transforming healthcare leadership and patient and family engagement

Welcome to

Transforming Healthcare Leadershipand Patient and Family Engagement

For resource downloads go to:

www.safetyleaders.org

Charles Denham, MD

Chairman, TMITCo-chairman, NQF Safe Practices Consensus Committee

Chairman, Leapfrog Safe Practices Program

TMIT High Performer WebinarSeptember 19, 2013

Welcome

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TMIT Mission

Accelerate performance solutions thatsave lives, save money, and build valuein the communities we serve andventures we undertake.

Disclosure Statement

Michael Maccoby: Employed by The Maccoby Group; Associate Fellow, Saïd Business School, Oxford UniversityRegina Holliday: Patient rights arts advocateMaryAnne Sterling: Employed by Connected Health Resources; Sterling Health IT ConsultingDoug Wilson: Employed by Next Solutions, Inc.Dan Ford: Employed by Furst Group; CAPS (Consumers Advancing Patient Safety) member; World HealthOrganization/Pan American Health Organization (WHO/PAHO) champion; TMIT Patient Advocate Team MemberBecky Martins: Founder, Voice4Patients.com; TMIT Patient Advocate Team MemberJennifer Dingman: Founder, Persons United Limiting Substandards and Errors in Healthcare (PULSE), ColoradoDivision; Co-founder, PULSE American Division; TMIT Patient Advocate Team MemberStephen J. Swensen: Employed by Mayo Clinic College of MedicineCharles Denham: Chairman, TMIT; TMIT education grantee of CareFusion and AORN with co-production byDiscovery Channel for Chasing Zero documentary and Toolbox including models; education grantee of GE with co-production by Discovery Channel for Surfing the Healthcare Tsunami documentary and Toolbox including models.HCC is a contractor or former contractor for GE, CareFusion, and Siemens. HCC and TMIT are collaborators andcontractors with Senior Care Centers.

Chasing Zero® is a registered trademark of CareFusion

The following panelists certify:

that unless otherwise noted below, each presenter provided full disclosureinformation, does not intend to discuss an unapproved/investigative use of acommercial product/device, and has no significant financial relationship(s) todisclose. If unapproved uses of products are discussed, presenters are expected todisclose this to participants.

TMIT certifies that:

• No funder or educational grantor had any influence or anydirect contact with researchers, analysts, or hospitalleaders contracted with TMIT involved in generation ofmodels, impact calculators, or consensus panels.

• Confidentiality of collaborators, patient data, and populationdata has been and will be strictly maintained.

Disclosure Statement

Reaction Panel

Doug Wilson Becky Martins Jennifer DingmanDan Ford

Speakers

Charles Denham Regina HollidayMichael Maccoby MaryAnne Sterling

Steve Swensen

Regina Holliday

Patient Rights Arts Advocate

Voice of the Patient and Family

Charles Denham, MD

Chairman, TMITCo-chairman, NQF Safe Practices Consensus Committee

Chairman, Leapfrog Safe Practices Program

Safe Practice Overview and Sharps

Culture

Sharps Injuries – Magnitude of the Problem

• 384,000 sharps injuries per year in the United States

• Operating Room one of the highest risk environments – Instruments andBlood Exposure

• 38% of all surgical procedures are on patients w/bloodborne pathogens

• Needle Safety and Prevention Act (2000) resulted in a decrease of injuriesfrom 24.1 to 16.5 per 100 beds (non-surgical sharps injuries)

• This drop of 31.6% attributed mainly to safety devices

• Conversely, surgical setting injury rate increased(6.5%) or 6.8 per 100 procedures from 2000 to 2006

• Cost can be as high as $4,838 per exposure withsignificant indirect costs; litigation, rehire, moral impact..

• 59% of medical students experience needlesticks

• 83% of surgical residents experience needlesticks;51% of residents do not report them…

• There are risks to patients – if worker is the one infected (132 cases ofpatients infected by a caregiver are reported)

Source: Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settingsversus nonsurgical settings after passage of national needlestick legislation. AORN J 2011 Mar;93(3):322-30.

