September 2014 was a time of change for the Tennessee Regional Group. Formed in 2013 as the Nashville Regional Group, membership was expanded last September. Shelby County (Memphis area) Part A, C and D grantees joined the Nashville Part A, C and D grantees and the Tennessee Department of Health Part B.At the same time, the group was embarking on its first formal, shared quality improvement project. A priority for group members was to improve outcomes related to the HIV Care Continuum. As a group they decided to focus on viral suppression.
NQC coach Dan Sendzik helped the group work through a structured process based on PDSA -Plan, Do, Study, Act-Cycles. Each provider used their data to identify a baseline, set a goal, and conducted their own PDSAs, based on their needs.
"We asked members to do a problem analysis with their own team, come up with a strategy, and report their activities to the group," says Dan. "They came back with a broad spectrum of responses."
"The NQC helped members refine what they were going to study and come up with specific, measureable items," says Michael Rickles, a research analyst for Nashville's Part A Program. "Everyone wanted to run with lots of ideas. We talked them down to doing something that was measureable-where their results could be linked to one specific action."
During the early days of the Regional Group there may have been reluctance to share data and challenges, but as they stepped through the joint QI project, members quickly developed trust and became comfortable presenting their problem analyses and results.
"We emphasized that the process was not about competition between providers," says Michael. "It is about sharing and helping, not judging and grading."
NQC played a critical role in building trust across group members, sending the key message that the process is about doing better.
"It was critical to have a non-biased partner that could lead us through the process," says Jennifer Pepper, Ryan White HIV/AIDS Program Program Administrator for Shelby County. "Dan worked directly with some providers to set their goals. It was a very different dynamic than if it had come from us as the Part A grantee."
To facilitate the process, NQC developed a tool that walked providers through the PDSA Cycle. It identifies the specific steps and provides concrete examples. The providers used the tool to record their steps and findings and report back to the larger group.
"Often we assume that people know the methodology," says Dan. "For people who do not do it every day, the tool really helped."
Dan also emphasized to participants that it is okay to modify the intervention during the project-that is one of the principle tenants of the PDSA Cycle. You measure, look at your result and make adjustments where necessary.
"We let them know that they don't have to hit the mark the first time," says Dan. "We encouraged people to make modifications. This is a vibrant and living process."
While the sharing of different approaches in and of itself was valuable, the quality improvement project also yielded results. By March 2015, three of the five members reported increases in their viral suppression rates ranging from 4 to 15 percent. By June 2015, four members had seen an increase over baseline ranging from 3 to 15 percent.
