Bright Futures WebinarSharing Learnings from Our Pilots

Provide an overview of the learnings from our Bright Futures Pilot countiesShare tools and resources for local implementationReview next steps for other agencies beginning implementation

Objectives

Buncombe

Anson

Ashe

Beaufort

Bertie

Bladen

Brunswick

Burke

Caldwell

Carteret

Caswell

CatawbaChatham

CherokeeClay

Columbus

Dare

Davie

Duplin

ForsythFranklin

Gaston

Gates

Graham

Greene

Guilford

Halifax

Harnett

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

McDowell

Macon

MadisonMartin

Moore

Nash

NewHanover

Northampton

Onslow

Orange

Pamlico

Pender

Person

Pitt

Polk

Randolph

Robeson

Rockingham

Rowan

Rutherford

SampsonScotland

Stanly

StokesSurry

Swain

Transylvania

Tyrrell

Union

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

Yancey

Chowan

Pasquotank

Perquimans

CamdenCurrituck

MontgomeryHenderson

GranvilleVance

Durham

Mecklenburg

LincolnCabarrus

RichmondCumberland

Alexander

Craven

Haywood

Alleghany

Mitchell Avery

Cleveland

Alamance

DavidsonEdgecombe

Greene

2

1

3 5

6

4

BertieDavie

1 Linda Harrison

2 Malyn Pratt

3 Melody McCune

4 Jean Vukoson

5 Lynette Robinson

6 Stephanie Fisher

Bright Futures Pilots

See Pilots Contact List for localagency contacts.

EHR Counties

Multidisciplinary team approach

How did we approach change?

Wilson Implementation Team

Pilots used the Value Stream Map & lean thinking to understand their “current state”in workflow processes

Identify waits and duplication (wastes)Clarify what happens at each stepHighlight PDSA ideas

How did we approach change?

Wilkes County: pink stickies = wait or waste

Wilkes PDSA Ideas

RN required tasks vs. CHA tasks

Wilkes County PDSA Ideas

Rockingham vsm

HHenderson Current State

Henderson Future State

PDSA ideas

Rockingham VSM from Regional Meeting

Rockingham Team VSM

Wilson Current State VSM

Wilson Futures State VSM

PDSA Wilkes

PDSA Rockingham

Percentages? TPR?

PDSA ALL:Where do we update

Changes in FH or PH?

A QI approach makes a big difference!“Doing the same thing as you have always done it will produce the same results.”“Trials helped engage staff in the process and

remove assumptions and “that won’t work attitudes.”

“The process forced us to think differently regarding staff roles.”

“Sharing data regarding improvements will support ongoing changes.”

What have we learned?

Nothing is perfect. Bright Futures meets a broad set of criteria but PDSAs revealed need for tweaking.There is no one right way to do this!

Who does what will vary agency to agency based on staffingSteps will vary: lab prior to provider or after providerTechnical support vs. hardcopy decision tools varies

What have we learned?

CHA Completes

Wilkes County

MD or NP Completes

Support RN completes

ERN or NP completes

Wilson County

What changes were made that resulted in improvements?

Reduced Lead TimeReduced waits between stepsEliminated bottlenecksRemoved stepsEliminate duplication in process & documentation

What changes were made that resulted in improvements?

Reduced Lead TimeEngage clients in providing information/completing forms where possibleUse interpreter to assist with history and pre-visit assessments (instead of RN & interpreter)

What changes were made that resulted in improvements?

Move to documentation by exceptionERNs become comfortable with less documentation: Training requirements vs.. practiceBF forms provide flexibility to support UAP completion

Yes No Don’t know or Unsure

CHA or Interpretercan assist with Y/N/Unsure

Or c

heck

box

es

ERN Practice

No need to SOAP each issue if it can be documented in this space

Targeted Guidance

Use Health Literacy strategies

What changes were made that resulted in improvements?

Policies & Procedures to support documentation of only positive findings or risk will be requiredDevelopment of EHR screens are moving to similar formats

History: Yes No Unanswered Physical: Not checked Not done

What changes were made that resulted in improvements?

Optimize staff to highest level of performance for education & licensure

Training & competency testing for UAPRN assessment, education, & program & population managementERNs as “providers”

What changes were made that resulted in improvements?

Developed technical supportsElectronic files for age specific forms including developmental forms

Henderson County translated the Initial History to Spanish/English

What changes were made that resulted in improvements?

Teach & empower staff Provide continuous feedback & ideas for improvement huddlesCreate lean “pull” systems if there is an beaver dam in lab, reroute patient to provider

What changes were made that resulted in improvements?

Reorganized or repurposed space to limit transportation and motion of staff & clients

Eye charts or VS in all exam roomsLabs in exam roomsCreate more than one space for tasks

Patient & Staff Satisfaction after implementation not yet available

“You mean I can leave now, we’re finished?”“The forms were easy to finish”“I like the new forms, this is taking less time!”

What was the response from staff & clients?

Ongoing monitoring of engagement of patients and families

During the past 12 months, how would you rate your satisfaction with the way your provider helps you feel like a partner in your child’s care?

How will we know we are moving toward our goal of improved child health?

Work with AAP to support licensure for EHR and HIS CWS development

BFTRK license covers 3 CH providers for hardcopy and electronic useRowan ready to move ahead with M & MCHA will “go live” with Netsmart product July 6Work on CWS begins this monthRCHNC & Jean will soon visit agencies who are currently using an EHR to format plans

Bright Futures Updates

Webinars in developmentHow to for HEADSSSCoding for additional screening tests such as HEADSSS, PSC and CRAFFT

Bright Futures added to this cohort of CHNT programNew Bright Futures Nutrition Manual is out

Bright Futures Updates

Regional Meeting dates set!Region 1: September 14Region 2: September 15Region 3: September 26Region 4: September 12Region 5: September 28Region 6: September 29

Same locations as Spring Meetings

Bright Futures Updates

Keep checking for new offerings

http://childrenyouth.brightfutureswebinar.sgizmo.com/s3/

We have a busy summer ahead!Most agencies want to implement in the next 4 months to take advantage of slower days of summerRCHNC are busy scheduling TA and resources to assist youWe have in place tools to monitor statewide starts and completions

Moving from Pilots to statewide implementation

Contact your RCHNC to develop an individual plan for JIT training and support for your agency & agree on an implementation monthYour RCHNC will provide you will archived QI trainings, tools, and the BFTRKCollect your baseline dataConvene your teamBegin your tests of change

Next Steps for You

Once you have implemented the full BFTRK for at least 1 month, collect your post implementation data and share it with your RCHNCCelebrate! Share your learnings and success with your clients, leadership team and BOH

Next Steps for You

Your RCHNC & Pilot colleagues QI webinars:

What is QI?Value Stream mapping

Data collection tools:Patient & client satisfaction surveysLead and cycle time tools

Project tracking tool: NewspaperUAP Competency Sheets (Rockingham Co)

Resources

Return to the Bright Futures Training Page & scroll down to the June 8 WebinarUse the link to complete the evaluationThen complete and print your certificateIf you have problems, please contact Elizabeth Mizelle at elizabeth.mizell@dhhs.nc.gov

Continuing Education

Please type your questionsin the Question Chat Box;we will answer as many as

possible in the webinar and theremaining will be posted on the

Bright Futures website.