Integrating Improvement Science and the Art of Leadership

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Integrating Improvement Science and the Art of
Leadership

• Jane Taylor, Ed.D.
• September 2009

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Model for Improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
Associates In Process Improvement
What change can we make that will result in
improvement
Edwards W. Deming
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Learning Our Way to Results
Will
RESULTS
Build confidence
New possibilities
Ideas
Sequencing and tempo
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What are we trying to accomplish?

• Aim
• Statements
• What?
• By when?
• For whom?
• How much?

• By January 2011,
• Union Hospital will reduce injuries - moderate
  or higher from a fall to less than 1 every 2
  years for our medical/surgical patients

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Aim Sample

• By June 2010 every bill that leaves our hospital
  will be error free and timely for all patients so
  that patients receive their bills within 1 week
  of discharge or visit and every charge is accurate

• By June 2010, ABC hospitals ED visit bills will
  be error free and sent to patients within 24
  hours of their visit.

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Your Turn select an important quality challenge

• Write an aim statement

• By when?
• What?
• For whom?
• How much- improvement?

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Why aim statements?
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How will we know that a change is an improvement?

• Measures
• Outcome
• Process
• Balancing

• Falls example
• Falls with injury moderate and above
• Assessment for falls risk compliance
• Assessment for injury risk
• Hourly rounds per day
• Privacy complaints
• Fall incidence

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Data Over Time Minimum Standard--Annotated Time
Series
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P D S A
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Why test Likelihood of Success
Adapted from The Improvement Guide A Practical
Approach to Enhancing Organizational Performance.
G. Langley, K. Nolan, T. Nolan, C. Norman, L.
Provost. Jossey-Bass Publishers., San Francisco,
1996.
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Where do changes come from?

• Clinical Guidelines
• Frameworks in public domain
• IHI.org
• NICHQ.org
• Other sites?
• Staff experience
• Known exemplars
• And . . .

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Adapt a Change to Your Unique Setting
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Tips for scale of change

• Test of 1
• Cut in 1/2 and cut in 1/2 again
• Ask for volunteers
• Do one yourself
• Ask what was tested today?

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Scope of PDSA
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Model for Improvement
Setting Aims Establishing Measures Selecting
Changes
2001 Associates in Process Improvement
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Whats all this have to do with Leadership?
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1. Leaders Establish and Oversee Specific
System-Level Aims with Board

• Help board
• Establish solid measures of system-level
  performancefor example, hospital mortality rate,
  cost per adjusted admission, adverse drug events
  per 1,000 doses
• Track and report monthly
• Adopt specific aims for breakthrough improvement
  of those measures

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As a Leader Heart Mind

• Commit personally to these aims. Communicate
  them to all stakeholders in a way that engenders
  heartfelt commitment to achieving them.

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Sidebar Ascension Health-- zero preventable
deaths or injury in 5 years at every hospital

• At every board meeting review patient stories
  about preventable deaths and approve the action
  plan to prevent similar events in the future.
• Track risk-adjusted mortality monthly
• Made the aim a management performance
  expectationzero preventable deaths and injuries

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2. Senior Leaders Focus on One or Two Aims

• Focus on one or two aims, supported by three or
  fewer drivers or key change ideas
• Dont overwhelm staff with cumulative burden of
  projects (especially when added on top of their
  daily work!).

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Example reduce mortality by 20

• Medical and Nursing Leader work on
• Hand hygiene
• Vaps, CLBSI, DVT, RRT, SSI
• Multi-professional rounding
• CFO works on
• Lean supplies at right place and time

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3. Pay attention to 1 or 2 aims!

• What you pay attention to tends to gets the
  attention of the entire organization.
• Ask about projects in regular project reviews.
• Ask about most recent tests of change.
• Make some yourself, and be transparent.
• Tell stories.

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4. Put patients and family on your improvement
teams

• Add will
• Add urgency and execution
• Add fresh ideas and perspective because they have
  an outside view

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5. Turn Finance Leader into an Improvement Leader
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6. Engage physicians as partners in improvement
not as customers

• Involve them in quality projects
• Link improvement to what matters to them
• Use data share common aim
• Make the right thing to do the easiest thing to
  do
• Communicate candidly
• Judiciously use their time

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7. Build improvement capacity

• Create capacity so all use Model for Improvement
• PDSA becomes integrated way of problem solving
• Testing, using a hypothesis, making predictions
  for learning are daily language and activities

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Model for Improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
Associates In Process Improvement
What change can we make that will result in
improvement
Edwards W. Deming
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Berwick Advices

• Get a clock
• Get together
• Get goal
• Get started