High-Impact Leadership: Developing Core Leaders Michael Pugh, MPH Dave Munch, MD

Transcription

1 C14 These presenters have nothing to disclose High-Impact Leadership: Developing Core Leaders Michael Pugh, MPH Dave Munch, MD December 11, :30-2:45 #IHIFORUM

2 Disclosure: P2 Michael Pugh and David Munch, MD presenting today have no relevant financial or nonfinancial relationship(s) within the services described, reviewed, evaluated, or compared in this presentation.

3 Session Objectives P3 1. Identify the four critical competencies core leaders must develop in order to become effective managers and leaders. 2. Recognize the key skills that core leaders must develop within each competency and the importance of each skill. 3. Utilize a self-assessment worksheet to develop themselves, other managers, and their teams. #IHIFORUM

4 Michael Pugh, MPH 4 Michael D. Pugh, MPH, President, MdP Associates, has more than 30 years of CEO experience in hospitals, health care systems, managed care, and health information technology companies. He is a consultant to senior leaders of health care delivery organizations, payer organizations, and government agencies on issues of quality, performance, strategy, and governance. Mr. Pugh serves as Senior Faculty at the Institute for Healthcare Improvement and co-authored two IHI white papers, High-Impact Leadership and Seven Leadership Leverage Points for Organization-Level Improvement in Health Care. He is an adjunct faculty member at the University of Colorado at Denver School of Business and an instructor in the Master of Science in Health Care Delivery Leadership Program at the Icahn School of Medicine at Mt. Sinai in New York. Mr. Pugh has served on the boards of the American Hospital Association, the AHA Health Forum, the Colorado Hospital Association, and The Joint Commission.

5 David Munch, MD 5 David M. Munch, MD, is Senior Vice President for Healthcare Performance Partners (HPP), advising hospitals and systems in process improvement and Lean transformation. He is also a faculty member with the Institute of Healthcare Improvement in the areas of patient safety and management systems. Previously, Dr. Munch worked at Exempla Lutheran Medical Center (ELMC) as Chief Operating Officer and as Chief Quality and Medical Officer, with responsibility in the latter role for stewarding improvements in quality, safety and reliable practice through the use of Lean, Six Sigma, and other methods. At ELMC, Dr. Munch participated in the Centers for Medicare and Medicaid Services demonstration project for reducing hospital readmissions, The Joint Commission's Transforming Healthcare Division pilot program for hand-washing, and the Agency for Healthcare Research and Quality s High Reliability Advisory Group..

6 IHI High-Impact Leadership 5 Years Later: What have we learned? 6 Adapted from: Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; Available on Adapted from: Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; Available on

7 5 Years Later: A High-Impact Leadership Driver Diagram Adopt New Mental Models Value & Cost Population Health Patient & Family Engagement Improvement as Daily Work Achieve Triple Aim Results for Populations Practice High-Impact Behaviors Be Person-Centered Engage with Staff Require Transparency Maintain Relentless Focus Practice Boundarilessness Develop Strategies and Execute Shape Culture Engage Across Boundaries Deliver Results Develop Capability Create Vision and Build Will Keep Persons at the Center Adapted from: Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; Available on

8 Five Years Later: Still a useful definition 8 Leadership is a process of social influence, which maximizes the efforts of others, towards the achievement of a goal. Kevin Kruse Kevin Kruse Forbes.com What is Leadership April 9, 2013

9 Five Years Later Shaping Culture: The need for intentionality 9 Organizational and Team Culture is shaped by the interdependent of leaders/managers and by the deployed. MDP 2018 Individual Leadership Behaviors Leadership System and Structure Leadership Actions

10 5 Years Later: Leading Across Boundaries Requires New Skills 10 Establish a shared purpose Communicate a shared vision Ask questions and listen to responses Build consensus Show respect for the partner s business models and constraints Adopt a collaborative approach and demonstrate patience Volunteer resources when needed Ensure that the right people are in the room

11 5 Years Later What have we learned? Adopting new Mental Models is key to leading change. How leaders and managers think drive priorities and actions. 2. Being Driven by Persons and Community also includes staff. 3. Culture shaping must be intentional. 4. High-Impact Leadership Behaviors are relevant at all levels but need to be translated. 5. Developing Capability needs to focus on developing clinical leaders and middle management. Adapted from: Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; Available on

