Expanded Criteria Donor SubGoal Awards

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01
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• What Is Our Charge for These Two Days?

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• What Are the Purposes of the National Learning
  Congress?

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• What Are Our Results?

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• What Is the Plan for the Next 500 Days?

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• Who Are We?

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National Learning Congress Charge

• All Teach, All Learn
• Recognize, Appreciate, Celebrate!
• Accelerate Progress
• Expand Results
• Generate Net Forward Energy
• Commit to Actions

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Generating Net Forward EnergyFocus On

• Good Stories
• Whats Working
• Whats Causing It to Work
• What We Can Do
• What We Can Do More Of, Better or Differently
• Stamping Out BTTW WADI

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Our Specific Purposes

• Celebrate Extraordinary Performance
• Conclude OTBC
• Launch ODTBC
• Generate Pull With a Tipping Point of the
  Nations Tx Surgeons Physicians
• Launch Donate Life America Donor Designation
  Collaborative

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Donor Designation Collaborative Aim

• Increase the number of Actionable Donor
  Designations in the United States to 100 million.
  
• 100 Million Americans have done what they need to
  do in their state to ensure that a donation
  decision is recognized and honored.

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State of the States
States Population Current ADD
ADD AIM 15 116.4M
1.6M 1 23.3M
20 28 147.2M
43.2M 29 58.9M 40 9
36.6M 17M 46
18.3M 50 52
300.2M 61.8M 21
100.5M 33
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Strategy

• First-person Consent Registries
• Multiple Portals of Entry
• Universal Call to Action
• Collaborative Relationships
• Aggressive Measurement and Goal Setting

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What Are Our Results?
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What Are Our Results?

• Large Sustained Increases in Donation

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What Are Our Results?

• Large Sustained Increases in Donation
• Recent Modest Increases in Organs Transplanted
  Per Donor

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What Are Our Results?

• Large Sustained Increases in Donation
• Recent Modest Increases in Organs Transplanted
  Per Donor
• Breakthrough Increases in Overall Numbers of
  Transplants

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What Are Our Results?

• Large Sustained Increases in Donation
• Recent Modest Increases in Organs Transplanted
  Per Donor
• Breakthrough Increases in Overall Numbers of
  Transplants
• DSAs With Breakthrough Performance in OTPD

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Our Old Reality
Collaborative Starts Here
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Breakthrough Increases in Organ Donation
1st National Learning Congress
Collaborative Starts Here
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Expanded Breakthrough Increases in Organ Donation
Collaborative Starts Here
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Recent Modest Increases in Organs Transplanted
Per Donor
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Breakthrough Increases in Organs Transplanted
Organs Transplanted Per Month With 12 Month
Moving Average
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Breakthrough Increases in Organs Transplanted
Organs Transplanted Per Month With 12 Month
Moving Average
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OTBC Collaborative Aims

• All Donors 3.75 OTPD
• Standard Criteria Donors 4.3 OTPD
• DCD Donors 2.75 OTPD
• ECD Donors 2.5 OTPD
• At Least 10 of Donors in Each DSA Are DCD

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Breakthrough Performance on OTPD at DSA Level

• 4 DSAs at 3.75 Overall
• 3 DSAs at 4.3 on SCD
• 1 DSA at 2.75 on DCD
• 9 DSAs at 2.5 on ECD
• 26 DSAs With At Least 10 Percent
• of Donors from DCD

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Celebrating Fundamental Change

• Large Sustained Increases in Donation
• Recent Modest Increases in Organs Transplanted
  Per Donor
• Breakthrough Increases in Overall Numbers of
  Transplants
• DSAs With Breakthrough Performance in OTPD

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The Next 500 Days

• Combined DonationTransplant Collaborative
• Donate Life America Donor Designation
  Collaborative
• Study of Transplant Program Success
• 1st Collaborative on Transplant Program Growth,
  Outcomes Design
• Robust National Spread

