Closing the Health Care Improvement Gap

Transcription

1 Session D3/E3 This presenter has nothing to disclose Closing the Health Care Improvement Gap Brandon Bennett & David Williams December 13, 2017

2 Welcome 2 Brandon Bennett Founder Improvement Science Consulting, Faculty for the IHI Improvement Advisor Professional Development Program, Fellow Carnegie Foundation for the Advancement of David Williams Executive Director of Improvement Science & Methods at the IHI, Faculty for the IHI Improvement Advisor Professional Development

3 3 In health care we have an inexplicably high tolerance for poor execution Jim Kim

4 A case study in transformation toward 4 improvement MEDIC serves as the ambulance provider for the county encompassing Charlotte History of Management best of the traditional Joe Penner, Executive Director and Improvement Advisor Discovered Quality as a Business Strategy

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7 Summarizing Deming s System of Profound Knowledge Understanding Variation Psychology of Change Appreciation of the System Theory of Knowledge + Subject Matter Expertise

8 Questions remain: 8 How do we enact this style of thinking across an organization in a practical way? What would our strategy be?

9 Quality as a Business Strategy (QBS) 9 Five activities all systems could adopt to enact QBS 1. Define the purpose of the organization 2. View the organization as a system 3. Obtain information to improve the system 4. Plan for improvement of the system 5. Manage improvement of the system

10 Define the purpose of the organization 10 API conducts research and provides education, training and consulting to help organizations foster continuous learning and improvement. Memorial Hospital s mission is To continually improve the health of individuals and families of our communities in a way that reflects our commitment, compassion and competence. Institute for Healthcare Improvement Improve health and health care worldwide toward Everyone has the best care and health possible

11 What is the purpose? 11 The purpose of an organization is the reason the organization exists, the need in society it fills

12 Why develop a statement of purpose? 12 Explains why the organization is important to society Explains why individuals should take pride in belonging to the organization Establishes the direction of the organization at every level and in all its work Helps prevent individuals from confusion and defining results in terms of their specialty or understanding

13 Purpose can include 13 Mission need the organization fills now and in the future Tenets how we will conduct ourselves when carrying out the purpose of the organization Vision where we would like to be and how we would like to be in the future

14 Using the statement of purpose 14 Alignment of roles In building a system for the continuous improvement of the organization In deciding what work the organization will do and will not do As a starting place for seeing the system

15 Stop and Reflect 15 Does your organization have a clear and concise statement of purpose? How is the purpose communicated through the organization? How often referenced? How often reflected on? How often when making decisions is it used as a point of reference to prevent mission creep?

16 View the organization as a system 16 How do we understand systems?

17 Traditional Answer Through Analysis Three step process 1. Take it apart 2. Try to understand what the parts do 3. Try to assemble the understanding of the parts into an understanding of the whole Understanding relationships between parts through cause and effect The result is the creation of knowledge about the parts of the system

18 Refresher: Process Mapping Tool for understanding and visualizing all the steps in a process Graphical representation of how inputs are transformed into outcomes

19 Problem with this style of reductionist thinking We are left with a bunch of parts with no cohesive way to put them together Step 1 Step 2 Step n Process outcome of interest Step 1 Step 2 Step n Process outcome of interest Step 1 Step 2 Step n Process outcome of interest Step 1 Step 2 Step n Process outcome of interest Step 1 Step 2 Step n Process outcome of interest

20 Pursuit of Understanding Instead of drilling down into the parts we need to step back in an effort to see the whole Defining a system in a slightly different way: the system as a whole will have properties beyond the sum of its parts it will have a purpose

21 To understand the nature of a system Step 1 see the system as a part of a larger system (see the system in its environment) Step 2 try to understand the larger system Step 3 disaggregate the understanding of the whole into an understanding of the parts by identifying its role or function in the system of which it is a part The explanation for a why always lies outside the system of interest Russell Ackoff

22 Organization as a System Driver Process A Suppliers Plan to Design & Redesign Improve of Processes, Products & Services Market Research Measurement & Feedback Need Purpose of the Organization Mainstay Process B C Production of Product or Service Distribution Outcome for Clients D E Support Process F G Support Process API, Inc All Rights Reserved Deming, Out of the Crisis, pg. 4

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26 Stop and Reflect How could a whole systems view assist your organization to align improvement priorities? What would it take to develop a systems view for your organization? Who could help you do this? 26

