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Studer Principles in Action

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  1. Studer Principles in Action

  2. Presenters • Bobette J. Shay RN, MS, BSN, CNOR Director of Operations TRHS Bettendorf Interim Director of Cardiology Service Line • Kevin M. Soeken, M.S. Customer Relations Management Coordinator Facilitator – TRHS Firestarters

  3. “Journey to Excellence” • TRHS Board challenged Senior Team to drive cultural change toward “Best Outcome, Every Patient, Every Time.” • CEO Selected Leaders & sent to Studer training • Leaders empowered to select participants from leads, managers and directors with consultant input and support

  4. Why go on this Journey?

  5. “In early civilizations, fire starters taught others how to keep the flame alive. If they were successful, the tribe lived. If they were not, the tribe died. It was that simple." Quint Studer Author of Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference.

  6. AIM: To implement and sustain a permanent culture of service excellence. • July 2009 began meeting • twice per month • 90-120 min • Members from all levels of leadership • Staff engagement through “ad hoc” committees

  7. Charter: Action/results oriented approach • Team Rules • Specific, timed agendas • Assignments & Reports • Check titles at door • Team Roles: • Core Leadership: Sponsors, Leader, Facilitator, Coach • Ad Hoc committees with specific tasks • Senior Team communication through Executive Sponsors

  8. Introducing the Brad Crowder Amanda Crowell Jodi Dykema Kurt Freddy Liza Kline Michael Patterson – Senior Leader Lynn Ripple Pam Samuelson Bobette Shay – Team Leader Kevin Soeken – Facilitator Jewels Stark Marilu Wink Kathy Yadon Vicki Felger - Coach Kathy Cunningham – Senior Leader

  9. Timetable

  10. AIDET Hourly Rounding Leadership Rounding Leadership Development HML Standards of Behavior

  11. AIDET Hourly Rounding Leadership Rounding Leadership Development HML Standards of Behavior

  12. AIDET • 2008 Pilot Classroom training • Bettendorf Medical and Surgical Units • Certification Trial on Surgical Unit • Rock Island Campus • Not Successful but lesson learned: • concepts simple but culture not ready • AIDET Service Champion Team formed

  13. AIDET CNO - Sponsor • Director - Lead • CRMC – Facilitator • Units Chosen • 6N - Surgical Unit • 4S - Oncology Unit • 5S - Rehab Unit • “Service Champions” chosen • Hand-picked by Unit Manager • Responsible to certify cohort of 5 peers

  14. AIDET • Biweekly meetings during development phase, regular attendance from CNO (now VP Quality) • Training program revised by CRMC & “fine tuned” by Service Champions Group • Training & Certification for Service Champions and “Super-Champions” completed first • Senior Team Members, Directors and Managers in attendance dispersed among many classes • Unit Staff assigned to Service Champion Cohorts after attending class • Integrated ancillary and support staffs from those units at the same time

  15. AIDET Hourly Rounding Leadership Rounding Leadership Development HML Standards of Behavior


  17. AIDET Incorporation • Hourly Comfort Rounds • Explanations of tests and treatments • Housekeeping • Therapies: Speech, PT and OT • Graduation Celebrations: • VP, Director and Manager participation • Individual and Unit Certificates • Firestarters Cookies!

  18. AIDET Initial Results

  19. AIDET More Lessons Learned • Establish Documentation of Classroom and Certification Process in advance • Assess Manager availability to observe & coach staff to the standard (A3 Analysis) • Plan for certifying 3rd shift and weekend staff • Prepare to encounter Task Orientation vs Patient Centered Orientation

  20. AIDET Hourly Rounding Leadership Rounding Leadership Development HML Standards of Behavior

  21. Leadership Rounding • Firestarters Team recommended rounding days/times for 2010: • Leads/Managers:  Tuesday, 9AM-11AM • Directors/VP's:  Thursday, 2pm-4pm. • Thank You Notes: 30/Quarter Minimum

  22. Leadership Rounding • Rounding Flowcharts to get process started • Later developed spreadsheet which incorporates information on these forms and rolls up Rounding, Thank You Note and Stoplight Report issues from Manager to Director to VP

  23. Leadership Rounding Lessons Learned • May need to adjust schedule but NOT the frequency • Leaders may object to minimum # of TYN (“too fake”) • Look outside their department • Look at support/ancillary depts. • LOOK! • Must have accountability at all levels or it is destined to fail! • Need to divide up departments among Senior Leaders • Balanced workload • Reasonable frequency of rounding • Stay focused on capturing wins at the Senior level

  24. AIDET Hourly Rounding Leadership Rounding Leadership Development HML Standards of Behavior

  25. Leadership Development • Fall Leadership Seminar • Interactive… and FUN! • Format • working sessions • learning sessions • “Studer 201” • Studer 101 = “Hardwiring Excellence” prerequisite to class (quiz results posted during session) • Table activities: focus on Leadership priorities • Obstacles • Things to add

  26. Leadership Development

  27. Leadership Development Table Discussion Priorities Obstacles Leadership Turnover Mistrust Resistance to Change Things to Add Teamwork across departments Front-line staff buy-in Dealing with Low Performers

  28. Firestarters A3 (High Level)

  29. Firestarters A3 Problem Statement Problem Statement “Ideally leadership would be stable, trust would be high and staff would exhibit willingness to change but in this case leadership instability and a lack of accountability/prioritization of activities create a culture of mistrust which directly results in resistance to change (all levels).”

