“Accelerating Improvement in

Patient Experience by Integrating Two

Proven Methodologies:

LSS Lean Daily Management and

Influencer®”

Presented by Greg Zobell and Teresa Deason

Introductions – Teresa Deason

• McCaw Cellular Communications

• Genie Industries

• Jefferson Healthcare

• The Everett Clinics

Teresa Deason is the President & Founder of Lean Synergy &

Solutions and Senior Consultant at JWA Consulting. Over 30

years experience in management , marketing, project

management, facilitation, training, quality improvement & lean.

Her lean expertise includes implementation of lean

management systems, value stream improvement, internal

consultant development, training and executive coaching.

• John C. Lincoln Health Network

• Children’s Hospital & Clinics of Minnesota

• Children’s Hospital Central California

• Nemours a Children’s Health System

Lean Clients include:

Introductions – Greg Zobell

Greg Zobell is the founder and managing partner of Zobell

Consulting, a consulting practice committed to inspiring service

and leadership excellence in healthcare organizations.

With over 30 years experience in Healthcare, Greg’s primary

role since November 2013 has been the Network Director for

the Patient Experience for the Scottsdale Lincoln Health

Network.

Healthcare Experience includes:

• Medical Technologist

• Associate Administrator at Good Samaritan Medical Center, Phoenix, AZ

• Associate Administrator at Banner Desert Medical Center, Tucson, AZ

• CEO, Kino Community Hospital in Tucson, AZ

Greg is a certified trainer for VitalSmarts Crucial Conversations®, Influencer®, and

ChangeAnything® & Crucial Accountability® courses.

“Deliver the

Best Patient Experience

in the Nation.”

Our Vision

Learning Objectives

• Understand the Six Sources of Influence

necessary for accelerated change.

• Learn how to integrate the LSS Lean Daily

Management System with the Influencer® Model

to improve specific HCAHPS results.

• Create a Patient Experience Daily Management

System Dashboard.

Challenge in Healthcare

Delivered Service Quality

• Versus industry norms

• Personal Needs

• Past Experience

• Word of Mouth

Expected Service

• Reliability

• Responsiveness

• Assurance

• Empathy

Perceived Service

“Would you recommend us to your friends & family?

Closing the Gap

Expected Service

• Reliability

• Responsiveness

• Assurance

• Empathy

Strategy

Standards

Execution

Communications

Delivered Service Quality

• Versus industry norms

• Personal Needs

• Past Experience

• Word of Mouth

Own the Gap

Strategy – Understand Patient Expectations

Standards – Delivery Clinical & Service Quality

Execution – Daily Action & Problem-solving

Communications – Outbound to Patient

LeadershipMindset

Methods

ManagementSystem1. Strategy Deployment2. Cross-functional Management3. Daily Management

Lean as the Management System

Good Results Come from Good Process

ResultsProcess

Nature of

people’s

actions at

the

process

• Quality

• Cost

• Delivery

• Safety

Process

outcomesConsequences

• Rewards (or lack of)

• Feedback

A lot of Toyota’s

management

focus is here

A lot of our

management

focus is here

Adopted from Mike Rother, Toyota Kata

A Model for Influencing Sustainable Change

Step 1. What

do you want to

achieve?Step 3. What are the

barriers?

Step 4. What tactics for all

Six Sources?

Step 2. What

few behaviors

will lead to the

greatest

amount of

change?

Key Steps for Sustainable Change

1. Identify the Goal/Target

2. Identify Vital Behaviors

3. Engage all 6 Sources of Influences

– Identify Barriers

– Identify Tactics

4. Daily Management to ensure Compliance,

Accountability & Transparency

The Worksheet

The Influencer Model

Step 1. What

do you want to

achieve?Step 3. What are the

barriers?

Step 4. What tactics for all

Six Sources?

Step 2. What

few behaviors

will lead to the

greatest

amount of

change?

What do you want to Achieve?

Step 1 – Clarify Measureable Results

15

S

M

A

R

T

Specific

Measureable

Achievable

Reasonable

Timely

By / / / ______________________(WHEN – Time bound) (WHO/WHAT – Specific)

from ___________ to ___________________(MEASURE - number, rate, % change and baseline - Measureable)

Step 1. What do

you want to

achieve?Step 3. What are the barriers?

Step 4. What tactics for all Six

Sources?

Step 2. What

few behaviors

will lead to the

greatest amount

of change?

The Influencer Model

The Big Idea

1.The best way to improve results

is to focus not on results, but on

the behaviors that produce

them.

2.Even with complex and long-

standing problems, just a few

vital behaviors can lead to

enormous change.