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We Have Momentum
Pacing Events
Donation Practices
75 Conversion 3.75 Organs Transplanted Per
Donor 100 Million Designated Donors
ODTBC
Transplant Practices
Transplant Collaborative
Spread Science
Donate Life America Collaborative
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Our Vision
Donors/year
9,000
75
6,000
50
Recipients/year
4/D
36,000
3/D
18,000
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Our Vision
Donors/year
9,000
75
6,000
50
gt 8,000
Recipients/year
4/D
36,000
3/D
18,000
gt 25,000
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Answer One of These Questions

• What insights do you have about current national
  momentum and the future?
• What do you plan to do at this Learning Congress
  to increase action and results?

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2 Wed_8.30ECD_Awards_GMcBride v2.ppt
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Expanded Criteria DonorSub-Goal Awards

• 2.5 organs transplanted per donor rate achieved
• over a consecutive 6 month period

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ECD Sub-Goal Award Winners

• Arkansas Regional Organ Recovery Agency
• California Transplant Donor Network

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ECD Sub-Goal Award Winners

• Golden State Donor Services
• Louisiana Organ Procurement Agency

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ECD Sub-Goal Award Winners

• LifeSource
• Center for Donation and Transplant

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ECD Sub-Goal Award Winners

• LifeCenter Organ Donor Network
• Quebec Transplant

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ECD Sub-Goal Award Winners

• Trillium Gift of Life

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2BWed_8.35Collab_Success_KOConnor
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Making Changes That Generate Results

• A Panel Discussion

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Generating ImprovementIn Four Domains

• Organ Procurement Organization
• Transplant Program
• Donor Hospital
• Donor Designation Registration

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Two Requests For You
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Two Requests For You

• Listen carefully for new ideas ways you can
  take action in your own Donation Service Area

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Two Requests For You

• Listen carefully for new ideas ways you can
  take action in your own Donation Service Area
• Participate in discussions at your tables and
  be prepared to share your feedback with the
  whole room

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Expert Panelists

• Charlie Alexander
• Cynthia Herrington MD
• Colleen Murphy
• Tracy Schmidt

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Format For Panel Discussion

• Each Panelist Will Describe Their Results
• Question For Discussion At Tables
• Hear From Audience
• Each Panelist Will Describe Their Practices
• Question For Discussion At Tables
• Hear From Audience
• Final Questions For Panelists

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First Question For Panelists

• You and your team have made real changes that
  have generated tremendous improvement what are
  the results you are seeing?

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Results

• Charlie Alexander

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Actual Organ Donors
2003 - 2006
2006 Detail DCD 20 of Donors ECD 20 of
Donors 21 of SCDs met CDC criteria for High
Risk or had positive Hepatitis B/C
status Population base of 3.01m
Conversion Rates have increased from 43 to 66
(2003-2006)
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Organs Transplanted
2003 - 2005
Whats Worked? Family Services Dept Innovative
Staffing Model Critical Care Medical Dir DSA
Buy-In Supportive Tx Centers Aggressive Tx
Centers
Organs Transplanted per Donor increased from 2.45
to 3.2 since 2003 (Goal3.75)
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Results

• Cynthia Herrington MD

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They Dont Grow On Trees

• Local Lung Programs 2001 2002 2003 2004 2005
  2006
• University of Minnesota 39 33 39 19
  46 40
• St. Marys (Mayo) 5 4 10 7 13
  13

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Lungs Thrive in 200560 in 06
They Dont Grow On Trees
University of Minnesota
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Results

• Colleen Murphy

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Sharp Hospital System

• Sharp Grossmont Hospital
• Initial conversion rate 19 (2003)
• Now Winner of 2 HRSA Medals of Honor
• Sharp Memorial Hospital Transplant and Trauma
  Center
• Initial conversion rate 50 (2005)
• Now conversion rate 80 and winner of HRSA
  Medals of Honor
• Sharp Chula Vista
• Initial conversion rate 22 (2005)
• Now conversion rate 100 (YTD 2006)
• In action to receive an award next year

