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NQC e-Newsletter |  Your expert guide to resources and technical assistance focusing on improving HIV care.




As we head into Fall, I am pleased to report to you that NQC recently conducted a second face-to-face learning session for the H4C Collaborative. As you can see in our update, this Collaborative, which involves Ryan White grantees from Arkansas, Mississippi, Missouri, New Jersey, and Ohio, has established action plans for improving their viral load suppression rates and is thinking about this important measure on a state-wide level. It is gratifying to see the work of all the participants and NQC is pleased to be leading this national improvement effort.


And don't forget that NQC is hosting our next Training-of-Trainers session in November (Nov 11-13, 2014). There is strong interest in this session so for all you that want to build your training skills, please sign up quickly. The link to the training application is in this newsletter. 



Clemens Steinbock

Director, National Quality Center


> In This Issue

> NQC Job Forum | Check it Out!


> NQC News | HIV Cross-Part Care Continuum Collaborative Update


The HIV Cross-Part Care Continuum Collaborative (H4C) initiative convened its second learning session in August. Participants from Ohio, New Jersey, Missouri, Mississippi, and Arkansas gathered to share the progress they have made since the inaugural learning session and to create and implement action plans to work in their communities over the coming months.


A primary focus of the learning session was the new Impact Cohort, which is being established through the collaborative. The Impact Cohort is intended to propel improvement that leads to higher levels of HIV viral suppression among patients at participating organizations. Overall, the goal is to see at least a 20 percent improvement in viral suppression rates across the five states, in alignment with the National HIV/AIDS Strategy, which amounts to about 1,100 lives. The cohort concept was designed by collaborative faculty made up of HAB and NQC staff, and feedback was collected from representatives of each state.


As H4C moves into learning session three, the focus will shift increasingly from performance measurement to quality improvement cycles. The upcoming learning session will bring the states back together to work on specific strategies to put in place to improve HIV viral suppression in their communities.


Contact Michael Hager at Michael@NationalQualityCenter.org for more information on the HIV Cross-Parts Care Continuum Collaborative.                    


> Provider Corner | Heartland CARES (Paducah, KY)


Staff turnover not only results in new faces around an organization, but it can also bring in new ideas and approaches. In the past two years, Heartland CARES in Paducah, Kentucky has brought on a new executive director, Andrew Halford, and a CQI Coordinator, Ashley Horn. Andrew and Ashley have worked to revamp the organization's quality improvement efforts.


Heartland CARES provides primary care, social services (medical case management), mental health support, nutrition programs, and housing support to approximately 400 consumers. It serves 26 counties in the Purchase, Pennyrile and Barren River districts of Western Kentucky as well as 17 counties in Southern Illinois. The organization receives both Part B and C funding as well as support from other sources. Like in many rural areas, HIV-related stigma is a significant barrier to entry to and retention in care.


The organization has taken an interdisciplinary approach to quality improvement. The CQI committee, which meets on a monthly basis, is made up of representatives from each department - primary care, mental health, nutrition, case management, and housing. It also includes two consumers. The committee is responsible for identifying performance goals, monitoring HAB performance measures, and looking at the organization's challenges at a systemic level.


"Discussing the challenges we are facing is the best part of the meetings," says Ashley. "Each member brings a different perspective to the table and it gives us a more complete view of what is happening within our organization."


In addition to revamping the CQI committee, Heartland CARES has also revised processes for obtaining consumer input. Previously, the consumer satisfaction survey was 6-8 pages long and participation was low. The survey was revised and it is now 2 pages long. All the questions are tied to performance measures so the data collected are used to track the organization's performance over time. Measures address issues such as satisfaction with provider interactions (e.g., do they listen to and answer questions?), wait times (for appointments, lab results, etc.), and whether services are meeting consumers' needs.


"We might think we are doing a great job but if consumers do not think so we need to find out why," says Ashley.


In addition to the consumer satisfaction survey, the mental health specialist has developed a short (5-10 minute) screening tool. The screening tool is used to assess the various indicators of mental health well-being. Well-being can have a significant impact on retention in care and adherence to treatment so it is important to provide such screenings so that the treatment team can take the results into consideration.


Heartland CARES has also made an effort to more effectively use data they are collecting for quality improvement.


