Learning Session One

Learning session #1 brings the clinical teams and faculty together for the first time. The event is typically two days, and this is what we recommend.  Some collaboratives have been successful with 1 ½ day opening sessions, but in our experience, one-day sessions don't work. This two-day event is an intense experience and includes an introduction to the Chronic Care Model, the Model for Improvement, and clinical change concepts. Learning sessions are not traditional educational events. They are interactive and include time for teams to work together and plan ahead.

Sponsors have a number of tasks to complete prior to the beginning of the learning session, including setting the agenda, scheduling action-period conference calls and acquiring faculty disclosure of any financial or other interests relevant to the collaborative topic.

Learning Session #1 places particular emphasis on four of the six Chronic Care Model (CCM) elements: Self-Management Support, Delivery System Design, Decision Support and Clinical Information Systems. These elements are clarified through presentations and breakout sessions. "Change Concepts" break down specific goals under each element for improving care.

Teams meanwhile meet to complete plans for improving care within their organizations and prepare for "plan-do-study-act" cycles in their first action period. Teams and the collaborative itself are subject to regular evaluation throughout the learning session.

Learning Session #1 Tools

Learning Session #1 Overview

This is a descriptive overview of Learning Session #1. The objectives that must be met during the learning session are included.

Learning Session #1 Task List

This task list breaks down the steps for preparing Learning Session #1 materials, gathering fees and handling other logistics, as well as setting an agenda and conducting plenary and breakout sessions.

Faculty Meeting Agendas for Learning Session #1

Faculty meetings for Learning Session #1 are usually scheduled immediately prior to the start of the learning session and at about the halfway point. The purpose of faculty meetings is: to orient faculty to the learning session objectives and agenda; to problem-solve any issues; and to identify teams that may need specific faculty interventions.

Learning Session #1 Agenda and Annotated Agenda

The following sample agenda is included in participants' materials. The agenda has been used in many collaboratives and changes should be carefully considered, as some sessions have a natural order. Shortening learning sessions has been attempted.

The annotated agenda provides additional information to the faculty on specifically how to run the learning session.

Team Grid: Learning Session #1

The completion of Learning Session #1 activities by each team indicates early adoption by team members of collaborative Models. The grid assists faculty in tracking learning session activities completed by each team. It is used during Learning Session #1 to support teams and guide faculty interventions.

Conference Call Sample Schedule

Collaborative faculty and team leaders hold a conference call each month during action periods to discuss general topics and assess the progress of teams’ efforts. These calls should be scheduled in advance of Learning Session #1 so they can be announced during the session itself. The Conference Call Sample Schedule will assist sponsors in scheduling Action Period #1 conference calls and designating appropriate faculty and topics. It is best to have a toll-free number for dialing in.

Faculty Disclosure Form

Collaborative faculty members must disclose significant financial interests or other relationships related to collaborative topics. Such interests include grant or research support, or participation in commercial ventures. These do not necessarily disqualify a faculty member, but they must be disclosed to participants in the interest of objectivity. Faculty members must sign a disclosure form for each learning session. The sponsor should keep the form on file.

Presentations and Breakout Sessions 

An ICIC faculty person opens the learning session with a presentation of the Chronic Care Model, including its development, a description of the six components of the Model, and the use of the CCM in managing chronic disease.  The following downloadable presentation template gives the presenter all possible information needed to do the talk: it can be used as-is or edited.  The same is true for the component presentations listed below. 
Learning Session #1 provides presentations and breakout sessions on four of the six CCM elements: Self-Management Support, Decision Support, Delivery System Design and Clinical Information Systems.  

There is also a Clinical Plenary Session addressing specific conditions and organizational obstacles to delivery of the best care. This session highlights condition-specific change concepts, specific goals for achieving improvement under each Chronic Care Model element. Supporting evidence for the Chronic Care Model, as well as practices associated with specific conditions, can be found in ICIC’s extensive bibliographies.

