Leading Transformational Change Together

Transcription

1 31 May 2017 Sweden Leading Transformational Change Together Utvecklingskraft Göran Henriks Maureen Bisognano President Emerita and Senior Fellow

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3 Social reliability and sustainability comes when you can 1. Be healthy 2. Be involved 3. Improve your and our competence 4. Equal services and treatment 5. Find your meaning in life Merlina Missimer, Institution for strategisk tillförlitlig utveckling, Blekinge Tekniska högskola

4 The IHI Triple Aim

5 Radical Redesign Principles Change the Balance of Power Standardize What Makes Sense Customize to the Individual Promote Wellbeing Create Joy in Work Make it Easy Move Knowledge, Not People Collaborate/Cooperate Assume Abundance Return the Money

6 Joy Meaning What matters to you? Mastery and mentorship Membership Rosabeth Moss Kanter

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9 Leadership Behaviors Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013

10 A Changing Workforce 2016 survey of hospital executives: Most critical issue facing healthcare leaders is attracting and retaining the best talent In the US, average age of nurses is approaching 50, and 25% of nurses are preparing to retire in the next decade Aging of the population: 10,000 baby boomers retire every day Predict we ll need to train and employ 1 million new nurses in the next 5 years And yet, staff recruitment and hiring is second to last on a list of fifteen prime imperatives of leaders

11 Use Data to Predict and Plan Pre-hiring Boomerangs Alumni recruitment Returnships

12 Credit: Greg Kingsley Mota, MSN, RN, NEA-BC, and Barbara Hill, MSN, APRN, AGCNS-BC, ACCNS-AG, CCRN, Emory University Hospital

13 Credit: Greg Kingsley Mota, MSN, RN, NEA-BC, and Barbara Hill, MSN, APRN, AGCNS-BC, ACCNS-AG, CCRN, Emory University Hospital

14 Credit: Greg Kingsley Mota, MSN, RN, NEA-BC, and Barbara Hill, MSN, APRN, AGCNS-BC, ACCNS-AG, CCRN, Emory University Hospital

15 Peoples actions are not goverened by things like rules and instructions No instead actions are based on peoples own understanding of the situation Sandberg, J. & Targama, A. (2013). Ledning och förståelse Lund: Studentlitteratur

16 Research Assistant, EA for Carol Cambridge, MA Wharton School, University of Pennsylvania BS Economics with Concentrations in Business and Public Policy Operations and Information Management Systems Current Work Research Assistant Employer Work Diversity and Inclusion Council EA for Carol (>5%) Board Support (5%) Strategic Past Work Experience (IHI and non-ihi) EA to COO/EVP, IHI Data Analyst, Summer Intern, Nevada Power Company LSAT/SAT Tutor, Kaplan Professional Interests Econ and public policy creating synergy between private/public sectors for better social outcomes Disparity/equity work closing outcomes gaps between socioeconomic groups Personal Interests (Optional) Cycling, Comedy, Reading, Beer (making/responsibly consuming), Music (playing and listening), technology, space/science

17 Building Capability Group 17 Houston, TX Kathy Luther, Vice President Cambridge, MA Joanne Healy, Sr. Vice President Amanda Swiatocha, Executive Director, Marketing Kayla DeVincentis, Project Manager Julie Landsman, Project Coordinator California, MD Jenna Elkins, Director of Event Planning Cindy Betti-Sullivan, BCG Operations Director Carly Strang, Executive Director, IHI Open School Jesse McCall, Sr. Project Manager Jameson Case, Director, Customer and Program Marketing

18 Outcomes Nurses satisfaction improved Walk fewer miles per shift Respond to patients needs more quickly Fewer patient falls and errors 40% reduction in overtime

19 A Swedish Moment What leadership behaviors will you test in the next week? How will you analyze and plan leading for joy?

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21 Design Innovation Exnovation Deprescription Co-design and co-production

22 Innovation-Spread-Exnovation Innovation Where are care models and processes broken? Where do we need new thinking? Innovation labs, design processes Harvesting Spread Where do we see variation in performance? How can we reliably spread to ensure that we can provide the best care to every patient, where they are? Transparent data Curiosity Spread Model Exnovation How do we stop what doesn t work anymore? How will we eliminate wasteful practices and processes? It takes courage!

23 Exnovation and Undiffusion Established procedures can be hard to abandon, even when evidence for change is strong - Preference for what is familiar - Cost of training and new equipment can be a barrier Speed and shape of undiffusion - Not a perfect reverse S curve - Conflicting data can affect rate of undiffusion - Late adopters of old standard are often the first to Exnovate Davidoff F. On the Undiffusion of Established Practices. JAMA Intern Med.2015;175(5): doi: /jamainternmed

24 A Swedish Moment How do you exnovate and undiffuse? Do you have a process for innovation?

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26 Habits Quality improvement Dosing Four questions Hudles Leading teams

27 Four Leadership Questions Do you know how good you are? Do you know where you stand relative to the best? Do you know where the variation exists? Do you know the rate of improvement over time?

