Plan-Do-Study-Act. We will know if the change was an improvement if the percent of active clients retained increases.

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1 Plan-Do-Study-Act Change Title: Client Enrollment Assessment and Expectations Team Name: Western Tidewater Health District Topic: Family Engagement Primary Driver 3- Retention of families in program. Cycle 1 Change # from Refined KDD: Start Date: November XX, 2014 End Date: March XX, 2015 Objective of Cycle Collect Data (Learn) Test a change Implement a change Please describe: What are we trying to accomplish? By March XX, 2015, the Western Tidewater Health District will increase the number of active clients retained from XX% to XX% How will we know that a change is an improvement? The number of active clients who are retained will be compared to the number of clients enrolled in the program at the start of this improvement work. We will know if the change was an improvement if the percent of active clients retained increases. What changes can we make that will result in an improvement? Nurse home visitors can work with clients on setting personal visit goals at each home visit. Additionally, they can individualize each home visit to what the client would like to work on/achieve. Finally, the nurse home visitors can use a set of standardized questions to assess the state of the client s goals at each home visit.

2 Predictions Tasks/Tools Needed to Complete the Cycle Plan What question(s) do we want to answer on this PDSA cycle? If the nurse home visitors ask clients about visit goals at each home visit, will the client remain in the program longer? If the nurse home visitors individualize home visits based on the client s goals, will the client remain in the program longer? If the nurse home visitors ask clients about visit goals and individualize home visits based upon those goals, then program retention will increase. 1. Tracking spreadsheet for the nurse home visitors to track clients goals and responses to the following question "have I met your goals for this visit today?" for each home visit. Plan for this Test 1. Who will implement the change? One nurse home visitor. One nurse home visitor will pilot the test by assessing clients feelings at the end of each visit to see if client feels their goals were met during the visit. 3. Where During home visits at the clients homes. 4. When The initial test will take place November XX, 2014-January XX, Plan for Collection of Data: 1. Who The nurse home visitor will collect the data. The nurse home visitor will note client goals and responses to the questions regarding whether or not goals are being met at each home visit on the tracking spreadsheet. Numbers of clients retained will be assessed monthly. 3. Where Commented [RV1]: Please provide the tracking spreadsheet referenced here. Commented [BD2]: If there is another staff person responsible for monitoring the retention data, also note them here. Commented [BD3]: Inferred from other text, please modify if inaccurate.

3 Tracking of goals and responses to the goal question will occur during home visits. Retention data will be pulled from client records. 4. When November XX, 2014-January XX, 2015 Do On November XX, 2014 one nurse home visitor was asked to include the goal question at each home visit and track responses on the tracking form. The nurse home visitor utilized the question and tracked responses at XX visits with XX families from November XX, 2014-January XX, Continued engagement was tracked during the period by XX Study Data: The nurse home visitor was successfully able to inquire at the end of every home visit (a total of XX visits) if she had met the clients goals for the day. Responses from clients were recorded on the tracking spreadsheet and tallied; all responses (100%) from clients were "YES" their personal goals for the visit were met. All clients tested (XX total clients) remained engaged and enrolled in the program. All clients were appreciative of being asked if their goals for the home visit were met. Commented [BD4]: Steps of the Do stage were inferred from other text, team should review for accuracy and add any additional steps that were taken. Act Adapt Adopt Abandon Lessons Learned: The act of systematically asking about goals offered specific time for questions or concerns from client to be raised, and on several occasions lengthened the time spent in the home as the client would bring up a new topic for discussion. In the next iteration, nurse home visitors will be advised to allot extra time in case the client discusses additional information at end of scheduled visit. Results are in line with prediction thus far. This PDSA has been a success. This process will be tested with the entire Western Tidewater NFP team on all clients enrolled with the adaptation that nurse home visitors allot extra time for additional discussion with client.

4 Next PDSA to begin testing 1/12/2015. Cycle 2 Plan Plan for this Test 1. Who will implement the change? The test will be expand to include all nurse home visitors. By March, 2015 the entire NFP team (3 nurse home visitors) will assess clients feelings at end of each visit to see if client feels her goals have been met during that visit. 5. Where During home visits at the clients homes. 6. When January 12, 2015-February XX, 2015 Plan for Collection of Data: 1. Who All three nurse home visitors will collect the data. The nurse home visitors will note client goals and responses to the questions regarding whether or not goals are being met at each home visit on the tracking spreadsheet. Numbers of clients retained will be assessed monthly. 3. Where Tracking of goals and responses to the goal question will occur during home visits. Retention data will be pulled from client records. 4. When January 12, 2015-February XX, 2015 Do On January XX, 2015 all of the nurse home visitors in the program were asked to test the goal question at each visit and track responses on the tracking form. Commented [BD5]: Inferred from other text, please modify if inaccurate.

5 Study Data: The nurse home visitors utilized the question and tracked responses at XX visits with XX families from January 12-February XX, Continued engagement was tracked during the period by XX The nurse home visitors were successfully able to inquire at the end of x/x (XX%) home visits whether the visit met the clients goals for the day. Responses from clients were recorded on the tracking spreadsheet and tallied; XX% of clients indicated that "YES" their personal goals for the visit were met. x/x (XX%) of clients tested remained engaged and enrolled in the program. Commented [BD6]: Steps of the Do stage were inferred from other text, team should review for accuracy and add any additional steps that were taken. Act Adapt Adopt Abandon Cycle 3 Lessons Learned: Based on the results of this cycle, the team decided to implement another cycle to see if similar results could be obtained. Commented [RV7]: This information was inferred, the team should review and edit as they see fit. Do On February XX, 2015 the nurse home visitors were asked to continue testing inclusion of the goal question at each visit and track responses on the tracking form. The nurse home visitors utilized the question and tracked responses at XX visits with XX families from February 9-February 23, Continued engagement was tracked during the period by XX Study Data: All nurse home visitors asked at each home visit (total number visits =XX) if clients goals were met for that visit. 100% of clients (Number of Clients) reported Yes goals met. Commented [BD8]: Steps of the Do stage were inferred from other text, team should review for accuracy and add any additional steps that were taken.

6 x/x (XX%) of clients who received the goal questioning at each visit remain actively engaged in the program as of March XX, Act Adapt Adopt Abandon Lessons Learned: The team did note that by asking if clients goals had been met, even after responding with Yes, clients often opened up to more conversation. Additional time was added to visit scheduling to accommodate. A checkbox has been permanently added to the nursing visit assessment form as a reminder to every nurse to ask at every visit if clients goals have been met and for standardizing nursing documentation. This PDSA was a success and change has been implemented in program practice. No further action required.