Transcript High-Impact Leadership
Slide 1
Conflict of Interest Declaration
We declare that we have no conflict of interest linked to the
work presented.
Slide 2
High-Impact Leadership
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations,
and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
Slide 3
New Mental Models
“Volume”
“Value”
Patient Satisfaction
Persons as Partners in their
Care
Increase Top Line Revenue
Continuously Decrease Per
Unit Cost
Complex All-Purpose
Hospitals and Facilities
Care Organized by Business
Model
Quality Departments and
Experts
Quality in Daily WorkEveryone
Slide 4
High-Impact Leadership Behaviors
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations,
and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
Slide 5
High Impact Leadership
Slide 6
“If you are dreaming about it…
you can do it.”
Sensei Chihiro Nakao
Slide 7
Slide 8
Why is Change So Hard?
Culture
Lack of Shared Vision
Misaligned Expectations
No Urgency
Ineffective Leadership
© 2014 Virginia Mason
Slide 9
Compact
Expectations members of an organization have
that are:
– Unstated yet understood
– Reciprocal
• The give
• The get
– Mutually beneficial
– Set up & reinforced by society and the
organization
© 2014 Virginia Mason
Slide 10
Clash of “Promise” and Imperatives
Traditional “Promise”
Legacy Expectations
Imperatives
• Improve
safety/quality
• Autonomy
• Implement EHR
• Protection
• Create service
experience
• Entitlement
• Be patient-focused
• Improve access
• Improve efficiency
• Recruit/retain
quality staff
© 2014 Virginia Mason
Slide 11
Vision Is Context for Compact
• Societal needs
• Local market
• Competition
• Organization’s
strengths
© 2014 Virginia Mason
STRATEGIC
VISION
Physicians give:
Organization gives:
• What the
organization
needs to achieve
the vision
• What helps
physicians meet
commitment
• What is
meaningful to
physicians
Slide 12
Virginia Mason Medical Center
Physician Compact
Organization’s Responsibilities
Physician’s Responsibilities
Foster Excellence
Focus on Patients
• Recruit and retain superior physicians and staff
• Support career development and professional satisfaction
• Acknowledge contributions to patient care and the
organization
• Create opportunities to participate in or support research
•
•
•
•
Listen and Communicate
•
•
•
•
•
• Share information regarding strategic intent, organizational
priorities and business decisions
• Offer opportunities for constructive dialogue
• Provide regular, written evaluation and feedback
Educate
• Support and facilitate teaching, GME and CME
• Provide information and tools necessary to improve
practice
Reward
• Provide clear compensation with internal and market
consistency, aligned with organizational goals
• Create an environment that supports teams and individuals
Lead
• Manage and lead organization with integrity and
accountability
© 2014 Virginia Mason
Practice state of the art, quality medicine
Encourage patient involvement in care and treatment decisions
Achieve and maintain optimal patient access
Insist on seamless service
Collaborate on Care Delivery
Include staff, physicians, and management on team
Treat all members with respect
Demonstrate the highest levels of ethical and professional conduct
Behave in a manner consistent with group goals
Participate in or support teaching
Listen and Communicate
• Communicate clinical information in clear, timely manner
• Request information, resources needed to provide care consistent with
VM goals
• Provide and accept feedback
Take Ownership
• Implement VM-accepted clinical standards of care
• Participate in and support group decisions
• Focus on the economic aspects of our practice
Change
• Embrace innovation and continuous improvement
• Participate in necessary organizational change
Slide 13
The VMMC Quality Equation
Q = A × (O + S)
W
Q: Quality
A: Appropriateness
O: Outcomes
S: Service
W: Waste
© 2014 Virginia Mason
Slide 14
Our current management system?
© DC Comics
© 2014 Virginia Mason
Slide 15
World-Class Management
Daily Management:
Leaders Have Two Jobs
1. Run your business
2. Improve your business
© 2014 Virginia Mason
Daily
Management
Slide 16
The FIVE Principle Elements of Daily
Management (Standard Work for Leaders)
Visual Controls
Create linked
visual systems
that drive action
Root Cause
Analysis
Asking “why” and
using data and
analysis to attack
problems
This
Discipline
Leaders
consistently verify
the health of
processes and
systems
© 2014 Virginia Mason
Daily
Accountability
Process
Establish
rounding process
at all levels
Or This
Leader
Standard Work
Leaders routinely
complete key
activities necessary
to run and improve
their business
Slide 17
Leaders’ Role in Signal Generation
“Leaders are signal generators who reduce
uncertainty and ambiguity about what is
important and how to act.”
Charles O’Reilly III
This
© 2014 Virginia Mason
Or This
Slide 18
“Distress” and Adaptive Work
Disequilibrium
Adaptive challenge
Limit of tolerance
Productive
range of
distress
Threshold
of learning
Time
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, 2002, p 108
© 2014 Virginia Mason
Slide 19
VMPS Standard Work for Leaders
CEO
Board
COO
Board
VP
Board
AD
Board
Director
Board
Supervisor
Board
Front Line
Board
© 2014 Virginia Mason
Slide 20
Effective Sponsorship
•
•
•
•
•
•
Vision of success
Set stretch goal
Provide resources
Remove barriers
“Fail forward fast”
Celebrate achievements
© 2014 Virginia Mason
Slide 21
Genchi Genbutsu
•
•
•
•
•
“It’s all lies”
Go where the action is
Know your people and let them know you
Vulnerability is ok
Connect the dots
© 2014 Virginia Mason
Slide 22
Managerial Courage
•
•
•
•
It will be worth it
Patients and staff depend on it
Leading change is hard work
Skeptics can become champions
© 2014 Virginia Mason
Slide 23
Flu Vaccination “Fitness for Duty”
•
•
•
•
•
Do we put patient first?
