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American Hospital Association (AHA)/ Health Research & Educational Trust (HRET) Hospital Engagement Network (HEN). North Dakota National Improvement Leader Fellowship (ILF) Wednesday, August 13, 2014. Objectives.

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American Hospital Association (AHA)/ Health Research & Educational Trust (HRET) Hospital Engagement Network (HEN)

North Dakota

National Improvement Leader Fellowship (ILF)

Wednesday, August 13, 2014


Objectives
Objectives Educational Trust (HRET) Hospital Engagement Network (HEN)

Identify opportunities and tactics for coaching front line teams on the useful application of improvement methods

Understand approaches to coaching improvement teams through examples from HEN hospitals

Use questions to drive learning

Identify models and resources for developing an organizational strategy for developing improvement capability


North dakota ilf achievements
North Dakota ILF Achievements Educational Trust (HRET) Hospital Engagement Network (HEN)

  • Number of Improvement Leader Fellows: 36

  • Number of HAB Templates*: 11

  • Number of IHI Open School Registrants: 13

  • Hospitals with highest number of OS modules completed: Northwood Deaconess Health Center (7); Catholic Health Initiatives – Mercy Hospital (6); Sanford (6); Essentia Health (5)

    * HAB Count as of 8/1/2014


What is ihi open school
What is IHI Open School? Educational Trust (HRET) Hospital Engagement Network (HEN)

  • Online courses focused on

    • Improvement capability

    • Patient safety

    • Tripe aim for populations

    • Person- and family-centered care

    • Leadership

    • Quality, cost and value

  • 12 month subscription

  • Continuing education units provided through IHI


Visit www ihi org hretilf
Visit www.ihi.org/hretilf Educational Trust (HRET) Hospital Engagement Network (HEN)


Coaching and building capability at the front line

Presented by: Educational Trust (HRET) Hospital Engagement Network (HEN)

Jane Taylor

Improvement Advisor (IA)

Institute for Healthcare Improvement (IHI)

Coaching and Building Capability at the Front line


Reflection on last month s ilf
Reflection on Last Month’s ILF Educational Trust (HRET) Hospital Engagement Network (HEN)

Discuss at your tables:

  • What did you learn about working styles (or other tools to improve teamwork) last month? Have you changed anything about your approach to working with your teams?

  • What changes have been effective?





Table discussion
Table Discussion Capability Building

If you have taken any of the IHI Open School modules, share one thing you found useful.


Coaching interventions
Coaching Interventions Capability Building

Doing tasks

for the

team

Consulting

Training

Coaching

Facilitating

Increasing client responsibility for providing content and managing the process

Coach in role of “doing for to get it done”

Coach in role of “empowering, eliciting, enabling to get it done”


Definitions
Definitions Capability Building


Coach s purpose building capacity for change plus quality improvement skills
Coach’s Purpose Capability BuildingBuilding Capacity for Change plus Quality Improvement Skills

  • Building capacity for change means the process of a team and organization taking on the tasks and functions necessary for sustainable change.

  • More is needed…

    • incorporating quality improvement principles and methods are necessary to know a change is an improvement and that improvement is sustained.


Execution model for improvement
Execution: Model for Improvement Capability Building

Langley, et al, The Improvement Guide, 2009

Improvement Guide. 2nd Edition, 2009


Using the lens of profound knowledge
Using the Lens of Profound Knowledge Capability Building

Appreciation

of a system

Theory of

Knowledge

Psychology

Understanding

Variation

Aim or Values


Coaching and capacity building

Hospital Story Capability Building

coaching and capacity-building


Essentia health fargo

Essentia Health - Fargo Capability Building

Teresa Nelson, RN

Clinical Quality Analyst


About us
About Us Capability Building

Essentia Health – Fargo is a 105 bed acute care hospital located in Fargo, North Dakota.

Part of an integrated health system serving patients in Minnesota, North Dakota, Wisconsin and Idaho.

Joint Commission accredited, Level II trauma center, providing a variety of inpatient and outpatient specialized services (including Advanced Primary Stroke Center, Certified Breast Cancer Center, Certified CAP Laboratory, only hospital in ND to have an Interventional Neurologist).


Harm across the board
Harm Across the Board Capability Building


Ade project
ADE Project Capability Building


Our teambuilding success
Our Teambuilding Success Capability Building

Key Implementations to the ADE Project

What Made our Team Successful

Monthly reviews of all inpatient records with elevated INRs (>5)

Were they potentially preventable? If so for what reason (predictable drug interaction; inappropriate dose ordered; administration error; inappropriate time to next appointment)

Invited Coumadin Clinic to be part of our team

Inpatient and outpatient protocols – reviewed and updated

Entering into incident database as an ADE and providing feedback/education to providers and staff

Pharmacy involvement with the management of inpatients on warfarin


Our approach
Our Approach Capability Building

How do we get people engaged to do improvement work?

