Seven leadership leverage points for organization level improvement in health care
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Seven Leadership Leverage Points for Organization-Level Improvement in Health Care. Presented by: Robert L. Colones, MBA President and Chief Executive Officer Florence, South Carolina. A Quality Leadership Challenge.

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Seven leadership leverage points for organization level improvement in health care

Seven Leadership Leverage Points for Organization-Level Improvement in Health Care

Presented by:

Robert L. Colones, MBA

President and Chief Executive Officer

Florence, South Carolina


Seven leadership leverage points for organization level improvement in health care1

A Quality

Leadership

Challenge

We have become good at making improvement happen for one condition, on one unit, for a while.

We have not learned how to get measuredresults, quickly, and ‘sustainably’, across many conditions for the whole organization.

Seven Leadership Leverage Points for Organization-Level Improvement in Health Care


Seven leadership leverage points for organization level improvement in health care2

‘Give me a lever long enough, and I shall move the world.’

ARCHIMEDES

The leverage points are offered as a sort of hypothesis …

If leaders are to bring about system-level performance improvement, they must channel attention to and take action on these points.

Seven Leadership Leverage Points for Organization-Level Improvement in Health Care


Seven leadership leverage points for organization level improvement in health care3

1

Establish and Oversee System-Level Aims for Improvement at the Highest Board and Leadership Level

Seven Leadership Leverage Points for Organization-Level Improvement in Health Care


1 system level aims for improvement

1 - System-Level Aims for Improvement


1 system level aims for improvement1

1 - System-Level Aims for Improvement


Seven leadership leverage points for organization level improvement in health care4

2

Develop an Executable Strategy to Achieve System Level Aims at Highest Level of Leadership

Seven Leadership Leverage Points for Organization-Level Improvement in Health Care


2 executable strategy four critical steps

2 – Executable Strategy: Four Critical Steps

  • A few, focused breakthrough quality and safety aims

  • Senior Team develops a ‘rational portfolio of projects’ with scale and pace to achieve breakthrough aims

  • Key projects are resourced with leaders and infrastructure

  • Senior Team monitors and responds


2 executable strategy

2 – Executable Strategy

Reliability

Theory

Quality as a

Core Value

Core

Success

Factors

Physician &

Executive

Engagement

Prioritization

Change

Theory

Improvement

Methodology


2 executable strategy quality is a core value

2 – Executable Strategy: Quality is a Core Value

Service

Science

Safety

Executive Team

Engagement

Physician

Leadership

“Just Culture”


2 executable strategy prioritization a few focused breakthrough quality and safety aims

2 – Executable Strategy: PrioritizationA few, focused breakthrough quality and safety aims


2 executable strategy ce prioritization a few focused breakthrough quality and safety aims

2 – Executable Strategy: CEPrioritizationA few, focused breakthrough quality and safety aims


2 executable strategy ce prioritization a few focused breakthrough quality and safety aims1

2 – Executable Strategy: CEPrioritizationA few, focused breakthrough quality and safety aims

The total potentially avoidable days are distributed across numerous DRGs,

but 45% of days are in the top twenty DRGs.

High Opportunity DRGs: Potentially Avoidable Days

4222.12DRG 106CABG with Cath

7320.61DRG 116PTCA with Stent/Pacemaker

1741.96DRG 107CABG without Cath

1122.63DRG 144Other Circulatory Dx

5880.43DRG 143Chest Pain

822.98DRG 075Major Chest Procedures

2960.75DRG 209Major Joint and Limb Procedures

1321.63DRG 475Resp. System with Vent

2060.97DRG 174GI Hemorrhage

1141.69DRG 122Circulatory Disorder with AMI

782.34DRG 493Laparoscopic Cholecystectomy

2320.75DRG 121Circulatory disorder AMI

424.03DRG 385Neonates

562.88DRG 239Path Fx and MS Malignancy

1301.21DRG 005Extracanial Vascular Procedures

1700.84DRG 298Nutritional and Metabolic-Peds

3200.41DRG 088COPD

1560.81DRG 316Renal Failures

961.23DRG 026Seizures and Headache-Peds

841.4DRG 110Major Cardiovascular Procedure

Example Data

Total Days Opportunity:

