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DISCHARGE PATIENT FLOW SOLUTION SESSION

CERTIFICATE OF APPRECIATION Presented to

Clara Barton

on the seventh day of May, A. D. two thousand and two.

On the occasion of completing the first Discharge Patient Flow Solution Session, I wish to extend to you my gratitude and appreciation for improving the flow of patients who are discharged from the institution and reducing the time that these patients must wait to leave the institution. It is through this level of commitment, hard work and cooperation that we are able to discover new ways of caring for patients by expediting the discharge process and ultimately earning their trust. It is because of people like you that we are make life better for our patients. VP Nursing Practice & Chief Nursing Officer VP Hospital & Clinic Operations

Solution Sessions Compressed Strategy Session That Deliver Big Results

Starring

Duke Rohe, drohe@pdq.net

Applications:

1. Shipping Blood Product via Pneumatic Tube System 2. Evaluating Material Transport Alternatives between Buildings 3. Creation of the GI Overflow Clinic to Service Patients on Off-Clinic Days 4. Revamping the Hospital Service for International Patients 5. Organizing the Thoracic Research Staff Output 6. Ideal Patient Experience Established For University Care Plus 7. Streamlining Discharge Services of Transportation, Lab and Pharmacy 8. Wheelchair Shrinkage Reduction 9. Referral Physician Database Integrity 10. Compressing The Outpatient Visit Day 11. Standardizing Charge Reconciliation

Right Way Wrong Way

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Table of Contents

Or

What’s on What Page

What Is it? 3 Solution Session Map 4 What Makes A Solution Session 5 Team Leader Role 6 ‘Don’t Dares’ of a Solution Session 8 Mr. Big Questions 9 Invitation to a Solution Session 10 Team Members: PreWork is 80% of the Success 11 What’s It Like In A Solution Session 12 Anatomy of a Sensing Session 15 Sensing Session Questions 17 Fact Finding Questions 18 Ways Managers Can Help 20 Session Plan 22 Sample Kickoff script 23 Sample Session Agenda 26 Way Managers Can Help Their Representatives 20 Post-it Brainstorming 27 Solution Session use of Osborn Parnes Creative Problem Solving 28 Sample Certificate Of Appreciation 29 Effective Sub Team Meetings 30 To Kill An Implementation 33 Check-off List 35 Art Gallery 38

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What Is It?

“WorkOut” is a time-compressed strategy session that brings all the parties involved in a problem together to explore, design and craft a solution in one setting. In theory, the doors are locked until a committable solution and plan of implementation are derived. It works off the premise that more time doesn’t make a better decision and a golf game isn’t much better with fifteen clubs than with five. This type thinking was a culture buster for GE. It was top down driven where Jack Welch, Mr. Big, came in and said “You guys all need to workout a common solution and I’m be monitoring your success”. Imagine a fast-forward decision-making process with diverse disciplines all developing a best-fit solution for the good of the system. The session’s agenda followed a creative problem solving technique used in high-paced “Thinking Expeditions”. Combining this strategy and technique creates model that can drive collective decision-making in most settings. Eight disciplines at M. D. Anderson Cancer Center were attempting to put the policy and procedures in place to send specimens and blood products safely through the tube system. All had their own opinion of what they wanted to be included in the tube use policy, but none had the ability to come up with a collective solution. After three months of committee gridlock, they called on the Office of Performance Improvement to get objective facilitation support. Having just completed “WorkOut” training from GE and having creative problem solving experience, both were combined into a high-impact session that resolved in 5 hours what couldn’t be accomplished in 3 months. From this experience, a methodology coined by nursing as a “Solution Session” was created and run in ten different applications. All ten have turned out successful deliverables. Not a bad average.

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Solution Session Map What is a Solution Session? An event oriented time compressed strategy session. All impacted who can make a decision are invited. All possible fact-finding is performed up front. The system of solutions is generated in a 2 to 4 hour session. Action teams develop the solutions and implement them. It’s value per hour-consumed ratio hard to match. When is a Solution Session Used?

