Leadership for Improvement

Transcription

1 Leadership for Improvement Carol Haraden PhD, Vice President IHI November 12, 2013

2 Safety as a Systems Property

3 Safety is not measured by the number of times you fall through the ice

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6 Safety is measured by the thickness of the ice upon which you are skating.

7 Leadership is key to success The currency of leadership is attention. How will you provide that attention? 1. Walk-rounds 2. Asking for data and reports 3. Meeting with the team regularly to understand progress, remove barriers and obstacles 4. move it up on your own agenda 5. Move it up on the senior team agenda 6. Meet with the program manager

8 The Program Manager is Pivotal " They are the glue " They need training in improvement and coaching " The PM has to be an encouraging, positive, can-do kind of person who is not easily discouraged or overwhelmed " Taking care of the PM

9 Critical Success Factors " Active executive leads " Presence " Regular meetings with team leads " Testing " Real time measurement " Tempo

10 Dansk Selskab for 10 What is most important in the early stage?

11 Dansk Selskab for 11 Leadership and the Team Meeting

12 Dansk Selskab for 12 Creating and managing the tempo of testing and spread

13 What are patient safety WalkRounds? A carefully planned discussion between " The leader and the staff " - - A person to record the conversation. A discussion for 1 hour maximum Located wherever frontline staff do their work 12/11/13 13

14 The Format

15 The Format

16 The Format

17 The Format

18 What are your biggest concerns for this work?

19 A Project Source: J. Reinertsen, 2005

20 Moving a Big Dot! June 6, 1944 Source: J. Reinertsen, 2005

21 What s the Difference? A Project Moving a Big Dot! Source: J. Reinertsen, 2005

22 The Differences Are " Level of ambition " Commitment: hearts pounding " Core strategy: staying alive " Clear measure of daily success: territory " Clear overarching goal: Berlin " People are shooting live ammo! " Will, Ideas and Execution!

23 Leading the Whole System to Provide Highly Efficient and Effective Results The Ground Level View (Staff) The Big Picture View (Management)

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28 Case failure or System failure?

29 Attribution Error A fault in the interpretation of observations, seen everywhere, is to suppose that every event (defect, mistake, accident) is attributable to someone (usually the one nearest at hand), or is related to some special event. The fact is most troubles with service and production lie in the system. - Deming (1986),p. 315) 29

30 30 How do we know if what happened here is special cause or common cause (happening throughout the organization)?

31 31 Using the information from the case, what data would we like to have about system performance? What processes failed? Are they unreliable throughout the organization?

32 Improving a System Problem " How do we understand the problem? " Where should we set the goal? " What will drive success? " What projects, when combined, will get us to our goal? " Do we have the capability at all levels? " What method should we use? " How will we provide oversight and learn from the work?

33 What Changes Can We Make? Understanding the System Outcome Primary Drivers Secondary Drivers Process Changes S. Driver 1 Change 1 P. Driver Change 2 S. Driver 2 Aim: An improved system S. Driver 3 Change 3 P. Driver Effect Drives S. Driver 1 Cause S. Driver 2

34 What Changes Can We Make? Understanding the System for Weight Loss Outcome Primary Drivers Secondary Drivers Process Changes Calories In Limit daily intake Substitute low calorie foods Track Calories Plan Meals AIM: A New ME! Avoid alcohol Drink H2O Not Soda Every system is perfectly designed to achieve the results that it gets Calories Out Work out 5 days Walk to errands Outcome = Structure + Process -Donabedian

35 What Changes Can We Make? Understanding the System for Weight Loss Outcome Primary Drivers Secondary Drivers Process Changes AIM: A New ME! Calories In Calories Out Every system is perfectly designed to achieve the results that it gets Limit daily intake Substitute low calorie foods Avoid alcohol Work out 5 days Walk to errands Track Calories Plan Meals See Drink H2O Not Soda change package Source: Richard Scoville, Improvement Advisor

36 How Will We Know We Are Improving? Understanding the System for Weight Loss with Measures Outcome Primary Drivers Secondary Drivers Process Changes AIM: A New ME! Weight BMI Body Fat Waist size Calories In Daily calorie count Calories Out Exercise calorie count Limit daily intake % of Substitute opportunities used low calorie foods Avoid alcohol Work out 5 days Avg cal/day Avg drinks/ week Days between workouts Track Calories Running calorie total Plan Meals offplan/week See change package Drink H2O Not Soda Sodas/ week Measures let us Monitor progress in improving the system. Identify effective changes. Walk to errands Etc... Source: Richard Scoville, Improvement Advisor

37 A Very Large System Problem Medication Safety PROBLEM Harm from medications alone occur in over 25% of all hospitalized patient. Harm to outpatients appears to be much higher.

38 An Example: Medication Safety Medication Safety Tier 1: Big Dot Hospitals Mental Health Primary Care Tier 2: Portfolio Med. reconciliation Standardize dosing Self med Family Capacity Correct list Patient capability availability Tier 3: Projects

39 An Example: Hospital Medication Safety Medication Safety Tier 1: Big Dot Med Surg Mental Health Pharm Tier 2: Portfolio Med. reconciliation IV pumps Self med Family Capacity Admix Standardized dosing Tier 3: Projects availability

40 Portfolio What would a portfolio of projects look like for various units/ departments/areas? 1. Patient/Client experience 2. Outcomes that matter (reliability) 3. Safety 4. Staff s joy in work

41 Oversight of Projects " Monthly reports " Monthly meeting with champion and Division Director or Unit Manager " 90 day goal setting " Quarterly report of all projects

42 Agenda for a Review Three Twenty-Minute Segments 1. SBAR: " Situation - run charts and problems " Background - changes and learning " Assessment - degree of belief that project will be successful " Recommendations - solutions and help needed 2. Problem solving 3. Action plan

43 What will it take? " Winning the hearts and minds or the staff " Focusing on improvement not targets " Leadership, leadership, leadership " Integration into daily work " Tying it all together " Creating infrastructure " Creating capability and capacity " Measurement that has meaning