SDAHO Conference /20/18

Transcription

1 BRINGING YOUR QUALITY AND IMPROVEMENT PROGRAMS HOME FOR A VICTORY SARAH PAVELKA, PHD, MHA, OTR/L, CPHQ, FNAHQ SDAHO Annual Conference - Quality Track- SDAHQ Weds Sept 20, 2018: 8:00 9:00 am & 1:30 2:30 pm OBJECTIVES Objectives Session 1, 8-9 am Differentiate between the theories of improvement that can help transform your organization for any quality professional new to seasoned. Demonstrate how to embed your quality program into your organization. Objectives Session 2, 1:30-2:30 pm Determine how to implement the theory of improvement with a difficult environment. Utilize success stories from other hospitals and gain from real life take home ideas. Formulate a plan for increased engagement in quality and improvement throughout your organization. TRANSFORMING YOUR ORGANIZATION Pavelka - Iowa Healthcare Collaborative 1

2 IMPROVEMENT STRATEGIES PDSA/ PDCA Lean Six Sigma Team S.T.E.P.P.S Patient Centered Care Magnet achievement Baldrige Patient Satisfaction Surveys Rounding/Walks Employee Spotlights Open 2-way communication Return on Investments ALIGNMENT TOOLS Strategic Planning Included? SMART goals Team Charters Included? Goals and Objectives Budgeting Cost accounting Core Measures Do you know the cost of not meeting them? Cost to perform the process More than lost charges TRANSFORMATIONAL LEADERSHIP THEORY Identification for the need to change, then through commitment and inspiration create vision/path for change (Bass, 1985) Pavelka - Iowa Healthcare Collaborative 2

3 SIGNIFICANCE Leadership actions / funding is related to outcomes of care Improving patient care in healthcare Support for productive leadership behaviors WHAT IS TRANSFORMATIONAL LEADERSHIP? Charisma Inspiration High commitment to projects Create trust Intellectual stimulation Acquire, transfer and apply knowledge Individual consideration Develop goals versus set them Management by Exception (avoid directions) Reward performance according to goals/ accountability Goals are tied to performance reviews TYPES OF PROJECTS Transformational Leadership great for: Long duration projects Projects with novelty Projects with uncertainty Pavelka - Iowa Healthcare Collaborative 3

4 EMBEDDING YOUR PROGRAM WHAT IT TAKES Understanding Systems Thinking Leadership and Followership Guide by example Teamwork and communication!! Understanding (culture) change Also Defined process (ex. PDSA, Lean, 6 Sigma) Use of the tools in every situation DEMING S THEORY OF PROFOUND KNOWLEDGE Foundation Principles Customer, Systems, Variation, Knowledge, Planned Change, People One of the most notable PDSA Deming s 14 points Statistical Process Control Variation: Common and Special 85% Process/System & 15% People Pavelka - Iowa Healthcare Collaborative 4

5 BY IMPROVING QUALITY Increases Productivity Decreases Cost Increases Profit Margins Decrease Price/ Increases Value Increases Market Share Opportunity to Stay in Business Jobs and More Jobs Deming repeatedly reminded us that we must continue to improve quality as the first step towards creating organizational performance. SYSTEMS THINKING A System is a group of interrelated processes that link together to produce a satisfactory result in meeting the expectations of the customer for which it is intended. Parts of a system: Purpose Customers Inputs Outputs Processes Measurements WHAT IS A SYSTEM? System Purpose Customer needs Methods Materials Machines Input Process Output People Environment Measures Deming repeatedly reminded us that the organization is a system of interrelated processes that work together to produce an output, product or service. Pavelka - Iowa Healthcare Collaborative 5

