Leading Quality Across a System

Transcription

1 A/B 01 These presenters have Nothing to disclose Petrina McGrath, R.N, M.N, PhD Executive Director, Quality & Safety Saskatchewan Health Authority Angela A. Shippy, MD, FACP, FHM SVP, Chief Quality Officer Memorial Hermann Health System Leading Quality Across a System December 11, 2018 David M Williams, PhD Senior Lead, Improvement Science & Methods Institute for Healthcare Improvement

2 Nothing to Disclose 2 We have no relevant financial or nonfinancial relationship(s) within the services described, reviewed, evaluated or compared in this presentation.

3 Our Core Faculty 3 Angela A. Shippy, MD, FACP, FHM Sr Vice President & CQO Memorial Hermann Health Petrina McGrath, RN, M.N., PhD Executive Director Quality and Safety - Saskatchewan Health David M. Williams, PhD Senior Lead Institute for Healthcare

4 Objectives 4 Identify key drivers to lead quality across a system. Identify key elements to build a foundation structure and culture. Identify key elements for continuous improvement plan design, performance improvement methodology/activity and sustainment. Identify common gaps for quality leaders. Identify opportunities to improve foundational knowledge.

5 What s the problem we were trying to solve? 5

6 What s the CQO role today? 6

7 IHI Research 7 WHITE PAPER IHI Innovation System AN IHI RESOURCE 53 State Street, 19th Floor, Boston, MA ihi.org How to Cite This Paper: Martin LA, Mate K. IHI Innovation System. IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; (Available at ihi.org) Martin LA, Mate K. IHI Innovation System. IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; (Available at ihi.org)

8 What s Our Theory?! 8

9

10

11 Develop Infrastructure: Creating Structures To Support Quality 11 Rate Your Organization: 1 Just Starting 2 Activity 3 Early Systematic Approaches 4 - Aligned Approaches 5 - Exemplar D.1 Make Quality and Safety core organizational aims D.2 Establish a Board Quality Committee D.3 Activate the executive team in support of quality D.4 Build a quality department D.5 Develop strong physician leadership D.6 Link quality with finance D.7 Align Incentives and Accountability D.8 Implement an improvement methodology D.9 Implement quality reporting

12 Develop Infrastructure: Creating Structures To Support Quality 12 D.1 Make Quality and Safety core organizational aims D.2 Establish a Board Quality Committee D.3 Activate the executive team in support of quality D.4 Build a quality department D.5 Develop strong physician leadership D.6 Link quality with finance D.7 Align Incentives and Accountability D.8 Implement an improvement methodology D.9 Implement quality reporting

13 Develop Infrastructure: Creating Structures To Support Quality 13 D.1 Make Quality and Safety core organizational aims D.2 Establish a Board Quality Committee D.3 Activate the executive team in support of quality D.4 Build a quality department D.5 Develop strong physician leadership D.6 Link quality with finance D.7 Align Incentives and Accountability D.8 Implement an improvement methodology D.9 Implement quality reporting

14 Develop Infrastructure: Creating Structures To Support Quality 14 D.1 Make Quality and Safety core organizational aims D.2 Establish a Board Quality Committee D.3 Activate the executive team in support of quality D.4 Build a quality department D.5 Develop strong physician leadership D.6 Link quality with finance D.7 Align Incentives and Accountability D.8 Implement an improvement methodology D.9 Implement quality reporting

15 Develop Infrastructure: Creating Structures To Support Quality 15 D.1 Make Quality and Safety core organizational aims D.2 Establish a Board Quality Committee D.3 Activate the executive team in support of quality D.4 Build a quality department D.5 Develop strong physician leadership D.6 Link quality with finance D.7 Align Incentives and Accountability D.8 Implement an improvement methodology D.9 Implement quality reporting

16 Key Points 16 Use the rating system to conduct a gap analysis Use drivers rated 3 or less as your opportunities for improvement Prioritize what you will emphasize Communicate, communicate, communicate!