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Results

• Tracy Schmidt

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Utah Donor Registry

• 67 age 16-75 on the registry
• (start date 2002)
• Organ donors on registry gt age 18
• 2004(61) 2005 (55) 2006 YTD (70)
• Consent rate of eligible organ donors on
  registry- 99 (5 years)
• Can measure effectiveness on target populations
• Age Silver Fox Initiative
• Participation by zip code

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Question For Table Discussion

• What results do you want to focus on improving?

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Question For Each Panelist

• Weve seen the incredible results of your work
  what are the specific changes and practices that
  have generated this kind of breakthrough
  improvement?

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Practices

• Charlie Alexander

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Organs Transplanted
2003 - 2005
Whats Worked? Family Services Dept Innovative
Staffing Model Critical Care Medical Dir DSA
Buy-In Supportive Tx Centers Aggressive Tx
Centers
Organs Transplanted per Donor increased from 2.45
to 3.2 since 2003 (Goal3.75)
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Practices

• Cynthia Herrington MD

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Youll get farther if everyone is rowing in the
same direction
They Dont Grow On Trees

• OPO
• Review current lung management protocol
• Identify lung transplant centers to work with
• Confer with other OPOs who are top performers in
  lung management
• Adopt new management strategies that have worked
  for others
• Tailor management to preserve lung function
• Expect procurement to take a little longer
• Call and keep calling centers to exhaust your
  search
• Expect that every lung can be recovered and aim
  to get every lung to meet the standard criteria

• Transplant Surgeon
• Review current acceptance protocol and make
  criteria more liberal
• Work with your OPO and any other OPO that needs
  advice
• Review donor management strategies your own and
  others and adopt new methods for lung recruitment
  and donor care
• Work with the OPO on borderline cases to help
  improve the lungs to make them acceptable for
  transplant
• Change your mind set, expect to say yes to
  every offer you receive
• Reevaluate your acceptance criteria
• Review those lungs that you turn down that are
  used elsewhere

Do it together
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Practices

• Colleen Murphy

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Best Practices in Action

• First hospital in San Diego to perform a DCD
• Chaplin rounds which grew to Social Worker rounds
• Electronic charting Clinical Trigger prompts
• System wide Donor Committee Meetings
• After Action Review via conference call
• Active participation by CEO on OPO advisory board.

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Practices

• Tracy Schmidt

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Utah Donor Registry

• Legislative framework
• Linkage to driver license
• Paradigm change of OPO hospital staff
• Donor designation vs. family decision
• All public education directed to registry
• Database controlled by OPO/internet based

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Questions For Table Discussion

• What practices described by our panelists might
  drive improvement in your DSA?
• What new opportunities for improvement do you
  envision?

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Question For Panelists

• What are the most important steps other leaders
  and teams can take to generate these kinds of
  results?

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4 Wed_9.45MiniPlenary_Change_PackageKOConnor.ppt
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Organ Donation Transplantation Breakthrough
Collaborative Overview

• Mini-Plenary Session
• Wednesday October 18, 2006
• 945 1030 AM

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ODTBC Overview

• What is the history and knowledge base that
  supports the ODTBC?
• What are the ODTBC goals in the historical flow
  of collaboratives?
• What is the intellectual capital from earlier
  collaboratives that the ODTBC is building on and
  adding to?
• What is the ODTBC Change Package, and how can you
  use it to drive rapid improvement?

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ODTBC Overview

• Who Is In The Room Today?
• ODTBC Team Members
• Faculty Leadership Team

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Our Request To You

• During This Session, And Over The Next Two Days,
  Keep Asking Yourselves This Question

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Our Request To You

• During This Session, And Over The Next Two Days,
  Keep Asking Yourselves This Question
• What Actions Can I Take To Rapidly Increase Organ
  Donation Transplantation Based On What I Am
  Hearing?

