 28, 2013

Primary Audience(s)

Aim/Initiative

Preferred Methods of Communication

Influencers (Secondary Audiences)

Current State Future State Messages1 to Move Audience to Future

State

CNAs IIPC/Reduce HAIs (pressure ulcers)

Face-to-face meetings; webinars

DONs, NH administrator

What does your audience know? CNAs know that pressure ulcer prevention is important What is your audience’s attitude toward this project?

CNAs care about their residents and want them to be healthy but some don’t feel there’s time to check for pressure ulcers.

What does your audience believe?

CNAs believe preventing pressure ulcers is important but they have other things to do.

How does your audience behave?

Some CNAs are actively checking resident’s pressure points for ulcers.

Others have not yet

What do you want your audience to know? There are simple steps they can take to prevent pressure ulcers that won’t take too much time.

What attitude do you want your audience to have toward this project? I can prevent pressure ulcers.

What do you want your audience to believe? It’s my duty to help prevent pressures and I can with a few simple steps.

How do you want your audience to behave? Actively check resident’s pressure points for ulcers each day.

Here are three simple steps you can take to prevent pressure ulcers.

When you visit a patient, make it your priority to check their pressure points for ulcers right away.

You are an important part of your resident’s care team. Let them know you care, check for pressure ulcers.

Overarching statements customized for each audience that are easy to understand, respond to an audience’s interests or concerns and empower the audience to act. See the

IISS FAQs for more information.

begun to engage in this behavior.

CNAs IIPC/Reduce HAIs (pressure ulcers)

Face-to-face meetings; webinars;

hard copy newsletters, phone calls

DONs, NH administrator

What does your audience know? CNAs know that pressure ulcer prevention is important What is your audience’s attitude toward this project?

CNAs care about their residents and want them to be healthy but some don’t feel there’s time to check for pressure ulcers.

What does your audience believe?

CNAs believe preventing pressure ulcers is important but they have other things to do.

How does your audience behave?

Some CNAs are actively checking resident’s pressure points for ulcers.

Others have not yet begun to engage in this behavior.

What do you want your audience to know? There are simple steps they can take to prevent pressure ulcers that won’t take too much time.

What attitude do you want your audience to have toward this project? I can prevent pressure ulcers.

What do you want your audience to believe? It’s my duty to help prevent pressures and I can with a few simple steps.

How do you want your audience to behave? Actively check resident’s pressure points for ulcers each day.

Here are three simple steps you can take to prevent pressure ulcers.

Use the PUP Checklist when checking residents for pressure ulcers.

When you visit a patient, make it your priority to check their pressure points for ulcers right away.

You are an important part of your resident’s care team. Let them know you care, check for pressure ulcers.

TACTICAL PLANNING & EVALUATION/Integrated Innovation Spread Strategy

Time Period: November 30, 2012 – February 28, 2013

PLANNING EVALUATION

Tactic Audience(s) Aim/Initiative Timeframe Measurement Results*

TACTICS WITH MEASUREMENT RESULTS

E-newsletter ALL ALL Ongoing How will you measure this tactic? Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 30%

35%

E-newsletter ALL ALL Ongoing How will you measure this tactic?

Constant Contact

What data will you use to measure? Percentage of emails opened

Goal: 35%

35% 28% - did not meet goal. Will monitor and report results and any necessary changes in the next submission.

TACTICS WITHOUT MEASUREMENT RESULTS

Steering committee meetings

All ICPC, IHPC Ongoing How will you measure this tactic?

Event evaluation

What data will you use to measure? Percentage of respondents who indicate they find collaboration beneficial for improvement activities.

No meetings held this quarter due to scheduling conflicts.

NEW TACTICS FOR NEXT QUARTER

Annual LAN event All All November 12-13, 2012 How will you measure this tactic?

Event evaluation

What data will you use to measure? Percentage of respondents who indicate they will take action.

SITUATIONAL ANALYSIS/Integrated Innovation Spread Strategy

Time Period: November 30, 2012 – February 28, 2013

Only one response to each question is required. Responses from every Aim/sub-Aim are NOT required. Information in this section should be different from what you submitted in the previous deliverable.

1) Using the table below, indicate the top THREE issues (political or economic issues, current or proposed policies that may affect your audience, etc.) across ALL AIMs that helped or hindered your stakeholder relationships during the quarter.

Issue Helped Hindered Comments/Explanation

Turnover X Turnover in participating nursing homes is making it difficult to improve our pressure ulcer rates as new staff need to be trained.

Partnership with state REC X The State Hospital Association, which is also the REC for our state, has been a solid partner for us and has helped us greatly in our recruiting effort for the REC LAN.

Competing initiatives X Some of our partners have expressed confusion over where to align resources due to competing initiatives in our state (i.e., HENS, QIO contract, health homes, etc.)

2) Using the table below, choose ONE CRISP activity/tactic and describe how you used measurement and the PDSA cycle to improve its effectiveness this past quarter.

What was the problem you addressed?

What was your plan? What did you do? How did you study the results and what did you find out?

How did you act to make adjustments? (A new “act” stage)

Low open rate for quarterly e-newsletter

Change email sender from QIO to name of the area project manager for the project

For our August newsletter we removed our QIO’s name from the sender field and replaced with [name of project manager]. We also took advantage of the early results feature in Constant Contact to determine early open rates.

We reviewed the open rates from the two previous quarters and compared them to the results following the change.

We noticed a slight increase in the open rate (0.5%). As a next step, we plan to experiment with more engaging subject lines to see if that increases the open rate as well.

3) What’s one thing you learned from something that happened this past quarter that could assist another QIO?

4) Other comments and/or suggestions? (Optional)