28 Leading Teams Multigenerational teams Multiprofessional teams Diverse and inclusive teams Include patients and families

29 Multigenerational Teams Traditionalists (71 to 88 years old): loyal Baby Boomers (56 to 70 years old): optimists Generation X (36 to 55 years old): questioning Gen Y, Millennials (21 to 35 years old): realistic Gen Z, igen (20 years old and younger): balanced

30 Multiprofessional Teams Learning together from the start Building skills in teams New ways to teach Using the IHI Open School as a platform for sharing

31 Diversity and Inclusion for Improved Teamness Cultural lunch and learns Ethnography and curiosity Reflection sessions, and what matters to you?

32 Lessons from Google The how, not who, of teams is what drives performance Five key dynamics: 1. Psychological safety 2. Dependability 3. Structure and clarity 4. Meaning of work 5. Impact of work Psychological safety: Do team members feel supported, and able to ask questions and take risks? Teams that felt safe beat targets by 17%, while teams that felt unsafe missed targets by 19% Psychological safety inspires a learning culture Jessica Wisdom and Henry Wei, Cultivating Great Teams: What Health Care Can Learn from Google. NEJM Catalyst Leadership Blog, 19 October 2016.

33 A Swedish Moment How will you answer the four questions? What are your plans for building effective teams?

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35 Pulse Survey Daily check Monthly pulse survey with different focus in addition to standard questions Coffees to follow up Annual measures Jidoka

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37 Employee Well-being Includes good health, job and retirement security, justice, appreciation, purpose, and happiness Contributes to productivity and high quality work, presenteeism, decreased turnover, and greater sense of teamwork

38 Strategies for Caring for the Caregivers Experience drivers: Fair pay Access to tools and resources to do the work Safe work environment Respect and dignity Experience differentiators: Inspiring mission and vision Values that embrace love, appreciation, and compassion Voice in decision making and work design Professional development and growth Staff well-being encouraged and supported Experience enablers: Differentiators possible Reasonable span of control Process and technology simplicity Role clarity Regular feedback Modified and adapted from Providence St Joseph Health, Greg Till, Chief Talent Officer

39 A Swedish Moment What is your strategy for caring for the carer? How will you see the pebbles?

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42 Ideas from IHI Pulse surveys- daily, monthly, annually Coffees- monthly conversations on key issues Ministry of Fun Olympics Health and Wellness Team Focus on joy Linson s story

43 How to Create a Joyful, Engaged Workforce Outcome: Patient experience Organizational performance Staff burnout 4. Use improvement science to test approaches to improving joy in your organization 3. Commit to making Joy in Work a shared responsibility at all levels 2. Identify unique impediments to Joy in Work in the local context 1. Ask staff what matters to you?

44 Critical Components for Ensuring a Joyful, Engaged Workforce Interlocking responsibilities at all levels Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Participative Management Recognition & Rewards

45 Critical Components for Ensuring a Joyful, Engaged Workforce Interlocking responsibilities at all levels Real Time Measurement: Contributing to regular feedback systems, radical candor in assessments Physical & Psychological Safety: Equitable environment, free from harm, Just Culture that is safe and respectful, support for the 2 nd Victim Wellness & Resilience: Health and wellness selfcare, cultivating resilience and stress management, role modeling values, system appreciation for whole person and family, understanding and appreciation for work life balance, mental health (depression and anxiety) support Daily Improvement: Employing knowledge of improvement science and critical eye to recognize opportunities to improve, regular, proactive learning from defects and successes Camaraderie & Teamwork: Commensality, social cohesion, productive teams, shared understanding, trusting relationships Wellness & Resilience Daily Improvement Real Time Measurement Camaraderie & Teamwork Happy Healthy Productive People Physical & Psychological Safety Participative Management Recognition & Rewards Meaning & Purpose Autonomy & Control Participative Management: Co-production of Joy, leaders create space to hear, listen, and involve before acting. Clear communication and consensus building as a part of decision making Meaning & Purpose Daily work is connected to what called individuals to practice, line of site to mission/goals of the organization, constancy of purpose Autonomy & Control: Environment supports choice and flexibility in daily lives and work, thoughtful EHR implementation Recognition & Rewards: Leaders understand daily work, recognizing what team members are doing, and celebrating outcomes

46 A Swedish Moment Plan your calendar for meaning, mastery, and membership Plan for commensality

47 Tack! Maureen Bisognano President Emerita and Senior Fellow Institute for Healthcare Improvement 20 University Road, 7 th Floor Cambridge, MA mbisognano@ihi.org