THAF Fellows Program. Engaging Board and Community Members in Quality/Patient Safety Initiatives. Ini

Transcription

1 THAF Fellows Program Engaging Board and Community Members in Quality/Patient Safety Initiatives Kimberly McNally, MN, RN, BCC President, McNally & Associates Ini

2 2 Today s session Indicators of an engaged board. Strategies for working collaboratively on quality journey. Ways to increase involvement to champion quality/safety initiatives.

3 3 What is board engagement? Right Board Work ENGAGEMENT Best Practices OUTCOMES Right Relationships Making care safer by reducing harm caused in delivery of care

4 4 Indicators of engaged board Forward-thinking group; work & meetings designed around critical issues Well-designed opportunities - meaningful deliberation - environment of trust, candor, respect Provide challenge and support to accelerate change Trustees feel their time, talent and energies well used; can articulate value produced

5 5 Engagement Pyramid Collaborative Leadership through Partnership between Board, executive & physician leaders - at all levels Physician Leadership Aligned metrics Board Leadership Executive Leadership

6 6 Why collaborative leadership? Healthcare organizations are messy, complex and interdependent Effective strategies require systems approach and inclusion of multiple perspectives Many stakeholders need to own parts of goals and solutions Leadership role is to build community of leaders

7 7 Collaboration Collaboration needs a different kind of leadership; it needs leaders who can safeguard the process, facilitate interaction and patiently deal with high levels of frustration. Chrislip & Larson

8 8 Board - CEO - Physicians Strong, accountable partnership between volunteer & professional partners grounded in collaboration are responsible for 100% of the pie!

9 9 Research says boards make a difference! Source: Hospital Board And Management Practices Are Strongly Related To Hospital Performance On Clinical Quality Metrics. Health Affairs, Tsai et al. August :

10 10 Research says. Trustees have direct impact on both performance of hospital management and clinical care quality Boards that paid greater attention to clinical quality had management that better monitored quality performance Boards that used clinical quality metrics more effectively had higher performance by hospital management staff on target setting and operations

11 11 Governance Practices and Performance Health systems with high performance in quality, safety and service Board members w/competencies, skills, diversity... constructive, well-informed deliberation and decision making (quality literacy, nursing representation) Establish and monitor hospital performance/goals Improve board performance (self-assessment) Source: Governance Practices and Performance in US Academic Medical Centers, Szekendi et al., American Journal of Medical Quality, 2014,1-6

12 12 3 modes of governance Strategic Generative Fiduciary Governance as Leadership: Reframing the Work of Nonprofit Boards Richard Chait

13 13 3 modes of governance Fiduciary = Oversight Fiduciary - performance accountability, fiscal integrity & regulatory compliance How do we know? What s the evidence? Goal = Protect assets. Ensure resources used efficiently & effectively in pursuit of mission.

14 14 Fiduciary questions How good is our hospital/health system? Are we achieving what we need to achieve? What are the external metrics we need to meet? What is our harm rate? How does our budget reflect our stated commitment to quality and safety?

15 15 3 modes of governance Strategic = Foresight Strategic - board makes major decisions about resources, programs and services Where are we headed? Goal = Guide organization from present to preferred future.

16 16 Strategic questions If we decide to partner with another organization, how do we know they have high quality? How ready are we to be accountable for the integrated costs, clinical outcomes and safety of care we provide with physicians and others along the continuum of care? How do we improve our IT infrastructure to support quality and safety?

17 17 3 modes of governance Generative = Insight Generative - board engages in deeper inquiry, exploring root causes, values, options, & new ideas; critical thinking How are we fulfilling mission? Goal = Shape thinking in other two modes. Define future. Frame mission- and values-based questions.

18 18 Generative questions Which conversations about safety/quality are missing or not effective? How do we really understand patient experience? How will we challenge ourselves to adopt best practices? What do we really mean by quality literacy? Implications for development? How can we communicate our commitment?

19 19 Shifting the conversation What patterns of data are we seeing over time? How is this connected to? What assumptions are we making? How else can we think about this?

20 20 Something to ponder Is our Board governing in all three modes with quality, safety and service? If not, what mode dominates? What s the outcome?