17

18 Create A Culture that Enables & Activates People: Creating the Activities and Environment that Support People to Act 18 Rate Your Organization: 1 Just Starting 2 Activity 3 Early Systematic Approaches 4 - Aligned Approaches 5 - Exemplar C.1 Define and integrate values that support quality and improvement C.2 Align visible practices with espoused values C.3 Use transparency as a lever C.4 Coach with the Socratic method to develop knowledge C.5 Hardwire scientific problem solving C.6 Profile improvement work and celebrate results C.7 Implement board and executive team rounding C.8 Focus on the patient s experience and include in the coproduction of daily work and improvement C.9 Emphasize systems-thinking and creating reliable standard work

19 Create A Culture that Enables & Activates People: Creating the Activities and Environment that Support People to Act 19 C.1 Define and integrate values that support quality and improvement C.2 Align visible practices with espoused values C.3 Use transparency as a lever C.4 Coach with the Socratic method to develop knowledge C.5 Hardwire scientific problem solving C.6 Profile improvement work and celebrate results C.7 Implement board and executive team rounding C.8 Focus on the patient s experience and include in the co-production of daily work and improvement C.9 Emphasize systems-thinking and creating reliable standard work

20 Create A Culture that Enables & Activates People: Creating the Activities and Environment that Support People to Act 20 C.1 Define and integrate values that support quality and improvement C.2 Align visible practices with espoused values C.3 Use transparency as a lever C.4 Coach with the Socratic method to develop knowledge C.5 Hardwire scientific problem solving C.6 Profile improvement work and celebrate results C.7 Implement board and executive team rounding C.8 Focus on the patient s experience and include in the co-production of daily work and improvement C.9 Emphasize systems-thinking and creating reliable standard work

21 Create A Culture that Enables & Activates People: Creating the Activities and Environment that Support People to Act 21 C.1 Define and integrate values that support quality and improvement C.2 Align visible practices with espoused values C.3 Use transparency as a lever C.4 Coach with the Socratic method to develop knowledge C.5 Hardwire scientific problem solving C.6 Profile improvement work and celebrate results C.7 Implement board and executive team rounding C.8 Focus on the patient s experience and include in the co-production of daily work and improvement C.9 Emphasize systems-thinking and creating reliable standard work

22 Key Points 22 Remove barriers Provide targeted training and tools Make improvement part of workflow Be a conduit between disparate data points and knowledge

23

24 Plan: Understand And Design To Meet The Customer Need 24 Rate Your Organization: 1 Just Starting 2 Activity 3 Early Systematic Approaches 4 - Aligned Approaches 5 - Exemplar P.1 Establish a system to obtain information relevant to the need the organization is trying to fill P.2 Focus efforts on the vital few with the greatest impact P.3 Prioritize equity P.4 Establish an annual and five year plan P.5 Integrate Quality Plan with Strategic Plan P.6 Develop an implementation and communication strategy

25 Plan: Understand And Design To Meet The Customer Need 25 P.1 Establish a system to obtain information relevant to the need the organization is trying to fill P.2 Focus efforts on the vital few with the greatest impact P.3 Prioritize equity P.4 Establish an annual and five year plan P.5 Integrate Quality Plan with Strategic Plan P.6 Develop an implementation and communication strategy

26 Plan: Understand And Design To Meet The Customer Need 26 P.1 Establish a system to obtain information relevant to the need the organization is trying to fill P.2 Focus efforts on the vital few with the greatest impact P.3 Prioritize equity P.4 Establish an annual and five year plan P.5 Integrate Quality Plan with Strategic Plan P.6 Develop an implementation and communication strategy

27 Key Points 27 View Organization as a System Deploy Horizontally and Vertically Translate the plan so it is meaningful and relevant to each area Finding the Right Balance manage the demand and capacity of teams & leaders