1. Devising cross function solutions are needed. 2. Where there is no process owner to an enterprise process. 3. Times where consensus via collective decision-making is imperative.

Who’s invited? • Content experts who can make binding decisions for their role, function or

department. • Those willing to commit to implementing decisions derived in the solution

Session. • Those who are willing to fight for the team’s solution. What is the manager’s role? • Either be at the Solution Session or assign someone who can make decisions

on your behalf? • Support your team representative by providing them the time, resources for

fact-finding (answering targeted questions) preparation needed for the Session?

• Do your best to assist all research all fact-finding questions and removing information barriers to making an informed decision at the Session.

What is the member’s role (member often is the manager)?

• Be prepared to commit to 8 hours of work for every hour of the Session length.

• Willingness to shed personal solution for the team’s solution. • Conduct fact-finding for your role, function • Make decisions for the department, function or role they represent • Gain input from constituents they represent and as well be the champion

of the implementation itself. What is the schedule like?

• Fact finding conducted between xx and xx. All members fact-finding will be shared with other members.

• Solution Session proposed date xx • Team session to develop solutions between xx and xx • First follow-up meeting xx • Team session to refine solutions between xx and xx • Second follow-up meeting xx

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What Makes Solution Sessions Successful Responsibility Flow As long as each know their role and responsibilities, then the best minds can make the most informed decisions for their customers, their peers and their organization. Squarely laying the responsibility of their role on their shoulders. The facilitator cannot do the team leader’s part, the team leader cannot do the leadership part, the team leader cannot do the participants’ part. The Solution Session brings together the greatest minds of the organization who have the most at stake in success and asks them to make the best informed decision toward solution. Then take action to make it happen. It’s responsibility alignment with attitude.

Facilitator: Role is to see to it that the Team Leader performs their role. Informs and coaches the Team Leader of how to conduct a successful Solution Session: Inquires as to how each of the steps is coming along, making certain they have a direct current from the leadership to the outcome of the process, that they KNOW that all key participants understand their role, their importance and are doing their fact-finding up front. The facilitator transfers the outcome responsibility to the Team Leader: “This Solution Session process works. It will succeed or fail based on you doing your part. If the participants don’t do their part, then you will have to make up the difference.” Team Leader: Role is to assure participants and their managers understand their role in the fact-finding, session and follow-up meetings. Conduct sensing sessions for those who are unknowns in terms of significance, role and commitment to the success of the session. Comment to the participants: “This Solution Session process works. It will succeed or fail based on you doing your part.” The Team Leader transfers the outcome responsibility Mr. Big: “This Solution Session process works. The team will come up with a set of solutions that have a firm business case. The only missing ingredient to make the them a success in this organization is leadership.” Mr./Ms. Big: Role is to sponsor the team, provide limits of sponsorship then do any necessary pushing within those limits. Pushing is generally not needed, but the mere fact it’s available at the team’s request validates the outcome’s importance. Mr./Ms Big kicks off and ends the Solution Session. They support the follow-up and final-up meetings. They do any organizational blocking and tackling to get the implementation in place. Their leadership is only missing ingredient needed to turn the team’s solution into reality. Be willing to fight for the team’s solution. Participant: Role is to do the fact-finding up front. Participate in the session. Represent department and peers of their role in the binding

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decision making of the session. This expansion of accountability is frightening to most participants and managers and yet honoring at the same time. It is a temporary leadership role during the Solution Session’s duration through implementation. Getting this understanding across is crucial at the invitation and sensing session. The participants funnel communication to and from peers within their role and/or within their department in the fact-finding and in the development and implementation stages. Participants do whatever is needed to support your subteam and the total team to create the best set of solutions and implementation. Each participant feels that failure or success depends on them doing their part. Manager of Participant: Role is to support the participant in fact finding, carving out the necessary time for them to prepare the subteam and total team solutions and implementation. Frequent inquiry as to any support needed will add confidence in the participant’s importance in their role and input to the total team. Subteams: Role is to take the ideas about solutions and develop them into actionable set of strategies. This might include culling out the undoable ideas, staging short and long term possibilities, creating procedures, policies, gain input and acceptance…whatever is needed to develop their set of solutions. There is a lead person deputized for each subteam at the Solution Session. The effectiveness of these meeting must be high and it is the Team Leader’s responsibility to insure that this occurs. The Team Leader conveys to each subteam: “The total team fails of they don’t do your crucial part.” Team: Role is to collectively pull subteam solutions together in a collective system of solutions and implementation support. Reinforced by the Team Leader to all the participants: The only way this team can fail is if you don’t do your part. The organization: Role is to endure and adapt to the proposed solutions by their finest. With targeted resolve fro the team, success is in the making.