Sharps Injuries – Causes

• Common devices causing injury

• Suture needles 43.4%

• Scalpels 17.1%

• Syringes 12.1%

• Worker Injuries:

• 15.6% Surgeons

• 17% Residents

• 30% OR nurses

• 37.1% Sx Technicians

• Surgeons and residents are most likelyto be injured during use of device

• Nurses and techs are most likely to beinjured when passing the device

Source: Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settingsversus nonsurgical settings after passage of national needlestick legislation. AORN J 2011 Mar;93(3):322-30.

Sharps Injuries – Socio-technical Barriers

• Low adoption of safety-engineered devices in ORsetting• Adoption of blunt suture needles – less than 5% in US

• Habituation period (getting used to new devices)

• Increase in pressure needed

• Change of technique

• Double gloving: Challenging for surgeons but benefit clearlydocumented

• Hands-free passing shows 35-59% effectivenessbut low adoption (workflow change)

• Usability of safety-engineered devices – e.g., scalpels

• Awareness – low promotion of devices to OR by manufacturers

• Leadership and Teamwork• Most injured member NOT the original user of device –

Surgeons reported 15.6% injuries vs. 84.4% of Sx team

• Lack of awareness of link between device choice and safety

• Low motivation to change workflow and devices

• Lack of enforcement and compliance monitoring

of reporting sticks and use of safety devices

Source: Interview with Dr. Janine Jagger – Engineered Sharps Injury PreventionDouble Gloving: Myth Versus Fact – http://www.infectioncontroltoday.com/articles/2011/04/double-gloving-myth-versus-fact.aspx

Sharps Injuries – Potential Solutions

• Raise awareness through educationalprograms – teach residents

• Evaluation of surgical procedures assharpless (up to 20% might qualify)

• Involve End User in design of safety-engineered devices a barrier – e.g., surgeonsand scalpels

• Educate Leadership – Clinical andAdministrative on business case of sharpsprevention program (ROI model and ImpactCalculator): AORN has developed programs.Double gloving plus other solutions couldreduce 15%-20% of injuries with vigilance.

Source: Makary MA, Pronovost PJ, Weiss ES, et al. Sharpless surgery: a prospective study of the feasibility of performingoperations using non-sharp techniques in an urban, university-based surgical practice. World J Surg 2006 Jul;30(7):1224-9.

Transforming Health Care Leadership:A Systems Guide to Improve Patient Care,

Decrease Costs, and Improve Population Health

Michael Maccoby, PhD

President, The Maccoby Group

Transforming Health CareLeadership:

A Systems Guide to ImprovePatient Care, Decrease Costs,

and Improve Population Health

Dr. Michael Maccoby Clifford L. Norman C. Jane Norman

The Maccoby Group4825 Linnean Avenue, NWWashington, DC 20008www.maccoby.com

Austin API, Inc.4604 Castle Pines CoveGeorgetown, TX 78628www.apiweb.org

Profound KnowledgeProducts, Inc.4604 Castle Pines CoveGeorgetown, TX 78628www.pkpinc.com

Why Transform Health CareOrganizations?

To Achieve the Triple Aim

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve PopulationHealth. Maccoby, Norman, Norman, Margolies (2013); Ch. 3, p. 37

Triple Aim

• Improve Patient Care

• Decrease Costs

• Improve Population Health

How Do Health Care OrganizationsHave to Change?

