Early Planning & Organization

This section focuses on the early planning and organization needed to launch a Breakthrough Series Collaborative. Included are information and recommendations for the development of the Collaborative charter, the Planning Group Meeting, as well as information on core staff needed to support a Collaborative.

Breakthrough Series Model

The Breakthrough Series (BTS) model is designed as a method to help refine and spread improvements and ideas throughout a system or set of systems. The goal of any BTS is to fill the gap between what is known (scientific knowledge and best practices) and what is being implemented, to the organizations that participate. It may be a part of a broad strategy to spread improvements across the country. A BTS is not intended for research, for new knowledge, a single-setting focus, small changes to existing systems, or as a benchmarking project.

The model has been applied by IHI to a variety of topics in over 33 Collaboratives involving 530 organizations and 830 teams. Topics range from Waits and Delays in Service Delivery to Improving Health Care for Children in Foster Care to Supply Chain Management for Hospitals and Hospital Networks.

The key phases of a BTS are:

Early Planning & Organization (Expert Meeting, Planning Group Meeting, Collaborative staffing, and the development of the Charter)
Change Framework (Defining the framework and the change concepts, applying the Model for Improvement, and developing the measurement strategy)
Engaging Teams
Learning Sessions and Action Periods
Spread and Dissemination

Stages of the Breakthrough Series

Topic Selection: The topic must represent an issue where there is a gap between current practice and the best available scientific knowledge. Additionally, there should be examples of best practice in the field. (COMPLETE for IPIP)

Selection of Collaborative Staff and Faculty: The Collaborative staff is composed of the Executive, Faculty, Chair, Project Director, Project Manager, and Project Coordinator. The Faculty members are a subset of the Expert Panel (see below) who support, mentor, teach, and monitor the progress of the teams.

Team Selection and Prework: Team selection entails the identification of teams that have the commitment and capacity to succeed. Once teams have been selected, they have six to eight weeks to lay the groundwork for success. This prework for Collaborative teams includes enlisting senior leader support, forming their team, developing their aim, determining baseline data for measuring progress, reading background material about best practices, and learning the Model for Improvement.

Learning Sessions: The Learning Sessions bring together the Faculty, the Collaborative staff, and members of all the Collaborative teams. Learning Sessions serve as forums for experts to provide instruction on the theory and practice of improving and tracking performance, as well as substantive content from the field. Each Learning Session also provides the teams with an opportunity to share information, report on their progress and what they’ve learned, and to engage in collaborative problem-solving with their colleagues. The most critical part of each Learning Session is the time each team spends planning for real changes within its system, while being coached and facilitated by the faculty in content and process. There are typically three Learning Sessions during a Collaborative.

Action Periods: The real work for the teams in the Collaborative occurs during the Action Periods. This is the time between Learning Sessions when each team applies changes using the Model for Improvement and tracks the effects of the changes. Action Periods involve continuous learning cycles in which the teams receive extensive support from the Faculty and the Collaborative staff through regular conference calls, a listserv, and the Extranet.

Spread: The goal of this phase is organizational transformation. Large organizations send one or more pilot teams to a Breakthrough Series. The Senior Leader needs to take specific actions to assure the success of the pilot team, sustain changes, and spread the improvements across the organization. Although the groundwork for spread is established at the first Learning Session, explicit spread activity typically begins at Learning Session 2 and continues throughout the remainder of the Collaborative.