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Solution Session Team Leader Role the hub of success

Roles and Responsibilities

1. Owner of the process – from design through implementation. 2. Act as Robocop for team assignments and commitments. 3. Maintain a bulldog mentality toward implementation success. 4. Good at pushing tasks on to those who are best at completing them. 5. Sustainer of the gain. 6. Work in tandem with the facilitator throughout the process. Free flow of

thought and communication between the two. 7. Be an awesome (not overbearing) contributing participant during the

session. 8. Expect to spend a 4 to 10 hours for every hour spent inside the workout

session(s). 9. Broadcast outgoing information to the team, be a funnel for incoming

information. 10. Do the legwork for those who don’t pull their load. 11. Keep your promises to the team and those impacted by the change. 12. Be a cheerleader for the team. 13. Celebrate ideas and successes often 14. Be willing to change yourself 15. Be an active part of the team 16. Have a ‘system’ mindset

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‘Don’t Dares’ of a Solution Session

Team Leader

1. Don’ t dare start a session without the resolve to make it successful. 2. Don’t dare invite someone to a session without telling them what is

expected of them, how important the resolution is, and how to prepare to make it productive.

3. Don’t dare ask people to come to a session without providing some pre- think questions.

4. Don’t dare waste the team’s time on what is not supportive of its purpose. 5. Don’t dare allow sub team meetings to be well facilitated or less than

effective. 6. Don’t dare conduct a session without handing out assignments that further

the team along toward its next meeting. 7. Don’t dare allow time passage to dampen team momentum.

Participant

8. Don’t dare come to a session ill-prepared; without first doing fact-finding

from your perspective. 9. Don’t dare come to a session unless you are willing to whole-heartedly

participate in its conclusion. 10. Don’t dare come to a session without a willingness to shed your solution

for the team’s solution.

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Mr. Big Questions Clarifying Leadership Commitment for a “Solution Session” In a Solution Session (a compressed, lock the door til’ you come out with a committable action plan) strategy session, Mr. Big is like the Jack Welch of GE; the one who leads the charge. Early in the design stages Solution Session, you had better know all about your power base. Where they are coming from, what they are looking for, how far are they willing to commit in the participation, implementation, and sustaining of change. It is much better to learn their unmentioned expectations and limits up front than it is find out along the way. A “Sensing Session” with leadership is necessary to • drive out incorrect assumptions that may be held by leadership and the Team

Leader concerning the change that is being requested. • establish up front, the communication and support needed between the Team

Leader and Mr. Big. • discover the boundaries of Mr. Big’s commitment. • pass along the success factors needed and how leadership can help or hurt

the outcome of the initiative. • give leadership confidence in the Team Leader’s confidence of being

successful given certain levels of support. Here are possible questions the Team Leader might use to gain mutual understanding about leadership support, needs and direction.

1. In leadership’s own words, what would they like to come out of this change initiative? Get 3 to 4 major goals.

2. Are there pre-set assumptions they hold about ‘the’ solution? Are they open for different alternatives? Would they yield to what the team derives?

3. What are the desired time frames for short, medium and long-term completion?

4. Will they be willing to run interference with those who resist the final change? Describe mild, medium, and mega-resistance that might happen. Note: if they hedge or stay vague, this is a loud message.

