leading quality improvement - ihi
TRANSCRIPT
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Leading Quality Improvement
Essentials for ManagersLesson 7: Manage Systems and Connections
April 18th, 2017
These presenters have
nothing to disclose
Janet Porter, PhDDave Munch, MDKathy Duncan, RN
Today’s Host2
Rebecca Goldberg, Project Coordinator, Institute for
Healthcare Improvement (IHI), coordinates multiple
projects focused on increasing value in health care by
improving quality and reducing costs. Currently,
Rebecca’s primary responsibility is coordinating and
hosting IHI’s Expeditions, monthly virtual support
programs focused on specific topic areas. Rebecca is a
recent graduate of Georgetown University in
Washington, D.C., where she obtained her Bachelor of
Science degree in human science with a minor in public
health.
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Phone Connection (Preferred)3
To join by phone:
1) Click on the “Participants”
and “Chat” icon in the top,
right hand side of your
screen to open the
necessary panels
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 .
WebEx Quick Reference
• Please use chat to
“All Participants”
for questions
• For technology
issues only, please
chat to “Host”
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Enter Text
Select Chat recipient
Raise your hand
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5
Chat
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Name and the Organization you represent
Example: Sam Jones, Midwest Health
Please send your message to All Participants
LQI Structure
9 Lessons in the program
– Each lesson is composed of:
1. Preparation work on the Learning Management System (videos,
articles, case studies, and an assignment)
2. A coaching call for that Lesson (WebEx call with faculty)
– Lesson preparation work opens two weeks before the lesson’s
coaching call (Lesson 8 pre-work will open after this call)
– While you complete your preparation activities, please feel free
to email the listserv, [email protected], or the Lesson faculty
with questions
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Lead Faculty7
Dr. David Munch, MD worked at Exempla Lutheran Medical
Center (ELMC) as the Chief Operating Officer from 2000 to
2005. He then assumed responsibilities as the Chief Quality
and Medical Officer stewarding improvements in quality, safety
and reliable practice using Lean, Six Sigma and other methods.
During his tenure ELMC participated in The CMS demonstration
project for reduction of hospital readmissions, The Joint
Commissions Transforming Healthcare division pilot program
for hand washing and The Agency for Healthcare Research and
Quality’s (AHRQ) High Reliability Advisory Group. He is
currently a faculty member with IHI in the areas of patient safety
and is the Senior Vice President for Healthcare Performance
Partners (HPP), advising hospitals and systems in process
improvement and Lean transformation.
LQI 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
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LQI Lessons
Lesson 1 – Know Yourself, Janet Porter
Lesson 2 – Managing Time and Attention, Dave Munch
Lesson 3 – Practice Improvement Essentials, Kathy Duncan
Lesson 4 – Coach Your Team, Dave Munch
Lesson 5 – Patient Engagement, Janet Porter
Lesson 6 – Problem Solving in a Culture of Safety, Dave Munch
Lesson 7 – Manage Systems and Connections, Dave Munch
Lesson 8 – Identify and Spread Successful Improvement, Kathy Duncan
Lesson 9 – Empower Teams to Engage in Improvement, Janet Porter
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Agenda
Welcome & Introductions
The ARUP Laboratories Case Study
Manage Systems and Connections
Debrief Action Period Assignment
Closing
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Case Study: ARUP Laboratories
What were the key differences between the first approach to make improvements that didn’t work and the second approach that was successful?
What are some of the possible reasons that the hospital and lab were having issues coordinating the testing and results process efficiently?
What role did Cecilia play in the success of this improvement? What role did the Q.I. facilitator play? What role should the hospital leadership play in this improvement?
What barriers do you think Cecilia faced in convening stakeholders across multiple systems?
What will need to be done to sustain these improvements
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Dr. W. Edwards Deming:
System of Profound Knowledge
Appreciation for a
System
Understanding
Variation
Theory of Knowledge
Psychology
If each part of a system, considered separately is made to operate as efficiently as possible, then
the system as a whole will not operate as effectively as possible
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Demings Definition of a System: A system is an interdependent group of items, people
and processes with a common aim
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`Would you tell me, please, which way I ought to go from
here?‘ Alice said. `That depends a good deal on
where you want to get to,' said the Cat.