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What is the history and knowledge base that
supports the ODTBC?
First Question
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Key Elements

• DHHS Call To Action in 2003
• Central Law of Improvement
• Knowledge of Diffusion of Innovation
• Change and Improvement Happens In A Very
  Predictable Way
• Belief That We Can Create The Future
• You Get More Of What You Focus On
• Focus On Results Progress

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Former HHS Secretary Tommy Thompson Launching the
Collaboratives at UNOS Donor Memorial
Groundbreaking April 2003
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The Central Law of Improvement
Every System Is Perfectly Designed To Produce
The Results It Is Producing

• Donald Berwick MD
• Institute For Healthcare Improvement
• Co-Founder and President

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The Central Law of Improvement
Every System Is Perfectly Designed To Produce
The Results It Is Producing

• Donald Berwick MD
• Institute For Healthcare Improvement
• Co-Founder and President

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A Corollary To This Law
Not Every Change Is An Improvement, But Every
Improvement Is A Change

• Donald Berwick MD
• Institute For Healthcare Improvement
• Co-Founder and President

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To Make Improvements, You Need Three Things

• Donald Berwick MD
• Institute For Healthcare Improvement
• Co-Founder and President

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To Make Improvements, You Need Three Things
Will Ideas Execution

• Donald Berwick MD
• Institute For Healthcare Improvement
• Co-Founder and President

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To Make Improvements, You Need Three Things
Will Ideas Execution
Change Package

• Donald Berwick MD
• Institute For Healthcare Improvement
• Co-Founder and President

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Core Guiding Principle

• Donald Berwick MD
• Institute For Healthcare Improvement
• Co-Founder and President

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All Teach, All Learn
Core Guiding Principle

• Donald Berwick MD
• Institute For Healthcare Improvement
• Co-Founder and President

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Adopter Categories

Innovators
Early Majority
Late Majority
Early Adopters
Laggards
Diffusion of Innovations, by Everett Rogers (1995)
16
2.5
13.5
34
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Adopter Categories

Innovators
Early Majority
Late Majority
Early Adopters
Laggards
Diffusion of Innovations, by Everett Rogers (1995)
16
2.5
13.5
34
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Adopter Categories

Innovators
Early Majority
Late Majority
Early Adopters
Laggards
Diffusion of Innovations, by Everett Rogers (1995)
16
2.5
13.5
34
34
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Adopter Categories

Innovators
Early Majority
Late Majority
Early Adopters
Laggards
Diffusion of Innovations, by Everett Rogers (1995)
16
2.5
13.5
34
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Adopter Categories

People Attending This Congress
Innovators
Early Majority
Late Majority
Early Adopters
Laggards
Diffusion of Innovations, by Everett Rogers (1995)
16
2.5
13.5
34
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The Dual Role Of ODTBC Team Members

• Taking Action, Testing and Making Changes To
  Drive Improvement
• Bringing Others Into This Work

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What are the ODTBC goals in the historical flow
of collaboratives?
Second Question
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Call To Action
Increase Transplantation
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Two Aims

• Increase U.S. Donation Rate To 75
• (ODBC Aim)
• Increase Organs Transplanted
• Per Donor To 3.75
• (OTBC Aim)

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Our Vision for the Future
Donors/year
9,000
75
6,000
50
Recipients/year
4/D
36,000
3/D
18,000
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Our Progress So Far
Donors/year
9,000
75
6,000
50
gt 8,000
Recipients/year
4/D
36,000
3/D
18,000
gt 25,000
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• We Are On
• The Right Track

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• Even if you're on the right track, you'll get
  run over if you just sit there.
• Will Rogers, US humorist showman
• (1879 - 1935)

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ODTBC Goals

• Increase U.S. Donation Rate To 75
• (ODBC Aim)
• Increase Organs Transplanted
• Per Donor To 3.75
• (OTBC Aim)