Breakthrough Series Collaborative Timeline

Tasks and timeline

Task / Responsible / Due Date (weeks before event) / Notes
Convene internal Collaborative staff to launch Collaborative / PD, PM, PC, IA* / 22 weeks / Select Chair, topic, and identify possible participants
Develop & draft Collaborative charter / PD, IA / 16 weeks
Identify selection criteria/begin enrolling teams / PD, IA / 15 weeks
Select Planning Group / PD, IA / 15 weeks
Finalize Learning Session dates / PM / 14 weeks
Finalize hotel contract / PM / 14 weeks
Finalize Collaborative charter / All / 14 weeks
Distribute marketing materials / PM, PC / 14 weeks
Convene Planning Group (meeting or call) / PM / 8 weeks
Draft Learning Session agenda / PM, PD / 8 weeks
Finalize change framework and measurement strategy / All / 8 weeks
Finalize prework materials / All / 8 weeks
Hold pre-Learning Session calls with participants / PD, PM / As soon as applications are received / Teams individual or small groups of fewer than 4
Finalize Learning Session agenda / PD, PM / 4-6 weeks
Coach Faculty on presentations and breakout sessions / PD / 6 weeks
Communicate logistics with Faculty / PM, PC / On-going
Register attendees for all teams / PC / On-going
Communicate with hotel (agenda, AV needs, catering, rooming lists, assign sessions to rooms) / PM / On-going
All Learning Session materials received for copying / PC / 2 weeks
Create Learning Session evaluation forms / PC, PM / 1 week / Consider accreditation evaluations & internal evaluations
Create working agenda, brief staff / PM / 1 week
Learning Session 1 (LS1)
Planning Group Meeting on eve of LS and debrief meeting between days 1 and 2
Process evaluations / PC / Within 1 week
Hold Collaborative Milestone Calls to debrief from Learning Session / All / Within 1 week
Conduct Conference calls with Collaborative teams between Learning Sessions / PD / Bi-weekly beginning 2 weeks after the LS
Hold Planning Group calls monthly to debrief from LS, review team progress, plan conference call topics, and plan for next LS / All / Monthly
Review agenda for Learning Session 2 / PD, PM / LS2 minus 6 weeks

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Task / Responsible / Due Date (weeks before event) / Notes
Facilitate discussion on listserv with Collaborative teams / PD / Ongoing
Review Senior Leader reports due monthly, follow up with teams as needed, communicate with Senior Leaders, assess teams and Collaborative progress / All / Monthly / Planning Group input needed
Milestone Calls to review overall Collaborative progress and plan necessary interventions / PD, PM / LS plus 1 month

Preparing for next Learning Sessions:

Finalize Learning Session agenda with Planning Group / All / 4 weeks
Coach Faculty and best teams on presentations and breakout session facilitation via phone and email / PD / 4 weeks
Communicate logistics with Faculty / PM, PC / On-going
Register attendees from all teams for the Learning Sessions / PC / On-going
Communicate with hotel (agenda, AV needs, catering, rooming lists, assign sessions to rooms) / PM / On-going
All Learning Session materials copied / PC / 2 weeks
Create evaluation forms / PM, PC / 1 week
Create working agenda and brief staff / PM, PC / 1 week

Learning Session 2 or 3 (LS2 or 3)

Planning Group meeting on eve of Learning Session and debrief meeting between days one and two
Process evaluations / PC / Within 1 week
Collaborative Milestone Call to debrief from Learning Session / PD, PM / Within 1 week
Collaborative Closeout Activities – listserv, Congress, or Summit, etc.

Roles in a Breakthrough Series Collaborative

Each Breakthrough Series Collaborative has a Chair who leads the overall Collaborative. The Chair is typically a well-respected, well-known leader in the field with deep knowledge, depth of experience, and sincere passion about the topic. The role of the Chair is to create a shared vision and provide intellectual leadership for the topic, to assist in forming and guiding the Planning Group, and to assist the Improvement Advisor to develop the conceptual framework and measurement system. The Chair leads and teaches at the Learning Sessions, coaches and mentors organizations and Senior Leaders to achieve goals, and reviews Collaborative progress. Generally one person serves as a Collaborative Chair. This establishes the Chair as the overall leader of the Collaborative and helps delineate clear lines of accountability and expectations. Some Collaboratives have Co-chairs. This arrangement can be helpful when the Collaborative focus is a topic that crosses multiple professional areas, such as improving health care for children in foster care. Co-chairs can lend multiple perspectives, build credibility with teams and divide the work. However, having Co-chairs can increase the workload for Collaborative Staff, who will have to manage multiple relationships and determine each Chair’s responsibilities.

The Executive acts as the liaison between the Collaborative and the sponsoring organization. The Executive is charged with maintaining the alignment between the Collaborative aim and the sponsoring organization’s priorities.

The Faculty must be well versed in the evidence base for the chosen topic, but primarily they must have practical experience in the development of a successful program. The Faculty should mirror the professional roles and types of organizations of the participating teams. The Faculty require excellent communication, coaching, and problem-solving skills to work with a wide variety of teams.

The Chair is supported by the CollaborativeStaff, which consists of a Project Coordinator, Project

Manager, Project Director, and Improvement Advisor.

The Project Coordinator handles the logistics of meetings, calls, and provides support for the Faculty and teams.

The Project Manager has expertise in project management and develops and manages the timeline for the Collaborative, the budget and contract work, and ensures timely deliverables.

