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Overview and Objectives

This exercise engages participants in a mock Quality Improvement project, which takes place in a medical practice. Taking on roles of providers and staff within the practice, each group reviews data on its performance in a defined aspect of care (“clinical” or “patient experience”) and then engages in a planning process to determine actions to improve their performance profile.

Objectives

By the end of this session, participants should be able to:

  • Review and describe quality profiles and “report cards” showing performance by the practice and/or individual physicians on defined measures.
  • Discuss how quality and performance data can affect the practice’s finances and marketplace position.
  • Describe strategies and initial steps that can help improve clinical quality and patient experience performance in practice.

Description of the Exercise

In breakout groups of 8-9, participants are told that they work in a clinical group practice. Individuals are assigned roles, including those of physicians, nurses, physician assistants, office manager, and front-desk staff member They receive data showing their group’s performance profile compared to other practices in a specific geographic and clinical area of care.

For its Mini-Rotation, THCI divided residents into three groups. Each group was given data for one of the following three performance profiles:

  1. Adult Diagnostic and Preventive Care (Clinical)
  2. Diabetes Care for Adults (Clinical)
  3. Care from Personal Doctors: How Well Doctors Coordinate Care (Patient Experience)

THCI created the performance profiles by using de-identified, publicly available, practice-specific data reported by the Massachusetts Health Quality Partners’ (MHQP) Healthcare Compass. For example, the area Diabetes Care for Adults is comprised of measures showing the percentages of adult patients with type 1 or type 2 diabetes who, during the past year, had at least one Hemoglobin A1c (HbA1c) blood test, one cholesterol LDL-C screening test, and a microalbuminuria test. The performance profile given to each group includes scores for the group’s practice compared to other local practices and to the state as a whole.

In the information THCI gave to the breakout groups, the practices were identified only as Practice A, B, C to provide anonymity. Each group was assigned one of the three practices; and each underperformed on some measures compared to other practices. These handouts are available for download below.

Educators who wish to set up a similar exercise can also seek performance data from their affiliated hospitals or practices, from a health plan, or from other local quality measurement organizations.

The groups then followed a series of steps:

  • Step 1 (10 minutes) – Review the Performance Profile and associated data for your group.
  • Step 2 (10 minutes) – Consider the causes of performance gaps.
  • Step 3 (25-30 minutes) – Plan a quality improvement strategy using a QI Planning Template provided as a guide, and considering the role of each group member in its execution.
  • Step 4 (5 minute) – Discuss a plan for communication with patients.
  • Step 5 – Reconvene in the main room for each group to summarize its discussion and plan for improvement

See Instructions to Participants, below, for more detail.

Additional information and materials for the Quality Improvement Exercise