21 Your Quality Journey On a scale of 1-10, how engaged is your Board currently? Where do you want to be?

22 22 UW Medicine s Quality Journey Build awareness Build systems, structures, culture Advance the conversation

23 IOM report what we believed We were focused on quality We have organized quality program We didn t have issues described in report We follow data and make changes when needed We felt data must be wrong

24 24 What we realized We were focused on quality however we needed to elevate quality to our top priority We had room to improve and it was our issue We were data poor, didn t know what we didn t know We had siloed quality program, not well integrated into operations We did follow data, however we weren t transparent and did not have good loop closure

25 25 UW Medicine 2010 We had solid accomplishments: Refocused our quality programs, well integrated at local level Significantly improved our data availability Developed quality dashboards at entity level Significantly increased transparency at local level Improved results

26 Strategic Plan Uniform approach to measurement and reporting for service and quality, with accountabilities Set performance standards that promoted excellent care and service from first contact through discharge and follow-up care Rapidly develop a focus around service and identify high impact immediate behaviors to improve patient and family experience

27 27 What was next... Expand our quality programs from local programs to unified system program Focus on service the same way we were focused on quality Develop common goals, leverage best practices, and develop a culture of accountability for quality and service across our system Provide system alignment

28 28 Where we are today Culture of service and quality excellence exists across UW Medicine. Yearly goals developed are standardized across health system with measurable outcomes. Data is robust and transparent Developed an accountable care network Focused on the triple aim Improved results.more work to do!

29 29 Early Journey Culture of collaborative leadership Recognizing fiduciary responsibility extends beyond finance Making sense of performance metrics Recognizing strategic importance of quality data and trends in public disclosure

30 30 Early Journey Developing quality literacy Benchmarking Challenging traditional assumptions & medical power structures Building will for improvement

31 31

32 32 Middle Journey Set directional focus w/board self-assessment, periodic retreats Reinforce commitment with meeting design Learn to ask better questions to understand factors underlying performance and what leaders are doing to address them

33 33 Align quality metrics with executive recruitment, selection and performance Middle Journey Design roles for entity and system boards and quality committees to ensure rigorous, proactive and effective oversight; reduce redundancy

34 34 Journey continues Transform care; new delivery models Continue focus on reducing HAIs Ongoing attention and focus on safety culture Broaden ambulatory setting metrics Understand population health/acn metrics Educate/engage next generation of clinicians

35 35 Levers to increase engagement Trustees participate in rounds Build physician leadership capacity Conduct benchmarking national, regional, internal Use dashboards targeted for different audiences Unpack metrics meaning, importance, factors that impact results

36 36 Observe culture and care in action listening and learning tours Understand challenges faced by front-line staff and physicians Demonstrate commitment to continuous improvement Set participation expectations Executive Safety Rounds How do you learn about quality goals? What aspects of clinical environment could lead to patient harm? What would make work you do safer for patients? What have you learned from near misses that may have occurred recently? What challenges do you have implementing safety protocols? Get Board out of board room

37 37 Levers to increase engagement Attend educational programs together Integrate patient voice/story at every opportunity; ask board to share their care experiences Build partnerships board/executive/physician leaders; unit level MD/Nurse Manager dyads; across continuum Recruit nursing and high-risk industry (e.g. aviation, nuclear plant, automotive) leaders to Board

38 The board meeting is the center of communication & relationship success or failure. 38 Larry Walker

39 39 Committee Meeting Tips Develop annual work plans Jointly prepare agenda Choose meaningful patient stories to set tone Provide right amount of data Watch for jargon ask for lay explanations Engage in dialogue re: two key dashboard indicators trending red

40 40 Committee Meeting Tips Pose questions to catalyze discussion Recognize leadership actions that enhance culture of safety Ensure shared understanding of what was heard at meeting, what will happen as result, and what s next Seek feedback on committee s effectiveness

41 41 Lessons Learned Clear agreements to support partnership. Provide timely feedback. Consistency is key. Everyone reporting same data. Cascade structured communication. Trust, transparency and acknowledgment of success are essential ingredients.

42 42 Lessons Learned Work to balance attention to metrics with time for blue sky thinking. Focus and sophistication emerges over time. Awareness re: fatigue with growing pace of change still move forward in face of uncertainty.

43 43 Call to action!! Envision the future Shape the agenda Advance the dialogue

44 44 To lead is to live dangerously because when leadership counts, when you lead people through difficult change, you challenge what people hold deartheir daily habits, tools, loyalties, and ways of thinkingwith nothing more to offer perhaps than a possibility. Ron Heifetz, Leadership on the Line

45 Thank you! Kimberly McNally, MN, RN, BCC President, McNally & Associates