QMVIG Coaching Engagement

About Program

Quality Measurement and Value-Based Incentives Group (QMVIG) consists of 5 divisions serving the Centers for Medicare &Medicaid Services (CMS). Each of these divisions works collaboratively to better facilitate measures, reports, and overall healthcare for all individuals. The 5 divisions within QMVIG are the Division of Chronic and Post Acute Care (DCPAC), the Division of Quality Measurement (DQM), the Division of Electronic and Clinician Quality (DECQ), the Division of Program and Measurement Support (DPMS), and the Division of Value-Based Incentives and Quality Reporting. Each of these divisions works collaboratively, structured by QMVIG's front office to better facilitate measures and reports. 

Key People

Background

QMVIG wants to enhance its capabilities to create a new culture within their organization. This new culture will involve the utilization of new tools, as well as virtual domain that assists with data archiving, project management, meeting support, and easier accessibility to exchanging pertinent information. The three main tools used to produce this vertical domain will be Confluence, Jira, and Slack. This will catapult QMVIG's mission to transform itself into a digitally forward, user-friendly organization. The pain points that the QMVIG program currently face includes:

• QMVIG faces the challenge of siloed knowledge repositories as well as gaps in knowledge transfer and information curation that can occur over time. As a result, QMVIG requires a fresh solution to knowledge management that is centralized, transparent, and accessible to the QMVIG community of Divisions
• DPMS currently uses SharePoint to house documents for both internal and external review, as well as a repository for these documents. The organization of this site is not effective for DPMS's current projects
• Some divisions need support to manage and track all action items for QMVIG, related to cross-component work, such as measure alignment and the MIPS/SSP/APMs strategy work. This will be critical support as CCSQ rolls out the National Quality Strategy in April to ensure alignment across QMVIG programs to meet the strategy goal
• QMVIG needs support to track upcoming timelines in a comprehensive manner across quality, policy, scoring, etc. 
• Advice/guidance on how best to document and maintain staff assignments and roles
• The QMVIG program needs support for MVP to coordinate the multiple facets (monitoring progress of: policy, MVP development, implementation, etc) of the framework, to ensure milestones are met, and tracking to overall MVP OKRs and metrics
• Some divisions in QMVIG lack the ability to set up alerts, reminders when workflow milestones are met or missed and set up reports and dashboards to monitor progress of documents as they matriculate through the workflow

Discovery

This phase lasted 3 to 4 months where the QMVIG team applied different discovery techniques to learn more about the QMVIG program. Discovery included the following activities:

• Ceremony observation: The QMVIG support team attended all necessary meetings organized by each division to understand the purpose and value
• Interviewed all the QMVIG division leaders and key staff members. Also the support team created a stakeholder map to identify key people and roles to understand the flow of value through each division and program
• The QMVIG support team did an analysis of all approved CCSQ tools with all the currently used QMVIG tools. This tool analysis document was submitted to the QMVIG Front Office for review and also to approve the tools recommended by the QMVIG support team

Recommended Approach

The CCSQ Centers of Excellence (Randolph Anagho, LACE coach, and Rob Fay, HCD coach) and the QMVIG support team will work together to support the QMVIG program. Since culture change and a focus on continuous improvement is a goal of QMVIG leadership, the Centers of Excellence recommend the following approaches to address the proposed support roadmap:

• Training: Each division attend Introduction to Human-Centered Design at CCSQ and LACE Foundations: Agility courses. These courses can be offered at the convenience of divisions or offered periodically for QMVIG
• Tools to support Virtual Workspace and Library
  • Slack
    • LACE/HCD can set up integrations with Jira and Confluence and discuss how the integrations may assist workflows.
  • Jira
    • LACE will setup (or coordinate with Atlassian team) needed Jira instances for QMVIG, create board views per division for tracking work initiatives, and define statuses for various work items.
    • The LACE team will deliver any necessary trainings on Agile processes when using Jira. This will help QMVIG division use Jira tools more efficiently to capture all of their needs
  • Confluence
    • HCD will work with the QMVIG support team to define global design standards and structure for each QMVIG division space, define navigation standards, create a "labels" guide to assist with content discovery/rollup, and create required page templates.
    • For library development, HCD can lead a content inventory to then recommend which documents may be stored in Confluence, which should be stored in Box/SharePoint, and which can maybe even change document type (e.g., Word > Confluence) moving forward. HCD can provide Information Architecture support to setup recommended storage structure/navigation/discovery across divisions
• Workshops
  • There are a number of workshops the CoEs can provide to help teams embrace a continuous improvement mindset. HCD offers some discovery and prioritization workshops. As part of helping teams adapt to agile meeting and planning ceremonies, the CoEs recommend that teams create Working Agreements / Social Contracts, and the CoEs can offer a workshop to create these agreements.

Strategy: Tracking QMVIG Progress

• Feature groupwide progress for meeting strategic objectives:
  • Tracking QMVIG performance on established internal objectives
  • Facilitating reoccurring discussions (bi-weekly) around objectives and key results with the team
  • Assisting with determining baseline and measuring progress
  • Creating a dashboard and attractive visuals for socialization
  • Assisting/coordinating subject matter expert (SME) teams, documenting lessons learned and next steps
  • Strategic areas of interest:
    • Department/Agency/Center/Group level strategy
    • Cross Cutting Strategies
    • 13th SOW Quality Measurement support

QMVIG Virtual Workspace: Strategy for Workspace Hub and QMVIG Library (Roadmap)

• Workspace Hub
  • Proposed Roadmap for tool rollout after presentation of tool analysis 
• QMVIG Library
  • Proposed timeline for completion of data repository

Risks

The only risk noted so far is program resistance to culture change which is;

• The OMVIG program is reluctant to embrace new tools recommended due to the complexity of using these tools. An example is they will prefer Confluence rather than Jira if they both provide the same functionality

To manage the risk,

• The QMVIG support team did a detail tool analysis on all the tools QMVIG currently uses versus what is approved by CCSQ with recommendations. This analysis helped them know the different functionality of each tool and also if it captures all their needs. 

The QMVIG support team plans to:

• Develop, organize and deliver trainings on processes using these tools and also refer them to the necessary tools trainings within CCSQ
• The QMVIG support team will send our a survey to QMVIG after tools are implemented to evaluate where coaching is required.

Timeframe

• Discovery phase took between 3 to 4 months period where we gathered all the information needed for training and coaching 
• Timeline for completion of recommended approach will take more than 7 months illustrated on the OMVIG workspace Hub and library roadmap