Clinical Plenary Session

The chair of the collaborative presents with practical, evidence-based clinical information on the current management of the condition. This is the most traditional presentation of the collaborative, similar to continuing medical education, but here the emphasis is mainly on how system change can enhance delivery of the right care. The clinical plenary session should complement information presented in the change concepts overview.

Change Concepts

Change concepts are specific principles that promote the six elements of the Chronic Care Model. Collaborative teams use these concepts to guide the progress of their system change efforts. When focusing on decision support, for example, a team might examine how to integrate specialist expertise with primary care, or how to embed evidence-based guidelines within daily clinical practice.

Change concepts are sometimes included in the pre-work packet, but must also appear in materials for Learning Session #1 and be emphasized throughout the collaborative. Collaboratives can revise the condition-specific concepts with faculty. If the team is working with ICIC staff, assistance is available for presenting the change concepts.

One way to present the change concepts is by providing a Change Package that helps the participants see the Model from different perspectives: as a one-page diagram; as a one-page high level overview; and as a detailed table demonstrating how a concept moves from vague to specific across the table (from left to right). If you choose to use a table like this, the participants will pay very close attention to the examples. Please ensure that the examples are appropriate to your collaborative, and contain references to tools that you can provide.  Check to make sure examples conform with current evidence-based guidelines for care.
Additional, condition-specific change packets are available from the Bureau of Primary Care’s “Health Disparities Collaboratives”

Self-management Support Presentation 

This presentation should reemphasize the basics of self-management support under the CCM -- working with the patient to establish a treatment plan and encouraging a more collaborative approach between patients and caregivers. The Self-management Support Presentation template can be used to prepare this presentation.

Learning Session #1 - Decision Support

Decision support is explored in one of the breakout sessions. The bulk of the session addresses how to evaluate guidelines. The session also provides resources on evidence-based Web sites and guideline sources.  See also "Evidence-Based Web Sites" at the bottom of this page. 
Another useful website for evaluating guidelines is found at the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration Web site

Learning Session #1 - Delivery System Design 

Much of the system redesign work falls under this component of the model.  Specific redesign changes are listed below this section.  You can download the Delivery System Redesign presentation.

Learning Session #1 - Roles for Delivery System Design 

 The generic "team role design grid" can help team members determine which staff members are best suited to handle certain tasks.  The downloadable grid allows you to lay out all the tasks in a given care process and assign staff to the tasks.

Learning Session #1 - Planned Care Visit Presentation

Planned visits are the cornerstone of care for people with chronic conditions. This Power Point presentation covers the basics of planned care and is often used in conjunction with "The Planned Care Visit" video, available from ICIC.

The 34-minute presentation takes viewers on a planned care visit in a typical office setting, realistically demonstrating how health care teams implement innovations in care for people who live with chronic illnesses. The presentation is based on the elements of the CCM and includes helpful information on the patient's experience, a behind-the-scenes look at provider team planning and care, and an in-depth self-management interview.
There are no VHS or DVD versions of the Planned Care series available and we are not creating additional copies.  Please watch the Planned Care series on our website. 

Learning Session #1 – Innovations in Delivery System Design 

For collaboratives on diabetes and chronic heart failure, there are condition-specific intervention descriptions below based on Chronic Care Model.  They include Chronic Care Clinics, other clinic-based interventions as well as home-based interventions.

Learning Session #1 - Clinical Information Systems

A final breakout sessions deals with Clinical Information Systems, specifically designed for patient registries outlining recommended care for certain conditions.  A related presentation is offered below.   Registries are an evolving technology that allows the practice team to do population-based care.  Electronic Health Records have been evolving in a parallel timeframe but not all EHRs have registry functionality.  It is imperative that this functionality be part of whatever IT system you choose. 
Below are documents that guide you in building your own registry. The general registry describes the purpose and use of registries. The condition-specific registries identify algorithms for diabetes, chronic heart failure, depression and asthma. Under each specific condition, there are also flow-sheets for care and chart abstraction tools.

