2 Techniques Great Leaders use for Sustainment

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2 Techniques for Sustainment

• Tony Gorski is CEO of Safer Healthcare. Mr. Gorski is an award-winning speaker, published author and recognized subject matter expert in helping hospital boards, CEOs and management teams transform operational performance and creating High Reliability Organizations (HROs). Mr. Gorski is also driving the launch of www.MyRounding.com, an iPad Leadership Rounding application for directors, managers and frontline staff. Mr. Gorski holds a Bachelor of Science in Engineering from Marquette University and a Masters of Business Administration from the University of North Carolina in Chapel Hill. Mr. Gorski currently resides in Denver, CO.

Tony Gorski, BSIE, MBA

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1. To understand the use and importance of Dashboards to inculcate behaviors post-process improvement

2. To learn the importance of Leadership Rounding as a method to sustain success.

Objectives

2 Techniques Great Leaders use for Sustainment

Tony Gorski BSIE, MBATuesday, September 10th, 2013

In this webinar we will discuss 2 techniques that Great Lean Leaders use to help change stick and sustain improvements:

Great Lean Leaders:

• Make the invisible………..visible. Dashboards drive direction and turn subjective views into objective data.

• Know that most of the work is after the Improvement Event takes place. Leading organizations leverage Leadership Rounding post-conversion to drive sustained improvements months/years after conversion.

2 Techniques used for Sustainment

Perfect Patient Index

1. Identify the key elements that drive a successful case that has no surprises

2. Use simple ‘Yes / No’ logic

3. Capture data for every case

4. Create graphical depiction

5. Post results and discuss in daily huddle

Hospital Case Study

• 9 elements defined– Pre-Surgical Testing– H&P– Consent– Block Request Accurate– Case Scheduled Correctly– Briefing– Timeout– Debriefing– Case Start

Make the invisible………..visible.

Dashboards drive direction and turn

subjective views into objective data.

10

Initial Target

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perfect Patient IndexOverall Performance

1 2 3 4 5 6 7

11

Initial Target

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perfect Patient IndexH&P / Consent / Pre-Surgical Testing

1 2 3 4 5 6 7

12

Initial Target

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perfect Patient IndexCase Sched Correctly / Brief / Timeout / Debrief / Case Start

1 2 3 4 5 6 7

13

Timeo

ut

Pre-Su

rg Te

sting

Case Sc

hed Corre

ctly

Block Req

uest Accu

rate

H&P

Consent

Case St

art Brief

Debrie

f0%

10%

20%

30%

40%

50%

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70%

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100%

Perfect Patient Index Elements% of Time Completed

1 2 3 4 5 6 7

Patient Safety Index Elements% Completed

14

Surgeon 4Surgeon 15Surgeon 16Surgeon 11Surgeon 12Surgeon 25Surgeon 26Surgeon 27Surgeon 13

Surgeon 3Surgeon 21

Surgeon 8Surgeon 9Surgeon 1Surgeon 7

Surgeon 10Surgeon 6

Surgeon 22Surgeon 19Surgeon 17Surgeon 14Surgeon 23Surgeon 24Surgeon 20

Surgeon 5Surgeon 2

Surgeon 18

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1866533332239111413114141319241052167151014

Perfect Patient Index by SurgeonTotal # of

Cases Measured

1 2 3 4 5 6 7

Patient Safety Index Elements% Completed

15

1 2 3 4 5 6 7

Surgeon 4Surgeon 16Surgeon 26Surgeon 13

Surgeon 3Surgeon 21

Surgeon 8Surgeon 11Surgeon 10

Surgeon 7Surgeon 1

Surgeon 15Surgeon 12Surgeon 25Surgeon 27Surgeon 23Surgeon 17

Surgeon 9Surgeon 22Surgeon 24Surgeon 19

Surgeon 6Surgeon 14Surgeon 20

Surgeon 5Surgeon 18

Surgeon 2

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1863223911541113633352414132119141067151410

Perfect Patient Index (w/o Case Starts) by SurgeonTotal # of

Cases Measured

Patient Safety Index Elements% Completed

16

Surgeon 16Surgeon 13Surgeon 21

Surgeon 4Surgeon 7Surgeon 8

Surgeon 12Surgeon 25Surgeon 26Surgeon 27

Surgeon 1Surgeon 11Surgeon 17

Surgeon 9Surgeon 10

Surgeon 3Surgeon 22Surgeon 14Surgeon 23

Surgeon 6Surgeon 24Surgeon 15Surgeon 20Surgeon 19

Surgeon 5Surgeon 2

Surgeon 18

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

6239181111333313524144213105142166719151014

CRM Index by SurgeonTotal # of

Cases Mea-sured

1 2 3 4 5 6 7

Best Practices in LeadershipSustaining Process Improvements through Transformational Rounds

Leadership Rounding

In the Context of Transformation

Leadership Rounding

“The practice of leadership rounding in hospitals should be embedded as a standard of care in all organizations.”

“Leadership rounding programs help reduce patient anxiety and increase levels of patient satisfaction and employee engagement.”

Leadership Rounding: What is it?