The Project Director is responsible for the oversight of the Collaborative, coaching the Chair and Planning Group in the Breakthrough Series methodology, managing prework development, recruiting teams, and coaching teams on the Model for Improvement. The Project Director coordinates the work of the Chair and Planning Group to develop the curriculum for the Learning Sessions and Action Periods. The Project Director works with the Improvement Advisor to track team and Collaborative progress, compiles and reviews monthly Collaborative reports, and coaches teams at Learning Sessions and during Action Periods.

The Improvement Advisor is an expert in improvement theory and methods and is responsible for the measurement strategy in the Collaborative. The Improvement Advisor designs a measurement system and coaches teams regarding measurement. The Improvement Advisor also teaches and coaches the Planning Group and teams on application of the Model for Improvement, and recommends strategies to achieve Collaborative goals.

Roles in a Breakthrough Series Collaborative (cont.)

The Planning Group consists of practitioners and researchers often selected from the Expert Meeting, who have significant experience in implementing and studying innovations in the field. This group of participants is convened at the beginning of the Collaborative to set the charge for the teams (this group includes the Chair, Improvement Advisor, Project Director, and Executive). Because they develop the “conceptual framework,” one or more must have hands-on experience with existing best practices. Other experts may be utilized as guest faculty at Learning Session or on conference calls but are not permanent members of the Planning Group.

The Collaborative teams are the focus of the Collaborative. They do not talk about changes; they implement them. There are three critical components that should be represented on each team: Team Leader (someone with authority to make decisions and remove barriers when necessary), Technical Expert (someone who does the work and has the practical and content experience), and the Day-to-Day Leader (someone to act as team manager). Teams may include a number of others who participate as changes are planned, tested and implemented.

The Senior Leader role is critical to the success of a Collaborative team. The Senior Leader is the visionary for each Collaborative team and is someone who works at an organization-wide level. This person ensures that the work of their Collaborative team is aligned with the organization’s strategic goals, promotes the work of the Collaborative team within their organization or system, monitors the progress of the team, and facilitates the spread of the improvements throughout the organization.

Role of Planning Group

The Planning Group needs knowledge of and a common understanding of two things: understanding of the issues most commonly faced in the relevant topic area and the approach for implementing best practices in this area. The Planning Group is also responsible for helping organizations achieve the Collaborative's goals. The general commitment of a Planning Group member includes activities in planning for the Collaborative, participating in the Learning Sessions, and team support and mentoring during Action Periods. Specific activities may include:

Collaborative Planning:

Specifying goals for the Collaborative
Determining Collaborative framework, key changes, and measurement strategy
Developing one or more case studies that illustrate(s) breakthrough improvement
Collecting supportive literature
Defining the ideal "team" necessary to address this topic in an institution
Identifying what makes change in this area difficult

Learning Sessions (Three two-day sessions):

Presenting in plenary and/or breakout sessions
Facilitating breakout sessions on specific topics
Consulting with and/or coaching teams

Action Periods (time between Learning Sessions):

Giving guidance on conference calls
Participating in e-mail discussion groups
Monitoring progress among a group of participants

The Planning Group works together on these tasks in a number of ways, including email discussion, an Extranet, and monthly Planning Group calls with Collaborative staff.

Planning Group Conference Calls

Planning Group conference calls occur throughout a Collaborative. These calls provide time for the Collaborative Chair, Faculty, Project Director, Project Manager, and the Planning Group members to discuss and plan for the Collaborative. In many long-term Collaboratives, Planning Group calls occur on a monthly basis.

Scheduling

Scheduling and setting up Planning Group conference calls is the responsibility of the Project Coordinator, who should ensure that key members (Collaborative Chair, Improvement Advisor) are available for the call.

Once a date and time have been determined, the Coordinator should arrange a call-in number with a vendor and email the Planning Group the relevant information: authorization code, call leader’s name, and the passcode to be provided as individuals call in.

Agenda

The agenda for the Planning Group conference calls should be determined by the Project Director and emailed out in advance of the call.

The agenda of a Planning Group call varies depending on the timing and current needs of the Collaborative. However, some examples of issues commonly discussed include:

Goals and objectives of Collaborative
Progress of teams participating in Collaborative
Learning Session development and educational content of the Learning Sessions

Other items to be discussed may include:

Issues related to reporting, Extranet use
Enrollment/registration
Specific information on any team/organization involved in Collaborative

Planning Group Meeting Agenda

[Project Name]Planning Group Meeting

[Planning Group Meeting Date]