2/18/2015

1

Leading Quality Improvement

Essentials for Managers

Session 1: Coach Versus Command

February 17, 2015

These presenters have

nothing to disclose

Janet Porter, PhD

Dave Munch, MD

Kathy Duncan, RN

Today’s Host2

Dorian Burks, Project Coordinator, Institute for

Healthcare Improvement, is a current coordinator for

web-based Expeditions. He also contributes to the IHI

work in the Triple Aim and Improvement Capability

focus areas, as well as the Leading Quality

Improvement series. Dorian is a member of the

Diversity and Inclusion Council at IHI, where he and

fellow staff members develop strategies to enhance

IHI’s inclusive culture, both internally and externally.

Dorian graduated from Massachusetts Institute of

Technology in Cambridge, MA where he received his

Bachelor of Science degree in Biology and humanities

concentration in Anthropology.

2/18/2015

2

Audio Broadcast3

You will see a box

in the top left hand

corner labeled

“Audio broadcast.” If you are able to

listen to the

program using the

speakers on your computer, you

have connected

successfully.

Phone Connection (Preferred)4

To join by phone:1) Click on the

“Participants” and “Chat” icons in the top right hand side of your screen.

2) Click the button on the right hand side of the screen.

3) A pop-up box will appear with the option “I will call in.” Click that option.

4) Please dial the phone number, the event number and your attendee ID to connect correctly .

2/18/2015

3

WebEx Quick Reference

• Please use chat to

“All Participants”

for questions

• For technology

issues only, please

chat to “Host”

5

Enter Text

Select Chat recipient

Raise your hand

6

Chat

6

Name and the Organization you represent

Example: Sam Jones, Midwest Health

Please send your message to All Participants

2/18/2015

4

7

Kathy Duncan, RN8

Kathy Duncan, RN, Faculty, IHI, co-leads IHI's National Learning Network. Ms. Duncan also directs IHI Expeditions, manages IHI's work in rural settings, and provides spread expertise to Project JOINTS. Previously, she co-led the 5 Million Lives Campaign National Field Team and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She also served as the content lead for the Campaign's Prevention of Pressure Ulcers and Deployment of Rapid Response Teams areas. She is a member of the Scientific Advisory Board for the AHA NRCPR, NQF's Coordination of Care Advisory Panel, and NDNQI's Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the director of critical care for a large community hospital.

2/18/2015

5

Today’s Agenda9

� Ground Rules & Introductions

� The Dan Harroff Case

� Coach Versus Command

� Action Period Assignment

10

Chat

10

What is your goal for participating in this program?

Please send your message to All Participants

2/18/2015

6

Ground Rules11

� We learn from one another – “All teach, all learn”

� Why reinvent the wheel? - Steal shamelessly

� This is a transparent learning environment

� All ideas/feedback are welcome and encouraged!

Objectives

At the end of the program, participants will be able to:

Describe the skills, tools, and resources needed by

a middle manager to lead quality improvement

efforts in their local settings

Demonstrate how to link department-level

improvement activities to the organization’s goals

and overall strategic plan

List at least three ways middle managers can be

successful in partnering with front-line staff in quality

improvement activities

12

2/18/2015

7

Schedule of Sessions

Session 1 – Coach Versus CommandDate: Tuesday, February 17, 12:00 – 1:00 PM ET

Session 2 – Understand and Manage SystemsDate: Tuesday, March 3, 12:00 – 3:00 PM ET*

Session 3 – Practice Improvement EssentialsDate: Tuesday, March 17, 12:00 – 1:00 PM ET

Session 4 – Build Sustainable SystemsDate: Tuesday, March 31, 12:00 – 3:00 PM ET*

Session 5 – Manage Connections Across SystemsDate: Tuesday, April 14, 12:00 – 1:00 PM ET

* Breakout session: Clinical Managers 12:00-1:00 PM ET, Quality Improvement

Managers 1:00-2:00 PM ET, Allied Health Professions Managers 2:00-3:00 PM ET

13

Schedule of Sessions

Session 6 – Identify and Spread Successful ImprovementsDate: Tuesday, April 28, 12:00 – 3:00 PM ET*

Session 7 – Partner with Patients and Families Date: Tuesday, May 5, 12:00 – 1:00 PM ET

Session 8 – Create a Culture of SafetyDate: Tuesday, May 19, 12:00 – 3:00 PM ET*

Session 9 – Empower Teams to Engage in ImprovementDate: Tuesday, June 9, 12:00 – 1:00 PM ET

14

* Breakout session: Clinical Managers 12:00-1:00 PM ET, Quality Improvement

Managers 1:00-2:00 PM ET, Allied Health Professions Managers 2:00-3:00 PM ET

2/18/2015

8

Session 1 Assignment

� Watch pre-work video

� Read the Dan Harroff Case

� Read The Blind Spot blog

by Dave Munch, MD

15

Leading Quality Improvement Team

Kathy D. Duncan, RN

Director, IHI

Jill Duncan, RN, MS, MPHDirector, IHI

David Munch, MDSenior Vice President

and Chief Clinical

Officer, Healthcare

Performance Partners

Janet Porter, MBA, PhD

Priincipal,

Stroudwater Associates

Kayla DeVincentis, CHES

Project Manager, IHI

Dorian BurksProject Coordinator, IHI

2/18/2015

9

Dave Munch, MD17

Dave Munch, MD, Senior Vice President and Chief Clinical Officer, Healthcare Performance Partners, leads the organization’s clinical and Lean Healthcare engagements. He previously served as Chief Clinical and Quality Officer at Exempla Lutheran Medical Center, where he led their Lean Production applications for more than five years, resulting in substantial improvements in both clinical and non-clinical processes. Dr. Munch has been a frequent speaker on leadership effectiveness and Lean transformation for a number of health care organizations, including The University of Rochester Medical Center, Yale-New Haven Health System, Tulane University Medical Center, Pittsburgh Regional Health Initiative, Institute for Clinical Systems Improvement, and the Voluntary Hospital Association. He served on the Agency for Healthcare Research and Quality's High Reliability Advisory Group, and he has an extensive background in hospital operations, health plan governance, physician organization governance, and clinical practice in Internal Medicine. Dr. Munch is a faculty member for the Belmont University Lean Healthcare Certificate Program.