12 Who are Core Leaders? 12 Everyone in the middle responsible for managing and leading divisions, departments, functions, programs, and/or clinical teams Managers Directors VP s Supervisors Clinical Leads Division Leaders Clinical Team Leaders Program Managers Physician Leaders 1. What do they need to know? 2. How do we develop their skills? MDP and DM 2016

13 13 You can manage things, but you must lead people Management MDP 2018 MDP 2016 Management Skills Allocating Will Building Budgeting Improving Staffing Measuring Hiring Supervising Ordering (Clinical) Planning Leadership Skills Strategic Thinking Will Building Team Building Communicating Prioritizing Aligning Role Modeling Engaging Visioning Leadership

14 Leadership Behaviors and Management Focus Shaped by Distance from the Work 14 Core Leaders Senior Leadership Vision & Strategy Shape Culture Allocate Resources Track Overall Results and metrics Directors and Managers Deploy Resources Manage structure Align efforts Translate Vision Track departmental results and key processes Team Leaders and Clinical Leads Provide service Manage daily work & Solve Problems Lead work and service teams Improve care and services Track unit performance and process Maintain quality control MDP & DM 2016

15 Core Leader Competencies 15 Management Manage the Work Build Team Capability Leadership Improve the Work Shape Team Culture MDP & DM 2016

16 Core Leader Development Competency Manage the Work Key Skills Manage Time & Resources Create Standard Work & Process Measure: Financial, Quality, Customer, Key Process Surface and Solve Problems in Real Time Engage Across Departmental/Team Boundaries 16 Core Leader Effectiveness Munch & Pugh 2017 Improve the Work Build Team Capability Shape Team Culture Prioritize and Align to Strategy and Aims Understand Current State, Cause and Target Condition Learn and use improvement tools and methods Reduce Variation and Waste Get Results and Sustain Them Develop Competency through Coaching Use the Whole Team Communicate Effectively Establish Respect and Accountability Share Vision and Build Will Promote Transparency Model the Way Encourage Mindfulness Keep the Person at the Center

17 Five Tactics for Managing Time 17 Tackle Performance Problems Adopt a Standard Work Mindset Delegate, Delegate, Delegate Drive Out Waste Manage Meetings Marguerite Samms, RN, MN, CPT Director Ldrshp Dev. Intermountain Healthcare

18 Solving Problems Effectively: Every Problem has a Simple Solution that is Wrong 18 If you were a teacher, how would you grade this students test response

19 A3 Thinking 19 What is the problem we actually have (not perceive)? What are the causes of the problem? Why is the defect occurring? How do the parts relate to the whole? How does the system influence the problem? What are we going to do to fix the problem? Repeated cycles of A3 thinking Note: Are we fixing the problem or putting a Band-Aid on it? How will we know our changes are effective? What systems and structures will be establish to support and sustain?

20 Performance Board: Tool for Situational Awareness 20 Quality/ Safety Patient Experience Cost of Care People and Partners Financial Sustainability History Performance Over Time Example: Run Chart Example: Run Chart Example: Run Chart Example: Run Chart Example: Run Chart Pareto Key Drivers of Performance Example: Pareto Chart Example: Pareto Chart Example: Pareto Chart Example: Pareto Chart Example: Pareto Chart Problem Solving Issue Background Example A3 Future State/Target Countermeasur es Action Plan Issue Background Example A3 Future State/Target Countermeasur es Action Plan Issue Background Example A3 Future State/Target Countermeasur es Action Plan Issue Background Example A3 Future State/Target Countermeasur es Action Plan Issue Background Example A3 Future State/Target Countermeasur es Action Plan Current Condition Root Cause Analysis Test/Cost/Bene fit Follow-up Current Condition Root Cause Analysis Test/Cost/Bene fit Follow-up Current Condition Root Cause Analysis Test/Cost/Bene fit Follow-up Current Condition Root Cause Analysis Test/Cost/Bene fit Follow-up Current Condition Root Cause Analysis Test/Cost/Bene fit Follow-up Daily Management Process Metric Example: Daily data x x x x Example: Daily data x x x x Example: Daily data x x x x Example: Daily data x x x x Example: Daily data x x x x

