Leadership Lessons for Spread and Scale

Transcription

1 Leadership Lessons for Spread and Scale Lisa Schilling, RN, MPH Vice President, CMI Center for Health Systems Performance C27: IHI Forum Orlando, FL December 9, 2014 Session Objectives Engage in discussion about learning and challenges in spread Describe how initiative complexity and local culture impact spread Identify strategies to address challenges 1

2 Disclosures Faculty have nothing to disclose The Greatest glory in living lies not in never falling, but in rising every time we fall. - Nelson Mandela 2

3 What Really Matters PRACTICE TRANSFERRABILITY 5 December 2, 2011 Kaiser Foundation Health Plan, Inc. For 2014 internal What Really Matters December 2, 2014 PRACTICE TRANSFERRABILITY 3

4 What Really Matters PRACTICE TRANSFERRABILITY December 2, 2011 Kaiser Foundation Health Plan, Inc. For 2014 internl us only Your Biggest Challenges Buy in from staff and executive leadership Speed of adoption Standardizing vs customizing Sustaining or making it stick Large complex program adoption and management 4

5 Discussion Groups Identify biggest challenges to spread Move to a table on this topic Discuss 3 items: Challenges Ideas One change you will try Appendix 5

6 Phase 1 Determine Organizational Readiness Start with the end Start in with mindthe end in mind Determine what is being spread Define target population & end state Establish timeframe to achieve scale Define measurement strategy including spread measures Align improvement to strategic objects Align improvement to Determine strategic if objects improvement links with strategic goals Craft a compelling message start with why Determine key members of chartered teams - who are the key stakeholders & sponsorship Assess practice readiness to spread Complete assessment of host site readiness to spread Plan for or identify sites based on learnings Revisit scale, scope and speed Assess site readiness Assess site to readiness receive to receive Complete readiness to receive assessment tool Plan for sequencing based on learnings Create monitor and review plan 11 Practice readiness to spread Does It Work? How Does It Work? Will It Work Elsewhere? Will It Spread? Comparative Performance Outcome vs. Process Improvement Attributable to Practice Strength of Evidence Logic Model Key Components Specific Processes Organizational Enablers Barriers and Risks Demonstrated Sustainability Demonstrated Transfer Adaptability Unintended Consequences Simplicity Cultural Fit Business Case Tools Implementation Support 12 6

7 Site readiness to receive Leadership Alignment Organizational Culture Implementation Infrastructure Operational Resources Strategic Alignment with Goals and Priorities Sponsorship & Leadership Oversight Infrastructure Cultural Readiness for Change Project Management & Championship Training Measurement and Monitoring Staff Capacity & Competency Space Technology Operational Infrastructure (# of units involved, relationships) 13 How much variation? Adapt locally vs. copy exactly Adapt locally Theory (Paul Plsek) Health care is a Complex Adaptive System Find local Attractors Use only Simple Rules Copy exactly Theory (Gabriel Szulanski) We re not as smart as we think Experience beats cleverness First import, then improve Strength Spread is more likely to occur if importers can adapt to their needs Strength Spread is more likely to get results if importers work with exporters to learn a proven model 14 7

8 Key components Minimum specifications NW Transition Care Bundle Elements What does the patient need? Transition Bundle I will have what I need when I return home I know when I should call and what number to use when I need help My regular doctor will know what happened to me in the hospital I understand my medications, how to take them, and why I need them I will see my doctor soon after my hospitalization I know someone will check on me when I am home. Risk Stratification with tailored care Specialized phone number on DC Instructions Standardized Same Day Discharge Summary Pharmacist reviewing medications in hospital PharmD phone call (high risk) MD appointments made in hospital within 5 (high risk) to 10 days. RN follow up Call within 48 hours. RN case mgmt 30 days (high risk) 15 8