Janet Porter, MBA, PhD18

Janet Porter, MBA, PhD, a principal with Stroudwater Associates, serves as a strategy, operational, and leadership development consultant to hospitals and physician practices. She has 35 years of experience as a hospital administrator, teacher, consultant, and public health leader.

Dr. Porter served as the Chief Operating Officer of Dana-Farber Cancer Institute; the Associate Dean of Executive Education at the University of North Carolina’s School of Public Health; the Interim CEO of the Association of University Programs in Health Administration (AUPHA); and the Vice President, and then COO of Nationwide Children’s Hospital in Columbus, Ohio. Currently teaching strategic management in the Healthcare Executive MBA program at the University of Miami, Dr. Porter is also an active adjunct professor at the University of North Carolina at Chapel Hill and Ohio State University. Janet received her BS and MHA from Ohio State University, and her MBA and PhD in health care strategy from the University of Minnesota. Janet has completed Intermountain Healthcare System’s Advanced Training Program, is certified in several leadership development tools including Myers-Briggs, Crucial Conversations and StrengthsFinder and serves as a Baldrige examiner. Janet serves on the AARP board of directors and the High-Value Healthcare Collaborative Advisory Board.

2/18/2015

10

The Dan Harroff Case

How might Dan engage the staff in the development of a

business plan for off-site services?

How should Dan approach coaching his previous peers

to transition their long-held management styles from

directive to more collaborative?

How should Dan build a case that working with QI on a

value stream could be worthwhile?

What recommendation would you give to Dan on how to

approach Dr. Newton with his goals to get the doctor’s

buy-in and support?

19

Conclusions

Dan engaged the Supervisors in an informal

brainstorming session and delegated the chairing of the

collaborative group, supporting their decisions

Dan shared and explained data which supported his

approach, and gave Dr. Newton the information he

needed to endorse Dan

Dan created a steering committee to oversee the

business plan

20

2/18/2015

11

Questions/Discussion21

Raise your hand

Use the chat

Coach versus Command

Dave Munch, MD

2/18/2015

12

Coaching

• “Coaching in its truest sense is giving the responsibility to the learner to help them come up with their own answers.”

– Vince Lombardi

• A manager’s task it simple---to get the job done and grow his or her staff. Time and cost pressures limit the latter. Coaching is one process which accomplishes both.

– John Whitmore

The 5 Elements of Coaching

24

PresencePresence

ObjectiveObjective

TimelinessTimelinessInteractionInteraction

ActionAction

2/18/2015

13

Coaching vs Commanding

25

Commanding

Routine Urgent Emergent

Coaching

• Engaging

• Collaboration

• Complexity

• Fluid

• Controlling

• Compliance

• Simplicity

• Rigid

Adaptive:

Help Coachee

to think for

self

Directive:

Think for

coachee

Collaborative:

Think with

coachee

Dysfunctional

Upward

Delegation

The Iron Rule: Never do for others

what they can do for themselves.

2/18/2015

14

Interconnected Responsibilities

•Do the Standard Work

•Surface Problems

•Solve those that they can

•Improve the Standard Work

StaffStaff

•Observe, Measure, Analyze, Action

•Coach the Front Line

•Support and Lead the Improvements

ManagementManagement•Align to Strategy

•Develop the System and Structures for Support

•Coaching in the Work

•Steward the Changes

ExecutiveExecutive

Performance Improvement, Decision Support, HR, I.T. Facilities

References and other reading

• The Heart of Coaching: Thomas G. Crane– Second addition, July 2002, FTA Press

• The Art of Powerful Question, Catalyzing Insight Innovation and Action: – Eric E. Gogt, Juanita Brown and Davis Isaacs. Whole

Systems Associates: www.theworldcafe.com

• Learning to Lead at Toyota: Steven J. Spear– Reprint R0405E: www.hbr.org

• The Blind Spot Parts I and II: – blog article by David Munch,

www.leanhealthcareexchange.com

2/18/2015

15

Action Period Assignment

Identify one of your key projects or activities and

delegate it to someone else. Use the opportunity as a

chance to develop your staff.

– Send your reflections to LQI2015@ls.ihi.org

Communications

All sessions are recorded

Materials are sent one week in advance

Listserv address for session communications:

LQI2015@ls.ihi.org

To add colleagues, email us at info@ihi.org

30

2/18/2015

16

Session 2

Tuesday, March 3: Understand and Manage Systems

– Clinical Managers – 12:00-1:00 PM ET

– Quality Improvement Managers – 1:00-2:00 PM ET

– Allied Health Professions Managers – 2:00-3:00 PM ET

31

Thank You!32

Kathy Duncan

KDuncan@IHI.org

Dorian Burks

DBurks@IHI.org

Please let us know if you have any questions or feedback following today’s session.