Identify Vital Behaviors

What are the

recommended vital

behaviors when

experiencing a rattlesnake

bite?

Call 911.

Elevate the bite area.

Stay calm.

Drive yourself to the hospital.

Put ice on the bite.

Cut open the bite and attempt

to suck out the venom.

Use a tourniquet.

Vital Behaviors Quiz

What few behaviors will

lead to the greatest

amount of change?

Crucial Moments:

•

•Vital Behaviors:

•

•Identify Crucial Moments

•

•

•

Describe Vital Behaviors

•

•

•

Step 2 – Identify Vital Behaviors

Step 1. What do

you want to

achieve?Step 3. What are the barriers?

Step 4. What tactics for all Six

Sources?

Step 2. What

few behaviors

will lead to the

greatest amount

of change?

The Influencer Model

Step 3: Engage All Six Sources of Influence

There is a Big Tug of War going on

Tactics for all Six Sources

Accountability &

Transparency

for Vital

Behaviors

Step 3 – Engage all of the 6 Sources

Today’s Workshop Focus is

Sources 5 & 6

Step 4 – LSS Daily Management System

How can we measure compliance to vital

behaviors?

• Observation

• Self-auditing

• Peer-auditing

• Patient feedback

You must first

Establish the Standard

“Without standards, there can

be no improvement”

— Taichi Ohno

The Basics

Standard Work & Standard Work Audits

– Documented procedure owned by an

individual, used by everyone

– Standard work documented & has an owner

– Evidence that everyone follows the standard

Documented Standard Work

for Vital BehaviorsCompliance to Standard Work

Standard Work Audit

100

95

90

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

Au

dit

Sc

ore

(%

)

4/2

7/2

009

4/2

8/2

009

4/2

9/2

009

4/3

0/2

009

5/1

/200

9

5/4

/200

9

5/5

/200

9

5/6

/200

9

5/7

/200

9

5/8

/200

9

5/1

1/2

009

5/1

2/2

009

5/1

3/2

009

5/1

4/2

009

5/1

5/2

009

5/1

8/2

009

5/1

9/2

009

5/2

0/2

009

5/2

1/2

009

5/2

2/2

009

5/2

5/2

009

5/2

6/2

009

5/2

7/2

009

5/2

8/2

009

5/2

9/2

009

Team: Deer Valley Inpatient Charge Nurses Date: Sheet of

Process Description: Whiteboard communication

Product: Whiteboard standard work

Location: Inpatient JCL DV

Standard Work Owner: Brenda Hollenbeak/ Christina Ridings

Op Description PCT RNElapsed time

(Minutes)Notes

1 Notified of staff assignment 60 60 2

a. New admission/Transfer

b. Shift change

2 Fill out staff names/date/DR name/Phone #/Room # 120 2

3 Meet & Greet 60 3

a. Introduce self.

b. Review already written (#2) information with the patient.

c. If family present ask pt if it is ok to review info with family in room.

4 Ask/Fill out patients preferred name 30 4

5 Ask/Fill out patients contact name/# 120 6

6 Review diet, activity, and precautions 90 7

7 Review POC: setting shift goals 175 10

8 Review DC plan and expected date 35 11

9 Review pain management; scale/set goal/next med available 120 13

10 Review/educate medication and S/E 120 15

11 Questions for care team 60 16

Seconds 120 810 0

Minutes 2 14 0

Standard Work

Time (seconds)

Daily Structure of

accountability &

transparency

Identify WHAT to

measure?

Lagging Measures

Leading Measures

Step 4 – LSS Daily Management System

Lagging Measures:

•

•

Leading Measures for

compliance to Vital Behaviors:

• Compliance to Standard Work

•

•

Fro

m S

tep

1

Step 4 – LSS Daily Management System

28

Patient Experience

Standard Work Audit

Re

su

lt M

ea

su

res

DEER

VALLEY

NORTH

MOUNTAIN

OSBORN SHEA THOMPSON

PEAK

71 (55%tile) 77 (80%tile) 78 (82%tile) 74 (70%tile) 83 (93%tile)

76 (30%tile) 81 (75%tile) 74 (30%tile) 77 (40%tile) 85 (90%tile)

75 (10%tile) 80 (40%tile) 77 (20%tile) 80 (40%tile) 84 (70%tile)

57 (10%tile) 60 (20%tile) 64 (40%tile) 65 (43%tile) 74 (80%tile)

70 (40%tile) 68 (30%tile) 70 (40%tile) 78 (92%tile) 68 (30%tile)

73 (92%tile) 71 (87%tile) 63 (45%tile) 60 (25%tile) 73 (92%tile)

