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Leading System Change

Explore the need for physician leaders capable of system-level leadership and identify tools for facilitating change at the system level. Understand key issues in building teams for health care workforce development.

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Leading System Change

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  1. Leading System Change MMA: Launching High Impact Health Care Teams Virginia Mohl, MD, PhD, DIO and Medical Director

  2. Objectives • Understand why we need Physician Leaders capable of System-level leadership. • Start to identify new tools for facilitating change at the system level. • Identify key issues in building teams who work in systems and implications for Health Care workforce development.

  3. Outline • Introduction: • Why physician leadership? • What new competencies are needed? • How to think at the system level? • One organization’s Journey • Methicillin-Resistant Staph aureus • Hypertension • Referral Communication • Medical Education • Summary and questions

  4. System Thinking • Who am I and how do I think? • What is my culture and how resilient is it? • What are the outside forces? • Where do we want to be in 5 years? What can I do now to create my preferred future?

  5. Why?Because Wicked Problems in Healthcare not solved by traditional problem solving

  6. Example 1: Adaptive change, Inpatient Eliminating the Transmission of Methicillin Resistant Staph aureus (MRSA) by Using the Positive Deviance (PD) Approach to Behavior and Social Change

  7. Key Interventions ~ The “Science” Bundle • Hand hygiene • Decontamination of the environment and equipment • Active surveillance cultures (ASCs) • Contact precautions (isolation) for infected and colonized patients

  8. What is Positive Deviance?A tool for Leaders Solutions before our very eyes The Premise: In every community there are certain individuals whose uncommon practices/behaviors enable them to find better solutions to problems than their neighbors who have access to the same resources

  9. Theatre In the Round A diverse audience, from many units across the clinic, assembles in the conference room… now an inpatient medical room. For the next 60 minutes, no one knows what to expect.

  10. The “Cultural” Bundle Make the invisible, visible ~ chocolate pudding to simulate contamination ~ Reinforce with Feedback Solutions that are co-created and owned ~ ownership vs. buy-in ~ discovery & action dialogues Act your way to a new way of thinking ~ create experiences that allow self-discovery

  11. Example 2 : Population Health, Outpatient Improving the Management of Hypertension Using a Positive Deviance Approach

  12. PD’s Discovery & Action Dialogues • How do you know whether your patient has hypertension? • In your own practices, how do you know you have an accurate BP? • What prevents you from doing this all the time? • In your own practices, how do you decide when to treat? What prevents you from doing this all the time? • Is there anyone who has a way that helps them overcome these barriers? (the positive deviants) • Do you have any ideas? How can we apply? Amplify? • What can we do now? Any volunteers?

  13. Results

  14. Example 3: Regional Quality/Safety Improving the communication between referring and receiving Clinicians using Operational Excellence

  15. Operational Excellence: Lean and Six Sigma Billings Clinic Referral Communication Improvement Plan

  16. Cause & Effect (Fishbone) Diagram The fishbone diagram helped the team to identify the key inputs that lead to dissatisfaction with the current process for both referring and receiving providers.

  17. The Team

  18. Need Both Technical Adaptive Science Bundle Cultural Bundle

  19. Verify - Transfer & Clinic Referral Data The top chart shows the number of transfers from outside Yellowstone County pre and post the Kaizen event in June 2012. The increase in average monthly transfers from outside Yellowstone county is approximately 13%. Statistically this increase is significant. The bottom chart shows the number of clinic appts. from outside Yellowstone County pre and post the Kaizen event in June 2012. This shows a decrease of approximately 1.5%; however, this change in appts. is not statistically significant and thus we would conclude that there has been no change.

  20. Example 3: National Medical Education Becoming an Independent Academic Medical Center

  21. What are the key forces driving Medical Education? 2016 estimate 44,000

  22. UGME Medical Student Rotations 2009 to Current 248% increase since 2009

  23. 15% solution Medical Education Month January 2016

  24. Office of Medical Education • Graduate Medical Education (GME) • Internal Medicine Residency • Family Medicine Residency • Exploring/preparing for Psychiatric Residency and 4th year General Surgery • Undergraduate Medical Education (UGME) • Medical Students • Nurse Practitioners • Physician Assistants • Continuing Medical Education (CME) • Conferences • Lecture series • Case conferences

  25. System Leadership is Different • Co-creation of desired future, one conversation at a time • Align change initiatives with stakeholders’ needs and values • Help others tolerate fears and losses that accompany change • Pay attention to environment • Courage, honesty, respect for others

  26. A different model

  27. From Teamwork to Team of Teams: Thank you! Primary Care Team Administrative Team

  28. You Must Learn to EMBRACE failure.

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