How to stage a successful in-house collaborative

Even if you don’t have the slightest chance of getting funds for that off-sight collaborative, don’t dismiss the idea out of hand. You could adapt elements of it to your own in-house collaborative.

Two years ago, the Rochester, MN-based Mayo Clinic health care system tried its first internal collaborative. Today, it runs several at once. It’s such a powerful tool for Mayo’s geographically dispersed system that it can’t afford not to, say the Mayo program’s champions, Jill Swanson, MD, a community pediatric and adolescent medicine practitioner, and Gene Dankbar, continuous improvement coordinator.

The current model runs on a streamlined cycle of six to nine months, compared to the original 12 to 14. Throughout the collaborative, teams from various facilities convene for seven to 10 topic sessions. Agendas for these one-day events include skill building on the PDSA (plan, do, study, act) process for rapid change, and techniques for overcoming barriers to change.

Participants learn from content consultants and through shared insights with their peers. "We hold topic sessions more often in the early months of the collaborative," Swanson explains, "because so many of the rapid change concepts are counterintuitive. We like to front-load people with the information. It helps them get over the idea that they have to study something forever before they act. We stress that they can try something for a short time, then do something different if it doesn’t work. It improves the sense of individual control when teams understand that they can try changes on a small scale and that they aren’t locked in to one way of doing something."

To assure productive topic sessions, facilitators distribute agendas, data, and background information prior to each meeting. They also schedule work periods into the day since it’s difficult for teams to meet during their regular office shifts. "We’ve been overwhelmed by the rate of attendance at the topic sessions," Swanson notes.

When teams go home to the cold realities of inertia and the conflicting demands of running the office while changing processes on the fly, they have technical assistance and moral support at their fingertips:

• An electronic listserv gives participants a forum for questions and answers as well as reminders of upcoming events and a mechanism for information storage.

For maximum benefit: Familiarize all participants with listserv use.

• Telephone conference calls keep the teams engaged between topic sessions.

For maximum benefit: Review conference call procedures including etiquette for the facilitator and pre-tests to make sure that the equipment works.

• Monthly team reports and feedback letters to the teams maintain the momentum.

For maximum benefit: Mention each success no matter how tiny. Interject a conversational tone, and keep the reports short. Wherever possible, illustrate points with simple graphs, charts, and bulleted lists.

• On-site faculty visits give teams the opportunity to work on unique challenges in their offices.

For maximum benefit: Be sure to visit the newcomers to the system. Like many other health systems, Mayo grew from a nucleus of one hospital and outpatient facility to encompass hospitals and clinics in several Midwestern states. Site visits can be like a warm welcome, easing the blend of diverse organizational cultures.