Transparency of Data: Clinical quality dashboard posted in all units; results = buy-in

Essentia Performance System (EPS): Huddles, Flow Boards and Gemba Rounds. Using the EPS allows staff to see how their work directly impacts performances (department-level initiatives tie into system-wide goals).

How do we build on strengths?

Know your team members and their working styles

It takes ‘everyone’ to succeed (analytical, driver, amiable, expressive)


Essentia health mission statement
Essentia Health Capability BuildingMission Statement

“We are called to make a healthy difference in people’s lives.”

QUESTIONS?


J Capability Buildingudge a man by his questions rather than by his answers.-Voltaire


Use of questions
Use of Questions Capability Building

  • Socratic method: a method of inquiry using questions to guide someone to a solution

    • 5 Whys

    • Drawing out rationale behind testing, conclusions and actions

  • Questions, Not Answers, Drive Thinking

    • Questions that stimulate our thought promote deeper thinking about the issue

    • Questions help define tasks, express problems and delineate issues

    • Questions can be used to reframe the thought processes to move in a different direction


Use of questions cont
Use of Questions, cont. Capability Building

  • Answers can arrest further thinking

    • Only when an answer generates a further question does thought continue its life as such

    • There are times when specific answers facilitate moving teams forward


Turn and talk
Turn and talk Capability Building

  • 1 person describes a recent PDSA cycle or dilemma related to your HEN work

    • Examples of tests or dilemmas might include reducing falls, pressure ulcers or VTEs, or personalizing care

  • The partner listens and asks questions

    Refer to the ICF Handout – Section C: Communicating Effectively

    5 minutes, then switch


Debrief
Debrief Capability Building

When you were describing your test or dilemma, what was the effect of the questions?

Did the questions spark ideas for future tests?

What was it like to be the questioner? What did you notice about the interaction?



Our Hospital Association includes Capability Building

* 25 bed Critical Access Hospital * 80 Bed Skilled Care Center

* 68 bed Basic Care Center * 37 Assisted Living Units * Family Practice Clinic in 3 locations * Surgical Clinic


Agenda Capability Building


Linkage Capability BuildingGrid


Table discussion1
Table Capability BuildingDiscussion

How do you currently build improvement capability?

Success and Challenges?


The Leadership Challenge Capability Building

To build a renewable infrastructure that produces a highly reliable quality and safety system by (fill in the date).

How good?

By when?


The Journey To Organizational Excellence Capability Building

Excellence

Sustainability

Capability

Capacity

“We are what we repeatedly do.

Excellence then, is not an act but a habit!

Aristotle (384 – 322 BC)


Capacity – having the right number and level of people who are actively engaged and able to take action.

Capability – the people have the confidence and the knowledge and skills to lead the change.

Helen Beven, “How can we build skills to transform the healthcare system?”

Journal of Research in Nursing

15(2) 139-148, 2010.


Key questions for building capacity and capability
Key Questions for Building Capacity and Capability Capability Building

  • Will you involve everyone or just a few targeted groups?

  • Who needs to know what?

  • What methods do you plan to use to build capacity and capability?

  • Do you have a model or framework to guide your journey?

  • How will you make sure the learning system can be sustained?

Adapted and expanded from a conversation with Tom Nolan, Associates in Process Improvement on material he presented at the IHI Strategic Partners Roundtable, April 17-18, 2006.


Improvement concepts, methods and applications must be woven into the fabric of daily life and at all levels of the organization.

  • From point where care is delivered,

  • To management meetings and strategy sessions

  • And, in the board and governance level decisions


Therefore, a woven into the fabric of daily life and

cascading

system to

build capacity and capability

is needed!


Many organizations start the cascade at the top… woven into the fabric of daily life and

…and,

trickle

downward!


While others believe that the cascade should start at the staff level…

upward!

percolate

…and


But successful organizations cascade down and percolate up throughout the entire organization
But successful organizations cascade down and percolate up throughout the entire organization

Top Down?

Details on the Microsystem can be found in:

Quality by Design: A Microsystems Approach. By E. Nelson, P. Batalden and M. Godfrey.

Jossey-Bass, 2007.

Macrosystem

Microsystem

Bottom Up?


But successful organizations cascade down and percolate up throughout the entire organization1
But successful organizations cascade down and percolate up throughout the entire organization

Top Down?

Details on the Microsystem can be found in:

Quality by Design: A Microsystems Approach. By E. Nelson, P. Batalden and M. Godfrey.

Jossey-Bass, 2007.

Macrosystem

Spread from the Middle?

Mesosystem

Microsystem

Bottom Up?


Who needs to know what
Who Needs to Know What? throughout the entire organization

Different levels of knowledge and skill in Improvement Methods are required at different levels of the organization.

Organizations that have been successful at building capacity and capability recognize that people have different abilities, skills and talents.