5. What amount of time, in hours, are they willing to spend supporting the project? (provide an weekly estimate for coming to kick off meetings, encourage the ranks, celebrate, attend progress meetings, …)

6. What resources can be spent on this initiative? What would be the limits? $$, time, change…)

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Invitation to a Solution Session Wimps need not apply

GI Overflow Clinic You pit a good worker against a bad system; the bad system will wing every time.

Rummler Brache Purpose of the session: To design a strategy and process to manage the variable patient care needs of the GI Overflow clinic in a reasonable and responsible manner. What is a Workout session: It is a time-compressed strategy session that brings all the parties involved in a problem together to explore, design and craft a solution in one setting. In theory, the doors are locked until a solution and plan of implementation are derived. It works off the premise that more time doesn’t make a better decision and a golf game isn’t much better with fifteen clubs than with five. This is intended to be a “fast-forward” decision making process with all disciplines developing a best-fit solution. Who is invited: All groups who have a vested interest in the GI Overflow Clinic will be asked to send a representative - physicians, clinic RNs, clinic PSCs, PAs, Research Nurses, and Business Center staff. Rules of engagement:

1. You will represent your discipline. That means you come with the authority to decide what will or will not be done by your discipline. Finding the boundaries and non-negotiables beforehand are essential. You will be provided with information to help you prepare for the session. To make the session as productive as possible, it may be necessary for you to meet with your peers before and after the workout session to get their feedback.

2. All data gathering, knowledge collection, benchmarking, determination of authority, rule challenging, and pre-thinking are done upfront. Remember that everyone at the session is depending on you to have sufficient knowledge to derive a committable solution in this one setting, so come prepared. A customized set of questions to guide preparation will be provided ahead of time.

3. You commit to taking the solution, redesigning your practices and policies for a pilot mode and then being the champion for your discipline to implement the solution Center-wide.

4. You commit to developing and setting the procedures in place to sustain the gain.

Nothing is done. Everything in the world remains to be done or done over

… Lincoln Steffens

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Team Members: PreWork is 80% of the Success Handout for prospective members.

Solution Session is a way of pooling diverse parties of knowledge to collectively make a more informed decision. Since the trademark of a Solution Session is to come up with a system solution in a single setting, everyone participating must arrive prepared with the knowledge, pre-thought and system mindedness to make it happen. Mr. Big and the other members of the session team are not going to like it if you arrive without the research needed to responsibly answer questions, make decisions and fully participate in the solution-finding. What you prepare for beforehand determines your value to the ultimate solution. Prepare the way: Think through what might be needed from your discipline’s perspective. 1. What is the data that might be needed to make an objective decision?

Number of staff involved, cost of negative event, occurrences or volume over time

2. What is the leeway you have in making concessions in current policy/practices for the good of the solution? Challenge traditional thinking here. What is the cost of doing it a different way? What about the cost of poor quality? What are the options that can be taken and what are their ramifications? You are preparing for solutions here, not protecting interests.

3. What are the resources you might need when you get into the “War Room” of the Solution Session? A single event solution may require just-in-time answers in the home department. You should have folks back in the home department ready to scramble to bring in what wasn’t planned on.

4. Put on your systems hat. It is not you versus another department. It is everyone versus the problem. Come expecting to change how you do things to make it better for the whole. You may have to subordinate your operation to optimize the system output. This kind of thinking will help your research as well.

5. Benchmark what other folks are successfully doing on this problem. How did they get there? What is the difference between your way and theirs? What is the scaffolding of their infrastructure or culture and how might we emulate it?

6. What can you get rid of? What can others get rid of? Anything in the way of friction free work is in the way.

The pressure is on. All others coming to the table have gone through this preliminary effort to make that. Come ready to do some horse-trading. What is not available in objective data, pre-work is done through horse-trading. In the Solution Session, you have the best minds working in a collective field so the corporate gut solution is going to be quite informed. The degree of success is dependent on everyone’s flex.

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What’s It Like In A Solution Session Preparation For The Solution Session The overwhelming success is dependent on all its members coming equipped to create solutions and make decisions for needed change to achieve the session’s purpose. Hopefully, before you arrive at the session all possible fact-finding regarding the topic has been evaluated.

