Transcript Leading for Safety_Thoughts on Structure Culture and
Leading for Safety: Thoughts on Structure, Culture and Governance
March 4, 2011
Debbie Barnard, MS, CPHQ
Victoria Inn Winnipeg, Manitoba
Presentation Outline
Introduction Reflections on Governance/Leadership, Structure/ Infrastructure and Culture Case Study Table Top Discussions Report Out/Reflections Closing Comments
Our Promise to Patients/Residents
Safety care” – “not harming people with our Effectiveness care” – “matching science to Patient centeredness – “nothing about me without me” Timeliness Efficiency Equity – “avoiding needless delays” – “Avoiding waste” – “Closing the gap”
IOM Report 1999 & CAES 2004 “The current care systems cannot do the job. The chassis is broken.
Trying harder will not work; we must change the systems of care.” Source: www.iom.edu
Are we up to it
Case Study: Dana-Farber Cancer Institute
FROM
Errors are rare
TO
Errors are everywhere Everything’s great Excellent, not perfect Great care Great care in a high-risk environment Made it up as you go along Principles of fair and just culture, guidelines, algorithms, flow sheets
Case Study: Dana-Farber Cancer Institute
FROM
Risk of disclosure/ confidentiality
TO
Moral duty, risk on nondisclosure, transparency Great staff, poor systems Great systems, great staff QI, RM, Safety staff drive the work Board, C-Suite, Chiefs, Chairs drive the work
Case Study: Dana-Farber Cancer Institute
FROM
Keep the board out
TO
Actively engage Keep doctors out of QI and RM Actively engage, nothing possible without them Deliver care to patients Partner with patients and families
Case Study
(Think Differently- video)
Governance & Leadership HOT TOPIC!
– Boards on Board – IHI 5 Million Lives – Effective Governance for Quality and Patient Safety - OHA Regional Programs 2011 – CPSI Board Resources & Toolkit
What Does the Evidence Tell Us?
Outcomes are better in hospitals (organizations) where: – The board spends >25% of its time on quality and safety.
– The board receives a formal quality measurement report.
– There is a high level of interaction between the board and medical staff on quality strategy.
Vaughn T, Koepke M, Kroch E, et al. J of Patient Safety . 2006;2:2-9.
What Does the Evidence Tell Us?
Outcomes are better in hospitals (organizations) where: – Senior executive compensation is based in part on quality and safety performance.
– The CEO is identified as the person with the greatest impact on QI, especially when so identified by the QI executive. Vaughn T, Koepke M, Kroch E, et al. J of Patient Safety . 2006;2:2-9.
Six Things That Boards Can Do
1. Set a specific aim to reduce harm this year and make an explicit, public commitment to measurable quality improvement (e.g., reduction in unnecessary mortality or harm).
2. Select and review progress towards safer care as the first agenda item at every board meeting.
• Get data on harms and hear stories; put a “human face” on data.
Six Things That Boards Can Do
3. Establish and monitor a small number of organization-wide “roll-up” measures that are updated continually and are transparent to the entire organization and its customers.
4. Commit to establish and maintain an environment that is respectful, fair, and just for all who experience pain and loss from avoidable harm.
• Patients, their families, and staff at the sharp end of error
Six Things That Boards Can Do
5. Develop the capability of the board. • Learn how the “best in the world” boards work with executive and MD leaders to reduce harm. • Set an expectation for similar levels of education/training for all staff.
6. Oversee the effective execution of a plan to achieve the board’s aims to reduce harm, including executive team accountability for clear quality improvement targets.
Culture
“Every enterprise has
four
organizations: the one that is written down, the one that most people believe exists, the one that people wished existed, and the one that the organization really needs.”
NHS Building & Nurturing an Improvement Culture
Scope for Leaders
What is the
meaning
of organizational culture?
How to
measure
organizational culture?
How to
build/change
organizational culture?
Tribal Wisdom of Healthcare
When you discover you are riding a dead horse, the best strategy is to: Beat the horse --> it may rise from the dead
Change riders --> it is clearly the rider’s fault the horse is not moving Appoint a committee --> if more people look at the horse , it may not be really dead . Arrange to visit other sites -> See how they ride dead horses Lower the standards: make dead horses acceptable
Structure/ Infrastructure
Viewing the Organization as a System: Linkage of Processes at appropriate Level of Detail
Low High
Inputs
Planning for Improvement
Source: L. Provost, Senior Fellow IHI Map Strategic Objectives to Organization system (processes) Common Themes Strategic Objectives High Leverage Processes or Services New Processes New Services Charter Allocate Resources for Improving the System Improvement Where do we focus?
Resources for Operating the Business
Can you build a house without a frame?
Committees Technology Supports – Databases and IT systems that communicate Reporting System Human Resources – Orientation & Competency Programs Source: L. Provost, Senior Fellow IHI
Execution of Improvement Work in Organizations
Projects Division or Department Level Whole Organizational level Source: L. Provost, Senior Fellow IHI
Execution Structure
Organizational Level (whole system) Sub-system Level Sub-system Level Sub-System Level Project Project Project Project Project Project Project Project Source: L. Provost, Senior Fellow IHI
Table Work and Discussion
26
Governance & Leadership
1. What do you think the leadership team did at DF to create their “to state”? 2. Leadership for improvement is difficult; what do you find most challenging in your organization?
3. What are some of the key strategies that the board and leadership team can do to “walk the talk”?
27
Culture
1.
2.
What’s at least one successful strategy or tactic you can share from your organization’s improvement journey?
Pretend you are coaching a new leader, how can you help them to begin to use a system view of their organization as a way of creating a new culture?
28
Structure & Infrastructure
1.
2.
3.
How do you think the leadership team at DF began to redefine their processes so that they could view their organization from a whole system perspective How can this approach support your team to connect structure, strategy and improvement?
Does your quality infrastructure require any changes to improve how quality improvement work gets done?
29
Report Outs
Observations & reflections from your group’s discussion Your contribution to the “Ten Powerful Ideas for the Future Now”