Pursuing Excellence: How to Turn Intentions into Reality

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Pursuing Excellence How to Turn Intentions into
Reality

• Patrice L. Spath
• MEDITECH Chief Nurse Executive Symposium
• Nov. 5, 2009

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Agenda

• Core elements of health care performance
  excellence
• Role of nurse leaders in performance excellence

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The Best of Intentions

• Little effort has been spent on changing the
  system that gives rise to, or permits, errors.
• Heres some of the actions San Jose Hospital took
  to improve the system
• Developed extensive program to assess patient
  satisfaction
• Standardized medication transcription
• Provided red-tagged wristbands for patients with
  allergies
• Developed medical staff clinical activity
  profiles to identify questionable practices
• Replaced problem-prone equipment such as IV poles
  and bedside commodes
• Strengthened nurse accountability for verifying
  blood prior to transfusion
• Standardized some equipment used by surgeons
• Established medical staff committee to deal with
  unacceptable physician behavior

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Process Problems are Still Common
Tucker, A.L., Edmondson, A.C. (2003) Why
Hospitals Dont Learn from Failures
Organizational and Psychological Dynamics that
Inhibit System Change, California Management
Review, 45(2), 55-72.
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Nagging Question

• Weve made progress improving quality and
  organizational performance, yet significant
  quality and performance issues remain

Why havent our good intentions resulted in a
greater rate of progress?
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Were not in Kansas Anymore
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Advancing Performance Excellence
Thinking DifferentlyThe necessary prerequisite
for turning good intentions into reality

• Sure we have to solve problems. Certainly stamp
  out the firebut stamp out the fire and get
  nowhere. Stamp out the fires puts us back to
  where we were in the first place.
• Dr. W. Edwards Deming

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How Do We Get Better?

• Quality improvement climate at Ellsworth County
  Medical Center (KS) in 1998
• Improvement projects lacked focus
• Measurement activities sporadic or not directed
  to most important aspects of patient care
• Few substantive changes or improvements

Roger Pearson, CEO
Betsy Lee, DNS
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Thinking Differently

• ECMC used the Baldrige criteria and
  self-assessment to evaluate their quality program
• Realized focus on fixing things needed to
  change to building organizational capacity where
  excellence is the way of doing things.

Spath, P. (2005). Leading your healthcare
organization to excellence a guide to using the
Baldrige criteria. Chicago Health Administration
Press.
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Baldrige Criteria vs. TJC Standards

• Build Organizational Capacity for Excellence
• Baldrige How do senior leaders communicate and
  evaluate organizational performance expectations?
  What is your strategic planning process, and how
  is the strategic plan communicated to the entire
  staff? How do you gather and analyze data to
  support strategic decisions? How is your
  education and training system tied to your
  strategic plan?
• Fix Things
• Joint Commission The organization constantly
  evaluates and improves its processes for
  medication use including  
• Selection, procurement, and storage
• Prescribing or ordering, and transcribing
• Preparation and dispensing
• Administration and
• Monitoring effects on the patient

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Enablers in the PerformanceExcellence Journey
Create theVision
Build Organizational Capability
Achieve Enhanced Performance
Clinical and Business Results
DriversLeadershipStrategic Planning
CapabilitiesHuman Resource FocusProcess
Management
Information Analysis
Baldrige Criteria
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Performance Excellence Core Values

• Visionary Leadership
• Patient-Focused Excellence
• Organizational and Personal Learning
• Valuing Staff and Partners
• Agility

• Focus on the Future
• Managing for Innovation
• Management by Fact
• Social Responsibility and Community Health
• Focus on Results and Creating Value
• Systems Perspective

http//www.quality.nist.gov
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Critical Driver Leadership

• Flynn, B.B. and Saladin, B. (2001). Further
  evidence on the validity of the theoretical
  models underlying the Baldrige Criteria.  Journal
  of Operations Management. 19 (6), 617-652.

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High Reliability Organizations

• Although operating in hazardous conditions, HROs
  have fewer adverse events than would be expected

• The HRO concept is now being applied in
  healthcare
• High reliability nearly defect-free care over
  time for a patient

• Becoming a High Reliability Organization
  Operational Advice for Hospital Leaders. AHRQ
  Publication No. 08-0022, February 2008, Agency
  for Healthcare Research and Quality, Rockville,
  MD. http//www.ahrq.gov/qual/hroadvice/

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Fix It Design More Reliable Processes

• Prevent failures
• Identify and mitigate failures
• Design system to decrease failure risk

Apply human factors and reliability science
principles
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Critical Driver Leadership
Build Organizational Capacity for High Reliability

• HRO Principles
• Preoccupation with failure
• Reluctance to simplify interpretations
• Sensitivity to operations
• Commitment to resilience
• Deference to expertise

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Preoccupation with Failure

• Leaders in HROs
• Preoccupied with their failures, large and mostly
  small (chronic unease dont rest on past
  successes)
• Watchful of potential safety concerns

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Reluctance to Simplify

• Leaders in HROs
• Encourage diverse opinions and experiences
• Understand that simplifications produce blind
  spots
• Accept and act as if there is more than one
  possibility

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Sensitivity to Operations

• Leaders in HROs
• Mindful attention to the latent conditions and
  operational problems that lead to failure
• Well-developed situational awareness (understand
  what is happening and why)
• Difficulties in operations are attended to
  immediately

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Commitment to Resilience

• Leaders in HROs
• Understand that errors and unforeseen situations
  will arise
• People are trained in recovering, adapting, and
  adjusting to mistakes
• Attention is on prevention and detection of
  errors at their early stages

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Deference to Expertise

• Leaders in HROs
• Empower lower level people to make decisions,
  especially during high tempo operations
• Provide front line staff with access to expertise
  when it is needed
• Actively encourage staff to ask for internal or
  external help

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Organizational Capacity for High Reliability

• Preoccupation with failure
• Reluctance to simplify
• interpretations
• Sensitivity to operations
• Commitment to resilience
• Deference to expertise

Mindfulness
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Turn Good Intentions into Reality
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Leaders Create the Capacity for Excellence
Solving the problems begins with owning the
problems. Because I am responsible for the design
and support of the systems currently in place, I
am part of the problem. To begin improvements, I
must ask, Why have I allowed this system to be
the way it is? Roger Pearson, CEO, ECMC
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High Performing Organizations

• Take a proactive approach to quality and
  continuous improvement it doesnt just happen
• Leaders champion quality and their actions
  reflect their words
• Realize that quality is a journey, not an event
• Create an environment in which excellence is our
  way of doing things

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Thinking Differently Create the Capacity for
Excellence
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Some Parting Thoughts

• Alisa Cohn
• Founder of Alisa Cohn Coaching, which provides
  business coaching for small and large business
  environments
• Professional experience includes CPA license and
  experience at PriceWaterhouseCoopers
• MBA from Cornell University

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http//www.alisacohn.com
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Enjoy the Conference

• Patrice L. Spath
• Brown-Spath Associates
• Forest Grove, OR
• 503-357-9185
• Email patrice_at_brownspath.com
• Website www.brownspath.com