28

29 Improve: Creating Breakthroughs in Improvement 29 Rate Your Organization: 1 Just Starting 2 Activity 3 Early Systematic Approaches 4 - Aligned Approaches 5 - Exemplar I.1 Develop improvement capability at all levels with core improvement tools I.2 Establish processes to prioritize frontline improvement projects based on organizational goals I.3 Improvement projects are charted using a standard method (e.g. Model for Improvement) I.4 Improvement projects are integrated into daily work I.5 A learning system exists for reporting, evaluation & feedback I.6 A process exists to implement standard work to scale

30 Improve: Creating Breakthroughs in Improvement 30 I.1 Develop improvement capability at all levels with core improvement tools I.2 Establish processes to prioritize frontline improvement projects based on organizational goals I.3 Improvement projects are charted using a standard method (e.g. Model for Improvement) I.4 Improvement projects are integrated into daily work I.5 A learning system exists for reporting, evaluation & feedback I.6 A process exists to implement standard work to scale

31 Improve: Creating Breakthroughs in Improvement 31 I.1 Develop improvement capability at all levels with core improvement tools I.2 Establish processes to prioritize frontline improvement projects based on organizational goals I.3 Improvement projects are charted using a standard method (e.g. Model for Improvement) I.4 Improvement projects are integrated into daily work I.5 A learning system exists for reporting, evaluation & feedback I.6 A process exists to implement standard work to scale

32 QI Dosing A basic feature of the dosing approach is an organization-wide plan for dispensing the appropriate dose of the SOI to the appropriate individuals. Many People Few People Knowledge transfer Coaching Mentoring Integration into daily work 32 Everyone Action, Coaching IHI Open School Improvement Science in Action & Improvement Coaches Leaders / Executives Leadership Workshops; Coaching Improvement Experts Improvement Advisors Self sufficient Shared Knowledge Deep Knowledge

33 Day in the life of a Manager 33 Source : Saskatchewan Health Authority

34 Key Points 34 QI Dosing Integrating into daily work Leadership Commitment Learning System Key Components (Tom Nolan, IHI)

35

36 Sustain: Assuring Predictable & Reliable Process 36 Rate Your Organization: 1 Just Starting 2 Activity 3 Early Systematic Approaches 4 - Aligned Approaches 5 - Exemplar S.1 Standardization: Processes to help define and disseminate standard work (i.e. What to do and how to do it) S.2 Accountability: Process to review execution of standard work S.3 Visual Management: Process performance information is continuously available to synchronize staff attention and guide current activities S.4 Problem Solving & Escalation: Processes for frontline problem solving and escalating issues requiring leadership resolution

37 Sustain: Assuring Predictable & Reliable Process 37 S.1 Standardization: Processes to help define and disseminate standard work (i.e. What to do and how to do it) S.2 Accountability: Process to review execution of standard work S.3 Visual Management: Process performance information is continuously available to synchronize staff attention and guide current activities S.4 Problem Solving & Escalation: Processes for frontline problem solving and escalating issues requiring leadership resolution

38 Sustain: Assuring Predictable & Reliable Process 38 S.1 Standardization: Processes to help define and disseminate standard work (i.e., what to do and how to do it) S.2 Accountability: Process to review execution of standard work S.3 Visual Management: Process performance information is continuously available to synchronize staff attention and guide current activities S.4 Problem Solving & Escalation: Processes for frontline problem solving and escalating issues requiring leadership resolution

39 Key Points 39 Standard Work that is continuously improved upon Leader Standard Work Management System links it all together Visual management, Tiered huddles, Leaders standard work

40 Alignment of Leader standard work 40 Source : Saskatchewan Health Authority

41

42 ACHE Healthcare Executive Leading Quality Across a System: Five core drivers for effective chief quality officers. Nov/Dec 2018 IHI Driver Diagram

43 43 IHI.org/CQO Wave 2 June 10 to October 18, 2019 Boston Workshops June 10 13, 2019 September 23 26, 2019

44 Thank you! 44