6 MISSION/VISION/ VALUES These are the guiding forces to the organization We want all of our energy pulling to: Accomplish our mission, Achieve our vision, Follow our values BREAKTHROUGH BENEFITS TO THE CUSTOMER Kano Model LEADERSHIP INVOLVEMENT Where the work is being done Observe directly how things are done Solicit barriers from staff Obtain improvement ideas from staff Functional barriers will dissolve Responsibilities Coach vs Authority Power to the people vs Manager Decision-making Mindset of big picture vs Functional focus Continuous improvement vs reactive nature and fighting fires Pavelka - Iowa Healthcare Collaborative 6

7 LEADERSHIP ROLE DO: Support the teams: Attended meeting Break down barriers: Listen and remove Communicate to others: Up and Down Accountability to you: Decision by fact Go to the GEMBA: Walking the floor Stay Positive: SMILE DON T: Run the team: Not your ideas Say No: Ask for more info Stay quiet: Will not spread Hide behind numbers: The past didn t work Hide in your office: They need to see you Talk negatively: It spreads HUMAN CENTERED BEHAVIOR CEO Patient Upper Management Staff Middle Management Middle Management Staff Patient Traditional Support Upper Management CEO Quality Organization Support TEAMWORK COMMUNICATION! LEADERSHIP BEHAVIORS & ROLES Lead by example Deploy policy and examples Commit to standards and resources Provide long-term vision and principles Understand Process Improvement Pavelka - Iowa Healthcare Collaborative 7

8 ROOT CAUSE OF FAILURE? Failure Not enough urgency Not creating a coalition Lack of vision Under communication Not removing obstacles No systematic planning No short-term wins Victory too soon Not anchoring changes into culture Need Measure, accountability Engagement, reward Commit, communicate All levels, recognition Alignment, performance Measure outcomes Communicate, thank you Processes stable Communicate, measure, performance, accountability CHANGE Reaction: WIIFM Positive: This will benefit me Control: I can make a difference Commitment: I want to help Loss: Grief cycle Stages of change NEGATIVE CHANGE CYCLE Pavelka - Iowa Healthcare Collaborative 8

9 CULTURAL CHANGE AND TEAM BEHAVIORS Necessary Elements Results Vision Skills Incentives Resources Implement Success Missing Elements Results Skills Incentives Resources Implement Confusion Vision Incentives Resources Implement Anxiety Vision Skills Resources Implement Slow change Vision Skills Incentives Implement Frustration Vision Skills Incentives Resources False starts DEALING WITH DIFFICULT ENVIRONMENTS QUANTIFICATION WHY DO THIS? Customers: health and healing Employees: need to understand Board of Directors: support Leadership team: buy-in Pavelka - Iowa Healthcare Collaborative 9

10 TYPICAL MEASURES OF GAINING $$$$ Do more Cut more overhead Reduce supply costs (quality of materials) Others? MORE THAN JUST DOLLARS TO THINK ABOUT Health personal or organizational? Influence of a culture Leadership support Employees acceptance Mission of the organization? Help us out here Fighting an up hill battle SELLING THE WHY? Start with Why The Golden Circle Circle of Influence WHAT HOW WHY Pavelka - Iowa Healthcare Collaborative 10

11 SELLING THE CHANGE - ADJUSTING THE FRAME Accentuate the positive aspects of the change Remain firm in commitment to change Remain calm in the throws of change Focus on the things that will not change Stay positive PERFORMANCE FRAMEWORK: A SYSTEMS PERSPECTIVE Performance Excellence: An integrated approach to organizational performance management that results in delivery of ever-improving value to customers, contributing to marketplace success, improvement of overall organizational effectiveness, capabilities, and organizational and personal learning. MISSION AND VISION Mission The overall function of an organization. Answers the question, What is this organization attempting to accomplish? Define patients, stakeholders, or markets served; distinctive or core business; or technologies used. Vision Desired future state of your organization. Describes where the organization is headed, what it intends to be, or how it could be perceived in the future. Pavelka - Iowa Healthcare Collaborative 11

12 WHEN AND WHO DO WE COMMUNICATE? Employees Leadership Board of Trustees/Directors Providers Community Patients/Family SUCCESS FROM OTHERS Profit is not the explanation, cause, or rationale of business behavior and business decisions; but the test of their validity. Peter Drucker Money is the language of upper management. Joseph M. Juran Pavelka - Iowa Healthcare Collaborative 12

