@pedroihi @theihi @masonfitzgerald @elft qi€¦ · @pedroihi @theihi @masonfitzgerald @elft_qi ....
TRANSCRIPT
@pedroIHI @TheIHI @masonfitzgerald @ELFT_QI
Objectives of the session
1. To increase awareness and understanding of the practical application of Joy in Work
2. To provide immediate learning through provision of a practical framework and top tips
3. To encourage sharing and learning of UK applications of Joy in Work
The structure
• Define
• Reflect
• Apply
What is Joy in Work? What makes for a good day? (15m)
Joy is more than absence of burnout…
Deming and Joy
“Management’s overall aim
should be to create a system
in which everybody may take joy in his
work.”
– Dr. W. Edwards Deming
Welcome to IHI
We will improve the lives of patients, the health of communities and the joy
of the health care workforce.
Welcome to IHI
The Burning Platform
Source: www.nam.edu/perspectives
Source:
www.nam.edu/
perspectives
Joy as a Strategic Priority
• Innovation Cycle 2: Expert Interviews – How do you think about joy in your
organization?
– Where does joy fit with mission, strategy or priorities?
– Do you measure joy? How and how often?
– Have you seen improvement or cost resulting in your joy in work improvement efforts?
Joy as a Strategic Priority
Outpatient • Kaiser Permanente Erwin Street
Medical Offices
• Charleston Area Medical Center
• Glen Cove Hospital, Northwell Health
Inpatient • Mount Auburn Hospital Labor and
Delivery Floor
• Nemours/Alfred l. DuPont Hospital for
Children Pediatric Intensive Care
• University of Michigan Cardiac ICU
Organizations and Trusts • Institute for Healthcare Improvement
• iMatter NHS Scotland
• Imperial College Healthcare Trust
• NHS Highland
Academic • University of Virginia School of
Nursing
• Penn State Altoona School of Nursing
• Innovation Cycle 3: Prototyping
Which of the critical components did
sites work on during prototyping?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Testing Changes for Shared Responsibility
Do you know what makes a good day for your colleagues?
Co-creating better days
Share visit note
documentation and
order entry with
other members of
the team
- KP
Peer Support training for those undergoing trauma from lawsuit,
or medical error - BWH
Staff training to de-escalate and respond to the
potential for violence toward staff and other
patients
- BIDMC
Break the rules week where staff
have permission to break rules in the pursuit of better
patient care
- IHI Leadership Alliance
“Collaboration hallways” to
co-locate staff across
professions
- University of Minnesota
Offer a regular course on listening &
storytelling to leaders and managers
- Barry Wehmiller
What other tests
of change should
we try?
Lessons Learned: New Mental Models Needed Reshape Improvement Efforts and the Culture
Salary and benefits are what really matters to staff
It is up to HR to raise satisfaction
Staff satisfaction leads to lower turnover
Old Thinking
Staff want meaning, purpose, camaraderie, choice, and equity
It is the job of leaders to drive a joyful workforce
AND happier patients and greater productivity
New Mental Models
Lessons Learned: Get Ready
• Prepare for “What Matters?” conversations – What if they ask for things I can’t do?
– How am I going to fix all of the things they identify?
• Assure leader capacity – Time and performance improvement skills
• Identify a senior leader champion – Aids when issues are identified beyond local scope
• Including all stakeholders (staff, physicians, and administration) at the beginning makes for an easier adoption of the projects
• Problems = common; solutions = one size fits one
Lessons Learned: Language Matters
• Joy in Work may not
resonate with
everyone – find what
works for your
organization
• Make sure your word
choice is aspirational
enough to inspire
action
“The word ‘joy’ was a barrier but
meaningful interactions was well
accepted.”
Lessons Learned: Measurement
• Measured as key organizational health data
point
• Successful practice is to:
– Survey all team members
– Transparently share results
– Involve team in implementing improvements
• Don’t reinvent the wheel!
– Use and refine assessments already in place
Joy Assessment Tools
• Daily Visual Measure
• Pulse Survey
• Net Promoter Score
• Hackman & Oldham’s Job Diagnostics Survey
• Mayo Leadership Dimensions Assessment
• Well Being Index
• AHRQ Safety Culture Tool
• Maslach Burnout Inventory
• Mini-Z: [email protected]
• Physician and Staff Engagement Surveys
IHI Organizational Diagnostic
Fall 2018
The pebbles in your shoes What getting in the way of joy?
The ELFT story……
14 September 2018 East London NHS Foundation Trust Page 26
3.35
3.4
3.45
3.5
3.55
3.6
3.65
3.7
3.75
3.8
3.85
3.9
3.95
4
4.05
2009 2010 2011 2012 2013 2014 2015 2016 2017
ELFT
National average
The culture we want to nurture
A listening and learning organisation
Empowering staff to drive improvement
Increasing transparency and openness
Re-balancing quality control, assurance and
improvement
Patients, carers and families at the heart of all
we do
Theme: Action:
Communication
Executive walkabouts - “what matters to you?”
