Transcript Deborah M. Nadzam, PhD, FAAN - Joint Commission Resources Lorrie Jones-Hartley, MSN, CRRN-A - Durham Regional Hospital © Copyright, Joint Commission Resources Organizational Capacity for Change.

Deborah M. Nadzam, PhD, FAAN
- Joint Commission Resources
Lorrie Jones-Hartley, MSN, CRRN-A
- Durham Regional Hospital
© Copyright, Joint Commission Resources
Organizational Capacity for
Change and Patient Safety
– Briefly describe Patient Safety
Connections service
– Provide background information about
Organizational Capacity for Change
– Describe application of OCC survey
– Discuss findings and use of OCC at one
organization
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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Presentation Objectives
• Goal: To significantly increase the
organization’s ability to take effective
actions on safety risks and produce
sustainable improvement in safety.
• Collaborative assessment: Project Team
including JCR consultants and client
organization leaders
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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Patient Safety Connections
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Clinical patient tracers
Shadowing clinicians and staff
Adverse event reporting assessment
Review of P.I. projects
Group interviews
Observations of practice
Conversations with frontline staff
Online surveys: AHRQ and OCC
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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Collaborative Assessment
Strategies
Organizational Capacity for Change
– William Q. Judge
– “OCC is a broad and dynamic organizational
capability that allows the enterprise to adapt
old capabilities to new threats and
opportunities, as well as create new
capabilities.” (Judge, 2005)
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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– E.V. Williams Chair of Strategic Leadership and
Professor of Strategic Management
Old Dominion University, Norfolk VA
Organization Capacity for Change
• Compares 8 dimensions across 3
groups
• 8 dimensions = 4 dualities
• Leadership must balance between
dualities
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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• Executives, managers, frontline staff
• Trusting staff:Trustworthy Leadership
• Capable Champions:Involved Middle
Management
• Systems Thinking:Systems
Communications
• Accountable Culture: Innovative Culture
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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8 Dimensions:4 Dualities
Trusting Workers
Trustworthy Leaders
Leadership presents a clear vision, inspires
confidence, and upholds organizational
values while encouraging change.
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Frontline workers are open to change, know
how change will help them, and trust leaders
to carry out change efforts.
Capable Champions
Involved Middle Management
Middle managers effectively connect front line
staff with leadership, balance the need for
change with the need to complete current
work.
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Change efforts are led by champions with
Interpersonal skills, leadership support, and
the will and ability to challenge the status
quo.
Systems Thinking
Systems Communications
People get the information they need in a
timely way, across units and from customers.
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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Change champions focus on causes
rather than symptoms, the importance of
aligning incentives, and the need to
change systems.
Accountable Culture
Innovative Culture
The organization attracts and retains
Creative people and support innovative
changes.
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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People meet deadlines; they have clear
Roles and responsibilities, and experience
Reasonable consequences for their
actions.
Organizational Capacity for Change (OCC) – Overall
Trustworthy Leaders
40
35
30
28.3
Capable Champions
25
Innovative Culture
30.1
27.7
24.1
32.1
29.5
27.0
24.0
20
28.5
25.2
25.1
21.9
15
10
5
29.6
24.8
Systems Thinking
Systems Communications
0
23.4
26.1
28.4
24.0
26.5
29.6
22.9
26.0
28.9
27.0
22.5
24.4
27.0
31.0
Accountable Culture
Involved Mid-Mgt
Trusting Workers
OCC-Overall
1st/2nd Quartile Split
2nd/3rd Quartile Split
3rd/4th Quartile Split
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29.3
26.6
20.5
23.7
•
•
Research shows that a rating below the first quartile
by any group, even when the overall score is in the
first quartile, is related to limited change capability.
The value of report is to:
• challenge managers to look more closely into
areas where there are differences in perception,
even though their own perception is that there are
no concerns, and
• focus improvement efforts on the organizational
capabilities related to executing change
initiatives. For example, Durham may expand its
review of frontline staff’s opinion related to
systems communication.
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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What do these differences mean?
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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Durham Regional Hospital’s
Opportunities for Change
Organizational Capacity for
Change
o 24 respondents
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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8 in the top group
12 in the middle group (including physicians)
4 in the frontline group
Trusting Workers
Trustworthy Leaders
Overall score for trusting workers 1st quartile
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o
Overall Score trustworthy leaders 2nd quartile.
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Executives and frontline staff scored them in the1st quartile
Middle manager them in the 2nd quartile.
Executives scored them in the1st quartile,
Both other groups scored them in 2nd quartile.
This represents an opportunity for further assessment and a
plan for developing a trusting relationship
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o
Capable Champions
Involved Middle Management
All staff rate involvement of middle management in the
first quartile

Correlates with AHRQ findings related to supervisors do not
sacrifice patient safety
o
Front line staff rate capable champions in the second
quartile.
o
Improving the effectiveness of department champions
would increase overall improvement capability.
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o
Systems Thinking
Systems Communications
o Systems thinking (focus on causes rather than symptoms, change systems)
 Senior staff and middle managers rate1st quartile
 Front line staff 2nd quartile
 Correlates with AHRQ in that staff feel mistakes are held against them and
working in crisis mode
o Systems communication is rated overall in the 2nd
quartile
 All groups rated 2nd quartile
o Developing effective, systematic communication
mechanisms, and monitoring and improving their
effectiveness is an opportunity for development
o Communications survey, developing report from SRS system, revamped
walk rounds
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 Correlates with AHRQ findings around communication
Accountable Culture
Innovative Culture
All staff rate Durham in the first quartile for accountable
culture, while front line staff rate innovative culture in the
second quartile.

o
Just Culture
This suggests that front line staff perceive the work
environment as having a stronger emphasis on
accountability than on supporting initiative, innovation, or
improvement at the front line.

Magnet journey, developing Patient Safety Champion Program
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o
Current Strengths - A sample
o The Board and Executive Team are driving
patient safety
o Communication from Senior Leaders
o Medication Management
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o Several safe practices have been implemented
More Strengths
o Strong peer-to-peer support at the front line
o The success of the Surgical Care
Improvement Project
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o Attention to employee morale and
professional growth
Themes of Concern
Alignment of the medical staff with the organization’s
commitment to quality and patient safety initiatives.
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Staff engagement throughout the organization in patient
safety activities
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New CMO, Revise Physician Peer Review, Compensate
Physicians for Committee involvement
Magnet, Patient Safety Champions, Walk Rounds
Variation in clinical practice across the organization and in
implementation of national patient safety goals.
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Magnet, Stroke Program
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o
Themes of Concern (continued)
Interdisciplinary communication re: clinical issues
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Performance improvement and sustainability
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Redesigned PI committee, Six Sigma Oversight
Communication channels for frontline staff to
express concerns about quality and patient safety
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Flash Rounds, Transport Communication Sheet
Revamp SRS system, revise Walk Rounds
Reporting and analysis of patient safety concerns,
adverse events and near misses.

Revamp SRS system with reporting capabilities
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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o
o Disseminate the results of the patient safety
assessment and improvements underway
o Prioritize focused areas posing greatest risks
to patients
o Develop specific strategies and timelines with
the involvement of staff, physicians, executive
leadership team, and Board
o Act!
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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Next Steps
Durham Regional Hospital – Patient Safety ConnectionsApril 2007
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Questions & Comments