Compelling science
Staff resistance
Staying the course
Organizational Pride
© 2014 Virginia Mason
Slide 24
VMMC Influenza Vaccination Rates
98.5%
100.0%
97.6%
98.9%
98.7%
99.6%
99.7%
99.8%
90.0%
80.0%
70.0%
60.0%
54.0%
50.0%
40.0%
30.0%
38.0%
29.5%
20.0%
2002 2003 2004 2005 2006 2007 2008 2010 2011 2012
© 2014 Virginia Mason
Slide 25
Ongoing Challenges - Culture
• Patient First
• Pace of Change
• Belief in Zero Defects
• Victimization
• Professional Autonomy
• Leadership Constancy
• “Buy In”
• Rigor, Alignment,
• “People are Not Cars”
Execution
• Drive for Results
© 2014 Virginia Mason
Slide 26
“In times of change,
learners inherit the
earth, while the learned
find themselves
beautifully equipped to
deal with a world that
no longer exists.”
Eric Hoffer
Copyright © 2009 Virginia Mason Medical Center. All Rights Reserved.
Slide 27
Creating a Culture of
Quality and Safety
Making Excellence a Way of Life
James M. Anderson
President and CEO, 1996-2009
Slide 28
2
Slide 29
Cincinnati Children’s (Fiscal 2013)
Registered beds
598
Operating revenue
$1.9 billion
Employees
13,852; 97 nationalities
Research grants
$158 million
Locations
16
Patients from 50 states; 53 countries
Department of Pediatrics for the University of
Cincinnati College of Medicine
3
Slide 30
4
Video
Slide 31
Tressel
Fragile System
– 15 years of intense work improving quality and safety
– 34% decrease in hospital-wide mortality
– 43% decrease in ICU mortality
Transparency
–
–
–
–
With families
With employees
With other institutions
With the outside world
We need to be able to talk about these things
5
Slide 32
Requirements to Create a
Culture of Quality and Safety
Vision: Take time to develop it thoughtfully
Plans: Focus on what needs to be done, not on
trailing results, like financial results
Consistent message: Consistent behavior, even
when there is increased risk
Management process that delivers sustainable
outcomes
6
Slide 33
7
Our Vision:
To be the leader in improving child health
• If we can deliver outstanding results in some
areas, why not all?
• What results are we delivering?
• How are we measuring them?
Slide 34
8
Creating a Culture
Slide 35
9
Business Units: Participants
1. Physician, nursing and business leaders
• Shared objectives
• Single budget
2. Access to senior leadership team
3. Predictable, recurring meetings
Slide 36
10
Business Units: Template Reports
Financial
• Activity over time expressed in numbers
• Holistic view as a framework for change
Non-financial
• How will we be safer, more accessible,
patient-centered, innovative?
• Focused attention on transformation
Slide 37
11
Other Tools
• Real time data
• Strategic planning
• Transparency
• High-reliability systems
• Learning from other high-risk industries
Slide 38
12
Final Thoughts
• Each part of the organization must perform well
for the whole organization to perform to potential
• Organizational structure reflects priorities
• Mechanisms must be hard-wired, predictable
and must foster agility
• Institutionalize boundaryless thinking, risk taking,
transparency, small tests of change
• Institution needs a shared, compelling vision and
high aspirations
Slide 39
Creating a Culture of Excellence
Michael J. Dowling
President & Chief Executive Officer
North Shore-LIJ Health System
Paris, France
April 2014
Slide 40
North Shore-LIJ Health System
40
Slide 41
The System Today
Clinical
Enterprise
Inpatient
facilities
Ambulatory /
outpatient
Long Term /
Home Care
Educational
Enterprise
Research
Enterprise
GME / CME
Discoveries
Medical
School /
Elmezzi
Publications
Clinical trials
CLI
Hospice
Joint
ventures
Insurance
Enterprise
“CareConnect”
Risk
Capitation
– Bundled
payments
Product
offerings
Joint
product
offerings
Employer
products
Population
health
Community
Health
Enterprise
Community
benefit
Access and
education
programs
Veterans’
programs
Children’s
programs
Partnerships
41
Slide 42
•
•
•
•
•
•
•
•
•
An Integrated System
Largest provider of health care in NY State – one of the largest employers
Major academic teaching center
Major commitment to research – The Feinstein Institute
Single governance – not just a collection of distinct, individual entities
Administratively and clinically integrated; Service Line approach to care delivery
Single system-wide management – clinical and administrative
Densely populated; competitive and diverse environment
Provides full continuum of care
Possesses insurance license and capabilities to take risk and sell products
42
Slide 43
We’re With You Every Step of the Way
43
Slide 44
North Shore-LIJ Culture Blueprint
44
Slide 45
Behavioral Expectations: Core Competency Model
Individual Contributor
Competency #1
Behavioral
Demonstration
Competency #2
Behavioral
Demonstration
Team Leader
Operational/Strategic Leader
Execution: Displays technical and functional expertise. Takes ownership of work,
structures job tasks and maintains appropriate pace in handling multiple deadlines to
achieve excellence by:
Completing assigned tasks
accurately and within
established timeframes and
budget, and adopting a
resourceful and resultsdriven approach.
Ensuring team performance
in achieving excellence
through organizing
resources, adjusting for
complexities, measuring
results, and planning for
improvements.
Creating a culture of
excellence and
accountability through
motivation of talent,
translation of strategy into
reality, exercising sound
judgment, and aligning
communication, people,
processes and resources.
Organizational Awareness: Understands how to overcome obstacles and ably works
through the realities of a large healthcare organization. Applies best approaches to
achieve business goals by:
Collaborating with peers,
managers and
internal/external customers
to solve problems in formal
and informal settings and
within the guidelines of key
policies and practices.
Displaying superior
understanding of group
behavior and organizational
politics, culture and
operations, and exhibiting
strong decision-making skills
that align to key business
priorities and objectives.
Understanding the
competition, creating solid
cross-functional
partnerships, and
successfully navigating the
organization’s culture to
obtain the buy-in necessary
to drive critical business
outcomes.
Slide 46
Individual Contributor
Competency #3
Behavioral
Demonstration
Team Leader
Operational/Strategic Leader
Enable Change: Willingly adapts to shifting business needs and seeks opportunities
to champion new processes and ideas. Anticipates and responds to change to
improve work outcomes by:
Seeking and acting on
feedback to identify
improvement
opportunities, displaying
enthusiasm for expanding
one’s knowledge and
scope, and thinking
differently to find new
solutions.