They have figured out who has what knowledge and skills and work from there. Therefore, a one size fits all approach will not work!


Who needs to know what throughout the entire organization ?

Many People

Few People

A key operating assumption of building capacity is that different groups of people will have different levels of need for PI knowledge and skill.

Everyone

(Staff,

Supervisors,

UBT lead

triad)

Change

Agents

(Middle

Managers,

Stewards,

Project

leads)

Operational

Leaders

(Executives)

Experts

(Improvement Advisors)

Our approach will be to make sure that each group receives the knowledge and skill sets they need when they need them and in the appropriate amounts.

Unit Based Teams

Source: Kaiser Permanente & IHI, 2008

Deep Knowledge

Shared

Knowledge

Continuum of PI Knowledge and Skills


Exercise throughout the entire organization

Who needs what?

  • This Exercise is designed to create a dialogue on what we call the “dosing formula.” That is, which groups of individuals within your organization need to have what levels of knowledge and skill to successfully build a sustainable infrastructure that produces highly reliable QI excellence?

  • The worksheet on the next page provides a list of Skills & Knowledge (the rows) associated with organizations that have demonstrated QI excellence. For each of the listed Skills & Knowledge items indicate the level or “dose” of Skill & Knowledge you think each group (the columns) needs using the following response scale:

    • 1 = They need to know the basic terms, concepts and methods when they hear them

    • 2 = They need to be able to use the terms, concepts and methods effectively

    • 3 = They need to be able to teach the terms, concepts and methods to others; can lead improvement


Exercise throughout the entire organization

Who needs what?


Exercise throughout the entire organization

Who needs what?


Table discussion2
Table Discussion throughout the entire organization

  • Discuss your matrix with your colleagues at your table

    • What is different? What is the same?

    • Gaps?

    • What are your next steps?


Fellowship participation open school modules2
Fellowship Participation: Open School Modules throughout the entire organization

What opportunities could you develop in your state to build a community of learners around improvement?


Next steps
Next Steps throughout the entire organization

  • Use co-creating the relationship and communication section of ICF worksheet with a team member

    2. “Discovery Shopping”

    • Observe a patient or family member using a service.

      • Shadow

    • Take notes, photos without people

      • What do you hear, feel, smell

      • What is the flow of events?

      • Where is it easy, difficult?

      • Where are waits, delays, not knowing?


Open school module pfc 102 a guide to shadowing
Open School Module throughout the entire organization PFC 102: A Guide to Shadowing


Other resources
Other Resources throughout the entire organization

http://www.ihi.org/education/IHIOpenSchool/resources/Pages/BobLloydWhiteboard.aspx


Fieldwork action items and closing

Presented by: throughout the entire organization

Meredith Baumgartner, MPH

Research Specialist, AHA/HRET HEN

Fieldwork action items and closing

64


Today s fieldwork and action items
Today’s Fieldwork and Action Items throughout the entire organization

65

ILF:

  • By August 20:

    • Use co-creating the relationship and communication section of ICF worksheet with a team member

  • By August 27:

    • Conduct the discovery shopping with a patient or family member and record your observations

  • For the virtual September 17th ILF:

    • Reflect on what you learned when you tried out the principles of co-creating the relationship and communicating effectively (from the ICF handout), and/or discovery shopping. Have you changed anything about your approach to working with your teams and patients? What has surprised you?


Coming next virtual ilf meetings

Wednesday, March 19: Eliminating HAB throughout the entire organization

Wednesday, April 16: Senior Leadership and Governance

Thursday, May 29: Engaging Patients and Families

Wednesday, June 25: Eliminating HAB 2.0

Wednesday, July 30: Teamwork

Wednesday, August 20: Communication

Wednesday, September 17: Improvement Momentum

Wednesday, October 15: Managing Multiple Projects

Wednesday, November 19: Culture Change

Coming Next: Virtual ILF Meetings

66


Materials and resources
Materials and Resources throughout the entire organization

  • Visit the Fellowship section on the private side of the AHA/HRET HEN website hret-hen.org

  • IHI Open School: www.ihi.org/hretilf


Upcoming events
Upcoming Events throughout the entire organization

August 26th and 28th (LIVE REPEAT) – VTE and HAPU Re-boot webinar

September 10th and 11th (LIVE REPEAT) – Falls Re-boot: Post-fall Huddles Webinar

September 19th - Live Stream ILF


Reminders
Reminders throughout the entire organization

  • Evaluations

    • We want to hear from you. Please drop your evaluation of today’s meeting in the brown box at the registration table

  • Continuing Education Units

    • Complete the sign-in sheet

    • Pick up the CE instructions handout at the registration table

  • Name badges

    • We recycle! Drop your badge off at the registration table


Thank you
Thank You! throughout the entire organization

70

Join us for the next virtual

Improvement Leader Fellowship on

Wednesday, September 17 at

1:00 – 3:00 PM CT!


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