Quality Improvement Leadership in Complex Healthcare Organizations

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Quality Improvement Leadership in Complex
Healthcare Organizations

• Dr. Tony Taylor FRCPC, MBA
• VP Medicine, Quality Patient Safety
• Fraser Health Authority

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BC Health Authorities
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BCs largest fastest growing Health Authority

• Services in 22 municipalities, 1.5 M people
• 12 acute care hospitals (2100 beds), 7000
  residential beds
• Mental health care, public health, home
  community care
• 22,300 staff, including 8,000 nurses, 3,200
  allied health professionals, 9,800 Clinical and
  Operational support personnel
• 2,300 physicians with privileges in FH hospitals
• 2.15B budget
• Diverse communities and populations

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Our Purpose

• To improve the health of the population
• and the quality of life of the people we
  serve.

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Our Values
Respect, caring and trust characterize
our relationships.
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Our Commitments

• To be passionate in our pursuit of quality and
  safe health care.
• To inspire individual and collective
  contribution.
• To be focused on outcomes, open to evidence, new
  ideas and innovation.
• To embrace new partners as teammembers and
  collaborators.
• To be accountable forensuring the greatest value
  isachieved for the greatestnumber of people,
  while operatingwithin our available resources.

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Fraser Health A Typical Day
42 babies born 117 kindergarten immunizations 210
hearing evaluations 59 long term care
assessments 1052 ER visits 2000 patients in acute
care beds 400 patients have surgery 236 clients
in Adult Day Programs 577 home care nursing
visits 7660 residents in LTC facilities 660
clients access mental health community
services 22 people die
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What is Quality?

• Accessibility
• Acceptability
• Affordability
• Effectiveness
• Efficiency
• Safety

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Accessibility

• Absence of barriers such as time, space, or
  language

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Accessibility

• Responsiveness
• Availability

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Acceptability

• The extent to which subjective experiences
  fulfill expectations

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Acceptability

• Satisfaction
• Feedback
• Expectations met

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Affordability

• The financial amount allocated to spend

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Affordability

• Out of pocket costs
• Indirect costs
• Capital costs
• Operating costs

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Effectiveness

• The ability to have ones needs met

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Effectiveness

• Value
• Desirable state
• Clinical outcome
• Clinical effect

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Efficiency

• The ability to produce the desired effect,
  product, or output with a minimum of effort,
  expense or waste

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Efficiency

• Alignment
• Integrated
• Appropriate

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Safety

• Absence of physical and psychological harm

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Safety

• No harm
• Limited risk
• Security
• Competency

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Patient Care
Patient Care
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Leadership

• The ability to get others to do what they do not
  want to and like it
• Harry
  S. Truman

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A Culture of SafetyWhat does this mean?

• Culture is reflected in behaviors determined by
  peoples values and beliefs
• Culture is not created by
• policy
• evidence (no matter how compelling!)
• education
• roll-out implementation

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What does it take?

• Influence the culture by hard-wiring the change
  into practice
• Clearly and relentlessly communicate and model
  the behaviors we wish to change
• Understand the impact of the desired change on
  both people and processes
• Build the change into the core business

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Culture Shift

• Must move from a culture of productivity to a
  culture of quality and safety
• Move from the financial driven agenda to the
  clinical driven agenda

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What Do Chief Executives Want?

• The pride and determination of professionals to
• improve the care they give
• Results
• Stories of how improvement has benefited patients
  and care providers
• Results
• Linking the improvement goals and measures to the
  organization's business goals

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Alignment
Once I realized that improvement wasnt a
desirable addition to the way we were doing
business it was our business we really began
to perform. We used it to crack the difficult
operational problems. We used it to attract good
staff. We used it to develop the team. We used it
to build our reputation Ian Winstanley, Chief
Operating Officer, Luton tPCT, Provider Services
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Organizational Transformation

• Potential is recognized
• Interest develops

• Engage front line
• Multiple QI projects
• Start to recognize value to pts
• Where we are now

Leaders explore
Quality Committees

• Quality label goes away
• Where we need to go

Transformation
Jim Reinertsen
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• Senior leaders get to the next level by
• seeing differently
• owning the problem
• aiming high and wide
• taking the plunge
• using leverage

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Aim High Aim Wide
High
Islands of Excellence
Transformation
AIM
Incremental Improvement
Just Good Enough
Low
System Level
Unit Level
BREADTH OF AIM
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Seven Leverage Points for Leaders

• 1. Set measured system-level aims and oversee
  their
• achievement at the Board level.
• 2. Align aims, measures and strategies in a
  leadership
• learning system
• 3. Channel attention to system-level aims and
  measures
• 4. Engage an effective and committed team
• 5. Engage the CFO in achieving the aim
• 6. Engage physicians in achieving the aim
• 7. Build the improvement capability necessary to
  achieve
• the aim

Seven Leadership Leverage Points Innovation
Series 2008 2nd Edition Institute for Healthcare
Improvement
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How Do We Want To Show Up?

• Need to establish system level aims performance
  measures
• Create alignment between operations, service
  planning, finance quality
• Currency of leadership is attention
• Right people on the bus
• Connect quality patient safety with business
  performance
• Engage physicians health professionals
• All staff must become patient safety officers

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7 Deadly Sins Of Change

• Start with a large pilot project
• Find one person to do it ALL
• Be vigilant and work harder
• If it works in the pilot unit DONT change it for
  the organization
• Appoint the successful team leader as the driver
  for change for the entire organization
• Look at the deficits on a quarterly basis
• Early on expect marked improvement in hospital
  wide outcomes

Roger Resar Carol Haraden IHI
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Key Steps to Integrate Quality Into Complex
Organizations

• Address strategic priorities, culture and
  infrastructure
• Engage key stakeholders
• Communicate and build awareness
• Establish, oversee communicate system level
  aims
• Track/measure performance over time
• Support staff, physicians, patients, families
• Align system wide activities and incentives
• Redesign systems and improve reliability

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Growing A Quality Management Culture

• Corporate Commitment (observable)
• Grassroots Involvement (part of the process)
• Quality Management Model (visual anchor)
• Standardized Procedures
• Reporting Feedback (trust)
• Education (technical and human factors)
• Support (consistent messages)

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Parting Thought

• Come to the edge, he said.
• They said, We are afraid.
• Come to the edge, he said.
• They came, he pushed them.
• And they flew.

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Questions

• Thank you