Regularly offering
feedback, analyzing
successes and failures to
identify improvement
opportunities, and
planning for and creating
avenues to implement
process enhancements
within the team.
Creating a climate that
embraces new and
different solutions,
removing barriers that
limit change, maintaining
a global line of sight, and
gaining commitment and
partnership from others to
execute change plans.
Competency #4
Developing Self: Takes consistent action to increase knowledge and skills.
Embraces challenging assignments and seeks learning opportunities to enhance
performance by:
Behavioral
Demonstration
Exercising self-accountability for becoming a subject matter expert within one’s own
job role, seeking performance-related feedback, and identifying learning
opportunities to explore with one’s manager.
Slide 47
Behavioral Expectations: Core Leadership Competency Model
Team Leader
Operational/Strategic Leader
Leadership
Competency #1
Managerial Courage: Acts with conviction to make the right decisions for the right reasons.
Exercises sound judgment and takes action to preserve the integrity of the organization by:
Behavioral
Demonstration
Adhering to a strict ethical and moral code in all
business decisions and dealings with people,
delivering critical messages honestly and
effectively, displaying the ability to make
difficult decisions in a timely manner, rewarding
those who display desirable behaviors, and
holding direct reports accountable for poor
performance. Also ensures direct reports are
compliant with mandatory trainings,
educational processes and system initiatives.
Leadership
Competency #2
Motivating and Inspiring Others: Leverages and embraces diversity and shares wins and
successes. Motivates and energizes others to achieve high-level results by:
Behavioral
Demonstration
Celebrating the efforts and achievements of
individuals and teams, creating a feeling of
belonging within the team, conveying
confidence in the ability of others to make
valuable contributions, and ensuring that team
members have the skills, support and resources
necessary to produce the desired results. Also
ensures direct reports are rewarded/recognized
for good performance, and that, when
appropriate, consequences are delivered to
drive the right behaviors.
Empowering and standing behind direct reports
and others to make ethical decisions, removing
political barriers that may limit or prevent
positive change, and implementing practices to
ensure that employees in assigned area(s) are
held accountable for their behavior and
performance at all levels. Additionally ensures
all employees in area(s) of responsibility comply
with mandatory training, educational
requirements and system initiatives.
Creating opportunities to promote team
successes at department and system levels,
managing with an “open door” policy, ensuring
assigned area(s) understand how each
contributes to the larger goals of the
organization, and continuously taking inventory
to ensure assigned area(s) are equipped with
the resources necessary to achieve superior
results. Additionally empowers leaders in
area(s) of responsibility to reward employees for
good performance and to deliver consequences,
as appropriate, to drive the right behaviors.
Slide 48
Team Leader
Leadership
Competency #3
Behavioral
Demonstration
Operational/Strategic Leader
Strategic Agility: Seeks opportunity to gain/share expertise with other areas to create
innovative strategies. Exercises both narrow and broad perspective to ensure business
success by:
Demonstrating complete understanding of
department’s workflow, operations and
necessary skill sets, leveraging the talents
of the team to brainstorm and anticipate
future consequences and solutions, and
partnering with other areas to share
knowledge and influence strategy
development outside of normal defined
scope.
Ensuring operations of assigned area(s)
align with the larger organizational goals,
establishing formal and informal processes
for high performers to become involved in
cross-organizational improvement efforts,
and leveraging connections with other
organizational leaders to develop and
execute breakthrough strategies that
impact organizational operations on
multiple levels.
Leadership
Competency #4
Developing Others: Continuously seeks opportunity to develop the capabilities of
others. Provides challenging stretch assignments and tasks to enhance departmental
performance by:
Behavioral
Demonstration
Holding frequent performance and
development discussions with direct
reports, providing diverse opportunities
for team participation in projects outside
of normal defined scope, and shaping
team roles to leverage skills, build
capabilities and foster team collaboration.
Developing high performers through
mentorship and coaching, creating
opportunities for joint problem-solving
and cross-functional learning through
shared projects, and embracing feedback
for one’s own improvement.
Slide 49
Behavioral Expectations: Core Values
Individual Contributor
Core Value #1
Maintaining relationships
with customers and
developing practices to
ensure customer satisfaction
within assigned area.
Expanding departmental
relationships with customers
and identifying opportunities
to increase customer
satisfaction through crossdepartment collaboration.
Integrity: Acts honestly and ethically to promote excellence at all levels by:
Respecting others at all
times, serving as a role
model, and adhering to
Behavioral
Demonstration privacy and confidentiality
practices.
Core Value #3
Operational/Strategic Leader
Customer Experience: Addresses the needs of customers to exceed expectations by:
Building relationships with
customers while
understanding and reacting
Behavioral
Demonstration to their concerns and
expectations daily.
Core Value #2
Team Leader
Leading by example,
protecting confidentiality,
and ensuring all team
members are empowered to
make decisions in the best
interests of the organization.
Acting as a leader of leaders
to ensure assigned area(s)
are held accountable for
acting in the best interests of
the organization at all times.
Excellence: Promotes quality in work performance to achieve business outcomes by:
Producing results of the
highest standards while
demonstrating passion for
Behavioral
the job, function,
Demonstration
department and
organization.
Ensuring the team
collaboratively produces
results of the highest
standards and fostering a
work environment that
recognizes and celebrates
successes.
Ensuring assigned area(s)
produce results of the
highest standards and
identifying/executing
opportunities to bring quality
to the next level.
49
Slide 50
Individual Contributor
Core Value #4
Helping direct reports and
others succeed through teambuilding, mentoring, coaching
and fostering an environment
of workforce engagement.
Helping those in assigned
area(s) to succeed through
mentoring and creating
practices and processes that
reinforce teamwork and
engagement at every level.
Caring: Demonstrates empathy toward others to promote an environment of trust by:
Treating everyone with
compassion and sincerity
regardless of background,
Behavioral
Demonstration appearance or orientation.