"When we run a report we are looking at the numbers. The CQI committee is digging deeper to find out the whole story," says Ashley. "Based on what the data tell us, we look at how we can address issues within our system."


Heartland CARES has been active in the NQC-sponsored Kentucky Regional Group. They have hosted conference calls and in-person meetings.


"You get to hear from others who may not be facing exactly the same challenges but they have responses that can be modified to your circumstances," says Ashley. "We have also been exposed to so many NQC tools and resources that we can use. These tools really empower us to do a better job."


While linkage to care and retention are goals of Heartland CARES, this task has gotten more difficult in recent years. As with many organizations in rural, lower incidence areas, Heartland CARES has lost funding for conducting outreach and HIV testing. This makes it difficult to reach out to high-risk population. There are two universities and three community colleges in Heartland CARES' service area.


"These young people lack an understanding of the disease," says Andrew. "There is huge need in this area but we do not have the resources to focus on reaching out and educating this population."


> NQC Offering | Upcoming TOT: November 11-13 in Las Vegas, Nevada


In November, NQC will hold a Training of Trainers (TOT) in Las Vegas, Nevada. Participants are expected to take what they learn and further spread quality management concepts within their organizations and communities. Sign up now to take part in this opportunity to build your training skills.


The overarching goals of the TOT Program include:

  • Enlarge the pool of qualified trainers on quality improvement in HIV care across the country;

  • Further spread quality management concepts by increasing the number of training opportunities for Ryan White grantees;

  • Increase the ability of NQC to refer requests for QI training to regional TOT trainers; and

  • Build capacity in Ryan White funded programs on quality improvement.


The TOT Program is designed for individuals with a strong experiential background in quality management and provides participants exposure to adult learning theories and available training resources so that they can assume the role as trainer in their organizations and communities. TOT participants learn how to plan engaging and effective workshops. They are also linked to quality improvement experts and peers facing similar challenges.


Before attending the rigorous face-to-face TOT session, participants are asked to complete "prework." This includes online learning, readings of quality publications, and participation in two conference calls.


Since the purpose of the TOT Program is capacity building, participants are asked to lead at least three trainings within 120 days of completing the session. This helps participants reinforce the knowledge they gained at the TOT as well as expanding the opportunities for providers of clinical and non-clinical services to gain quality management knowledge and expertise.


For more information | nationalqualitycenter.org/index.cfm/17290 


> NQC e-Newsletter | Volume 7 | Issue 73 | Oct. '14


Quick Links


> Upcoming Events

> Upcoming Events | Sept. - Oct.


October 16 | National TA Call | The Right Tool for the Job - Using QI Tools

November 11 - 13 | NQC Training-of-Trainers Program

November 20 | Top Ten Reasons Why Your PDSA Cycles Fail and What to Do About It


National Quality Center

New York State Department of Health

AIDS Institute

90 Church Street, 13th floor

New York, NY 10007-2919

Phone | 212.417.4730

Fax | 212.417.4684

Email | Info@NationalQualityCenter.org 


Sharing, Training, Consulting.

Improving HIV Care.


> Consumer Perspective | Katrina Barnes


"It is not just what you say, but how you say it." This old saying resonates with Katrina Barnes. As she starts a new job as a peer navigator with the Dekalb County Board of Health in Georgia, Katrina will be keeping in mind the importance of effectively communicating with the target audience.


Prior to becoming a peer navigator, Katrina served as a peer advocate. In this part-time position, Katrina worked with newly diagnosed individuals, with a focus on African American men who have sex with men, transgender individuals, and refugees. The refugees are primarily from Africa and speak various languages. Many have a very limited understanding English. "It can be heart breaking to not speak their language," says Katrina. "It takes so much effort to try to communicate and you know that you are not truly answering their questions. I wish I could speak their language."


The new peer navigator position is part of a pilot project - Katrina is one of five navigators that will be following consumers over a 6-month period to ensure that they are linked to and remain in care. The navigators will work with consumers - on their request - to help them through the system and help them identify and overcome their own personal barriers to care. While interaction will be at a regular basis, depending on the consumer's needs, it may be more frequent as needed. Check-ins with consumers will occur at 3-month intervals.