You have done due diligence is discovering best practices (benchmarked) either within the institution or in other institutions. You have canvassed fact-finding input from your counterparts in your department or your role in the organization. You have explored the negotiable and non-negotiable with your leadership concerning possible decision-making in the session. Finally any fact-finding questions you have of any of the other of the session members has been sent to the team leader. Coming equipped with all this knowledge is your part in a successful session. What Can You Expect In The Session The session length is 4 hours depending on the magnitude of the change it is tackling. Participants claim it is one of the fastest four hours they have ever spent. It feels like an explosion of ideas that form into settle into a set of solutions that have the entire team fighting for their development and implementation. The session will seem too fast for some, especially nurses, for they like to complete one task before moving onto the next. The lack of time is the stimulant to push past personal agendas to derive a set of team solutions. The output will seem half-baked, but the solution will be fully developed in the series of post meetings. Here’s how it goes: This is one of the most energy packed strategy session you have ever attended. The participants will be broken into teams of eight. It will almost seem like a competition of who can come up the most ideas. Each team member will be equipped with a post-it pad and a marker. The team’s goal is to come up with as many ideas (real and far fetched) as possible. It may sound odd, but in this session Quality is equal to Quantity. This is a creative problem solving process, so the more ideas created, the more to choose from. All ideas are captured via post-it notes. Rule: One idea per post-it; each post-it has at least two words; subject and verb hopefully. As soon as you write it down you call it out for your team members to hear then post it on the flip chart.

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• Mess or Objective -Finding: 30 minutes. This is broken into two parts. Twenty minutes is spent generating as many ideas about messes relating to the given topic. Ten minutes is spent converging clustering the post-its into natural categories. Each category is then given a theme header. Throughout the session, the facilitator aggressively pushes each team to generate more and more ideas, help them get unstuck from evaluating ideas, and think outside the box.

• Problem –Finding: 45 minutes. This is the most important part of the

session and the hardest to get used to. A good problem statement is half solved. It is the also the hardest to get used to. The suggestion is to try your hand at converting problem issues into problem statements. The problem statement usually with the word “How to…” Example: Problems such as User error, Wrong types of specimens sent, General Education (i.e. of the system, needed phone numbers), Back-up policy if system is down (currently non-existent), Turnover of employees would be converted to How to reduce user error, How to minimize wrong types of specimens sent, How to make everyone aware what is needed to be know, How to have a bullet proof backup system, How to deal with high turnover of staff understanding the system. Thirty five minutes is given to generating problem statements for the for the categories of Messes. To extract more problems, the facilitator calls out, “These are the only problems in our way of absolute success!” Ten minutes is given to converge these into common themes with headers.

• Solution-Finding: 45 minutes. This is the fun part. Each of the teams

consolidates all the problem statements into a single wall of problems. Solution Finding is done with all thirty brains (if there are 30 members) focusing on each problem. Each problem statement is read out to the entire group, determined if it’s worth a solution, and then solutions are offered. 35 minutes given to generating solutions 10 minutes to cluster them into natural them (often the same as the problem themes). Notice these are solutions in seed form, and will be further developed on the follow-up and final-up meetings.

• Action/Acceptance Finding: 30 minutes. The solutions themes are taken

on by teams made up of members in the session. Usually 4 to 6 members. A team leader is assigned for each session. Members readily sign up for teams they have a passion for. You look odd if you are not signing up.

• Presentation: 15 minutes. Mr. Big usually returns to here the summary of

solutions that each of the teams. Certificates for participation are often handed out afterwards.

• Food Finding: Generally, a catered meal is waiting at the end of the

session for all that good brainwork.

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It’s best to set the follow-up and final-up schedule at the Solution Session. If possible schedule the meetings is two weeks and four weeks post session. If that’s not possible, then attempt to get as close to it as possible. Half the session’s success relies on keeping the team’s energy level remaining high around bringing their part of the solution back to the big group.