Create a Learning Organizationwith Leadership at All Levels

From Bureaucracyto a Learning Organization

From Silos To an Interdependent System

VPAdministrationand Support

Porter

Services

Butler

VPResearch &Development

Halleck

VPDistribution

and Service

Marketing

Sheridan

Region 3

Handcock

Region 2

Grierson

Region 1

Buford

Planning

President

Production of Product or ServiceB

MarketResearch

Distribution

CustomersSuppliers

Purpose of theOrganization

Measurement& Feedback

Design &Redesign ofProcesses &Products

Plan toImprove

Support Processes

Defining Attributes of a Health CareLearning Organization

A social system where all the parts interact to

achieve the purpose of serving patients

Learning from practice is widely shared and used

for innovation and improvement

Learning is used to inform the community, aid in

the prevention of illness, and improve

population health

Transformation Requires Leadership,Not More Management

• Management is based on Task Accomplishment

• Management can be delegated

• Leadership is based on Relationships

• Leadership Can NOT be Delegated (i.e., Relationshipscan not be delegated)

• A Learning Organization Leverages Leadership fromALL Roles (not just Managers)

• Both leadership and management are necessary forthe success of organizations

What Do We Have to Do to TransformHealth Care Organizations?

Eliminate CounterproductiveManagement Myths by EmployingStrategic Intelligence and Profound

Knowledge

What Management MythsMust be Eliminated?

12 myths are addressed

We will focus on 6 myths today

Myths We Will Highlight

1. Leaders are Born, not Made

2. The Best Results are Gained by Managing Bythe Numbers

3. People Need to be Held More Accountable

4. Incentives Will Get People to Change

5. To Improve Quality, It Costs More

6. To Motivate People, We Just Need to PayAttention to Them and Be Caring Bosses

Myth #1:

• Leaders: People Who Have Followers

• Three Types of Leaders

• Not all Leaders are

Managers

• Not all Managers

Are Leaders

Leaders are Born, not Made

Myth #2

Understanding Variation

Using Different ImprovementStrategies Based on Common Cause

or Special Causes

The Best Results are Gained byManaging By the Numbers

Using Measures for Judgment Versus Learning

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs & Improve PopulationHealth, Maccoby, Norman, Norman, Margolies (2013); Ch. 7

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve PopulationHealth. Maccoby, Norman, Norman, Margolies (2013)

What Can We Predict for the Target of 7.5Unplanned Returns to the ED?

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs& Improve Population Health, Maccoby, Norman, Norman, Margolies (2013); Ch. 7, p. 119

What Can We Predict for the Targetof <2 Infections/1000 Patients?

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs& Improve Population Health, Maccoby, Norman, Norman, Margolies (2013); Ch. 7, p. 119

Mistake One vs. Mistake Two• MISTAKE 1: React to an outcome as if it came from a special cause, when

actually it came from common causes of variation.

• MISTAKE 2: Treat an outcome as if it came from common causes of variation,when actually it came from a special cause.

ACTUAL SITUATION OF SYSTEM

ACTION NO CHANGE CHANGE

Take action on individualoutcome; Treat as aspecial cause variation.

- $Mistake 1

+ $Correct Decision

Treat outcome as part ofsystem; work on changingthe system-Treat ascommon cause variation

+ $Correct Decision

- $Mistake 2

Myth #3:

Attribution error

System thinking

People Need to be Held MoreAccountable

Attribution Error

• Attribution theory describes the tendency forobservers to underestimate situational (the system)influences and overestimate individual motives andpersonality traits as the cause of behavior.

Production of Product or ServiceB

MarketResearch

Distribution

CustomersSuppliers

Plan toImprove

Support Processes

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve PopulationHealth. Maccoby, Norman, Norman, Margolies (2013); Ch. 6, p. 100.

Who or What Is to Blame?

“A fault in the interpretation ofobservations, seeneverywhere, is to suppose thatevery event (defect, mistake,accident) is attributable tosomeone (usually the onenearest at hand), or is relatedto some special event. The factis most troubles with serviceand production lie in thesystem.”

