Developing Learning Collaboratives

In the NIATx model of process improvement, the continuous flow of ideas among peers in a learning collaborative drives successful Change Projects. In a NIATx learning collaborative, a group focused on improving a specific aim meets regularly for six months to a year and works together to achieve that aim.

Who Establishes the Learning Collaborative?

The convener—the government or other purchaser of services—establishes the learning collaborative, working with an organization such as NIATx to provide orientation, training, and coaching for the duration of the collaborative. See Leadership [link] for more information on roles and responsibilities with the learning collaborative.

Learning Collaborative Structure

Research on learning indicates that children and adults learn best in an interactive environment. Actively engaged participants are more likely to retain new information and concepts. The NIATx learning collaborative model encourages interactive peer networking that allows peers to learn from each other as well as from experts both inside and outside the field.

Many successful NIATx projects have developed learning collaboratives based on the following model.

Introductory Meeting

An introductory meeting is a an opportunity for the convener to reveal the vision, begin building momentum for change, introduce a broad audience to process improvement, and begin to explore the barriers and challenges potential participants will want to focus on to achieve the vision. It is best to invite a large audience of executive directors to this meeting to ensure open access to improvement opportunities, a strong response of interested participants, and to develop an understanding of the challenges common across agencies. The SSA or Executive Sponsor should personally invite agencies to participate in this meeting.

Introductory meetings often occur as a one-three hour teleconference, in-person at a neutral, centrally located facility, or adjunct to another large audience conference or meeting. The introductory meeting should provide information on the duration of the collaborative, the possible timeline of events, meeting and reporting requirements, the coaching support available for participants, and how interested agencies and stakeholders can enter the collaborative. It is very helpful to have a local Change Leader NIATx experience describe her agency’s experience with process improvement, including applications, changes made, and lessons learned.

Selection Process

The SSA or convener’s vision and goals for system-wide performance management matter greatly in the selection process of the participants for the collaborative. The most effective learning collaboratives form to address specific issues or aims of interest across all participants of the collaborative.

The selection of participants for the collaborative should be strategic and competitive. Recruit highly motivated providers. Recruit provider agencies that can and are willing to travel conveniently to peer meetings. Within a year, new providers can be added to the collaborative and the experienced members can become peer mentors for the new members. The use of a screening process including an application or proposal submission is advised to assist in selecting agencies.

Orientation Meeting

Provider agency Executive Sponsors who have agreed to participate in the process improvement project must be invited to an orientation meeting, held during the first month of the project. The goal of this meeting is to stress the importance of the CEO/agency director making a commitment to the project in terms of time and personnel. Planned activities and support services will be clarified.

At this three-hour orientation meeting, participants are asked to do the following preparatory work to prepare for project implementation:

• Conduct an agency walk-through to identify potential improvements to existing agency procedures used during the assessment, admission, and active phase of the treatment process.
• Assign an Executive Sponsor who will support the project, make it an agency priority, remove potential barriers, and participate directly when necessary.
• Assign a Change Leader who will provide daily leadership, keep the project organized, and assure that the Change Team continually works to achieve improved results.
• Develop a baseline (through the compilation of existing client data or collection of new data) over two months to ensure that the improvements implemented can be quantified. For example: total number of admissions, intake/assessment appointment and first post-admission appointment no-show rates, and 30- and 60-day client continuation rates.

Each participating agency should be asked to submit, in writing, their baseline data, as well as a brief report summarizing the findings of their agency walk-through. This information should be collected at or before the kick-off workshop.

Kick-Off Workshop or Learning Session

The process improvement collaborative should officially kick off in the middle of month four at a 1-2 day workshop or learning session held at a hotel or conference center centrally located among the provider agencies. The kick-off workshop should be co-facilitated by the system-level Executive Sponsor, system-level Change Leader, and NIATx process improvement coach. Additional content may also be delivered by other Change Leaders with NIATx process improvement experience.