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What is the intellectual capital from earlier
collaboratives that the ODTBC is building on and
adding to?
Third Question
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Two In-Depth Studies Of High Performing Teams

• Conducted by The Lewin Group HRSA
• Dozens of Intensive Site Visits, Hundreds of
  In-depth Interviews with High Performers
• Distillation of Common Themes Strategies
• Two Comprehensive Reports Published
• Provided Objective, Evidence-Based Foundation For
  Collaborative Change Packages

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Expert Planning Group Faculty Assembled By HRSA
Leadership Team

• OPO Leaders Front-Line Staff
• Donor Hospital Leaders Front-Line Staff
• Transplant Program Leaders Front-Line Staff
• Expert Consultants (System Redesign, Social
  Marketing, Quality Improvement, Leadership
  Development)

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Development of CollaborativeChange Packages

• Informed By Expert Planning Group Using Findings
  From In-Depth Studies
• Synthesis and Summary of What Works
• Real-World Proven Practices
• Practical Resource For Teams To Take Action
• Living Document Improves Over Time With Input
  From Teams and Front-Line Staff

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What We Have Learned

• The Collaborative Approach To Increasing
  Transplantation Works
• Disciplined Use Of The Model For Improvement Is
  Critical To Success
• To Make Rapid Progress, We Need To Take Bold
  Action
• Taking Action Means Making Requests Offers

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What We Have Learned

• The Collaborative Approach To Increasing
  Transplantation Works
• Disciplined Use Of The Model For Improvement Is
  Critical To Success
• To Make Rapid Progress, We Need To Take Bold
  Action
• Taking Action Means Making Requests Offers

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One Person Making One Request Can Make All The
Difference

• Susan McVey Dillons son Michael was the first
  DCD donor in Philadelphia in 1995
• In January 2004, Susan McVey Dillon made a bold
  request to over 1000 donation transplantation
  professionals
• DO WHATEVER IT TAKES TO INCREASE
• DONATION AFTER CARDIAC DEATH
• Dont Accept I Cant Or I Wont

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One Person Making One Request Can Make All The
Difference

• Susan McVey Dillons son Michael was the first
  DCD donor in Philadelphia in 1995
• In January 2004, Susan McVey Dillon made a bold
  request to over 1000 donation transplantation
  professionals
• DO WHATEVER IT TAKES TO INCREASE
• DONATION AFTER CARDIAC DEATH
• Dont Accept I Cant Or I Wont

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The Monthly Number of DCD Organs Transplanted Has
Almost Tripled!
2006 through June
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Intellectual Capital From Earlier Collaboratives

• Proof That This Approach Works
• Knowledge of How To Best Use The Model For
  Improvement
• Data and Results Powerful Evidence Base For
  Progress
• Continuously Expanding Cadre of Supporters
  Expertise
• Two Change Packages That Have Improved Over Time
  With Input From Teams

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What is the ODTBC Change Package, and how can you
use it to drive rapid improvement?
Last Question
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ODTBC Change Package

• Extensive, Practical Tool-kit of Strategies,
  Change Concepts, and Testable Actions
• Synthesis of All Prior Work Knowledge
• Incorporates All Improvements Made Over Past
  Three Years
• Includes Essential Bundles
• First Things First,
• High Leverage Changes,
• High Leverage Transplant Practices

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ODTBC Change Package

• Extensive, Practical Tool-kit of Strategies,
  Change Concepts, and Testable Actions
• Synthesis of All Prior Work Knowledge
• Incorporates All Improvements Made Over Past
  Three Years
• Includes Essential Bundles
• First Things First,
• High Leverage Changes,
• High Leverage Transplant Practices