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Anatomy of a Sensing Session: Overview: You want everyone coming to the Solution Session fully aware and equipped to make informed decisions. The Sensing Session is a way to assure the Team Leader that those coming know what they are committing to, understand their role in fact-finding, and give them a sense of how the session and follow-up meeting will be conducted Goal:

1. Bring on board those in question of importance, comprehension, and commitment of the Solution Session.

2. Drive out up-font apprehension on the participant’s and team leader’ part 3. Add legitimacy to the Session success.

Participants: This can be a collective meeting of attendees or a one-on-one with the team leader. Anatomy: 1. Preliminary: Best if the Solution Session invitation, purpose, description and

fact-finding question have been distributed ahead of time. 2. Aspects elaborated in the session

a. If it is a group session, establish facilitator ground rules to assure an efficient meeting: Ask permission to interrupt to assure equal airtime for all attending or keep discussion on topic.

b. Origin of the project need for the Solution Session. Good if the value of instituting the change could be quantified.

c. Specify the Session purse and scope (what’s included and what not) d. Who sponsored (Mr. or Ms. Big) the change e. Explanation of why they were selected to attend f. Elaboration of others who will be attending (those impacted) g. Explanation of what’s in it for them to participate. h. Give brief description of what and how a Solution Session is run

i. Mr. Big (sponsor) ii. Invitation and Fact-Finding question crafted iii. Sensing Session conducted iv. Solution Session event

• Mess Finding • Problem Finding • Solution Finding • Action Finding

v. Ideas created are both short term (within one year) and long term

vi. Follow-up and Final-up meeting along with in-between meeting to form up the actual solutions

vii. When final recommendations are formulated and submitted, the only ingredient missing for success is leadership.

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i. Explanation of their commitment (they represent their department and their role across the organization within the scope)

j. Review the fact-finding questions as a means of opening dialogue. Highlight that the success of the session hinges on goof fact-finding.

i. Explain what form the fact-finding is to be returned and by when ii. Reinforce that it is their obligation to create fact-finding question

for others in the session if it can impact the success of the session.

k. Pause and ask the group, “What do you think about conducting the session in this fashion? ”

l. Provide the schedule to date or at least when they can expect m. If group session, conduct a Hot wash-up.

i. Write down Like: what did you like about this session. ii. Next, write down Better: what would have made this session run

better iii. Go around room and have each share their likes, them repeat

for betters. iv. Conclude the meeting

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Sensing Session Questions Great answers start with great questions

People Questions

1. Can the emotion of the problem be used as leverage? 2. What reservations do they have or obstacles to overcome in order to be a

full-blooded participant? 3. Are there tethers to upstream departments that keep them from acting

decisively and do the up-streamers need to be brought into the Workout session?

4. What effect does the problem have on their operation in manpower or service?

5. Are they improvement-oriented or rule-oriented? 6. Do the flex or freeze in the face needed change? 7. Do they use data or expert opinion in decisions making? 8. Are they influenced by departmental peer opinion? 9. Are they influenced by Mr. Big’s opinion? 10. How permeable are they to internal and external customer needs? 11. Where does fixing the problem fit with respect to their other commitments?

Can Mr. Big help here? 12. Are they a reluctant or hair-on-fire participant?

Process Questions The brain is a wonderful organ. It starts working in the morning and does not

stop until you get to the office… Robert Frost General

1. What are your outputs’ critical measures of service performance? 2. What is the average patient wait in your area? 3. If you work with patient material, how long does it stay in your area? 4. What are the ‘moments of truth’ that are key for a pleasant patient visit? 5. What are the things in the way of providing top service? Do you have

influence or are they out of your control? 6. Are there downstream handoffs, what are their needs/requirements to

deliver top service? (at the end of your process is a customer – what are their accuracy, timing needs?)

7. Do you know the bottlenecks of your process? How do you keep it from getting constricted?

8. Is the incoming workload match appropriate schedule and mix of staff?

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Fact Finding Questions People tend to commit to a decision if they have exhausted all the facts.

