Fostering engagement and innovation through leadership accountability. June 16, 2015

Transcription

1 Fostering engagement and innovation through leadership accountability June 16,

2 Presentation Outline 1. Ideas Matter 2. Rouge Valley Health System s Approach to Idea Generation About Rouge Valley Getting Started Our Approach Leadership Accountability Recognition Results 3. Other Key Engagement Initiatives 4. Lessons Learned 2

3 Ideas Matter 3

4 The Benefits of Staff Ideas High Performing Idea Systems have been found to show several important benefits: o Create a culture of daily improvement o Address improvement opportunities that are difficult for managers to see o Enhance staff engagement and increase morale o Promote rapid organizational learning o Close the gap between staff and leaders Baptist Health Care: 14,000 staff ideas lead to $5.5M in cost savings Key features of effective idea systems include: o Ideas are integrated into everyday work o The emphasis is on small ideas o Front-line performance metrics focus ideas on what is important o Both managers and workers are accountable for their roles in the idea process 4

5 Getting the Best Employee Ideas Harvard Management Update FEBRUARY 28, 2008 Workers become more engaged when they see their ideas being used. And managers, seeing the impact of employees ideas, give employees more authority which leads to more and better ideas. frontline workers have better knowledge of the particularities of products, services, and processes than managers do. They re better positioned to spot problems and opportunities. Pushing decision making down to the front lines for as many ideas as possible leads to better decisions, faster implementation, and lower processing costs; it also frees up managers time. 5

6 Quality and Safety as the Spark for Employee Engagement Davood Abdollahian, MD, Paul Nagy, PhD 2014 studies across many industries have linked employee engagement to higher performance. This linkage holds true even within health care. For example, in 2012, the National Health Service in the United Kingdom conducted a survey of 280,000 health care employees, which demonstrated that employee engagement scores correlated with lower patient mortality, higher patient satisfaction, lower staff absenteeism, lower staff turnover, and even lower infection rates. Yet the idea of engagement remains a relatively new and understudied concept for management. 6

7 Rouge Valley s Approach to Idea Generation 7

8 About Rouge Valley Rouge Valley Centenary (RVC) Stats 2700 staff 300 active MDs Rouge Valley Ajax and Pickering (RVAP) Program RVAP RVC RVHS Outpatient Clinic (ACU) 90, , ,266 Emergency 63,791 66, ,003 MRI Scans 7,037 8,930 15,967 Surgical Outpatients 5,168 9,491 14,659 Surgical Inpatients 1,592 3,167 4,759 Cardiac Catheterizations N/A 4,784 4,784 Births 1,471 2,163 3,634 8

9 Our Staff Total Total Temporary Part-Time Temporary Full-Time Casual Regular Part-Time Regular Full-Time Total : - - 9

10 Four Pillars of Our Quality Framework 10

11 The STAR Framework Corporately Defined Expectations for Lean Deployment and Sustainment Reported on corporate balanced scorecard STANDARD All of the following are in place: Process Control Boards Performance Trending Boards 6S A3 Rounding Kaizen Participation Leader Training ADVANCED All of the following are in place: Sustainment of Standard level Kamishibai Safety Calendar (could be part of kamishibai system) Idea Board with problemsolving huddles Department leads and sustains its own kaizen events (at least 2 per yr) ROLE MODEL All of the following are in place: Sustainment of Standard and Advanced levels Internal knowledge sharing (joint kaizen with another dept; facilitator for another dept s Lean event; lead an in-service; internal article or poster presentation) External knowledge sharing (e.g. joint kaizen event with external partners; conference presentation; published article) Use of one or more higherlevel Lean tools (e.g. Kanban, Andon, SMED/changeover, etc.) 2010/11 90% 10% 0% 2011/12 100% 40% 10% 2012/13 100% 67% 33% 11

12 Getting Started What to measure Ideas Generated Pros Cons Recognizes staff engagement in Gaming is relatively easy bringing forward ideas regardless of Not necessarily linked to the feasibility or merit of the idea improvement Encourages risk taking and builds Good ideas and not so good ideas are trust in the team (there are no silly counted equally; may not encourage ideas) critical thinking around idea Acknowledges that there might be generation barriers to implementation outside of Does not incent leaders to act on staff the team s control (e.g. funding, ideas (not acting on ideas will be resources, competing priorities) viewed as disrespectful of staff who took the time to submit ideas) Ideas Implemented Pros Linked to improvement Leaders have an incentive to act on staff ideas discouraged Leaders have an incentive to empower staff to take ownership for idea implementation in order to get as many smaller ideas ideas implemented as possible Gaming is more difficult Cons Staff that bring forward ideas that are not implemented (for whatever reason) may be Ideas for large scale change may drain resources making it difficult to implement Big ideas and small ideas are counted equally May contribute to quick implementation without adequate planning and risk assessment 12