72 (45%tile) 74 (60%tile) 73 (50%tile) 66 (17%tile) 73 (50%tile)

60 (47%tile) 53 (25%tile) 45 (<10%tile) 48 (10%tile) 75 (92%tile)

90 (90%tile) 86 (60%tile) 81 (20%tile) 82 (25%tile) 90 (90%tile)

27 (23%tile) 32 (47%tile) 70 (83%tile) 65 (51%tile) 75 (98%tile)

Discharge Information

Food Quality

Responsiveness

Pain Management

Medication Communication

Cleanliness

Noise

Patient Experience Scores 03-03-14

Overall Hospital Rating

Nurse Communication

Physician Communication

Make it Visual

on a

Dashboard

Le

ad

ing

Mea

su

res

JOHN C. LINCOLN NORTH

MOUNTAIN CASE STUDY

Hospital Compare April 2012-March 2013Patient Experience Scores

National

Average

Arizona

Average OSBORN SHEA

THOMPSON

PEAK

DEER

VALLEY

NORTH

MOUNTAINOverall Hospital Rating

70 69 68 72 77 69 67Nurse Communication

78 76 73 75 77 73 72Physician Communication

81 77* 69 75 76 72 72

Responsiveness

67 65 64 63 62 62 57Pain Control

71 70 69 73 75 68 68Medication Communication

64 62 57 61 62 60 57Cleanliness

73 69 68 70 75 64 70Noise

61 57 47 52 66 53 51Discharge Information

85 85 78 81 78 84 82

These

scores are

adjusted for

Mode and

Estimated

Patient Mix

Below National Average

Top Quartile

SLHN Hospitals – Apr 2012-Mar 2013

HCAHPS Patient Experience Scores

Key #2:

Find

Vital

Behaviors

Key #3:

Engage all

Six

Sources of

Influence Find Vital BehaviorsA high-leverage action that, if routinely

enacted, will lead to the results you want.

Tend to lead directly to better results

Tend to break us out of self-defeating

patterns of behavior

Tend to cause many other behaviors to

flow naturally.

Identify Crucial MomentsThe point in time where the right behavior, if

enacted, leads to the results you want.

The Model: The New Science of Leading Change

Improving Medication Communication

1. Clearly write New Medication

and 2 Side-effects on every

Whiteboard

2. Conduct Teach-back with

every patient on new

Medications

3. Leadership Audit of vital

Behaviors

Identify Crucial Moments Nurse Leader Rounding to Patients

Executive Leader Rounding with Nurse

Leaders to the Patients

Whiteboard Dialogue with Patients

Pain Management (Control)

Call Button Response

Communication about Medication

Discharge Instructions

Service Recovery on

concerns/complaints

Room/bathroom cleanliness

Noise Control

Discharge Phone Calls

Shift Change

Doctor Communication

Motivation Ability

Pers

on

al

So

cia

lSt

ruct

ura

l

Service Standards

and Behaviors

Patient Rights

“The Right Thing to Do”

HCAHPS survey results

Active listening to patient

feedback (Stories)

Study Best Practices

Understand Default

Future

Deliberate Practice of Teach-

Back Skills

Nursing Leader Rounding &

/Coaching Skills

Standard Work

Nurses keep daily score on

Medication Communication

Enlist the power of opinion

leaders in Hospital Team

focused on improving

Medication Communication

Daily Management System

with Daily Huddles

Practice Accountability

Leader audit through

rounding

Leader Feedback and

Coaching

Daily Management System

Accountability

Reporting in Leader Huddles

Pharmacy providing

Medication Information

Meaningful rewards and

celebrations

Performance

appraisals and other

formal Accountability

Compensation system

Whiteboards in patient

rooms

Weekly HCAHPS

Scoreboards

Standard Work Checklists

Standards/Behaviors

visual cues: posters,

Standard of the Month

Medication Information

folders in Patient Rooms

To achieve 64

% Always for

Medication

Communication

by December

31, 2013.

(67% Always

by 12/31/15)

Will it be worth it? Can I/we do it?

Key #2:

Find Vital Behaviors

Key #3:

Engage all Six Sources of

Influence

Purpose: To ensure that all RNs utilize and exhibit the

vital behaviors for medication education with our patients.

