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Leading Quality Improvement

Essentials for ManagersLesson 4: Coach Your Team

March 7, 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”

4

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 5 pre-work will open after this call)

– While you complete your preparation activities, please feel free

to email the listserv, lqi2016@ls.ihi.org, or the Lesson faculty

with questions

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Lead Faculty7

David 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.

Supporting Faculty8

Kathy D. Duncan, RN, faculty, Institute for Healthcare

Improvement (IHI), directs IHI Expeditions and manages IHI's

work in rural settings. Previously, she provided spread expertise to

Project JOINTS, 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.

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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 – Managing Systems and Connections, Dave Munch

Lesson 8 – Empower Teams to Engage in Improvement, Janet

Porter

Lesson 9 – Identify and Spread Successful Improvement, Kathy

Duncan

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Agenda

Welcome & Introductions

Debrief Action Period Assignment

– Dan Harroff Case Study Questions

Coaching Your Team

Closing

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Action Period Assignment

Provide your responses to the Dan Harroff Case

Questions and be prepared to discuss during our

session.

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The Dan Harroff Case13

The Dan Harroff Case

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?

How should Dan approach coaching his previous peers

to transition their long-held management styles from

directive to more collaborative?

How might Dan engage the staff in the development of a

business plan for off-site services?

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

value stream could be worthwhile?

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Conclusions

Dan shared and explained data which supported his

approach, and gave Dr. Newton the information he

needed to endorse Dan

Dan engaged the Supervisors in an informal

brainstorming session and delegated the chairing of the

collaborative group, supporting their decisions

Dan created a steering committee to oversee the

business plan

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Interconnected Responsibilities

•Do the Standard Work

•Surface Problems

•Solve those that they can

• Improve the Standard Work

Staff

•Observe, Measure, Analyze, Action

•Coach the Front Line

•Support and Lead the Improvements

Management•Align to Strategy

•Develop the System and Structures for Support

•Coaching in the Work

•Steward the Changes

Executive

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

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Coaching

“Coaching in its truest

sense is giving the

responsibility to the learner

to help them come up with

their own answers.”

– Vince Lombardi

Coaching: The Development of People

CoachingPresence

Aim

Timely

Active Inquiry

Action & Follow-up

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The Five Elements to Coaching

Presence: Know yourself, know your people, be in the work– Observe directly to know specifically what people are doing

Objective - Every coach has a playbook– Build your Playbook: Strategic to tactical including the basics

– If there are too many: develop rotating weekly (or monthly) schedule

– Be specific about the coachee’s role: GRRATE

– Goals, Roles, Responsibilities, Accountabilities, Timeframe, Empowerment

Timeliness: Immediate intervention is the most effective– John Shook - “Know normal from abnormal, and know it right

now.”

The Five Elements to Coaching

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

The Action: Advancing Performance and Development

– What is your role in supporting and empowering the coachee:

address barriers, etc.

– Reflect & Discuss Follow up

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Approach determined by level of knowledge and situation

Instruction

Socratic Method

None Intermediate Advance

Coaching

Commanding

Routine Urgent Emergent

Level of Knowledge

Situation

Dysfunctional

Upward

Delegation

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The Most Important Characteristic of Coaching

Use Active Listening– Verbal and Nonverbal– Coaching is 80% listening, 20% talking

Types of Questions:

Diagnostic Questions

– Open, exploring the thinking of the coachee

Suggestive Questions

– Making a suggestion through a question

– There is danger here, be careful

Process oriented questions

– How are we doing? Am I being helpful? Do you understand

what we are trying to do in this conversation?

Personal revelations and admissions

Edgar Schein

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Powerful Questions

Why,

How,

What?

Who, When,

Where?

Which, Yes/No

More Powerful

Less Powerful

My Favorite Powerful Questions

What did you observe?

What possibilities exist that we haven’t thought of yet?

How would that work?

What would it take to,…?

Why is that the case?

What would that look like?

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The Power of Coaching

JCAHO Transforming Care

UnderstandingThe Problem

ManagerCoachTraining

ManagerCoaching

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Weekly Hand Hygiene Rates

October 2008-December 2010

P UCL Average LCL

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Outcome Measures

Does all this washing make a difference?

HAI Prevalence Correlated with Hand Hygiene Compliance

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HAI Prevelance per 1,000 pt days Hand hygiene percent compliance

Problem Solving QuestionsThe Heart of Coaching: Thomas G. Crane

Global– How are things going?

– What are your goals?

– What are you trying to accomplish?

Problem Identification– What results have you achieved

so far?

– Where are you stuck?

– What kinds of problems are you encountering?

Options and Solutions– What solutions have you

attempted?

– What do you see as your options?

– Do you want input from me?

Planning– What is your “go forward” plan?– How can you apply what you’ve

learned to your job?– Who else would benefit from

knowing this?

Support– What can I do to better support

you?– Whose support do you need?– Would it be helpful to talk again?

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Going Forward

Identify one of your key projects or activities and

delegate it to someone else. Use the opportunity as a

chance to develop your staff.

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References and other reading

Humble Inquiry: The gentle art of asking instead of telling:– Edgar H. Schein. Berrett-Koehler Publishers 2013

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

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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 sessions 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:

LQIJan2017@ls.ihi.org

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Lesson 5

Janet Porter, MBA, PhDConsultant

Stroudwater Associates

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Tuesday, March 21, 1 PM ET

Partner with Patients and Families

Thank You!36

Rebecca Goldberg

rgoldberg@IHI.org

Please let us know if you have any questions or

feedback following today’s LQI Coaching Call.