13 THINGS TO CONSIDER: TYPICAL (??) Does your organization have a true cost to provide care? Do you know the cost of process or outcomes? How much does a medical error cost? How much are non-value added activities costing? Cost of square footage? THINGS TO CONSIDER: OTHERS Bring facts, not hunches Category of costs Goods and Services Errors Lost profits Customer incurred costs Unique methods to calculate RETURN ON INVESTMENTS (ROI) Need a baseline of measures to compare Cost: labor, materials, supplies and overhead Calculations: $$$ Benefits of improvement = Return on Investment $$$ Spent for improvement Ratio Pavelka - Iowa Healthcare Collaborative 13

14 TYPES OF RETURN ON INVESTMENT (ROI) Calculations Savings Hard savings reduce actual costs Soft savings more with less Cost of Quality or Cost of Defects Cost to avoid, find, make and repair errors Failure dollars Materials, labor, defect correction, and customer service HARD SAVINGS - EXAMPLES Supplies and Materials reduced Overtime saved Equipment rental reduced Space eliminated (rent or sell it) Labor - natural / normal self selection DO NOT EVER REDUCE THE WORKFORCE IN A QUALITY IMPROVEMENT EFFORT SOFT SAVINGS - EXAMPLES Time: Process, Labor and/or Overhead Time saved x amount performed x ave. hourly wage 10 min x 3/day x 7 days/wk x 52 wks/yr x $20/hr = $ min/hr Satisfaction: Staff and Patient Retention: Cost to recruit another Physical Space: for more value added activities Pavelka - Iowa Healthcare Collaborative 14

15 SAVING EXAMPLES Patient Satisfaction Market Share: 26% to 44% ROI = $6.5M net revenue Patient Safety Falls: 4 to 0 ROI: $152K saved in cost & LOS Patient Safety Infections: 2% to 0% ROI: $297K saved in cost & LOS Lessons Learned Measure and transparency Finance as a resource not an outcome Great culture and connect to the purpose COST OF QUALITY OR COST OF DEFECTS Seven Wastes (Lean) Patient Satisfaction lost customers Medical Errors or Harm Fees (Legal and Insurance) Every year it adds up Mayo s example = five to one ROI PLANNING FOR ENGAGEMENT Pavelka - Iowa Healthcare Collaborative 15

16 QUALITY PLANNING Addresses: Strategic & action planning Plans implementation Adequate resources are ensured for plans Accomplishments are measured and sustained Stresses: Long-term sustainability How plans are changed if circumstances require Competitive or collaborative environment Core competencies Sustainability QUALITY PLANNING CONTINUED While many organizations are increasingly adept at planning, plan execution is still a significant challenge. This is especially true given market demands to be agile and to be prepared for unexpected change, such as volatile economic conditions or disruptive technologies that can upset an otherwise fast-paced but more predictable marketplace. QUALITY PLANNING OUTCOMES The special role of planning is to align work systems and learning initiatives with your organization s strategic directions. Thereby ensuring that improvement and learning prepare you for and reinforce organizational priorities and achievement. Assist in tracking successes and achievements with measurements. Pavelka - Iowa Healthcare Collaborative 16

17 ORGANIZATIONAL ASSESSMENTS Patient-focused excellence Focus on drivers of customer engagement, customer health status, new markets, and market share Key factors in competitiveness and sustainability Operational performance improvement Innovation Short- and long-term productivity and growth Cost containment Building operational capability (speed, responsiveness, & flexibility) Investment in strengthening your organization Organizational and personal learning Mission STEPS TOWARD MATURITY Pavelka - Iowa Healthcare Collaborative 17

18 SARAH PAVELKA, PHD, MHA, OTR/L, CPHQ, FNAHQ Pavelka - Iowa Healthcare Collaborative 18