Core Value #6
Operational/Strategic Leader
Teamwork: Inspires others to work together to achieve organizational goals by:
Helping others to succeed and
collaborating to identify and
solve problems with the
Behavioral
Demonstration whole team.
Core Value #5
Team Leader
Fostering two-way dialogue
with customers and direct
reports to explore concerns
and ideas, and creating a work
atmosphere where each
employee feels valued.
Establishing practices to
ensure a workplace and
customer environment where
all individuals feel confident
that their concerns and ideas
will be heard and addressed.
Innovation: Generates creative solutions to positively impact business goals by:
Displaying openness to and
suggesting new ideas,
challenging the status quo,
Behavioral
and respecting the creative
Demonstration influence of others.
Encouraging the formation of
new ideas and promoting an
environment where impactful
suggestions are recognized
and considered for
implementation.
Establishing a work
environment that welcomes
new ideas and assisting
assigned area(s) with
implementation of ideas
through use of leadership and
influence.
50
Slide 51
Making the Workforce Your Competitive Advantage
Leadership Loyalty
Ensuring leadership is accessible
and loyal to our employees
Recognize Value
Recognizing the value of the
workforce
Display Caring
Workforce
Engagement:
Caring for all workforce
members and their families
Provide Growth
Providing opportunities for
growth and development
Solicit Feedback
Respect Diversity
Soliciting input from the
workforce & involving
employees in collaborative
decision-making
Promote inclusion
Offer Reinforcement
How each employee’s
work contributes to the
organization’s goals
Creating a multi-dimensional,
trust-based relationship
with the workforce
Two-Way
Communication
Performance
Management
Linking vision, goals and values to
individual performance
Clear communication channels
between managers and
employees
51
Slide 52
The Center for Learning & Innovation:
Organizational Structure
ORGANIZATIONAL
DEVELOPMENT
BEGINNINGS
PATIENT SAFETY
INSTITUTE
SIMULATION
BASED EDUCATION
LEADERSHIP
DEVELOPMENT
COACHING
PHYSICIAN
LEADERSHIP
INSTITUTE
PHYSICIAN
BEGINNINGS
SCHOLAR PIPELINE
EMERGENCY
MEDICAL INSTITUTE
ADMINISTRATIVE
FELLOWSHIPS
PARAMEDIC
EVALUATION AND
ASSESSMENT
LEADERSHIP
DEVELOPMENT
INTERPROFESSIONAL
TEAM EDUCATION
MEDICAL
SCHOLARS
PIPELINE PROGRAM
NEW YORKERS FOR
CHILDREN
PROGRAM
ATTENDING AND
RESIDENT
PHYSICIAN
PROGRAMS
LEAN / SIX SIGMA
PROGRAM
CONTINUING
MEDICAL
EDUCATION
ADVANCED EMT
AEMT & EMT
RECERTIFICATION
HYBRID
SIMULATION
CLINICAL
COLLABORATIVES
IS 59 PARTNERSHIP
EDUCATIONAL
RESEARCH
CLINICAL
EDUCATION AT
PATIENT SAFETY
INSTITUTE
PROGRAM /
PROJECT
MANAGEMENT
EHR CONTENT
DEVELOPMENT
DEPARTMENT
TEAM BUILDING
CHANGE
MANAGEMENT
FACILITATION
CUSTOMIZED
SESSIONS
CLINICAL
TRANSFORMATION
CLINICAL SKILLS
EDUCATION
INSTITUTE FOR
HEALTH
PROFESSIONS
CLINICAL SKILLS
EDUCATION
BIOSKILLS
EDUCATION CENTER
EMERGENCY
MEDICAL
TECHNICIAN
DEPARTMENT
SPECIFIC
EDUCATION
WORKFORCE
DEVELOPMENT
HOFSTRA NORTH
SHORE LIJ SCHOOL
OF MEDICINE
ACLS/BLS
CLINICAL
SIMULATION
DOMESTIC AND
INTERNATIONAL
INTERNSHIPS
CONTINUING
MEDICAL
EDUCATION
VENDOR
SPONSORED
PROGRAMS
INDUSTRIAL
ENGINEERING
52
Slide 53
How Leadership is Built: Leadership Capabilities
In order for education to make a business impact, it needs to focus on
the four core elements of learning. The Business needs to design
educational processes that help build capabilities that drive change
with knowledge, actions, beliefs and networks.
Knowledge
What do people
need to know that
is different?
Actions
What do people
need to do that is
different?
Beliefs
What do people
need to believe that
is different?
Networks
What networks
need to be
different?
•Self awareness
•Team leadership
tools
•Strategic thinking
•Influencing and
network techniques
•Innovation tools
•Lead high
performing teams
•Demonstrate
increased self
awareness of
strengths and
potential derailers
•Drive strategy
development and
market knowledge
•Leadership’s
impact on strategic
results and value
•Engagement and
play to your
strengths
•Drive the industry,
company and self
forward
•Collaborative
medicine
•Program
participants and
alumni
•Support teams and
resources
53
Slide 54
12 Principles of Leadership
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Be authentic, accountable and caring
Be humble and recognize the power of team
Energize your culture every day
Paint the picture
Create systems behind the smiles
Be positive and enthusiastic
Grow talent including your own
Communicate and engage
Foster an environment of low fear and high trust
Celebrate innovation and risk taking
Recognize, recognize, recognize
Ethics are everything
54
Slide 55
A Sample of Specific Strategies
•
Beginnings
— Selection, recruitment, on-boarding
— Setting expectations early
•
Talent development and management
— Creating multiple opportunities for learning and growth
•
Identification of emerging leaders and high
potentials
— Focus on opportunities at all levels of the organization,
not just the top
•
Succession planning
— Cross-fertilize and promote transparency
55
Slide 56
•
Maximize the use of simulation
— Real life experiences that enhance teamwork,
communication and skill
•
Engagement and input
— Allow free flow of ideas from all parts of the organization
•
Recognition and reward
— Feedback – closing the loop
56
Slide 57
“Perfection is not attainable, but if we
chase perfection we can catch excellence.”