Valuing staff
Creating a “thank you” culture
Team working
Time for team reflection
Fair treatment
Developing collective, inclusive leadership
14 September 2018 East London NHS Foundation Trust Page 29
Our approach to improvement
14 September 2018 East London NHS Foundation Trust Page 30
Trust
Directorate
Team
Profession
Our approach to improvement
Recommend the Trust as a place to work (Trust Average 70%)
14 September 2018 East London NHS Foundation Trust Page 31
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0-9 10-19. 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100
Driver Diagram
Good Day Measure
50.628% 87.000%
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% M
ost
ly Y
es
Millharbour Ward - P Chart
84.141%
88.889%
30%
40%
50%
60%
70%
80%
90%
100%
1 -
13/0
7/1
72
- 14
/07/
17
3 -
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- 19
/07/
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- 25
/07/
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- 27
/07/
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- 3
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- 2
3/04
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% M
ost
ly Y
es
QI Team - P Chart
74.613%
90.654%
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100%
1 -
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% M
ost
ly Y
es
Isle of Dogs - P Chart
59.272%
0%
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80%
90%
100%
1 -
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/06/
17
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% M
ost
ly Y
es
EPCT North West - P Chart
1 2 1 2 1 3 3 3
5 7
2 3 1 2 2 1
4 4 2 2 2
4 3 6
3 6 5
2 4 4
7
2 3 4 4 3
11 14
5
Days taken to reach subgroup
1 1 2 2 2
1 1 1 1 1 1 1 2 2 2
1 1 2 2 2 2 2 2 2 2
1 2 2 2
3 3
1 1 2 2 2
1 2 2 2 2 2 2 2 2 2
3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Days taken to reach subgroup
1 1 2 2 4
11
7
3 6 5 5 4 4
8
3
9
4 3 4 6 5
Days taken to reach subgroup
2 2 2 2 2 2 2 3 2 4
2 2 2 2 2
22 22
2 2 2 1 2 2 2 2 2 3 2 3 2 5 4 5 5
7 5
8 6
Days taken to reach subgroup
18 Oct
26 July
15 Aug
GO
OD
DA
Y M
EA
SU
RE
September
2018
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100%
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All Teams
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ABT Team
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Biggleswade CMHT
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Business Development Unit
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C&H Rehabilitation and Recovery Service
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Coborn centre for adolescent mental health
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Community Children's Nursing Service
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Community Eating Disorder Service
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EPCT North West
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Executive Team
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Ludgate Ward
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Medical Management Team
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Morrison Ward
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1/8
/18
4/8
/18
7/8
/18
10/8
/18
13/8
/18
16/8
/18
19/8
/18
22/8
/18
25/8
/18
28/8
/18
Newham Child and Family Consultation Service
0%
20%
40%
60%
80%
100%
2/7
/18
4/7
/18
6/7
/18
10/7
/18
12/7
/18
16/7
/18
18/7
/18
20/7
/18
24/7
/18
26/7
/18
30/7
/18
1/8
/18
3/8
/18
7/8
/18
9/8
/18
13/8
/18
15/8
/18
17/8
/18
21/8
/18
23/8
/18
28/8
/18
30/8
/18
Older People's OT Team
0%
20%
40%
60%
80%
100%
2/7
/18
4/7
/18
6/7
/18
10/7
/18
12/7
/18
16/7
/18
18/7
/18
20/7
/18
24/7
/18
26/7
/18
30/7
/18
1/8
/18
3/8
/18
7/8
/18
9/8
/18
13/8
/18
15/8
/18
17/8
/18
21/8
/18
23/8
/18
28/8
/18
30/8
/18
Quality Assurance Team
0%
20%
40%
60%
80%
100%
2/7/
18
4/7/
18
6/7/
18
10/7
/18
12/7
/18
16/7
/18
18/7
/18
20/7
/18
24/7
/18
26/7
/18
30/7
/18
1/8/
18
3/8/
18
7/8/
18
9/8/
18
13/8
/18
15/8
/18
17/8
/18
21/8
/18
23/8
/18
28/8
/18
30/8
/18
Richmond Wellbeing Service
0%
20%
40%
60%
80%
100%
2/7/
18
4/7/
18
6/7/
18
10/7
/18
12/7
/18
16/7
/18
18/7
/18
20/7
/18
24/7
/18
26/7
/18
30/7
/18
1/8/
18
3/8/
18
7/8/
18
9/8/
18
13/8
/18
15/8
/18
17/8
/18
21/8
/18
23/8
/18
28/8
/18
30/8
/18
Therapeutic Community and Outreach
0%
20%
40%
60%
80%
100%
2/7/
18
5/7/
18
8/7/
18
11/7
/18
14/7
/18
17/7
/18
20/7
/18
23/7
/18
26/7
/18
29/7
/18
1/8/
18
4/8/
18
7/8/
18
10/8
/18
13/8
/18
16/8
/18
19/8
/18
22/8
/18
25/8
/18
28/8
/18
Westferry Ward
0%
20%
40%
60%
80%
100%
2/7/
18
5/7/
18
8/7/
18
11/7
/18
14/7
/18
17/7
/18
20/7
/18
23/7
/18
26/7
/18
29/7
/18
1/8/
18
4/8/
18
7/8/
18
10/8
/18
13/8
/18
16/8
/18
19/8
/18
22/8
/18
25/8
/18
28/8
/18
Willow Ward
0%
20%
40%
60%
80%
100%
2/7/
18
4/7/
18
6/7/
18
10/7
/18
12/7
/18
16/7
/18
18/7
/18
20/7
/18
24/7
/18
26/7
/18
30/7
/18
1/8/
18
3/8/
18
7/8/
18
9/8/
18
13/8
/18
15/8
/18
17/8
/18
21/8
/18
23/8
/18
28/8
/18
30/8
/18
Bedford CRHT Team
3
Exercise 3: Applying the learning
Based on what you have discussed, and what you have heard, what is your plan upon
returning to your place of work? (5 minutes)
Questions?
@pedroIHI @TheIHI
@masonfitzgerald @ELFT_QI