The goals of this learning session:

1. Build interest and confidence in conducting process improvement projects.
2. Familiarize Change Team members with the concepts underlying a structured improvement process and the use of rapid-cycle change strategies.
3. Provide an opportunity for the prioritization of improvement needs based on existing data and agency walk-through results.
4. Create a quick-start roadmap for initiating service improvements.
5. Clarify the sequence of planned project activities.

At this two-day workshop, participants:

• Are exposed to evidenced-based process improvement practices
• Hear case examples from their peers
• Participate in multiple interactive sessions that will provide an opportunity to learn, share, plan, and implement process improvement strategies through change exercises
• Learn concrete approaches to better understand their clients’ needs, discover organizational barriers to successful treatment, and make successful changes
• Develop a process improvement “quick start roadmap” that could be used by the Change Teams to guide the process improvement project rollout when back at their respective agencies
• Hear more about next steps (provider progress tracking responsibilities, upcoming meetings, site visits, etc.)

The workshop needs to be interactive in nature, and participants need to be given several opportunities to network with representatives from other treatment agencies, as well as with the meeting facilitators. The site visits and monthly conference calls that will follow in future months should be tentatively scheduled, and participants must leave the workshop with tools necessary to initiate Change Projects.

Change Leader Training

To ensure effective improvements with lasting positive impact on an agency or a system, someone must lead the Change Team and motivate Change Team members to get the job done. Specific training for change leaders that builds their confidence and teaches the skills needed to lead Change Projects is an invaluable part of the learning collaborative. To meet this need, NIATx offers the Change Leader Academy. In addition to the Change Leader Academy, a mid-course (around month eight) face-to-face meeting of Change Leaders should be held to energize the group and motive them to keep making progress with their respective projects.

The half-day Change Leader meeting should be held at a central location. Change Leaders should bring one or two of their Change Team members with them to the meeting.

1. Begin the meeting with a review of Change Project progress to date. Each Change Leader (or a designee) should be asked to provide the group with a brief progress report.
2. After the progress reports, aggregate progress from the participating agencies should be reviewed. In addition, give each Change Leader a copy of the data from his agency (to use for comparison purposes).
3. During the discussion of progress tracking, the payer institution coordinator needs to reinforce the importance of tracking progress (in the form of the Change Project reporting forms or through client-specific tracking sheets).
4. Conclude with a brief discussion of the completion conference (to be held at end of Month eleven or twelve) and other next steps.

Regular Meetings

Successful learning collaboratives meet monthly or more often via teleconference or in person. Establishing a standard meeting agenda promotes productive meetings. Each meeting should allow ample time for participants to share their experiences. The convener moderates the meeting and sets the agenda, arranging for guest speakers when the collaborative needs assistance.

Final Meeting

Near the end of Month eleven or twelve, the Change Teams from each agency should be invited to a full-day final meeting. This meeting is often called a completion conference if the collaborative is ending or a learning session if the collaborative is continuing for another year.

The purpose of the final meeting is two-fold:

1. To celebrate the successes of each Change Team (by reporting on a Change Project that led to improvements in client engagement/access and/or retention/continuation)
2. To share ideas, strategies, and recommendations regarding the continuation of process improvement strategies within collaborative’s region and sustainability of the current change projects.

The Change Teams will be given a unique opportunity to interact with payer representatives to provide their impressions on their experiences and recommendations for sustaining the process improvement efforts currently underway.

Interactivity should be designed into the meeting agenda. Start the meeting off with a session in which one or more representatives from each Change Team present a 15-minute overview of their experience with process improvement and the changes that they made. Following the presentations, groups can participate in an open discussion with representatives from NIATx, the state or payer organization regarding next steps and sustainability issues.

Additional Information

• Successful Learning Collaboratives
• Learning Collaborative Sample Materials

Further Reading

• The Breakthrough Series
• What do you mean by collaborative learning?
• Designing Peer-to-Peer Learning Exchanges
• A Model of Work-Based Learning