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ODTBC Change Package

• Extensive, Practical Tool-kit of Strategies,
  Change Concepts, and Testable Actions
• Synthesis of All Prior Work Knowledge
• Incorporates All Improvements Made Over Past
  Three Years
• Includes Essential Bundles
• First Things First,
• High Leverage Changes,
• High Leverage Transplant Practices

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Structure of Change Package

• Hierarchical Framework
• ODBC Section
• OTBC Section
• Other Bundle Sections

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Structure of Change Package

• Hierarchical Framework
• ODBC Section
• OTBC Section
• Other Bundle Sections
• Three Levels
• Overarching Strategy
• Change Concepts
• Actionable Items

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How can you use the Change Package to drive
rapid improvement?
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• Think of the change package as a roadmap, not a
  blueprint.
• Dr. Frank Zampiello
• ODTBC Co-Director
• ODBC Improvement Advisor

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OTBC Strategies

• Intent
• Relationships
• Advanced Practice
• Push
• Pull

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An Example
Goal Increase SCD OTPD
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An Example
Goal Increase SCD OTPD
Strategy Advanced Practice
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An Example
Goal Increase SCD OTPD
Strategy Advanced Practice
Measures DMGs met SCD OTPD
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An Example
Goal Increase SCD OTPD
Strategy Advanced Practice
Measures DMGs met SCD OTPD
Findings SCD OTPD Increases
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An Example
Goal Increase SCD OTPD
Strategy Advanced Practice
Measures DMGs met SCD OTPD
Findings SCD OTPD Increases
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An Example
Goal Increase SCD OTPD
Strategy Advanced Practice
Plan Do Study Act
Measures DMGs met SCD OTPD
Findings SCD OTPD Increases
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How To Use The Change Package

• Read it, review it, refer to it, revisit it
• Select those action items that will help you make
  the most rapid progress
• Use these action items to apply the Model For
  Improvement Test Changes!!
• Integrate Testing With Measurement Strategy
• Make it better and share your learning
• Connect with others with expertise results
• Ask ODTBC faculty for guidance ideas

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ODTBC Improvement Advisors

• Dina Steinberger
• U. Wisconsin OPO, Madison, WI
• Brenda Welsch
• LifeSource, Minneapolis, MN

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We Have Incredible Momentum
National Pacing Events
ODBC FTF HLCs
ODBC, OTBC ODTBC
75 Conversion 3.75 Organs Transplanted Per
Donor
OTBC HLTPs
Affinity Group Events
Spread Science
Donate Life America Collaborative
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4 Wed_9.45MiniPlenaryDina
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Learning How to Apply Knowledge The Model for
Improvement

• Ginny McBride
• Dina Steinberger
• Brenda Welsch

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The Improvement Model A powerful catalyst
Current DSA Systems And Outcomes
PDSA
New System Designed to Achieve IMPROVED OUTCOMES 7
5 3.75 OTPD

Learning Sessions Building upon knowledge base
by learning current national best practices
from high-performing teams
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MFI Sessions

• Interactive
• Fast-paced
• Action oriented
• Scheduled to provide team work time
• Productive
• Access to expert faculty coaches
• Leave ready to be in action
• Fun!

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• Part I Wednesday 215 300 pm
• Will and Ideas Creating powerful Aim
• statements, Measurement for Improvement,
• Finding the Ideal Ideas for change
• Part 2 Thursday 1000 1145 am
• Execution PDSA cycles
• Hardwiring the MFI into daily operations
• Completing the PLAN phase of your first PDSA
• Time to consult with faculty coaches
• PDSA Consults Thursday 200 245 pm
• Belle Chasse Room

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6Wed_10.45Leadership_MiniPlenaryKOConnor.ppt

• (need Phyllis Weber ppt)

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Driving Improvement Through Joint Accountability
and Shared VisionOPOs, Transplant Programs, and
Donor Hospitals Teaming TogetherCase Studies
From Three Donation Service Areas
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Intent of This Session

• Showcase real-world examples of active and
  intentional teaming among Transplant Programs,
  Donor Hospitals, and OPOs, generating changes
  leading to increased results.
• Profile the joint accountability and shared
  vision for improvement.
• Profile the results.
• Stimulate discussion and action.