Improvement Talk Template

The Improvement Leader will be trained to present the Model for Improvement at IHI’s Breakthrough Series College. Templates for the entire improvement presentations are provided to college graduates. These slides can be used as examples to supplement the Improvement Talks presented at Learning Session #1.
Examples of PDSA cycles used in the presentations "Model for Improvement" and "Accelerating Improvement" should be specific to the collaborative's chronic disease emphasis. "Accelerating Improvement" focuses on frequent testing of changes and rapid PDSA cycles to achieve more rapid improvement in measures. In the "Measurement and Reporting" presentation, the Monthly Report Template should be thoroughly discussed.

Team Meetings

During their first meeting, teams detail their plans for system change during Action Period #1. They outline general goals, select populations and choose specific measures to implement. Teams must also assess each member’s ability to undertake implementing system change as well as determine what other resources should be tapped. With assistance from the faculty, team members work together to complete the First Team Meeting Worksheet. Special attention should be paid to the "aims" and "measures" sections.
Once they have agreed on a general plan, the team meets a second time to discuss specific changes for various elements of the Chronic Care Model. CCM elements emphasized in Learning Session #1 are Clinical Information Systems, Delivery System Design, Decision Support and Self-management Support.

The intent of the Second Meeting Worksheet is to help teams plan their "plan-do-study-act" (PDSA) cycles for Action Period #1. The team should complete one worksheet for each of these model elements. The faculty should circulate around the room as the team works on the worksheet to offer assistance.

Reporting Templates

The following templates can be used to help standardize care for specifiic clinical changes (i.e., annual foot exams for patients with diabetes), increase staff involvement in more aspects of patient care, and create a more cohesive team.

PDSA Worksheet

The PDSA worksheet is used by the teams while they are learning the steps of the PDSA cycles. Numerous steps make up a process; small changes in each step can be tested to determine if the change improves the process. Collaborative teams accelerate change in their organizations by using the PDSA cycle to test the small changes. For each change that is tested, the team proposes a plan, listing expected outcomes of the change and methods for measuring the outcomes. The do what they have proposed, and they study the outcomes to determine if the outcomes met the expectation for the change. Finally, they act on their conclusions by either retesting the change or moving on to test another change in the next step of the process. Teams can use this worksheet to structure the PDSA cycles tested in Action Period #1. The worksheet is linked to the talk, "Accelerating Improvement", given on the second day of Learning Session #1.


Plan-Do-Study-Act Self-Management Support Examples

Good examples can help make presentations more understandable. These slides are used during the second improvement advisor talk on "Accelerating Improvement". They are from the Catahoula Parish Community Health Center and describe their tests and implementation of self-management goal setting, as well as the results they achieved in process measures.

The Chronic Care Model Bibliography

Supporting evidence for the Chronic Care Model can be found in ICIC’s extensive bibliographies and databases. The bibliographies reflect current evidence for each model element, as well as care for specific conditions. Materials for Learning Session #1 should include the model bibliography, as well as bibliographies on any specific conditions addressed in the collaborative.

Team Assessment Scale

Team progress, as well as the collaborative itself, is subject to regular evaluation.
The collaborative director and technical expert assess the progress of collaborative teams monthly by scoring them on a scale of one to five. A score of one signifies simply that a plan has been agreed upon and a score of five indicates that all goals have been met and the best-known care is being provided. At a minimum, teams should strive to reach level "four," which indicates the team has met at least half its goals and is well on the way to implementing the Chronic Care Model’s essential elements.

Learning Session #1 Evaluation

Evaluations are completed by participants at the end of each learning session and are used to improve future learning sessions as well as future collaboratives. Each faculty member receives a general summary of the evaluations, along with any specific comments about their performance. This sample evaluation is edited to mirror your agenda.

Evidence-based Web Sites

Additionally, there are several great sites created by professionals interested in evidence-based medicine.  These sites can help you learn how to read studies, grade evidence, develop and/or evaluate guidelines.  Note: most of these are not US sites.