“Leadership rounding is the practice of structured conversations and questions to engage physicians, staff and patients a regular basis to improve the culture and service of an organization as well as to identify opportunities for improvement.”

Current Practices

Leadership Rounding

Why do it?

The single biggest problem with communication is the illusion that it has taken place.

George Bernard Shaw

Leadership Rounding: Why do it?

• Senior Leader and Management Visibility

• Physician, Staff and Patient Engagement

• Break Down Organizational and Hierarchical Barriers

• Organizational Cohesion

• Hardwire Process Improvement

• Transform the Culture of Care

Who is Currently Doing it?

How many organizations are currently using the following rounding practices?

1. Executive Leaders

2. Vice President Levels

3. Department Directors

4. Department Managers

5. Front Line Staff

How Frequently are You Rounding?

What is the frequency of the rounding within your organization?

1. Executive Leaders

2. Vice President Levels

3. Department Directors

4. Department Managers

5. Front Line Staff

• Never

• Yearly

• Quarterly

• Monthly

• Weekly

• Daily

• Hourly

1. Planning and Execution

2. Project Management (Who and How)

3. Tools and Templates

4. Accountability

5. Reporting

6. Sustainment

7. Continuous Improvement

Leadership RoundingKey Considerations and Foundational Elements

Round

Issue Issue

Best Practice

Rounding Structure

Interview

Issue Issue Issue

Interview

Issue Issue Issue

Interview

Issue

BENEFITSRounding Supports Culture, Service, Patient Safety and Quality Goals

1. Builds Culture of Service

2. Enhances Employee Relations

3. Identifies Opportunities for Improvement

4. Increases Levels of Satisfaction

5. Shines a Light on Patient Safety

Rounding for Rounding Sakevs. Rounding for Results

1. What’s going well?

2. Who is deserving of recognition?

3. What one thing can I do to support you?

4. What resources do you need to do your work?

BENEFITSRounding Supports Culture, Service, Patient Safety and Quality Goals

1. Serves to retain staff / physicians

2. Builds employee relations and morale

3. Creates recognition opportunities

4. Documents resource needs

Questions Pre Post Gain

Communication w/Nurses (% always) 73% 82% 9%

Communication w/Doctors (% always) 76% 80% 4%

Responsiveness of Hospital Staff (% always) 57% 67% 10%

Pain Management (% always) 67% 74% 7%

Communication about Medicines (% always) 55% 59% 4%

Cleanliness of Hospital Environment (% always) 67% 79% 12%

Quietness of Hospital Environment (% always) 50% 54% 4%

Discharge Information (% yes) 78% 83% 5%

Overall Rating (% 9 & 10 rating) 60% 82% 22%

Willingness to Recommend (% yes: definitely) 64% 84% 20%

HCAHPS Results (12 months of Rounding)

Focus on Patient and Associate Safety

• Evidenced based standard work and decision-making

• Blame-free culture with accountability and transparency

• Shared knowledge with effective RCA process

Continuous Improvement Principles of “Lean”

• All associates empowered to make changes and “stop the line”

• Increase quality, decrease waste, decrease cost, increase satisfaction

Rounding with Purpose

Dept. Dept.

Hospital

Dept. Dept. Dept.

Hospital

Dept. Dept. Dept.

Hospital

Dept.

System

GroupGroup Group

Dept. Dept.

Hospital

Dept. Dept. Dept.

Hospital

Dept. Dept. Dept.

Hospital

Dept.

System

GroupGroup Group

Appreciation(Recognition & Rewards)

• People love specific & positive feedback

• Behavior that is recognized positively will be repeated

• Pay is way down the list of employee motivation factors…recognition at the top

• Complimenting takes getting used to!

Leadership Rounding Worksheet

Leadership Rounding Worksheet

Take the time to Structure your rounds…

Do you have a rounding strategy? How frequently do your different levels Round? Do you have a set calendar / schedule? Is there a standardized checklist / questionnaire? How do you record / gather information? Method of follow-up? Designated individual

Leadership Rounding Worksheet

Provide Quick Tips to the Team…

Introduction – quick tips Pulse Check & Collect Actionable Data Closing the loop

Leadership Rounding Worksheet

Create Custom Rounding Templates…

Scripts Question Sets Data compilation methods

SharedVision

Skills /Training

Incentives ResourcesAction

RequiredSuccessfulChange

Skills /Training

Incentives ResourcesAction

RequiredConfusion

SharedVision

Incentives ResourcesAction

RequiredAnxiety

SharedVision

Skills /Training

ResourcesAction

RequiredGradualChange

SharedVision

Skills /Training

IncentivesAction

RequiredFrustration

SharedVision

Skills /Training

Incentives ResourcesFalseStarts

Leaders Identify the Missing Link

Your Takeaways…

• Feel– Have I used Dashboards to drive awareness?

• Think– What items should be on our Dashboard?– Do we have ‘structured rounding’ discipline?– Can we create a Rounding Dashboard?

• Do– Determine the key elements of your Perfect Patient Index– Create your PPI Dashboard– Develop a ‘structured rounding’ template to conduct consistent

Transformational Rounds

Questions and Answers