-Vince Lombardi
57
Conflict of Interest Declaration
We declare that we have no conflict of interest linked to the
work presented.
Slide 2
High-Impact Leadership
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations,
and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
Slide 3
New Mental Models
“Volume”
“Value”
Patient Satisfaction
Persons as Partners in their
Care
Increase Top Line Revenue
Continuously Decrease Per
Unit Cost
Complex All-Purpose
Hospitals and Facilities
Care Organized by Business
Model
Quality Departments and
Experts
Quality in Daily WorkEveryone
Slide 4
High-Impact Leadership Behaviors
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations,
and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
Slide 5
High Impact Leadership
Slide 6
“If you are dreaming about it…
you can do it.”
Sensei Chihiro Nakao
Slide 7
Slide 8
Why is Change So Hard?
Culture
Lack of Shared Vision
Misaligned Expectations
No Urgency
Ineffective Leadership
© 2014 Virginia Mason
Slide 9
Compact
Expectations members of an organization have
that are:
– Unstated yet understood
– Reciprocal
• The give
• The get
– Mutually beneficial
– Set up & reinforced by society and the
organization
© 2014 Virginia Mason
Slide 10
Clash of “Promise” and Imperatives
Traditional “Promise”
Legacy Expectations
Imperatives
• Improve
safety/quality
• Autonomy
• Implement EHR
• Protection
• Create service
experience
• Entitlement
• Be patient-focused
• Improve access
• Improve efficiency
• Recruit/retain
quality staff
© 2014 Virginia Mason
Slide 11
Vision Is Context for Compact
• Societal needs
• Local market
• Competition
• Organization’s
strengths
© 2014 Virginia Mason
STRATEGIC
VISION
Physicians give:
Organization gives:
• What the
organization
needs to achieve
the vision
• What helps
physicians meet
commitment
• What is
meaningful to
physicians
Slide 12
Virginia Mason Medical Center
Physician Compact
Organization’s Responsibilities
Physician’s Responsibilities
Foster Excellence
Focus on Patients
• Recruit and retain superior physicians and staff
• Support career development and professional satisfaction
• Acknowledge contributions to patient care and the
organization
• Create opportunities to participate in or support research
•
•
•
•
Listen and Communicate
•
•
•
•
•
• Share information regarding strategic intent, organizational
priorities and business decisions
• Offer opportunities for constructive dialogue
• Provide regular, written evaluation and feedback
Educate
• Support and facilitate teaching, GME and CME
• Provide information and tools necessary to improve
practice
Reward
• Provide clear compensation with internal and market
consistency, aligned with organizational goals
• Create an environment that supports teams and individuals
Lead
• Manage and lead organization with integrity and
accountability
© 2014 Virginia Mason
Practice state of the art, quality medicine
Encourage patient involvement in care and treatment decisions
Achieve and maintain optimal patient access
Insist on seamless service
Collaborate on Care Delivery
Include staff, physicians, and management on team
Treat all members with respect
Demonstrate the highest levels of ethical and professional conduct
Behave in a manner consistent with group goals
Participate in or support teaching
Listen and Communicate
• Communicate clinical information in clear, timely manner
• Request information, resources needed to provide care consistent with
VM goals
• Provide and accept feedback
Take Ownership
• Implement VM-accepted clinical standards of care
• Participate in and support group decisions
• Focus on the economic aspects of our practice
Change
• Embrace innovation and continuous improvement
• Participate in necessary organizational change
Slide 13
The VMMC Quality Equation
Q = A × (O + S)
W
Q: Quality
A: Appropriateness
O: Outcomes
S: Service
W: Waste
© 2014 Virginia Mason
Slide 14
Our current management system?
© DC Comics
© 2014 Virginia Mason
Slide 15
World-Class Management
Daily Management:
Leaders Have Two Jobs
1. Run your business
2. Improve your business
© 2014 Virginia Mason
Daily
Management
Slide 16
The FIVE Principle Elements of Daily
Management (Standard Work for Leaders)
Visual Controls
Create linked
visual systems
that drive action
Root Cause
Analysis
Asking “why” and
using data and
analysis to attack
problems
This
Discipline
Leaders
consistently verify
the health of
processes and
systems
© 2014 Virginia Mason
Daily
Accountability
Process
Establish
rounding process
at all levels
Or This
Leader
Standard Work
Leaders routinely
complete key
activities necessary
to run and improve
their business
Slide 17
Leaders’ Role in Signal Generation
“Leaders are signal generators who reduce
uncertainty and ambiguity about what is
important and how to act.”
Charles O’Reilly III
This
© 2014 Virginia Mason
Or This
Slide 18
“Distress” and Adaptive Work
Disequilibrium
Adaptive challenge
Limit of tolerance
Productive
range of
distress
Threshold
of learning
Time
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, 2002, p 108
© 2014 Virginia Mason
Slide 19
VMPS Standard Work for Leaders
CEO
Board
COO
Board
VP
Board
AD
Board
Director
Board
Supervisor
Board
Front Line
Board
© 2014 Virginia Mason
Slide 20
Effective Sponsorship
•
•
•
•
•
•
Vision of success
Set stretch goal
Provide resources
Remove barriers
“Fail forward fast”
Celebrate achievements
© 2014 Virginia Mason
Slide 21
Genchi Genbutsu
•
•
•
•
•
“It’s all lies”
Go where the action is
Know your people and let them know you
Vulnerability is ok
Connect the dots
© 2014 Virginia Mason
Slide 22
Managerial Courage
•
•
•
•
It will be worth it
Patients and staff depend on it
Leading change is hard work
Skeptics can become champions
© 2014 Virginia Mason
Slide 23
Flu Vaccination “Fitness for Duty”
•
•
•
•
•
Do we put patient first?