Process Steps:

1. Inform Patient of Medication & Side Effects

2. Update Whiteboard

3. Educate Patient Using the Side Effect Teaching Sheet

4. Conduct Patient Teach Back

5. Document Care Notes

6. Update Discharge Folder

Vital Behaviors: Medication Communication

Engage 6 Sources: LSS Daily

Management System

34

Patient Experience

Lag

gin

g R

esu

lt M

easu

res

DEER

VALLEY

NORTH

MOUNTAIN

OSBORN SHEA THOMPSON

PEAK

71 (55%tile) 77 (80%tile) 78 (82%tile) 74 (70%tile) 83 (93%tile)

76 (30%tile) 81 (75%tile) 74 (30%tile) 77 (40%tile) 85 (90%tile)

75 (10%tile) 80 (40%tile) 77 (20%tile) 80 (40%tile) 84 (70%tile)

57 (10%tile) 60 (20%tile) 64 (40%tile) 65 (43%tile) 74 (80%tile)

70 (40%tile) 68 (30%tile) 70 (40%tile) 78 (92%tile) 68 (30%tile)

73 (92%tile) 71 (87%tile) 63 (45%tile) 60 (25%tile) 73 (92%tile)

72 (45%tile) 74 (60%tile) 73 (50%tile) 66 (17%tile) 73 (50%tile)

60 (47%tile) 53 (25%tile) 45 (<10%tile) 48 (10%tile) 75 (92%tile)

90 (90%tile) 86 (60%tile) 81 (20%tile) 82 (25%tile) 90 (90%tile)

27 (23%tile) 32 (47%tile) 70 (83%tile) 65 (51%tile) 75 (98%tile)

Discharge Information

Food Quality

Responsiveness

Pain Management

Medication Communication

Cleanliness

Noise

Patient Experience Scores 03-03-14

Overall Hospital Rating

Nurse Communication

Physician Communication

Lea

din

g M

easu

res

Daily Tracking of Compliance to Standard Work

Weekly

Medication Communication

Total HCAHPS

Quarter to Date

Leader Rounding Compliance

White Board Compliance

Bedside Report

John C. Lincoln North Mountain Hospital

Measures2012

Jan-2013

Feb-2013

Mar-2013

Q1 Q1Apr-2013

May-2013

Jun-2013

Q2 Q2Target

BaselineMo.

ActualMo.

ActualMo.

ActualQT

ActualMo.

TargetMo.

ActualMo.

ActualMo.

ActualQTD

ActualMo.

Target2013

Patient Experience n=145 n=117 n=106 n=375 n=182 n=153 n=124 n=472

HCAHPS % 9 or 10 69 64 59 67 64 69 67 72 69 68^ 69 71

HCAHPS - Nursing 73 73 69 73 71 73 78 75 75 76 75 79

HCAHPS - Doctors 74 73 71 72 72 75 80 74 77 77 75 81

HCAHPS - Call Button Response 57 61 54 63 58 59 64 50 57 61 62 66

HCAHPS - Pain 70 65 57 71 65 70 73 69 72 71 70 71

HCAHPS - Medication 58 53 62 62 58 57 72 69 73 71 62 64

HCAHPS - Cleanliness 71 72 65 68 69 69 71 70 74 71 70 73

HCAHPS - Noise 52 50 47 49 49 52 56 54 60 56 54 60

HCAHPS - Food 29 24 18 24 22 29 24 38 25 29^ 30 34

HCAHPS-Discharge Instructions 84 81 81 86 82 84 86 86 87 86 84 85

ED Overall Satisfaction 44 51 48 52 50 45 48 54 50 50 46 50

The Results – Medication Communication

Mode adjustments and ESTIMATED Patient Mix Adjustments have been applied

to the dimension scores. Scores for the individual questions do not have adjustments applied.

FY 2016

VBP

Thresholds

John C Lincoln North Mountain Hospital Phoenix, AZ

Ap

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62.33 68.13 72.77Communication about

Medications56.1 58.9 62.5 63.5 55.0 55.4 57.3 57.9 70.8 64.7 68.6 71.81

62.

33

68.

13

72.

77Med Explanation 73.3 75.9 78.3 80.4 72.7 74.0 75.4 75.7 82.9 78.1 80.3 83.1

62.

33

68.

13

72.

77Med Side Effects 46.2 49.2 54.0 53.9 44.6 44.2 46.6 48.1 66.8 59.3 64.8 67.1

0.0

0

0.0

0

0.0

0Number of Surveys 191 191 180 270 209 219 256 185 228 219 223 154

90

thP

erc

en

tile

0

10

20

30

40

50

60

70

80

2009 2010 2011 2011 4Q 2012 1Q 2012 2Q 2012 3Q 2012 4Q 2013 1Q 2013 2Q 2013 3Q 2013 4Q 2014 1Q

EMRImplementation

Influencer

Begins

John C. Lincoln North Mountain Hospital

Medication Communication

DMS

Refresh

Excellence Award

Questions & Answers