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Three DSA Teams

• Louisiana Organ Procurement Agency
• LifeCenter Northwest
• California Transplant Donor Network

146
Questions For Presenters

• What were the first steps you took to collaborate
  on increasing donation and transplantation in
  your DSA?
• What were the benefits that you first realized?
• What other actions did you take as you began to
  see benefits of collaboration?
• What unexpected benefits did you realize?

147
Questions For Presenters

• What are the key lessons you have learned
  together?
• What are the results your collaboration has
  generated?
• What are your plans to build on this success?
• What are the next steps you plan to take?
• What actions would you recommend for others who
  want to replicate your success?

148
Questions For Audience

• What do you like about what this team has done?
• What ideas for change and improvement flow from
  this presentation that you can test in your DSA?

149
Necessitated Collaboration Three Estates, One
Goal

• Erin Wray, Director of Recovery, LOPA
• Annette Faraldo, In-House Coordinator, MCLNO
• Marian ORourke, Transplant Administrator, Tulane
  Hospital and Clinic

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What We Did

• Transferred consented patients from
  Charity-Elmwood to Tulane Hospital for management
  and recovery
• Converted 4 of 5 potential donors, all since
  August 2006

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Why We Did It

• Charity forced to function on a much smaller
  scale
• Only 2 ORs and 9 ICU beds to handle area traumas
• Opened in April 2006, saturated on second day
• Donor management and recovery not a viable option
  on-site
• Other patient transfer agreements not in place

152
The Opportunity

• Tulane Hospital and Clinic not functioning at
  full capacity
• Unstaffed and unused beds and units available for
  donor management
• ORs more readily available for recoveries
• Relationship with LOPA and Tulane transplant
  program set wheels in motion

153
Lessons Learned

• Be realistic about expectations across the board
• Be flexible chances are it wont work as planned
  the first few times
• Address issues as quickly as possible
• Get the admitting procedure and billing straight
• Never lose sight of our dual advocacy role

154
Questions For Audience

• What do you like about what this team has done?
• What ideas for change and improvement flow from
  this presentation that you can test in your DSA?

155
Collaboration in the Northwest
Relationships Leading to Success
Donor Hospital DCD policies Transplant Center
acceptance Lives Saved
156
Strategies

• Developed an OPO DCD policy
• Fostered Hospital Relationships
• Partnered with Transplant Centers

157
Questions For Audience

• What do you like about what this team has done?
• What ideas for change and improvement flow from
  this presentation that you can test in your DSA?

158
Increasing Availability of Transplanted Organs

• Joint Accountability and Vision
• Wednesday, October 18, 2006
• 1045-1130

159
CTDN Intent

• Focused efforts on DCD potential
• Embrace collaborative goals
• One manager driving policy and practices
• Push donor hospital adoption of policies
• Regular review of all potential and actual DCD
  donors
• Outside experts tapped for re-educating CTDN
  staff and transplant surgeons

160
CTDN DCD History 2003 thru 2006 YTD (10/5)
161
Community Health Network (SFGH) Experience

• Right thing to do following learning session
  with internal champion in action
• Family driven process without complete policy
  sign off no obstacles too big
• Three DCD donors (of 13 DCD donors in the DSA)
• 3.6 organs transplanted per donor
• Valuable lessons learned from first experience
  were quickly adopted to next cases
• After action reviews on all cases

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Questions For Audience

• What do you like about what this team has done?
• What ideas for change and improvement flow from
  this presentation that you can test in your DSA?