10,543 days


2 executable strategy ce prioritization a few focused breakthrough quality and safety aims2

2 – Executable Strategy: CEPrioritizationA few, focused breakthrough quality and safety aims

EXAMPLE


2 executable strategy oe prioritization a few focused breakthrough quality and safety aims

2 – Executable Strategy: OE PrioritizationA few, focused breakthrough quality and safety aims

Creating Efficiency of Work:

Operational Effectiveness

  • Deployment of “Lean” methodology

  • Eliminate waste or non-value added work

  • Make processes flow smoothly

  • Involve staff in redesign of work


2 executable strategy oe prioritization a few focused breakthrough quality and safety aims1

2 – Executable Strategy: OEPrioritizationA few, focused breakthrough quality and safety aims


2 executable strategy oe

2 – Executable Strategy: OE

RIE Results from Cardiac Value Stream –

Nursing Documentation Time Saved

fromto

Pre-population of fields60.0 minutes12.0

Electronic documentation40.012.0

Peds Questions10.0 0.5

ED TBA paperwork40.0 0.0

Room orientation20.0 0.0

Speech screens10.0 3.0

Diabetic bundle/flow sheet 4.4 1.4

Plans of care24.0 8.0

Plus other …

Total Time Savings: Admission History, 60 minutes per patient

admitted to 27 minutes; Plan of care, 24 minutes to 8 minutes


2 executable strategy four critical steps1

2 – Executable Strategy: Four Critical Steps

  • A few, focused breakthrough quality and safety aims

  • Senior Team develops a ‘rational portfolio of projects’ with scale and pace to achieve breakthrough aims

  • Key projects are resourced with leaders and infrastructure

  • Senior Team monitors and responds


2 executable strategy key projects resourced with leaders infrastructure

Clinical Effectiveness

-Teams are Physician-Led

-Work for 3 months at 2 week intervals

-4 to 5 Physicians

-Care Manager RN, MSN

-Educator

-Implementer

-Multi-disciplinary Team

-VP Champion

Operational Effectiveness

Team Leader

Work for 6 to 12 months in VSA, @ 1 RIE/month

OE Facilitator with certification in ‘lean’

9 members with 3 in the area of focus, 3 up/downstream, and 3 ‘fresh eyes’

VP Champion

2 – Executable Strategy:Key Projects Resourced with Leaders, Infrastructure


2 executable strategy key projects resourced with leaders infrastructure1

2 – Executable Strategy: Key Projects Resourced with Leaders, Infrastructure

1. Establishing a Sense of Urgency

2. Forming a Powerful Guiding Coalition

3. Creating a Vision

4. Communicating the Vision

5. Empowering Others to Act on the Vision

6. Planning and Creating Short-Term Wins

7. Consolidating Improvements and Producing Still More Change

8. Institutionalizing New Approaches

  • John Kotter, Leading Change


2 executable strategy monitor and respond

‘The currency of leadership is attention.’

J. Reinertsen, MD

Formal & Informal resources focus on the aims

Inside: calendars, meeting agendas, project reviews, performance feedback and compensation systems

External: Transparency

2 – Executable Strategy:Monitor and Respond


2 executable strategy monitor and respond1

2 – Executable Strategy:Monitor and Respond


Seven leadership leverage points for organization level improvement in health care

STOP

START

Focus on “Ideal” & rate of improvement

Focus on benchmarks

Rely on people/Process Technology serves P&P

Relying on technology

Running the organization on “principles”

Thinking “tools” &

“best practices”

Leading from the front, constant reinforcement

Delegating leadership


Seven leadership leverage points for organization level improvement in health care

STOP

START

Few, visual, focused metrics that matter

Dozens of metrics

Internal focus (specialty, unit, role…)

Patient centered, Value Steam focus

Lead through Principles, Standard work.

Managing by Control

Improving what we know …greater complexity

Lead transformation …start with simple


Seven leadership leverage points for organization level improvement in health care

STOP

START

Experts collect data, Design/manage projects

Access knowledge & Creativity of workforce

Double digit gains in vital areas

Incremental improvement

Bottom up execution Agile and adaptive

Top down execution Rigid command & Control

The “fitness” mentality

The “fix” mentality


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