13 Getting Started Target Setting There is wide variation in target setting practices across organizations. In general, the advice is to be conservative with target setting in early years and build over time once the capacity of the organization to implement changes increases. Targets are not meant to be punitive and should consider the organization's capacity to implement change ideas as under resourcing places kaizen initiatives at risk. Some of the questions that emerge are: Should the target be the raw number of ideas or the number of ideas per employee? How are employees defined and counted? FTEs vs. headcount? (the FTE approach gives higher weight to FT employees, those who spend the most time at the organization) Which staff groups are included FT, PT, casual? Our review found that, for the most part, targets are based on the number of suggestions per employee. Manufacturing organizations use a target of 3 suggestions per employee per year, although some feedback indicates that this ranges from 2-50 suggestions St. Mary s General Hospital (Kitchener) set a target of 1000 suggestions per year St. Francis Health set a target of 1 suggestion per full time employee in the first year Utah North Region of Intermountain Healthcare did not set targets for the first few years of their programs. Over time, a modest goal of 1 suggestion per employee was identified 13

14 Idea Boards at RVHS RVC Birthing Centre RVC Pharmacy 14

15 Impact Just Do Its PDSAs Layout of the Idea Board New Improvement Ideas In Progress Work & Ideas Implemented Ideas PICK Chart Celebrations Implement Challenge Possible Kibosh Almost Implemented Ideas Stephanie passed her AQ Exam! Week 1 Week 2 Week 3 Week 4 Week 5 Zero department pressure ulcers! Difficulty

16 Idea Board Standard Work

17 Impact Just Do Its PDSAs Layout of the Idea Board Difficulty New Improvement Ideas Implement Possible PICK Chart Challenge Kibosh Review and record In any Progress new Start with work in progress: Work & Ideas improvement opportunities: a) Just Do Its any barriers -e.g., opportunities identified to moving forward? on stat sheet b) PDSAs if the status -Ask staff what barriers they indicator is green, are encountering in their day acknowledge the work and move on; if the status is red, ask about barriers. Use the PICK chart to get feedback Move completed from staff work to the about whether working on this Improvement will have high Ideas or low Implemented section Monthly impact (+/- and daily) whether tracking it is easy on a or run hard chart to do If an or opportunity simple bar chart falls into Kibosh, circle back with Improvement the originator Tickets but do and not PDSAs place on get the PICK moved chart over to this area once completed All patient or employee safety or quality issues are immediately moved to be worked on If opportunity is related to existing PDSA, driver, or Review other work the implemented in progress, move ideas the and if any Improvement opportunities Opportunity in sustaining form to that them PDSA to be incorporated Discuss Almost Implemented any celebrations Ideas on the unit. As Week capacity 1 Week becomes 2 Week available, 3 Week problems 4 Week 5 can be moved from PICK chart to work in progress Assign resources to new work in progress with owner(s), & mentor / coach Implemented Ideas Celebrations

18 Idea Board and Huddle Training Step 1: Classroom Training Review of objectives and standard work Overview of coaching role Participants practice leading huddles Step 2: Gemba Coaching Experienced coach provides real time feedback Develop managers skills to coach staff Transition coaching support to operational leaders Weekly Idea Board Huddle 18

19 Rouge Valley Accountability Structures RVHS Quality Improvement Plan (QIP) RVHS Corporate Scorecard RVHS Leader s Personal Business Commitments Board SMT PETE Quarterly Reviews on Progress to Target 19

20 Owner / VP Department Count Number of Departments with STAR Requirements in Place by VP: Quarter 4 6S Process Control Board Performance Trending Board Kamishibai Safety Calendar Idea Board / Performance Huddles A3 Department Completed the Event / Project Requirement? Generated Implemented Number of Departments at STAR (All Criteria Met) Number of Departments Satisfying 0 Criteria Number of Departments Satisfying 1 Criteria Number of Departments Satisfying 2 Criteria Number of Departments Satisfying 3 Criteria Number of Departments Satisfying 4 Criteria Number of Departments Satisfying 5 Criteria Number of Departments Satisfying 6 Criteria Number of Departments Satisfying 7 Criteria YTD: Number of Ideas Campos Topaloglou Brazeau Gooding Gowrie James Williams McCutcheon Dr. Mohan Total YTD: Number of Ideas 20

21 Cumulative Number of Ideas Generated (By Portfolio) Note: New presentation of metric for 2014/15. Annual Target also broken down into quarterly targets for Number of Ideas Implemented 21

