Designing a large-scale multilevel improvement initiative: The improving performance in practice program *

Abstract

Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and preventive services using a common approach across specialties. The long-term goal of IPIP is to create an ongoing, sustained system across multiple levels of the health care system to accelerate improvement. IPIP core program components include alignment of leadership and leadership accountability, promotion of partnerships to promote health care quality, development of attractive incentives and motivators, regular measurement and transparent sharing of performance data, participation in organized quality improvement efforts using a standardized model, development of enduring collaborative improvement networks, and practice-level support. A prototype of the program was tested in 2 states from March 2006 to February 2008. In 2008, IPIP began to spread to 5 additional states. IPIP uses the leadership of the medical profession to align efforts to achieve large-scale change and to catalyze the development of an infrastructure capable of testing, evaluating, and disseminating effective approaches directly into practice.

A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ’s EvidenceNow initiative

“…The intervention for participating practices began in January 2016 and ended in November 2017. It consisted of provision of “1 to 1” practice coaching to implement quality improvement strategies including rapid cycle techniques 5 , 6 . Practices also received access to a CVD population management dashboard designed specifically for their practice from the HHN registry.…”

More Extensive Implementation of the Chronic Care Model is Associated with Better Lipid Control in Diabetes

“…9,10 IPIP combines 2 improvement designs: a “1-to-many” or collaborative design 17 and a “1 to 1” practice coaching model design. 6 By participating in IPIP, primary care providers and staff are introduced to QI methods with the help of an onsite QI practice coach. The practice team learns how to implement and monitor their QI efforts and participates in learning networks with peer organizations that share practice improvement strategies.…”

“…After evaluating experiences over the first year, the national team, in collaboration with state-level IPIP stakeholders and international experts in systems improvement, agreed that a more formal guidance document, called a change package, was essential to enabling the change processes within practices. To provide a measurement tool to capture the implementation of change package activities, the IPIP leadership simplified and sequenced 6 elements of the CCM to 4 key drivers of practice change, 6 resulting in the development of the Key Driver Implementation Scales (KDIS).…”

Integrating the organizational change literature: a model for successful change

“…Large scale change can be defined as a "holistic alteration in processes and behaviors across a system that leads to a step change in the outputs from that system" (p. 265) (Oldham, 2009). It engages all stakeholders in the change process and requires having strong collaboration and visionary leadership in order to succeed (Boga and Ensari, 2009;Boyd, 2009;Brigham, 1996;Margolis et al, 2010;Oldham, 2009 change on the organization. He believed that for such changes efforts to take place, it needs to be customized to align with specific departmental and units culture (Stock, 1993).…”