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Pre-work: Pre-work is the period between a hospital’s commitment to participate and the Collaborative’s first Learning Session. During this time, the Learning Collaborative team, project champions, and hospital improvement teams work to develop and strengthen the needed structures for collaborative improvement.

Learning Sessions: Learning Sessions are virtual meetings that bring together the multidisciplinary improvement teams from each participating hospital and expert faculty to exchange ideas about the topic and specific changes outlined in the bundle as well as the Model for Improvement. The Learning Sessions include time for each hospital’s team to work together to integrate learning and plan for how to immediately incorporate learning into their improvement processes. There are three Learning Sessions conducted during the Learning Collaborative. Teams progressively learn more from each other in each Learning Session through dynamic scheduled sessions and activities, and through informal networking and dialogue.

Action Periods: Action Periods are the time between Learning Sessions, when hospital improvement teams use the Model for Improvement to implement small, rapid-cycle, PDSA tests of change. The impact of those changes is then evaluated with measures including those in the Learning Collaborative’s Measurement Strategy (outlined in further detail in each Bundle’s Implementation Packet). Participating hospitals submit data measures quarterly to the data team at the University of Montana Rural Institute for Inclusive Communities (UM RIIC). UM RIIC creates and shares individualized facility reports to be shared back with facility teams, and aggregate reports to be shared amongst the Learning Collaborative. Improvement teams are supported during Action Periods by conference calls, interactive web-based discussions, online sharing platforms, site visits, coaching, and mentoring to enable them to learn from state and national experts as well as from other hospital improvement teams across Montana.

Model for Improvement: In addition to the foundational structure of the Breakthrough Series and the guiding standardization of AIM Patient Safety Bundles, the Learning Collaborative will use the Model for Improvement as a structured approach used by teams to drive improvement. The Model for Improvement is based on IHI’s three pivotal questions in addition to the traditional PDSA cycle, utilizing time-based aims alongside process and outcome measures to track improvement and evaluate progress. PDSAs initially test changes on a very small scale to quickly identify promising ideas, and then incrementally scale up improvements based on rapid cycle testing and learning to adapt and develop changes into robust and reliable standard processes. MFI stresses prediction and measurement as critical features of change evaluation and includes an array of techniques to help guide the journey from change innovation to prototyping, to implementation and spread.