OPERATIONALIZING CHANGE. Lori Ann Hinga Nurse Consultant Solutions Healthcare Redesign Experts

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1 OPERATIONALIZING CHANGE Lori Ann Hinga Nurse Consultant Solutions Healthcare Redesign Experts

2 GROUP JUGGLING The Plan/Goal Each group will have three balls being passed simultaneously and the group will have successfully juggled the three balls The Process Assign a leader The leader will throw one ball to another team player The team player then throws the ball to another until the last player receives the ball and throws it back to the leader Once the team has mastered juggling one ball the leader will introduce ball #2 When the team has successfully juggled two balls the leader will initiate ball #3 Dropping The Ball When a ball is dropped the team must start over with one ball

3 WHAT DOES JUGGLING HAVE TO DO WITH CHANGE? What were your immediate thoughts when the goal of juggling three balls was introduced? Did anyone resist or speak negatively about the activity? What strategies, if any, did your team discuss and/or implement? When? Did they work? If not why not? How did your team feel when each additional ball was introduced? Were adjustments made to your team s original plan? Did any team players drop the ball? How did you feel when this happened? What was the reaction of the team? How did the team react when the goal was accomplished?

4 TO IMPROVE IS TO CHANGE

5 FUNCTIONAL & PRACTICAL CHANGE Identifying opportunities Collecting and analyzing data Improving systems quality Planning & timelines Organizing and managing Responsibilities & Accountability Measuring & Reporting Managing the team Sustaining the change

6 CHANGE IS NOT UNIQUE TO COMMUNITY HEALTH CENTERS

7 ARE WE MANAGING CHANGE? Layering Attempting to meet standards/ requirements by placing additional work on top of inefficient systems/processes and expecting something different

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9 THE CURRENT CULTURE Understand the organization s current culture What do team members believe are the organization s current values?

10 CULTURE CHANGE Altering entrenched patterns and/or processes Transformation Redesign Changing the way we think

11 WHY MUST WE CHANGE?

12 WHAT IS SYSTEMS CHANGE? Acknowledged Recognized and accepted need to/for change A valued clear and compelling vision Communicated Positively and continuously conveys the need and benefits Clearly Defined A strong change management team with assigned roles Precise goals and prioritized strategies A performance improvement tool Planned A developed plan with specific timeline and measures of success Assigned Responsibility and Accountability Consulted and Informed

13 WHAT IS SYSTEMS CHANGE? Trained Specific & Scheduled Managed Change and resistance Integrated Policy Developed and/or revised Transparent Celebrated short term wins Assessed Collected, evaluated, reported data Identified trends and gaps Established root cause Implemented corrective action plan Sustainable Continuous quality improvement

14 WHAT ARE WE DOING? Organizational Self-Assessment Which initiative(s) have we successfully implemented? What are the requirements/standards? Which standards are currently in place? Does our current process provide the data necessary to measure our performance and support the change? Which standards require implementation? What process will provide the data necessary to measure our performance?

15 HOW ARE WE DOING? Collecting, evaluating and continuously monitoring data is central to the success of planned changed and quality/process improvement What data is needed to measure a specific change? How will the data be accessed/extracted? What will the data be measured against? Evidence Based Guidelines/Standards Organizational Goal Benchmark Best Practice

16 MEASURING & REPORTING Collecting and Analyzing Data Which standards are being met/exceeded? Which standards require improvement? Which standards cannot be measured/reported? Reporting Who collects, trends and reports the data? Who needs to know what? How often? Reporting tool?

17 DASHBOARDS Measure 4th Qtr st Qtr nd Qtr 2011 Trend 3rd Qtr 2011 Trend 4th Qtr 2011 Trend 1st Qtr 2012 Trend 2nd Qtr 2012 Press Ganey All Facilities Rank Overall 80% 70% 79% 65% 82% 96% 88% Specialty Clinics Overall Family Medicine General Surgery 68% 77% 63% 59% 81% 91% 60% 67% 94% 93% 96% 99% 99% Internal Medicine n<7 25% 80% 65% 89% 98% 99% Gynecology 99% 99% 95% 97% 99% OB/GYN 60% Pediatrics Vascular Surgery Urology Quality Bonus CP information about medications CP Instructions for follow-up care CP spoke using clear language 44% 31% 24% 44% 70% 52% 26% 90% 95% 84% 97% 96% 99% 87% 60% 71% 99% 88% 90% 99% 94% 14% 68% 93% 82% 99% 97% 89% 66% 95% 74% 91% 50% All Clinic Measures BMC Target National Benchmark Standards % of patients with documentation of allergies and adverse drug reactions in EMR >80% CMS/NCQA >80% >50% MU >50% 98.0% 98% 99% Pts age >2 have recorded height, weight, BMI every visit >80% CMS/QIP/ MU >80% >80% 99% Patients 18 and older with a list of current meds including med name, dosage, frequency, route** Smoking status documented for patients 13 years and older >80% MU >50% 65.5% 73% 73% Blood Pressure checked every visit >80% MU 77.0% 24% 99%

18 PLANNING QUALITY IMPROVEMENTS

19 THE FOUNDATION A detailed implementation plan Systems/processes requiring improvement Goals Strategies for improvement Measures of success A projected timeline Timing is everything

20 ENGAGEMENT ORGANIZATIONS CHANGE WHEN THE PEOPLE WITHIN THEM CHANGE! People are motivated to change at an emotional level Emotions can promote change or undermine it Foster feelings that facilitate change minimize those that prohibit it

21 MOTIVATING CHANGE Continuously reinforce the benefits of the change- Presenting the changes as a way to deliver better patient care can make it easier for team members to feel good about the changes and become more invested Emphasize 21 st century medicine needs to be PATIENT AND TEAM CENTERED Recognize team members for his or her contributions Individual team members will feel valued

22 RECOGNIZE ALL PROGRESS!

23 PUTTING IT TOGETHER Change is not unique to community health centers Change requires a defined process, roles and responsibilities Get to know how change happens within your organization (Roles, Teams and Committees) A process management tool (PDSA) is not optional A detailed implementation plan & timeline are crucial to success Organizations change when the people within them change Care Teams must understand the benefits to the change Patient focused benefits Plan for reporting data and progress keep it simple

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25 QUESTIONS?

26 THANK-YOU!