Leadership and Safety Climate

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Leadership and Safety Climate
March 18, 2008
Presenter Sue Gullo, RN,MS
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Improving Leadership For Quality

• Establish executive accountability.
• Address culture at all levels.
• Demonstrate visible leadership behavior.
• Use patient stories and input.
• Establish aims and monitor system level
  improvement.
• Orientate Board agendas.
• Address Board level learning and education.

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Questions to ask at every level of the
organization

• How good is our care?
• Is our care getting better?

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Setting Aims- Executive Level

• Set a specific aim to reduce harm this year ?
• Make an explicit, public commitment to measurable
  quality improvement ?

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Getting Data and Hearing Stories- Executive Level

• Select and review progress toward safer care as
  the first agenda item at every board meeting.
• Ground the work in transparency, and putting a
  human face on harm data.
• Engage with patients and families.
• Tools chart audit case study of a specific case

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USA Campaign Blog Entry

• Greeted by VP for Performance Improvement Dan
  Varnum and Tom Evans of the Iowa Healthcare
  Collaborative, we heard more about Mercys story
  of improvement.  Dan identified Mercys greatest
  transformation as their development of a culture
  of safety.  By changing the attitudes of leaders
  and team members, they found they were able to
  work cooperatively to achieve sustainable
  results.  To help to align their work and
  maintain a uniform focus, they now perform
  multidisciplinary rounds, arrange doctors and
  nurses into pods in the emergency department to
  facilitate improved communication flow, and
  practice daily goal setting in the ICU.  From
  board reports to quality measurements and
  statistics, Mercy is also working to make their
  practice increasingly transparent.
• While they have found success in engaging teams
  of providers, what was also astonishing about
  Mercy was their focus on the patient and family. 
  In a newly renovated facility, Mercy has designed
  their patient rooms to accommodate family members
  by including couches, desks, and internet
  connectivity.  After observing an eye-opening
  catheterization procedure, the patients family
  was brought in immediately.  Mercy doesnt
  believe in restricted patient visiting hours and
  its this commitment to the patient that really
  impressed us.
• What surprised me most, though, happened on our
  ride back to the airport.  Clinical Safety
  Coordinator Monica Gordon described how she felt
  that Mercy still had so far to go.  This hospital
  which had achieved so many great clinical
  outcomes and created a community seemed to be at
  the top.  However, this desire to constantly
  strive for better was a display of the true
  engagement of Mercys staff in the improvement
  process.  Campaign or no Campaign, they intend to
  continue their work in quality improvement. 
  Theres no better campaign statement than that.

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5Million Lives Entry

• The organization regularly and transparently
  reviews
• its performance data.
• Honest, frequent assessment of data by everyone
  in the
• organization, including front-line staff (and,
  often, the
• public), allows high-achieving facilities to stay
  agile, focusing
• energies on their most acute problems and
  building joint
• accountability for progress.

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5 Million Lives Entry

• The organization invests in human capital and
  continuous
• learning, building capacity at all levels.
• Hospitals we visited invested significant
  resources in
• developing staff to better execute safety and
  quality initiatives
• at all levels of the organization, systematically
  exchanging
• new evidence and new approaches to managing
  change. In
• particular, supporting and developing middle
  managers led
• to strong unit-level results that tied to the
  larger safety and
• quality agenda of the organization.

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What It Takes to Win

• Will
• Ideas
• Execution

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Winning Execution Strategies

• Pick a patient segment upon which to test
• Work with those who want to work with you
• Small tests of change, small tests of change,
  small tests of change
• Learn as you go develop process for review and
  improvement
• Encourage customization

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Engage Leadership and Governance

• The Goal
• Boards in all hospitals will spend at least 25
  of their meeting time on quality and safety
  issues
• Full Board will have a conversation with at least
  one patient (or family member of a patient) who
  sustained serious harm at their institution
  within the last year

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What Does the Evidence Tell Us?

• Outcomes are better in hospitals where
• The Board spends gt25 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
• 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 et. al. J of Patient
Safety 22-9
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Six Things That Boards Can Do

• 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)
• 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
• Establish and monitor a small number of
  organization-wide role up measures that are
  updated continually and are transparent to the
  entire organization and its customers

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Six Things That Boards Can Do

• 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
• 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
• Oversee the effective execution of a plan to
  achieve the Boards aims to reduce harm,
  including executive team accountability for clear
  quality improvement targets

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In Summary

• It is within your power to make a difference one
  patient at a time. It is your choice.
• Never believe that a few caring people can't
  change the world. For, indeed, that's all who
  ever have.
• Margaret Mead