–W. Edwards Deming

Health Care as an Interconnected System

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs& Improve Population Health, Maccoby, Norman, Norman, Margolies (2013); Ch. 10

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs & Improve Population Health. Maccoby, Norman, Margolies (2013)

Myth #4:

Types of Incentives depend onthe type of work

Incentives Will GetPeople to Change

Incentives Depend on the Type of Work

Transactional Work

• Rewards and NegativeConsequencesGenerally IncreaseProductivity andMotivation

Knowledge Work

• Rewards and NegativeConsequencesGenerally DECREASEProductivity andMotivation

How does this thinking relate toPay for Performance … Payingdoctors to see more patients?

What Motivates?— Intrinsic Motivation +

(Reasons, Responsibilities, Relationships, Recognition)

ExtrinsicMotivation

(Rewards)

Compliant Motivated

Demotivated(Not Engaged)

Frustrated

How Can We Motivate Those Whose WorkRequires Thinking & Knowledge?

1. Reasons: the purpose of our work

2. Responsibilities: our roles and work

3. Relationships: within the system and withcollaborators and customers

4. Recognition: for significant contributions

5. Rewards

– Intrinsic

– ExtrinsicTransforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve PopulationHealth. Maccoby, Norman, Norman, Margolies (2013); Ch. 5, p. 62

Myth # 5:

Inspection vs. Improvement

Model for Improvement

System Map Integration

To Improve Quality, It Costs More

Inspecting In Quality VersusImprovement of the System

Theory of KnowledgeModel For Improvement

• Three Questions

– What are we trying toaccomplish?

– How will we know thata change is animprovement?

– What changes can wemake that will result inimprovement?

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve PopulationHealth. Maccoby, Norman, Norman, Margolies (2013) Ch. 9 p. 179

System Map Integration

Myth #6:

Creating a Leadership Philosophywhich creates Engagement &

Collaboration

To Motivate People, We Just Need to PayAttention to Them and Be Caring Bosses

Developing a Leadership Philosophy:Four Questions

1. What is the purpose of this organization?

2. What ethical and moral reasoningdetermines the key decisions we make?

3. What practical values do we need to practiceto achieve the purpose?

4. How do we define goals and results so theyare consistent with our purpose and values?

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs& Improve Population Health, Maccoby, Norman, Norman, Margolies (2013); Ch. 4

Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve PopulationHealth. Maccoby, Norman, Norman, Margolies (2013); Ch. 4 p. 46

Summary

Purpose

Practical Values

Vision

Ethical & MoralReasoning

1. Reasons2. Responsibilities3. Relationships4. Rewards5. Recognition

Summary

Purpose

Practical Values

Vision

Summary

Purpose

Practical Values

Vision

Production of Product or ServiceBC

MarketResearch

Distribution

CustomersSuppliers

Plan toImprove

Support Processes

Summary

ProcessesPoliciesProceduresPerception

Purpose

Practical Values

Vision

Structure

Production of Product or ServiceBC

MarketResearch

Distribution

CustomersSuppliers

Plan toImprove

Support Processes

Strategic Intelligence

Strategy:

"the art or skill of carefulplanning toward anadvantage or desired end“

Strategic Intelligence:

Gaining these strategicskills

Summary

• Health Care Leaders Need to Challenge Old Ways ofThinking (myths)

• Transformation Requires Leveraging LearningThroughout the Organization

• Managers should be leaders, and in fact, most can bedeveloped for leadership roles

• Understanding variation allows leaders to make betterdecisions and develop useful strategies forimprovement

• To motivate people we need to understand the type ofwork they do, ensure alignment to the organization’sPhilosophy, and utilize the 5 Rs of Motivation

Regina Holliday

Patient and Family Engagement:Using SpeakerLink® to Match Speakers and Seekers

Patient and Family Engagement:Using SpeakerLink to Match Speakers and Seekers

A presentation byRegina Holliday

Disclosure SlideI have presented or painted before these venues and companies:

How do those who speak from the patient view help Seekers?

We connect the silos of thought and practice.

We provide new eyes and new ears to focus on old problems.

We live withintheBig Picture.

How does SpeakerLink® help those who wish to speak?

