VUMC Quality Pillar Goal: Pioneer Program

Michael Cull, PhD, MSN

Director, Education and Dissemination

Office of Quality and Patient Safety

Roadmap

• Quality Pillar• Organizational Culture• Culture Change and Organizational

Learning• Pioneer Programs

FY2012 GOALFY2011 Baseline

FY2012Threshold

FY2012Target

FY2012Reach

Reduce O/E Mortality 0.73 0.73

(409 lives)0.71

(440 lives)0.69

(470 lives)

Reduce Healthcare Acquired Infections

1.01(recalibrated)

0.91(- 57 infections)

0.86(- 86 infections)

0.76(- 145

infections)

Reduce Adverse Events

1.42(recalibrated to

FY12 convention)

1.28 1.20 1.13

Achieve Top Performance in Clinical Programs

88% 88% 90% 95%

Improve System Reliability 10 6 – 7 8 – 9 10 – 12

FY2012 Goals

FY2012 GOALFY2011 Baseline

(Projected)

FY2012Threshold

FY2012Target

FY2012Reach

Reduce Readmissions inAMI, HF, Pneumonia populations

New Refine and Verify Baseline

Develop or Adopt Predictive

Models and Target

Improvement Efforts

Reduce Readmissions by

10% for each clinical condition

Advance a Culture of Patient Safety, Improvement, and Reliability

NewEnlist and

Prepare Three Pioneer Programs

Initiate Two Projects per

Program from Menu

Increase Safety Climate Survey

Response Rate to 65% in targeted

programs(faculty,

management, staff, residents,

fellows, inclusive)

FY2012 GoalsContinued

FY2012 GOALFY2011 Baseline

(Projected)

FY2012Threshold

FY2012Target

FY2012Reach

Reduce Readmissions inAMI, HF, Pneumonia populations

New Refine and Verify Baseline

Develop or Adopt Predictive

Models and Target

Improvement Efforts

Reduce Readmissions by

10% for each clinical condition

Advance a Culture of Patient Safety, Improvement, and Reliability

NewEnlist and

Prepare Three Pioneer Programs

Initiate Two Projects per

Program from Menu

Increase Safety Climate Survey

Response Rate to 65% in targeted

programs(faculty,

management, staff, residents,

fellows, inclusive)

FY2012 GoalsContinued

FY2012 GOALFY2011 Baseline

(Projected)

FY2012Threshold

FY2012Target

FY2012Reach

Reduce Readmissions inAMI, HF, Pneumonia populations

New Refine and Verify Baseline

Develop or Adopt Predictive

Models and Target

Improvement Efforts

Reduce Readmissions by

10% for each clinical condition

Advance a Culture of Patient Safety, Improvement, and Reliability

NewEnlist and

Prepare Three Pioneer Programs

Initiate Two Projects per

Program from Menu

Increase Safety Climate Survey

Response Rate to 65% in targeted

programs(faculty,

management, staff, residents,

fellows, inclusive)

FY2012 GoalsContinuedCULTUR

E

Step 1: Sit downStep 2: Hold on for 8 seconds

Landing a passenger jet on the Hudson

A successful landing

QPS Mission

• Continuously inspire improvement for the health and safety of patients, families, faculty and staff;

• Advance a culture of habitual excellence and high reliability; and

• Champion discovery, innovation, and transformation in healthcare to high reliability and bring excellence to full-scale.

Organizational Culture

• What is organizational culture?• Should it be changed?• Can it be changed?• If so, what strategies are available?

Culture

“A pattern of shared basic assumptions that was learned by a group as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way you perceive, think, and feel in relation to those problems“

Edgar Schein

Why Change Culture?• Culture supports - or creates barriers for -

systems' efforts to innovate and learn.1

• Cultures that emphasize affiliation, teamwork, and coordination implement and sustain more CQI initiatives.2

• By contrast, cultures that emphasize formal structure, regulations and reporting relationships.3

What is Vanderbilt’s Culture?

Subcultures

Subcultures

Types of change

• Revolutionary

• Sub-groups, targeted

• Incremental

Types of change

• Revolutionary

• Sub-groups, targeted

• Incremental

Types of change

• Revolutionary

• Sub-groups, targeted

• Incremental

How will we advance the Culture?

Artifacts – Values – Assumptions - Beliefs

How will we advance the Culture?

Artifacts – Values – Assumptions - Beliefs

CULTURE change vs SYSTEM change

“Changing the system, will change what people do. Changing what people do, will NOT change the system.”

Peter Scholtes

What will change look like?

…people in the organization identifying with new role model heroes… telling different stories to one another… spending their time differently on a day-to-day basis… asking different questions and carrying out different work rituals.4

What is the Pioneer Program?

An intensive, yearlong program designed to support service line level improvement goals and advance a culture of patient safety, quality, and reliability at VUMC.

Vehicles for change

Resistance to Planned Culture Change 5

• Lack of Ownership• Complexity• External Influences• Lack of Appropriate Leadership• Cultural diversity• Dysfunctional consequences

Ownership and Cultural Diversity

• Internal RFP process

• Collaborative learning

• Interdisciplinary involvement

Pioneer Program

Pioneer Program

Complexity, External Influences and Dysfunctional Outcomes

• Collaborative learning

• Design and Scoping, goal alignment

• QPS expertise

Pioneer Program

Leadership and Dysfunctional Outcomes

• Stated strategic goal

• Required Leadership involvement

• Formal report-outs and celebration

What did we expect?

• What is the mission, make-up, and organizational structure of your program?

• What are some examples of successes and challenges with improvement projects?

• How will program leadership contribute to the Pioneer year?

• What do you hope to accomplish and how will this advance VUMC’s goal of creating a culture of safety, quality, and reliability?

Evaluation Criteria

• Organizational readiness / maturity

• Commitment to the process

• Energy for change

• Alignment with VUMC quality and patient safety goals

• Leadership engagement

Selection

10 Person selection committee22 full proposals submitted for review

Pioneer Year Design

• Kick-off with Lucian Leape, MD

• Comprehensive curriculum that encompasses both internal and external subject matter experts

• Modified IHI Learning Collaborative model

• Customized sessions with onsite technical assistance for project design, scope, implementation, and evaluation

Learning Sessions

• Safety Culture• Julie Morath, RN, MS

• Leadership an promoting professional accountability• Gerald Hickson, MD• Ranja Ramanujam, PhD• Tim Vogus, PhD

• Teamwork and Improvement Science• Allan Frankel, MD

• Reliability and Safety Science• Tim Vogus, PhD• Allan Frankel, MD

Between Sessions Plan

• Bi-weekly collaborative calls: • Updates• Discussion of barriers• Interactive educational component with SME

• Independent between-session team meetings

• Ad-hoc training and consultations using supported coaching

Wraparound model of support

Threshold – Target - Reach

Questions?