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VUMC Quality Pillar Goal: Pioneer Program. Michael Cull, PhD, MSN Director, Education and Dissemination Office of Quality and Patient Safety. Roadmap. Quality Pillar Organizational Culture Culture Change and Organizational Learning Pioneer Programs. FY2012 Goals. FY2012 Goals Continued.

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vumc quality pillar goal pioneer program
VUMC Quality Pillar Goal: Pioneer Program

Michael Cull, PhD, MSN

Director, Education and Dissemination

Office of Quality and Patient Safety

  • Quality Pillar
  • Organizational Culture
  • Culture Change and Organizational Learning
  • Pioneer Programs

FY2012 Goals



FY2012 Goals



FY2012 Goals



qps mission
QPS Mission
  • Continuously inspire improvement for the health and safety of patients, families, faculty and staff;
  • Advance a culture of habitual excellence and high reliability; and
  • Champion discovery, innovation, and transformation in healthcare to high reliability and bring excellence to full-scale.
organizational culture
Organizational Culture
  • What is organizational culture?
  • Should it be changed?
  • Can it be changed?
  • If so, what strategies are available?

“A pattern of shared basic assumptions that was learned by a group as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way you perceive, think, and feel in relation to those problems“

Edgar Schein

why change culture
Why Change Culture?
  • Culture supports - or creates barriers for -systems' efforts to innovate and learn.1
  • Cultures that emphasize affiliation, teamwork, and coordination implement and sustain more CQI initiatives.2
  • By contrast, cultures that emphasize formal structure, regulations and reporting relationships.3
types of change
Types of change
  • Revolutionary
  • Sub-groups, targeted
  • Incremental
types of change1
Types of change
    • Revolutionary
  • Sub-groups, targeted
  • Incremental
types of change2
Types of change
  • Revolutionary
    • Sub-groups, targeted
    • Incremental
culture change vs system change
CULTURE change vs SYSTEM change

“Changing the system, will change what people do. Changing what people do, will NOT change the system.”

Peter Scholtes

what will change look like
What will change look like?

…people in the organization identifying with new role model heroes… telling different stories to one another… spending their time differently on a day-to-day basis… asking different questions and carrying out different work rituals.4

what is the pioneer program
What is the Pioneer Program?

An intensive, yearlong program designed to support service line level improvement goals and advance a culture of patient safety, quality, and reliability at VUMC.

resistance to planned culture change 5
Resistance to Planned Culture Change 5
  • Lack of Ownership
  • Complexity
  • External Influences
  • Lack of Appropriate Leadership
  • Cultural diversity
  • Dysfunctional consequences
ownership and cultural diversity
Ownership and Cultural Diversity
  • Internal RFP process
  • Collaborative learning
  • Interdisciplinary involvement
complexity external influences and dysfunctional outcomes
Complexity, External Influences and Dysfunctional Outcomes
  • Collaborative learning
  • Design and Scoping, goal alignment
  • QPS expertise
leadership and dysfunctional outcomes
Leadership and Dysfunctional Outcomes
  • Stated strategic goal
  • Required Leadership involvement
  • Formal report-outs and celebration
what did we expect
What did we expect?
  • What is the mission, make-up, and organizational structure of your program?
  • What are some examples of successes and challenges with improvement projects?
  • How will program leadership contribute to the Pioneer year?
  • What do you hope to accomplish and how will this advance VUMC’s goal of creating a culture of safety, quality, and reliability?
evaluation criteria
Evaluation Criteria
  • Organizational readiness / maturity
  • Commitment to the process
  • Energy for change
  • Alignment with VUMC quality and patient safety goals
  • Leadership engagement

10 Person selection committee

22 full proposals submitted for review

pioneer year design
Pioneer Year Design
  • Kick-off with Lucian Leape, MD
  • Comprehensive curriculum that encompasses both internal and external subject matter experts
          • Modified IHI Learning Collaborative model
  • Customized sessions with onsite technical assistance for project design, scope, implementation, and evaluation
learning sessions
Learning Sessions
  • Safety Culture
      • Julie Morath, RN, MS
  • Leadership an promoting professional accountability
      • Gerald Hickson, MD
      • Ranja Ramanujam, PhD
      • Tim Vogus, PhD
  • Teamwork and Improvement Science
      • Allan Frankel, MD
  • Reliability and Safety Science
      • Tim Vogus, PhD
      • Allan Frankel, MD
between sessions plan
Between Sessions Plan
  • Bi-weekly collaborative calls:
      • Updates
      • Discussion of barriers
      • Interactive educational component with SME
  • Independent between-session team meetings
  • Ad-hoc training and consultations using supported coaching