Transcript Iowa Health System 2010 Leadership Symposium April 20, 2010

Studer Principles
in Action
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
“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
Why go on this Journey?
“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.
• 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
• 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
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
Timetable
AIDET
Hourly Rounding
Leadership Rounding
Leadership Development
HML
Standards of Behavior
AIDET
Hourly Rounding
Leadership Rounding
Leadership Development
HML
Standards of Behavior
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
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
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
AIDET
Hourly Rounding
Leadership Rounding
Leadership Development
HML
Standards of Behavior
PATIENT
CENTERED
COMMUNICATION
BUNDLE
Focused
AIDET
WHITE
BEDSIDE
HOURLY
5
KWKT
A
Acknowledge
I
Introduce
D
Duration
E
Explanation
T
Thank You
BOARDS
SHIFT REPORT
COMFORT ROUNDS
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!
%tile Rank
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Q1 2009
Q2 2009
Q1 2010
Tell you what
new medicine
was for
Nurses explain in
a way you
understand
How well your
pain was
controlled
Instructions on
how to care for
yourself at home
Explanations of
what will happen
:T&T
Nurse Kept you
informed
Promptness in
response to call
light
Courtesy of
person cleaning
your room
Room
Cleanliness
Nurses listen
carefully to you
Nurses treat you
with
courtesy/respect
Communication
with Nurses
AIDET Initial Results
Values between 50 - 95% will get some
incentive payment.
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
AIDET
Hourly Rounding
Leadership Rounding
Leadership Development
HML
Standards of Behavior
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
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
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
AIDET
Hourly Rounding
Leadership Rounding
Leadership Development
HML
Standards of Behavior
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
Leadership Development
Leadership Development
Table Discussion Priorities
Obstacles
1. Leadership Turnover
2. Mistrust
3. Resistance to Change
Things to Add
1. Teamwork across departments
2. Front-line staff buy-in
3. Dealing with Low Performers
Firestarters A3 (High Level)
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).”
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
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.
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)
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
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)
AIDET
Hourly Rounding
Leadership Rounding
Leadership Development
HML
Standards of Behavior
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
Post HML Training Actions
•
All Leads, Managers, Directors and Senior
Team are being asked to:
1. Re-recruit high performers
2. Engage/challenge Middle performers
3. “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
AIDET
Hourly Rounding
Leadership Rounding
Leadership Development
HML
Standards of Behavior
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”
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.
What
are
A.C.E.S?
A
•
•
•
•
Accountability
Appreciation
Attitude
Appearance
C
•
•
•
•
Compassion
Consistency
Commitment
Confidentiality
E
•
•
•
•
Energy
Etiquette
Excellence
Equality
S
• Safety
• Service
• Smile
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
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
ACES Phase II
•
Accountability Plan
– Pledge of Peers
– Manager’s Moments
– Roll out timing
•
Public Posting of ACES for general
public
ACES Lessons Learned
•
•
•
With tools and some guidance, frontline 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
Summary
AIDET
Hourly Rounding
Leadership Rounding
Leadership Development
HML
Standards of Behavior
Questions
and
Comments
For more information, contact:
Bobette J. Shay
RN, MS, BSN, CNOR
(563) 742-2616
[email protected]
Kevin M. Soeken, M.S.
Customer Relations Management Coordinator
(309) 779-2995
[email protected]