It is much easier to fly when there is a safe place to land.

Let Patients Speak

We must encourage every committee,conference, and hospital boardto actively recruit and include patientsin every aspect of the care process fromdesign to implementation to resolution.

Invite patients and you will include artists,poets, and writers in creating health policy.

MaryAnne Sterling, CEA

CEO, Sterling Health IT Consulting

Lessons Learned from a (Reluctant) Speaker/Advocate:A Family Caregiver Educating the Masses

LESSONS LEARNED FROM A(RELUCTANT) SPEAKER/ADVOCATE:A FAMILY CAREGIVEREDUCATING THE MASSES

September 19, 2013

Agenda

• Background (the CliffsNotes version of my story)

• How and why I became a speaker

• My speaking purpose

• What I give to my audiences

• What I’ve learned from my audiences

• Personal best practices

• My toolbox

Background(the CliffsNotes version of my story)• Caregiver and healthcare system navigator for aging

parents for last 17 years• 3-out-of-4 parents/in-laws have some form of dementia

• Father showed first signs in late-1970s

• Advocate for family caregivers• Bringing family caregiver voice to several federal advisory

committees

• Alzheimer’s Association Ambassador (Senator Warner’s Office) forthe implementation of National Alzheimer’s Project Act (NAPA)

• Small business owner• Spearheading innovative new projects to improve how patients and

family caregivers navigate the healthcare system

How and why I became a speaker

• Began meeting withlegislators in 1997 to bringawareness to AD and itsimpact on familycaregivers

• Evolved to speaking athealthcare conferences,testifying at hearings, andproviding public commentat Alzheimer’s AdvisoryCouncil meetings

• Personal mission to educateothers on the challenges ofcaregiving for aging parents

• Frustration at lack ofcommunity support for ADpatients and their families

• Desire to share myexperiences and new ideason familycaregiver/healthcare systemcollaboration

• Therapy …

My speaking purpose

• Educate

• Motivate

• Start the conversation …

Walking Gallery Jacket #78

What I give tomy audiences

• So they canbeginmaking adifference

• To thinkabout howthis appliesto them

• To apply intheircommunity

• To showthings froma differentperspective

Newinformation

New ideasand tools

Actionitems

Challenge them to thinkoutside the box …

What I’ve learned from my audiences

• Many can relate to my situation

• They are eager to hear different perspectives

• They want to learn from my experiences

• They want to share their stories too

• They don’t care if I’m not perfect

• They feed off of my energy

• They have great questions

Personal best practices

• Prepare!• Know your audience/tailor your message

• Practice the delivery and don’t rely on a teleprompter

• Don’t assume anything

• Start by drawing your audience into the story• Show them how your topic impacts them

• Healthcare is personal; your speech/talk/conversation shouldbe too

• Use plain language

• Don’t forget the visual learners

• Give your audience action items

• Always take the time to interact• Take questions from your audience and answer them honestly

My toolbox

• My story

• My mission

• My Walking Gallery jacket

• And a great speech coach …

http://www.mhealthsummit.org/about-summit/super-sessions-corporate-spotlights

Contact info

• E-mail:msterling@sterlinghealthit.com

• Twitter: @SterlingHIT

http://www.safetyleaders.org/templates/pageTemplateRecentArticles.jsp

Are You Listening … Are You Really Listening?

One Hundred Thousand Voicesfor Safe and Appropriate Imaging of Children

Standard #1: Minor Head Trauma Imaging

Standard #2: Dual Phase Head and Chest CT Imaging

Standard #3: Pediatric CT Imaging Protocols

Reaction Panel

Doug Wilson Becky Martins Jennifer DingmanDan Ford Steve Swensen

Martin A. Makary, MD, MPHSurgeon, ResearcherJohns Hopkins School of Medicine and School of Public Health

October 17, 2013 Webinar

Regina Holliday

Voice of the Patient and Family

transforming healthcare leadership and patient and family engagement

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