`I don't much care where--' said Alice.
`Then it doesn't matter which way you go,' said the Cat.
Purpose
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Connecting to True North
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Systems: Processes and Interactions at all levels
Governance
Out Patient
Executive Leadership
Supply Chain
-Home, SNF-Rehab, etc.-Community
-Surgery-Critical Care-Med-Surg
Management
FacilitiesHR
Entry:E.D. or Front
Desk
Staff
I.T.Revenue
Cycle
Organizational Goals
The Patient Flow
The Support Areas
Strategies & Tactics
Clear Front Line Work
Department Plans
Imaging Lab
Med-SurgStepdown
The 4 Steps to Agreement18
Step 1: Here is what I need
Step 2: Here is what I can give
Step 3: This is what I need from you
Step 4: Do we agree?
Peter Block: “Flawless Consulting”
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The Four Rules in Use
1. Activities are highly specified in terms of content,
sequence, timing, location and outcome
2. Connections between workers are standardized, direct,
unambiguous and paced
3. Pathways through which products and services flow are
simple and standardized
4. Improvements are made by workers close to the
process using the scientific method with a coach
Stephen Spear & H. Kent Brown: Decoding the DNA of the Toyota Production System
HBR reprint 99509 Sept. Oct. 1999
Polling Question
On a scale of 1 (highly siloed) to 5 (highly collaborative)
grade your organizations “systemness”
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Connecting to Your Patients:
Reflections of Patient and Family Voices
To be listened to, taken seriously, and respected as a care partner– To have my family/caregiver treated the same way
– To participate in decision making at the level I choose
To always be told the truth– To have things explained to me fully and clearly
– To receive an explanation and apology if things go wrong
To have information communicated to the entire care team– To have my care timely and impeccably documented
– To have these records made available to me if requested
IHI Website: Partnering with Patients and Families To Design a Patient- and Family-Centered Health Care System, A Roadmap for the Future, A Work in Progress
Reflections of Patient and Family
Voices (continued)
To have coordination among all members of the health
care team across settings
To be supported emotionally as well as physically
To receive high-quality, safe care
IHI Website: Partnering with Patients and Families To Design a Patient- and Family-Centered Health Care System, A Roadmap for the Future, A Work in Progress
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Polling:
How effective is your connection with your boss?
– Using the “4 Steps to Agreement” evaluate the effectiveness with
your boss
With your staff: what is your predominant style?
– Commanding or coaching?
How strong are the connections with the “horizontals”?
– Are the connections effective?
– Do you have aligned incentives?
How well do you connect with your patients?
– How do you know? E.g. HCAHPS scores
How effective is your connection with your boss?
1 (Poor, often adversarial)
2 (Below Average, not well connected)
3 (Average)
4 (Above average)
5 (Excellent)
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Connection with your staff
With your staff: what is your predominant style?
– 1 (commanding, authoritative)
– 2 (coaching)
Where do you want it to be?
– 3 (commanding, authoritative)
– 4 (coaching)
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How strong are the connections with the “horizontals”?
1 (poor, competitive)
2 (ok but not very intentional)
3 (average)
4 (better than most organizations but we have
opportunity)
5 (excellent and getting better)
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How well do you connect with your patients?
1 (poorly, we are in the lowest quartile)
2 (below average, 2nd quartile)
3 (above average, 3rd quartile)
4 (excellent, top quartile)
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Your Job:
Create Beautiful Music
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Questions?
Please chat in or, if you are connected by
phone, raise your hand to be unmuted!
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LQI Communications
All calls are recorded
– Recording and materials sent in post-call email and uploaded to
your MyIHI account
Pre-work materials are located in LMS
Listserv address for session communications:
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Lesson 831
Tuesday, May 2, 1 PM ET
Empower Teams to Engage in Improvement
Janet Porter, MBA, PhDConsultant
Stroudwater Associates
Thank You!32
Rebecca Goldberg
Please let us know if you have any questions or
feedback following today’s LQI Coaching Call.