Q&A WITH OPCA ANNUAL AWARD WINNER Sarah Salisbury and the Data Heroes

Q&A WITH OPCA ANNUAL AWARD WINNER Sarah Salisbury and the Data Heroes

2019-20 OPCA ANNUAL AWARD FOR VALUE

Share your name, position, and CHC: Sarah Salisbury, Quality Coordinator for Lane County Health & Human Services Quality & Compliance Division

What does this award mean to you? I am very grateful to be recognized by the OPCA for this award. Quality Improvement work has been a growing passion of mine over several years and this is a wonderful affirmation of that work. QI has been gaining momentum within healthcare for years now and it’s gratifying to see those principles translated into improved patient care at our FQHC clinics.

Why do you think your work earned an Annual Award of Excellence? Or nominee can share why the nominated you. Taken from nomination document, written by Ron Hjelm, Executive Director of the CHCs of Lane County: Sarah leads the quality improvement activities within the Health & Human Services Department of Lane County. Sarah has been instrumental in leading quality improvement initiatives designed to engage front line staff in learning how to use Tableau software, and to incorporate the use of this software reporting tools in Plan, Do, Study, Act (PDSA) cycles to achieve improved clinical outcomes. Our initial Data Heroes were: Patient Care Coordinators: Angel Cavenaugh, Emily Christensen, Christie Sears, and Susie Spidell; along with Team RNs: Ariel Cooper and Emily Bellinger.

The Lane County CHC Data Heroes, who were recognized for their work in early 2020 and by OPCA in May. Missing from the photo is Christie Sears.

Sarah Salisbury is an inspiration. She exudes enthusiasm about quality improvement! Her enthusiasm is infectious, but she doesn’t let her enthusiasm overshadow those around her, rather she transfers and leverages her enthusiasm to empower direct service staff with whom she works so that they become the central figures in adopting, driving, and celebrating quality improvement efforts. Sarah has been a dynamic force in the ability of the CHC staff to use data and systematic quality improvement processes to more rapidly and effectively improve quality outcomes…and did we say, “While having fun!”?

Sarah and her colleagues in our quality improvement group identified a significant gap, and an opportunity with our newly expanded Tableau reporting capabilities. They knew that those with access to data, mostly leadership, were not part of the actual work being done by the front line staff who did not have robust access to data.  This data access disparity added to an organizational gap between staff and leadership. Staff often felt that data was a punitive tool, never really helping them with the work of caring for their patients. Sarah and our QA team developed the concept and adopted the tag line “Data Heroes” to identify and celebrate “early adopters” of the Tableau software for effective quality improvement.

The CHC’s initial “Data Heroes” team was comprised of patient care coordinators and registered nurses who volunteered to learn about the Tableau software in what was designed to be a series of trainings. Sarah did a fantastic job in the initial training sessions, quickly guiding the data heroes through the ABCs of learning how to use the software. To say that the Data Heroes embraced the technology and QI concepts would be an understatement. Not waiting for the weekly classes, the Data Heroes took personal and collective initiative to accelerate their learning. They then ardently transitioned to working with Sarah to learn how to apply their newly acquired Tableau skills to a systematic quality improvement project. They chose to focus on the important metric of improving glucose control in patients with diabetes.

First, the Data Heros quickly identified that the A1C data was not being entered consistently in our EMR across all of the care teams. Once they discovered this, they, without any prompting from leadership, built a PDSA plan to correct this problem. They wrote the policy and procedure, for approval. They designed a simple training for their peers and conducted the training themselves.  They used the real time reporting capability in the Tableau reports they developed to champion the importance of accurate and consistent data entry with their peers throughout the CHC. Using education, encouragement, competition, and yes, peer pressure, they achieved true “rapid cycle improvement.” Sarah and the Data Heroes team didn’t stop there. Now that they had more accurate data, the Data Heroes team developed several additional actionable reports, and workflows for the use of these reports, to enable care teams to more proactively manage care to the CHC’s full cohort of patients with diabetes. Ultimately, A1c values improved between 34% and 68% by team after this effort.

Their project, the resulting findings from the project, and their ability to turn those results into tangible paths to improve the health and lives of the patients at the CHC, are not only a clear demonstration of their ingenuity and ability to think outside of the box to identify new efficiencies, but also their clear focus on solutions and desire to serve.

What are three thing important things people should know about your work? It’s been so encouraging to work with teams across our department and see the enthusiasm they share about their improvement projects. Once people have an understanding of basic QI principles it’s amazing to see how quickly they begin to apply this to not only their work, but their everyday life.  I think curiosity is the main ingredient for success in this work. Wondering “why, what if, and how come” are crucial questions we can ask ourselves throughout our day. I’ve had the most fun with teams when I’ve asked this of them and they shake their heads, look around the room at each other, shrug their shoulders and say “I don’t know? I never thought to ask?” Often, after that, possibilities and ideas come pouring out and things begin to get really fun.

How does the work you do impact your community? I’m fortunate to have the opportunity to work with many dedicated professionals at our Community Health Center clinics. In addition to the A1C work that our Data Heroes did, which has made a tremendous difference in the care of our patients who have diabetes, our clinics have gathered over three thousand PRAPARE surveys through multiple plan-do-study-act (PDSA) cycles as part of a QI project. Because of their willingness to do the extra steps required to initiate these sometimes challenging conversations, as well as spend the time inputting the data and gathering resources to respond to identified needs, our community is in a position to more fully understand not only the impact of Covid-19 on our patients and community, but also to evaluate and adjust our recovery response to this pandemic.

How has your work changed since COVID-19? How do you think it will change going forward? Certainly these first few months of COVID-19 have been highly disruptive to all of us, I think no more so than for our medical professionals. It requires a certain amount of creativity and ability to think outside the box and continue trying to care for people when traditional approaches are suddenly not available and there is so much uncertainty. However, in the midst of this disruption and uncertainty there have been opportunities for us to pursue alternatives to our traditional care modalities, specifically utilizing telehealth. Despite the rapid deployment of this technology and the obstacles that came with that, our data collection has shown that many patients have had a very positive experience with telehealth.

Personally, I was initially highly uncomfortable with online meetings and have great respect for our patients and providers who jumped right into this. While I find it really exciting to be in a room with people sharing ideas and feeling the energy build around projects, I have been working on engaging differently when in virtual meetings. Despite those challenges there are also really exciting possibilities and opportunities to explore. I’m really interested to see how this continues to shape our work and trust that while there will be some challenges, we can use this platform to enhance and improve care to our patients in new and different ways.

Anyone you want to thank for your award? I am exceedingly grateful for my supervisor, Micah Brown, and Division Manager, Lisa Nichols who gave me the opportunity to fill this newly created role several years ago. I’m also so appreciative of the frontline staff at the CHC who not only go above and beyond providing care to their patients, but also create space for possibility.

Anything else you want to share? I’m proud to be a part of the quality improvement work that is being done across our department and thankful to our leadership who value and prioritize this improvement work in the midst of many pressing and competing needs.

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