27 Obtain information to improve the system Driver Process A Suppliers Plan to Design & Redesign Improve of Processes, Products & Services Market Research Measurement & Feedback Need Purpose of the Organization Mainstay Process B C Production of Product or Service Distribution Outcome for Clients D E Support Process F G Support Process API, Inc All Rights Reserved Deming, Out of the Crisis, pg. 4

28 Methods for Market Research 28 Informal Conversations Empathy Journey Maps Written Surveys Group Interviews Observation Personal Interviews Immersion Experiences Benchmarking

29 Measurement and Feedback 29

30 What are System Measures? Think of them as vital signs for the system of interest Take into account the concerns of multiple stakeholders in the system as well as the purpose of the system Patients/Customers Employees Shareholders/Owners Operations Broader Environment (Community)

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32 What information do they provide? Three things: 1. They display the present performance of the system to managers and administrators 2. They take advantage of data over time to provide predictions of the systems future performance in the near term 3. Provide insight into interaction effects and unintended consequences across the system when changes are made in one part of the system or when its environment begins to change

33 Stop and Reflect 33 What measures in your system are currently be used in a predictive way? Where do you see gaps in the measures leadership uses for decision making in managing the system Past Performance Present Performance Future performance Indications that a problem is occurring

34 Plan for improvement of the system Driver Process A Suppliers Plan to Design & Redesign Improve of Processes, Products & Services Market Research Measurement & Feedback Need Purpose of the Organization Mainstay Process B C Production of Product or Service Distribution Outcome for Clients D E Support Process F G Support Process API, Inc All Rights Reserved Deming, Out of the Crisis, pg. 4

35 Two types of plans important for organizations 35 Planning to operate Focus is on resource allocation to run existing processes Planning to improve Focus is on design and redesign of processes, services or products The focus of planning is to improve the organization from the view point of the external customer

36 Checklist for understanding if an organization is incorporating planning to improve The planning system includes strategic objectives to improve the organization from the viewpoint of the external customer 2. The planning system balances short-term and long-term needs of all of the stakeholders of the organization 3. The planning system identifies what part of the organizational structure will be designed or redesigned 4. The planning system provides information that is sufficient to guide development of new products or services (do we have the data we need?) 5. The planning system provides an allocation of resources (budget, personnel, time, etc.) to improve the organization

37 Importance of integration and allocation 37 Planning to operate and planning to improve are competing for scare resources within the organization Having each type aligned to the purpose of the organization and running in parallel with each other can help ensure the right mix and balance of each

38 38 Stop and Reflect Most organizations, by their nature, have robust planning to operate systems, but it is more rare to find organizations that also incorporate planning to improve Take stock of your organization: does it have a strong planning to improve system in place along side the system for planning to operate? What opportunities do you see for greater integration of the two

39 Manage improvement of the system Driver Process A Suppliers Plan to Design & Redesign Improve of Processes, Products & Services Market Research Measurement & Feedback Need Purpose of the Organization Mainstay Process B C D Production of Product or Service Distribution Outcome for Clients E Support Process F G Support Process API, Inc All Rights Reserved Deming, Out of the Crisis, pg. 4

40 6 activities for managers and leaders to accomplish effective implementation of a plan to improve 1. Organize for improvement (what structures, governance or otherwise are necessary), create them 2. Provide for education and training as pertains to the improvement effort (improvement knowledge and content knowledge) 3. Use the Model for improvement to guide the development of simple and complex improvement projects aligned to the purpose and system 1. What are we trying to accomplish? 2. What changes can we make that will result in improvement? 3. How will we know that a change is an improvement? 40

41 6 activities for managers and leaders to accomplish effective implementation of a plan to improve 4. Guide teams and individuals using charters, sponsors, role description/allocation and assist in barrier removal 5. Learn from the improvement efforts 6. Redeploy resources as the system evolves through the ongoing improvement it is engaged with. Work to continuously align resource allocation to the purpose of the system (mission: current state and vision: future state) 41

42 Cincinnati Children s Hospital All materials courtesy of Uma Kotagal and CCHMC

43 How did they achieve this? By creating a policy environment that prioritizes clinical improvement All clinicians has written into their contracts time for clinical care and time for improvement of the system Care without continuous improvement is not enough By creating an infrastructure to support innovation and translational research All materials courtesy of Uma Kotagal and CCHMC

44 All materials courtesy of Uma Kotagal and CCHMC

45 All materials courtesy of Uma Kotagal and CCHMC

46 Discussion and Questions 46

47 Thank you 47