21 Visual and Daily Management 21

22 Deming s Definition of a System: A system is an interdependent group of items, people and processes with a common aim. 22

23 Systems: the Interdependencies 23 The Patient Flow Governance Executive Leadership Management Staff Organizational Goals Strategies & Tactics Department Plans Clear Front Line Work Entry: E.D. or Front Desk -Surgery -Critical Care -Med-Surg Med-Surg Stepdown Out Patient -Home, SNF -Rehab, etc. -Community The Support Areas Imaging Revenue Cycle HR I.T. Facilities Supply Chain Lab

24 The System of Continuous Improvement: Interlocking Responsibilities and Development 24 Do the Standard Work Surface and Solve Problems Improve the Standard Work Staff Management Core Ldr Standard Work Situational Awareness Visual & Daily Mgmt. Gemba & Observation Surface problem Develop Your People Coach team to solve them Executive Standard Work Align to Strategy Develop Management Systems System and Support Structures Gemba and Coaching Steward the Changes Executive Performance Improvement, Decision Support, HR, I.T. Facilities Improve Process & Performance while Developing People: Learn by Doing

25 25 Coaching Coaching in its truest sense is giving the responsibility to the learner to help them come up with their own answers. -Vince Lombardi

26 The Five Elements to Coaching 26 1.Presence: Know yourself, know your people, be in the work Be physically present. Observe directly to know specifically what people are doing Be Mentally Present: Give this your whole attention 2. Objective: Every coach has a playbook Build your playbook: strategic to tactical including the basics If there are too many areas, develop rotating weekly (or monthly) schedule Be specific about the coachee s role: GRRATE Goals, Roles, Responsibilities, Accountabilities, Timeframe, Empowerment Single Point Accountability

27 The Five Elements to Coaching Timeliness: Immediate intervention is the most effective John Shook - Know normal from abnormal, and know it right now. Requires being there (vs in a meeting or other off-site function) 4. Interaction: Active Inquiry It is not about the right answer, it is about The Right Question To understand where they are and why they are there To listen for stuck points, blind spots and build other alternatives To stimulate learning, create new insights and come to agreement 5. The Action: Advancing Performance and Development Who, What by When The coach also has responsibilities here: address barriers, make connections, etc. Reflect & Discuss Follow up

28 Powerful Questions 28 More Powerful Why, How, What? Who, When, Where? Which, Yes/No Less Powerful

29 Respect Accountability 29 Respect -Clarity of responsibilities -Training & competency development -Ongoing Feedback & Support -Right Environment Accountability -Reliability -Relationships -Trust -Communication -Problem Management

30 The 4 Disciplines of Execution Chris McChesney, Sean Covey and Jim Huling 30 Focus on the Wildly Important Goals Act on the Lead Measures Keep a Compelling Scorecard Create a Cadence of Accountability

31 31

32 32 When you get home, download and complete the Developing Core Leaders Self-Assessment Tool What are your plans for personally exploring gaps and developing skills and competencies? Discuss with your team how you might use this tool for developing the managers, supervisors and team leaders who report to you?

33 Core Leader Development Competency Manage the Work Key Skills Manage Time & Resources Create Standard Work & Process Measure: Financial, Quality, Customer, Key Process Surface and Solve Problems in Real Time Engage Across Departmental/Team Boundaries 33 Core Leader Effectiveness Munch & Pugh 2017 Improve the Work Build Team Capability Shape Team Culture Prioritize and Align to Strategy and Aims Understand Current State, Cause and Target Condition Learn and use improvement tools and methods Reduce Variation and Waste Get Results and Sustain Them Develop Competency through Coaching Use the Whole Team Communicate Effectively Establish Respect and Accountability Share Vision and Build Will Promote Transparency Model the Way Encourage Mindfulness Keep the Person at the Center

34 34 Five Things to Start next Tuesday 1. Examine how you think and adopt new mental models about your job as a manager & leader. 2. Make sure that your organization/department is working on important issues what matters to your customers and clients 3. Intentionally shape culture practice High-Impact Behaviors 4. Think system/process and lead across boundaries 5. Put new emphasis on developing your team don t expect someone else to do it.

35 35 Michael Pugh MdP Associates, LLC cell: David Munch M.D. cell: (303) office: (615) CONTACT INFORMATION