Compelling science
Staff resistance
Staying the course
Organizational Pride
© 2014 Virginia Mason
Slide 24
VMMC Influenza Vaccination Rates
98.5%
100.0%
97.6%
98.9%
98.7%
99.6%
99.7%
99.8%
90.0%
80.0%
70.0%
60.0%
54.0%
50.0%
40.0%
30.0%
38.0%
29.5%
20.0%
2002 2003 2004 2005 2006 2007 2008 2010 2011 2012
© 2014 Virginia Mason
Slide 25
Ongoing Challenges - Culture
• Patient First
• Pace of Change
• Belief in Zero Defects
• Victimization
• Professional Autonomy
• Leadership Constancy
• “Buy In”
• Rigor, Alignment,
• “People are Not Cars”
Execution
• Drive for Results
© 2014 Virginia Mason
Slide 26
“In times of change,
learners inherit the
earth, while the learned
find themselves
beautifully equipped to
deal with a world that
no longer exists.”
Eric Hoffer
Copyright © 2009 Virginia Mason Medical Center. All Rights Reserved.
Slide 27
Creating a Culture of
Quality and Safety
Making Excellence a Way of Life
James M. Anderson
President and CEO, 1996-2009
Slide 28
2
Slide 29
Cincinnati Children’s (Fiscal 2013)
Registered beds
598
Operating revenue
$1.9 billion
Employees
13,852; 97 nationalities
Research grants
$158 million
Locations
16
Patients from 50 states; 53 countries
Department of Pediatrics for the University of
Cincinnati College of Medicine
3
Slide 30
4
Video
Slide 31
Tressel
Fragile System
– 15 years of intense work improving quality and safety
– 34% decrease in hospital-wide mortality
– 43% decrease in ICU mortality
Transparency
–
–
–
–
With families
With employees
With other institutions
With the outside world
We need to be able to talk about these things
5
Slide 32
Requirements to Create a
Culture of Quality and Safety
Vision: Take time to develop it thoughtfully
Plans: Focus on what needs to be done, not on
trailing results, like financial results
Consistent message: Consistent behavior, even
when there is increased risk
Management process that delivers sustainable
outcomes
6
Slide 33
7
Our Vision:
To be the leader in improving child health
• If we can deliver outstanding results in some
areas, why not all?
• What results are we delivering?
• How are we measuring them?
Slide 34
8
Creating a Culture
Slide 35
9
Business Units: Participants
1. Physician, nursing and business leaders
• Shared objectives
• Single budget
2. Access to senior leadership team
3. Predictable, recurring meetings
Slide 36
10
Business Units: Template Reports
Financial
• Activity over time expressed in numbers
• Holistic view as a framework for change
Non-financial
• How will we be safer, more accessible,
patient-centered, innovative?
• Focused attention on transformation
Slide 37
11
Other Tools
• Real time data
• Strategic planning
• Transparency
• High-reliability systems
• Learning from other high-risk industries
Slide 38
12
Final Thoughts
• Each part of the organization must perform well
for the whole organization to perform to potential
• Organizational structure reflects priorities
• Mechanisms must be hard-wired, predictable
and must foster agility
• Institutionalize boundaryless thinking, risk taking,
transparency, small tests of change
• Institution needs a shared, compelling vision and
high aspirations
Slide 39
Creating a Culture of Excellence
Michael J. Dowling
President & Chief Executive Officer
North Shore-LIJ Health System
Paris, France
April 2014
Slide 40
North Shore-LIJ Health System
40
Slide 41
The System Today
Clinical
Enterprise
Inpatient
facilities
Ambulatory /
outpatient
Long Term /
Home Care
Educational
Enterprise
Research
Enterprise
GME / CME
Discoveries
Medical
School /
Elmezzi
Publications
Clinical trials
CLI
Hospice
Joint
ventures
Insurance
Enterprise
“CareConnect”
Risk
Capitation
– Bundled
payments
Product
offerings
Joint
product
offerings
Employer
products
Population
health
Community
Health
Enterprise
Community
benefit
Access and
education
programs
Veterans’
programs
Children’s
programs
Partnerships
41
Slide 42
•
•
•
•
•
•
•
•
•
An Integrated System
Largest provider of health care in NY State – one of the largest employers
Major academic teaching center
Major commitment to research – The Feinstein Institute
Single governance – not just a collection of distinct, individual entities
Administratively and clinically integrated; Service Line approach to care delivery
Single system-wide management – clinical and administrative
Densely populated; competitive and diverse environment
Provides full continuum of care
Possesses insurance license and capabilities to take risk and sell products
42
Slide 43
We’re With You Every Step of the Way
43
Slide 44
North Shore-LIJ Culture Blueprint
44
Slide 45
Behavioral Expectations: Core Competency Model
Individual Contributor
Competency #1
Behavioral
Demonstration
Competency #2
Behavioral
Demonstration
Team Leader
Operational/Strategic Leader
Execution: Displays technical and functional expertise. Takes ownership of work,
structures job tasks and maintains appropriate pace in handling multiple deadlines to
achieve excellence by:
Completing assigned tasks
accurately and within
established timeframes and
budget, and adopting a
resourceful and resultsdriven approach.
Ensuring team performance
in achieving excellence
through organizing
resources, adjusting for
complexities, measuring
results, and planning for
improvements.
Creating a culture of
excellence and
accountability through
motivation of talent,
translation of strategy into
reality, exercising sound
judgment, and aligning
communication, people,
processes and resources.
Organizational Awareness: Understands how to overcome obstacles and ably works
through the realities of a large healthcare organization. Applies best approaches to
achieve business goals by:
Collaborating with peers,
managers and
internal/external customers
to solve problems in formal
and informal settings and
within the guidelines of key
policies and practices.
Displaying superior
understanding of group
behavior and organizational
politics, culture and
operations, and exhibiting
strong decision-making skills
that align to key business
priorities and objectives.
Understanding the
competition, creating solid
cross-functional
partnerships, and
successfully navigating the
organization’s culture to
obtain the buy-in necessary
to drive critical business
outcomes.
Slide 46
Individual Contributor
Competency #3
Behavioral
Demonstration
Team Leader
Operational/Strategic Leader
Enable Change: Willingly adapts to shifting business needs and seeks opportunities
to champion new processes and ideas. Anticipates and responds to change to
improve work outcomes by:
Seeking and acting on
feedback to identify
improvement
opportunities, displaying
enthusiasm for expanding
one’s knowledge and
scope, and thinking
differently to find new
solutions.