  30. Firestarters A3 Countermeasures 1.Leadership Development (HML) 2. Senior Leader Priorities: Director/Manager/Lead Priorities 3. AIDET & Hourly Comfort Rounding Embedding 4. Accountability Tools 5. Rounding: Manager Rounding on Patients & Staff

  31. Firestarters A3s • 5 independent A3 analyses drew same conclusion: Lack of Senior Leader prioritization of organizational goals creates leader (Lead, Manager and Director) confusion on daily prioritization of activities.

  32. Firestarters • Current Countermeasures • Nurse Manager/Manager redesign through Blueprint Unit (6North) critical to: • AIDET • Accountability • Rounding on Staff and Patients • Increased Senior Leader clarity around top TRHS Priority Activities (2010 Quality Plan)

  33. 2010 TRHS Goals and Priorities:Quality and Service • Reduce harm by 25% • Leadership rounding for outcomes: drives staff engagement • Hourly Patient Comfort Rounds • Manager/Employee Rounding for outcomes • Post-harm huddle to capture root cause • Quality Huddle: Weekly at TMC, Biweekly at TVNHA • Reduce Readmissions by 30% • Patient education and patient teach-back • Improve patient satisfaction to meet established targets • AIDET • Staff Recognition • High-Middle-Low performer conversations

  34. 2010 TRHS Goals and Priorities:Quality and Service • All activities filter back to one of the three priorities mentioned • Each level of leadership seeks direction and clarification from their “one up” concerning priority of activity • Moving toward taking the analysis out to where the action is (unit huddles, group observations, etc.; “Swarm” methodology)

  35. AIDET Hourly Rounding Leadership Rounding Leadership Development HML Standards of Behavior

  36. High/Middle/Low Performers • All Leads, Managers, Directors and Senior Team required (and desired!) HML training • Prerequisite assignment • Use 2009 Employee evaluations to classify employees as high, middle, or low performers • Lessons Learned • Many annual evaluations did not match up with employees ratings on the HML continuum • Managers discovered that they had given employees a ‘needs improvement” in the same areas two years in a row

  37. Post HML Training Actions • All Leads, Managers, Directors and Senior Team are being asked to: • Re-recruit high performers • Engage/challenge Middle performers • “Up or out” low performers with clear support from HR: “You decide who, we will help with the when and how.” • Re-evaluation of Annual evaluation tool to incorporate/utilize HML principles • Next Leadership Seminar: Hiring for Fit

  38. AIDET Hourly Rounding Leadership Rounding Leadership Development HML Standards of Behavior

  39. Standards of Behavior • Objective of the Standards of Behavior Team • Create a positive and consistent culture by creating a mechanism that will support Trinity’s Mission and Vision. • Create a culture that will be sustaining and continually evolving • Create a living, breathing document for staff to re-commit to annually thus ensuring it does not become a “flavor of the month”

  40. We, Trinity, promise to uphold these Standards of Behavior and exceed expectations ensuring Excellence F.I.R.S.T. and “The best outcome, every patient, every time” by adhering to these A.C.E.S standards.

  41. What are A.C.E.S? A C E S • Accountability • Appreciation • Attitude • Appearance • Compassion • Consistency • Commitment • Confidentiality • Energy • Etiquette • Excellence • Equality • Safety • Service • Smile

  42. ACES Initial Actions • Presentation made to Firestarters on 3/29 • Presentation to Senior Leadership on 4/5 • Standards Promise to be signed by Senior Team • Presentation to Management Team on 4/21 • Standards Promise to be signed by all Leaders

  43. ACES Phase I • Internal communications and engagement tools • Tri-fold material • Certificate of Agreement/Commitment • Badge Buddies • Internet postings • Town Hall meetings • Posters • Recognition Cards • NetLearning modules • Linkages: • Performance Assessment • TOPS planners • Hiring for Fit/Interviewing process

  44. ACES Phase II • Accountability Plan • Pledge of Peers • Manager’s Moments • Roll out timing • Public Posting of ACES for general public

  45. ACES Lessons Learned • With tools and some guidance, front-line staff are very ready to participate and guide elements of their own performance • Staff have some excellent ideas… just ask them! • Managers and staff involved in the process are really looking forward to the Pledge of Peers” development

  46. Summary AIDET Hourly Rounding Leadership Rounding Leadership Development HML Standards of Behavior