Based on her own experience and her work, Katrina knows that it is important to have a peer available to people when they are newly diagnosed. "No one wants to talk about HIV until it hits them," says Katrina. "They still have the shock factor and cannot hear anything anyone is telling them. This is where the voice of someone who has lived though it is so important."


Katrina models her interactions with the newly diagnosed on her own experience. As she interacts with consumers, knowing that she has been though a similar experience helps to create a bond and build trust. It also serves to help establish Katrina as the voice of experience and provides confidence to other consumers that remaining in treatment is the best choice.


Katrina participated in the NQC's Training of Consumers on Quality in Atlanta, Georgia in spring 2013. One of Katrina's take away messages was that you can make a difference in a variety of ways. Katrina has been active in speaking with State senators in Atlanta, Georgia about the impact of the Affordable Care Act on people living with HIV.


"I learned that I can tell things in my own voice and in ways that reflect my own personality," says Katrina. "I don't have to be an angry agitator to effectively convey a message. There are other ways."


In all her work, Katrina keeps in mind her own personal journey and her work to help other people living with HIV.


"No one wants to talk about HIV until it hits them or affects someone they know," says Katrina. "If I can work with them though this transition and help them embrace treatment I can make a difference. Treatment is what people need. Treatment is prevention."


As Katrina says, "People with HIV need to talk about and dispel fears since no one else is going to talk about it. Young people who are newly diagnosed see things differently from those who were diagnosed five or 10 years ago. They know they are going to live but just need to know how they are going to live. They need to know the steps of their journey."


> Quality Tip of the Month | PDSA Cycle (Part 1) - Take AIM


One of the most important parts of any PDSA Cycle is the initial planning phase. Many of you have heard of the Aim statement in PDSA Cycles. Simply put, the Aim is what it is you want to accomplish with your change activity. Your Aim statement should state your broad goal, be time specific, and be measureable. Without this basic foundation, your project runs the risk of losing its intended focus and worse - failure. This simple question may generate hours of discussion but in the end, it will lead to a clear focus for your improvement efforts and greatly increase your chance of success.


Remember, involve key stakeholders in your discussions as well. The more input into shaping your aim, the more likely that the stakeholders will "buy-in" and be enthusiastic about your quality improvement project.


Check out this NQC resource on PDSA Cycles:


Quality Academy: Tutorial 13, The PDSA Cycle or How Can We Accelerate Improvements in HIV Care?

This tutorial focuses on the PDSA Cycle: what it is, how it fits into the Model for Improvement, why it is important, and how to use the PDSA Cycle in HIV programs. The module provides numerous examples and tips for success to help people avoid pitfalls and easily integrate this model in their quality improvement activities.



> National TA Call | The Right Tool for the Job


Our webinar this month will focus on the use of quality improvement (QI) tools as a means of understanding where breakdowns in processes occur, fostering ideas from staff, and examining all the elements that comprise a process.


By using QI tools, you are giving yourself a much better chance of your PDSA Cycle succeeding and creating an environment of inclusion with your staff.


Next month NQC will present a National TA Webinar on PDSA Cycles and examine the top 10 reasons why PDSA Cycles fail - and how to fix them.This month our webinar sets the stage for that call by going back to the basic step of fully understanding what the problem is you want to solve.


Our learning objectives are:

  • Providing a better understanding of flow charting, brainstorming and Ishikawa Diagrams

  • Practical application of QI tools

  • How they inform the development of Aim statements and efficient PDSA Cycles 

"We cannot solve our problems with the same level of thinking that created them"  (Albert Einstein)


For more information | nationalqualitycenter.org/index.cfm/17403 

NQC Job Forum| Check it Out! 


Just a reminder that NQC has a Job Forum section on our website. The Job Forum lists quality improvement related positions from Ryan White Program grantees.  Currently, there are two postings for your review. 

NQC encourages you to send us your posting for review and placement in the Job Forum.  And of course, this service is of no cost to Ryan White Grantees. 

> About Us


We provide no-cost, state-of-the-art technical assistance to all Ryan White Program-funded grantees to improve the quality of HIV care nationwide.  


Send questions, comments, or suggestions | newsdirector@NationalQualityCenter.org  


This e-Newsletter is produced by the National Quality Center, a quality improvement initiative funded through a cooperative agreement with the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau. For more information | NationalQualityCenter.org  


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