Regularly offering
feedback, analyzing
successes and failures to
identify improvement
opportunities, and
planning for and creating
avenues to implement
process enhancements
within the team.
Creating a climate that
embraces new and
different solutions,
removing barriers that
limit change, maintaining
a global line of sight, and
gaining commitment and
partnership from others to
execute change plans.
Competency #4
Developing Self: Takes consistent action to increase knowledge and skills.
Embraces challenging assignments and seeks learning opportunities to enhance
performance by:
Behavioral
Demonstration
Exercising self-accountability for becoming a subject matter expert within one’s own
job role, seeking performance-related feedback, and identifying learning
opportunities to explore with one’s manager.
Slide 47
Behavioral Expectations: Core Leadership Competency Model
Team Leader
Operational/Strategic Leader
Leadership
Competency #1
Managerial Courage: Acts with conviction to make the right decisions for the right reasons.
Exercises sound judgment and takes action to preserve the integrity of the organization by:
Behavioral
Demonstration
Adhering to a strict ethical and moral code in all
business decisions and dealings with people,
delivering critical messages honestly and
effectively, displaying the ability to make
difficult decisions in a timely manner, rewarding
those who display desirable behaviors, and
holding direct reports accountable for poor
performance. Also ensures direct reports are
compliant with mandatory trainings,
educational processes and system initiatives.
Leadership
Competency #2
Motivating and Inspiring Others: Leverages and embraces diversity and shares wins and
successes. Motivates and energizes others to achieve high-level results by:
Behavioral
Demonstration
Celebrating the efforts and achievements of
individuals and teams, creating a feeling of
belonging within the team, conveying
confidence in the ability of others to make
valuable contributions, and ensuring that team
members have the skills, support and resources
necessary to produce the desired results. Also
ensures direct reports are rewarded/recognized
for good performance, and that, when
appropriate, consequences are delivered to
drive the right behaviors.
Empowering and standing behind direct reports
and others to make ethical decisions, removing
political barriers that may limit or prevent
positive change, and implementing practices to
ensure that employees in assigned area(s) are
held accountable for their behavior and
performance at all levels. Additionally ensures
all employees in area(s) of responsibility comply
with mandatory training, educational
requirements and system initiatives.
Creating opportunities to promote team
successes at department and system levels,
managing with an “open door” policy, ensuring
assigned area(s) understand how each
contributes to the larger goals of the
organization, and continuously taking inventory
to ensure assigned area(s) are equipped with
the resources necessary to achieve superior
results. Additionally empowers leaders in
area(s) of responsibility to reward employees for
good performance and to deliver consequences,
as appropriate, to drive the right behaviors.
Slide 48
Team Leader
Leadership
Competency #3
Behavioral
Demonstration
Operational/Strategic Leader
Strategic Agility: Seeks opportunity to gain/share expertise with other areas to create
innovative strategies. Exercises both narrow and broad perspective to ensure business
success by:
Demonstrating complete understanding of
department’s workflow, operations and
necessary skill sets, leveraging the talents
of the team to brainstorm and anticipate
future consequences and solutions, and
partnering with other areas to share
knowledge and influence strategy
development outside of normal defined
scope.
Ensuring operations of assigned area(s)
align with the larger organizational goals,
establishing formal and informal processes
for high performers to become involved in
cross-organizational improvement efforts,
and leveraging connections with other
organizational leaders to develop and
execute breakthrough strategies that
impact organizational operations on
multiple levels.
Leadership
Competency #4
Developing Others: Continuously seeks opportunity to develop the capabilities of
others. Provides challenging stretch assignments and tasks to enhance departmental
performance by:
Behavioral
Demonstration
Holding frequent performance and
development discussions with direct
reports, providing diverse opportunities
for team participation in projects outside
of normal defined scope, and shaping
team roles to leverage skills, build
capabilities and foster team collaboration.
Developing high performers through
mentorship and coaching, creating
opportunities for joint problem-solving
and cross-functional learning through
shared projects, and embracing feedback
for one’s own improvement.
Slide 49
Behavioral Expectations: Core Values
Individual Contributor
Core Value #1
Maintaining relationships
with customers and
developing practices to
ensure customer satisfaction
within assigned area.
Expanding departmental
relationships with customers
and identifying opportunities
to increase customer
satisfaction through crossdepartment collaboration.
Integrity: Acts honestly and ethically to promote excellence at all levels by:
Respecting others at all
times, serving as a role
model, and adhering to
Behavioral
Demonstration privacy and confidentiality
practices.
Core Value #3
Operational/Strategic Leader
Customer Experience: Addresses the needs of customers to exceed expectations by:
Building relationships with
customers while
understanding and reacting
Behavioral
Demonstration to their concerns and
expectations daily.
Core Value #2
Team Leader
Leading by example,
protecting confidentiality,
and ensuring all team
members are empowered to
make decisions in the best
interests of the organization.
Acting as a leader of leaders
to ensure assigned area(s)
are held accountable for
acting in the best interests of
the organization at all times.
Excellence: Promotes quality in work performance to achieve business outcomes by:
Producing results of the
highest standards while
demonstrating passion for
Behavioral
the job, function,
Demonstration
department and
organization.
Ensuring the team
collaboratively produces
results of the highest
standards and fostering a
work environment that
recognizes and celebrates
successes.
Ensuring assigned area(s)
produce results of the
highest standards and
identifying/executing
opportunities to bring quality
to the next level.
49
Slide 50
Individual Contributor
Core Value #4
Helping direct reports and
others succeed through teambuilding, mentoring, coaching
and fostering an environment
of workforce engagement.
Helping those in assigned
area(s) to succeed through
mentoring and creating
practices and processes that
reinforce teamwork and
engagement at every level.
Caring: Demonstrates empathy toward others to promote an environment of trust by:
Treating everyone with
compassion and sincerity
regardless of background,
Behavioral
Demonstration appearance or orientation.