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8Wed_11.45TeamWorkJScanlon.ppt
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(No Transcript)
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DSA Team Planning
Sharing and Processing Our Experience
167
Two Great Truths About Creating Profound Change.
168
Profound Change
Ride a tricycle
Ride a bike
I POD
Disc player
Married
Single
75, 3.75
50, 3.0
169
Blink, Malcolm Gladwell
Thin slicing by the adaptive unconscious.
Thinking Without Thinking
Rapid Cognition
170
Great Truth 1 InSight Listen with intent to
see the way that is already there.
171
But when they declared her the winner and she
stepped out from behind the screen, there was a
gasp
172
It wasnt just that she was a woman, and female
horn players are rare, It wasnt just that bold
extended high C
173
It was because they knew her. Landsman had
played for the Met before as a substitute. Until
they listened to her with just their ears,
however, they had no idea she was so good.
174
When the screen created a pure Blink moment, a
small miracle happened, the kind of miracle that
is always possible when we take charge of the
first two seconds they saw her for who she truly
was.
Malcolm Gladwell, Blink, 253-254
175
Different Blink Results
AuditionScreen
NoScreen
176
Different Blink Results
AuditionScreen
Intent 75, 3.75, 10

NoScreen
Critical Thinking

177
The way is often hidden until intent discloses it.
What are the ways I can move my DSA closer to
75, 3.75, 10, 0?
178
In your DSA team, share the ways you have seen!
What are the ways I can move my DSA closer to
75, 3.75, 10, 0?
179
DSA Team Work
Share your insights from the breakouts
the ways I see to move to 75, 3.75, 10, 0 are
______________
180
DSA Team Planning
Lessons Learned Information Sharing
181
Two Great Truths About Creating Profound Change.
182
Blink, Malcolm Gladwell
Thin slicing by the adaptive unconscious.
Rapid Cognition
Thinking Without Thinking
183
Great Truth 1 InSight Listen with intent to
see the way that is already there.
184
Great Truth 2 Action
Say Yes Say And
185
Great Truth 2 Action
Say Yes Say And
Then have fun. Figure out a playful PDSA way to
do it.
186
People are much more likely to act their way
into a new way of thinking than to think their
way into a new way of acting
Richard Pascale Jerry Sternin, Harvard
Business Review, May 2005
187
Blink
Improvisation
Keith Johnstone
188
Keith Johnstone. Rule of agreement in
improvisation. In life, most of us are highly
skilled at suppressing action
189
Keith Johnstone. Rule of agreement in
improvisation. In life, most of us are highly
skilled at suppressing action Bad improvisers
block action, often with a high degree of skill

190
Keith Johnstone. Rule of agreement in
improvisation.
Good improvisers develop action Good
improvisers seem telepathic everything looks
prearranged
191
Keith Johnstone. Rule of agreement in
improvisation. This is because they accept
all offers made which is something no normal
person would do.
192
This Room, This Moment
1,800 people as insight in action all with the
same intent
75 3.75 10 0
Saying yes!
193
Two Great Truths

• Listen with intent to see the way that is
  already there.
• Say yes, say and.

194
"There are two kinds of truth, small truth and
great truth. You can recognize a small truth
because its opposite is a falsehood.The opposite
of a great truth is another great truth."
Niels Bohr
195
Great Truth
Opposite
There is a way if you say there is.
196
Great Truth
Opposite
There is a way if you say there is.
There is no way if you say there isnt.
197
Great Truth
Opposite
There is a way if you say there is.
There is no way if you say there isnt.
You can do what you are asked if you say yes.
198
Great Truth
Opposite
There is a way if you say there is.
There is no way if you say there isnt.
You can not do what you are asked if you say
no.
You can do what you are asked if you say yes.
199
DSA Team Work
Use yes and and to power up you game plan.
The actions we will take to move to 75, 3.75,
10, 0 are _______________
200
Volunteers join us on the stage

• An action we are taking is ___________________
• A big insight from today is ___________________

201
DSA Team Work
Use yes and and to power up you game plan.
The actions we will take to move to 75, 3.75,
10, 0 are _______________
202
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