22 Cumulative Number of Ideas Implemented (By Portfolio) 22

23 Recognition 23

24 New ideas are a vital part of our continuous improvement culture at Rouge Valley. Our team of staff, physicians, midwives and volunteers come up with many ideas that help us provide a better patient experience. The patient experience/team engagement (PETE) quality committee is sponsoring an idea celebration on Tuesday, March, 31, 2015 at both RVC and RVAP from 12:00 to 1:00 pm. At this event, we will present an award for the top two ideas at each site as selected by the PETE committee. One grand prize per site will be awarded for the best implemented improvement idea. A second award will be given for one idea from each site that has been generated, but not yet fully implemented. The winners will be selected using the following criteria: 1. Originality of idea 2. Transferable (how easily can this idea be adopted by other departments) 3. Lean thinking (contribution to waste reduction, visual management, respect for people, etc.) 4. Positive impact on patients (on access to care and service excellence), via team engagement, and fiscal responsibility 5. a) Implementation has been completed (grand prize); b) Idea is generated, but not yet fully implemented (runners up). Submissions may include ideas that have come forward from staff, volunteers, physicians, or midwives that have been implemented, or are in the process of being implemented, between April 1, 2014 and March 20, Applications must be submitted no later than Monday, March 23, and must be validated by the manager of the unit, or another staff member (charge staff, healthy workplace champion, etc.) who can confirm idea generation and implementation. Applications are available from the HR department at both sites, or Access Application: On the Intranet under the Employee Centre Home Page Forward completed forms to: crsamuel@rougevalley.ca. SHARE YOUR IDEAS!! Cake and Beverages will be served Key Contact Name: Department: Describe the Idea Is this idea: Fully implemented? If so, when was it implemented. In progress? Expected date of full implementation. IMPROVEMENT OPPORTUNITY Key Contact Phone: Date Idea implemented: Please provide a description of where this idea can be observed in action: What are the actual/expected benefits from this idea: Describe the benefits from implementation of this idea was there significant change to a process? Are there less steps in the process? What other changes have been observed? If applicable, please provide detailed before/after drawings of action plan with this application. Please check off and describe any or all wastes that were impacted by this improvement: Transportation: was there less walking/moving for a person or object as a result of this improvement? Defect/rework: Motion: was there a reduction in searching for supplies? Patients? Paperwork? Excess processing: Waiting: was there less waiting for information? Supplies? Overproduction: Inventory: was inventory reduced because of this improvement? Please circle any/all the corporate dimensions that your idea impacts Access Service Team Fiscal Please describe how this improvement has enhanced patient or customer service: How does this idea make RVHS better for our staff? Do you see potential opportunities for this idea to be spread across other areas? If so, please explain briefly how/where this might happen: In this space, please provide pictures or diagrams that help describe the improvement idea 24

25 Video Clip of Example of Ideas at RVHS =PLI15kvPeM6uKIoC9VajCR0rwx_ZzIbe72&index=1 25

26 Results 26

27 Cumulative Number of Ideas Generated and Implemented at RVHS departments across RVHS report idea generation and implementation on a quarterly basis 27

28 Number of Departments with STAR Requirements in Place 28

29 RVHS Staff Engagement Scores In 2014: our overall engagement score increased by 7.2 points over 2012, and is 5.7 points above the 2012 OHA average. positive scores for every question were higher than our 2012 results, and five of the six were higher than the 2012 OHA average. for the category how would you rate RVHS as a place to work? our 2014 rate was 0.6% higher than 2012, and 1.2 % higher than the 2012 OHA average. The greatest difference between our 2014 rate and the 2012 OHA average was in the category this organization really inspires the very best in me in the way of job performance. This category also saw the greatest increase (7.2%) from our 2012 rate. 29

30 t of our daily work nt and/or hospital LMS Staff Feedback (Wave 1) 2. There are regular meetings on units/departments that focus on the review of unit/department performance metrics and result in plans to improve processes etrics impact the 3. Department performance metrics are openly displayed and reviewed with front line staff on a regular basis 4. Senior Leaders are aware of front line issues and challenges (the way things really are around here) ring forums across rovement 6. Employee and physician suggestions on how to improve department and/or hospital performance are actively solicited and used to drive 7. Employees and physicians understand how their area's performance metrics impact the whole organization's performance 8. The organization facilitates regular knowledge/idea sharing forums across units/departments that are related to hospital improvement icians are involved 1. I understand what the department goals are for the next year 5. Learning is an important part of our daily work 9. Visual displays of hospital performance data are regularly reviewed and used to drive improvement 10. When changes are made in my unit/department, employees and physicians are involved in the process POST LMS Score PRE LMS Score POST LMS Score PRE LMS Score Note: A score of 6 or above indicates a positive response There were 56 respondents in the pre-lms survey and 36 respondents in the post-lms survey (See appendix for details) 30

31 Other Key Engagement Initiatives 31

32 A resource for compassionate and caring communication S.T.A.R.T. with Heart SM Respond with H.E.A.R.T. Coach with H.E.A.R.T. SM

33 S.T.A.R.T. with HEART SM Goals Increase awareness of impact of every patient, visitor and employee interaction, every day, every time Understand the role of the employee, physician, or volunteer is greater than tasks associated with his/her job Understand that employees should feel empowered to deliver world-class care Before I care how much you know, I want to know how much you care [RVHS Patient]

34 Lessons Learned 34

35 Lessons Learned It is not just about the number of ideas implemented!! The idea board and huddle have several objectives: Staff participation in idea generation and implementation Promote continuous improvement as part of everyone s job Team communication and prioritization of opportunities Managing the work in progress to accelerate implementation To create coaching opportunities to develop problem solving capabilities in our staff and to teach leaders to delegate and share responsibility Effective huddles require coaching and support. Leaders require feedback and encouragement to develop this new skill 35