Core Value #6
Operational/Strategic Leader
Teamwork: Inspires others to work together to achieve organizational goals by:
Helping others to succeed and
collaborating to identify and
solve problems with the
Behavioral
Demonstration whole team.
Core Value #5
Team Leader
Fostering two-way dialogue
with customers and direct
reports to explore concerns
and ideas, and creating a work
atmosphere where each
employee feels valued.
Establishing practices to
ensure a workplace and
customer environment where
all individuals feel confident
that their concerns and ideas
will be heard and addressed.
Innovation: Generates creative solutions to positively impact business goals by:
Displaying openness to and
suggesting new ideas,
challenging the status quo,
Behavioral
and respecting the creative
Demonstration influence of others.
Encouraging the formation of
new ideas and promoting an
environment where impactful
suggestions are recognized
and considered for
implementation.
Establishing a work
environment that welcomes
new ideas and assisting
assigned area(s) with
implementation of ideas
through use of leadership and
influence.
50
Slide 51
Making the Workforce Your Competitive Advantage
Leadership Loyalty
Ensuring leadership is accessible
and loyal to our employees
Recognize Value
Recognizing the value of the
workforce
Display Caring
Workforce
Engagement:
Caring for all workforce
members and their families
Provide Growth
Providing opportunities for
growth and development
Solicit Feedback
Respect Diversity
Soliciting input from the
workforce & involving
employees in collaborative
decision-making
Promote inclusion
Offer Reinforcement
How each employee’s
work contributes to the
organization’s goals
Creating a multi-dimensional,
trust-based relationship
with the workforce
Two-Way
Communication
Performance
Management
Linking vision, goals and values to
individual performance
Clear communication channels
between managers and
employees
51
Slide 52
The Center for Learning & Innovation:
Organizational Structure
ORGANIZATIONAL
DEVELOPMENT
BEGINNINGS
PATIENT SAFETY
INSTITUTE
SIMULATION
BASED EDUCATION
LEADERSHIP
DEVELOPMENT
COACHING
PHYSICIAN
LEADERSHIP
INSTITUTE
PHYSICIAN
BEGINNINGS
SCHOLAR PIPELINE
EMERGENCY
MEDICAL INSTITUTE
ADMINISTRATIVE
FELLOWSHIPS
PARAMEDIC
EVALUATION AND
ASSESSMENT
LEADERSHIP
DEVELOPMENT
INTERPROFESSIONAL
TEAM EDUCATION
MEDICAL
SCHOLARS
PIPELINE PROGRAM
NEW YORKERS FOR
CHILDREN
PROGRAM
ATTENDING AND
RESIDENT
PHYSICIAN
PROGRAMS
LEAN / SIX SIGMA
PROGRAM
CONTINUING
MEDICAL
EDUCATION
ADVANCED EMT
AEMT & EMT
RECERTIFICATION
HYBRID
SIMULATION
CLINICAL
COLLABORATIVES
IS 59 PARTNERSHIP
EDUCATIONAL
RESEARCH
CLINICAL
EDUCATION AT
PATIENT SAFETY
INSTITUTE
PROGRAM /
PROJECT
MANAGEMENT
EHR CONTENT
DEVELOPMENT
DEPARTMENT
TEAM BUILDING
CHANGE
MANAGEMENT
FACILITATION
CUSTOMIZED
SESSIONS
CLINICAL
TRANSFORMATION
CLINICAL SKILLS
EDUCATION
INSTITUTE FOR
HEALTH
PROFESSIONS
CLINICAL SKILLS
EDUCATION
BIOSKILLS
EDUCATION CENTER
EMERGENCY
MEDICAL
TECHNICIAN
DEPARTMENT
SPECIFIC
EDUCATION
WORKFORCE
DEVELOPMENT
HOFSTRA NORTH
SHORE LIJ SCHOOL
OF MEDICINE
ACLS/BLS
CLINICAL
SIMULATION
DOMESTIC AND
INTERNATIONAL
INTERNSHIPS
CONTINUING
MEDICAL
EDUCATION
VENDOR
SPONSORED
PROGRAMS
INDUSTRIAL
ENGINEERING
52
Slide 53
How Leadership is Built: Leadership Capabilities
In order for education to make a business impact, it needs to focus on
the four core elements of learning. The Business needs to design
educational processes that help build capabilities that drive change
with knowledge, actions, beliefs and networks.
Knowledge
What do people
need to know that
is different?
Actions
What do people
need to do that is
different?
Beliefs
What do people
need to believe that
is different?
Networks
What networks
need to be
different?
•Self awareness
•Team leadership
tools
•Strategic thinking
•Influencing and
network techniques
•Innovation tools
•Lead high
performing teams
•Demonstrate
increased self
awareness of
strengths and
potential derailers
•Drive strategy
development and
market knowledge
•Leadership’s
impact on strategic
results and value
•Engagement and
play to your
strengths
•Drive the industry,
company and self
forward
•Collaborative
medicine
•Program
participants and
alumni
•Support teams and
resources
53
Slide 54
12 Principles of Leadership
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Be authentic, accountable and caring
Be humble and recognize the power of team
Energize your culture every day
Paint the picture
Create systems behind the smiles
Be positive and enthusiastic
Grow talent including your own
Communicate and engage
Foster an environment of low fear and high trust
Celebrate innovation and risk taking
Recognize, recognize, recognize
Ethics are everything
54
Slide 55
A Sample of Specific Strategies
•
Beginnings
— Selection, recruitment, on-boarding
— Setting expectations early
•
Talent development and management
— Creating multiple opportunities for learning and growth
•
Identification of emerging leaders and high
potentials
— Focus on opportunities at all levels of the organization,
not just the top
•
Succession planning
— Cross-fertilize and promote transparency
55
Slide 56
•
Maximize the use of simulation
— Real life experiences that enhance teamwork,
communication and skill
•
Engagement and input
— Allow free flow of ideas from all parts of the organization
•
Recognition and reward
— Feedback – closing the loop
56
Slide 57
“Perfection is not attainable, but if we
chase perfection we can catch excellence.”
-Vince Lombardi
57