GI OverFlow Clinic In Clinic Lobby 1. Is the patient kept aware of how long they might end up waiting? Are there periodic check-

ins (guidelines) just to let them know they have not been forgotten? How often? Are the expectations set up front if a longer than desired wait is known?

2. Is there understanding on how to deal/diffuse with patients who have are demonstratively? Appointment related 3. Is overbooking allowed? Are there certain physicians who do this more than others? Are

they aware of it and the impact it has on their patients? Can PAs have an impact on minimizing this occurrence?

4. Do you know your no-show rate? Do you know what impact tele-mindering will have? Do you know how you stack up to the other clinics? Are there best practices sought among clinics?

5. How do you handle late arrivals? Are they placed in next available, non-scheduled slot? Or is it first come first serve? Is the practice consistent among all clinics? Should it be?

6. What is the average elapsed days for first available appointment slots for a) ASAP appointments and b) routine appointments

Facility 7. Are there cosmetic changes that would professionalism /personalize/servicize the visit with

little cost? Educational material 8. Could Education videos be used to add value during a patient wait (while saving time of

caregiver)? 9. Are the Education materials clear, complete, concise, in laymen’s language, consistent

among areas, professional, delivered just-in-time, confirmed as understood? 10. Is the signage clear, professional, friendly? Does the customer know where and when to go

to their next station? Internal Communication 11. Does the internal communication pipeline clear, pertinent, uncluttered? Are there collective

meetings (all staff) at a frequency? Are old expired communication deleted? Physician awareness 12. Are there informal, fun, effective ways of making physicians aware of impact on patient

wait/inconvenience? Place a value on patient wait/hour and issue IOUs for the month? 13. Is there a means for a Doctor give up/communicate his unused slots to other Doctors 3

weeks out? Can there be an incentive for doing such? 14. Is there backup when a physician is out and a patient wasn’t informed? Staff education 15. Is there a fast track learning process for newcomers (including the things to watch out for,

physician preferences, unwritten codes of conduct…) Service awareness 16. Who are all your internal customers? Do you know their timing needs, accuracy needs? 17. What portion of the time are all the necessary ingredients available for an appointment?

Chart, Results, staff for time of appointment? 18. Call for help: Is there a list of who to contact for help by type if need?

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19. Is there a measure of service ‘drops’ (i.e. where the patient drove in from Laredo and we failed to notify them their doctor is out of town)?

20. What are the rules and freedoms in recovering from a service ‘drop’ (parking voucher, meals on us…)?

Billing 21. Is it timely, clear and accurate? How do you know? 22. Is it easy getting to communicate with a counselor and how fast do they respond? Would it

be helpful to get the patient to rate our financial service at the end of the call? Communication/Phone/Voicemail 23. How easy is it for the patient to get the answer they need? How do you measure it? Call drop

rate, hold time? Is there a decision tree to get the right inquiry to the right person? Is the voicemail greeting consistently informative among staff and among clinics? Do you have a greeting quotient or a report card?

24. If you have voicemail that patient access – is there a minimum requirement for greeting info? What about voicemail coverage when someone is on leave? Are all voicemail returned within the next business day?

25. Does the Communication suffer from page ping-pong or do return pages come with the name of the initiator? Is it communicated via overhead intercom or directly to the receiving doctor?

26. Are patients scheduled at their convenience or the hospitals? When multiple ancillary services are required are they scheduled tightly together yet with sufficient lead tome for the result to be ready for the clinic?

Organizational learning 27. Is there a method for passing along lessons learned, problem prevention, which could be

standardized or made available for organizational (all clinic) learning? 28. Is there any means of line-balancing (staff sharing) such that some clinics aren’t swamped

while others are idle? Could there be a reward for a clinic migrating available staff to a ‘swamped’ clinic?

Process Questions 29. What are your outputs’ critical measures of service performance? 30. What is the average patient wait in your area? 31. If you work with patient material, how long does it stay in your area? 32. What are the ‘moments of truth’ that are key for a pleasant patient visit? 33. What are the things in the way of providing top service? Do you have influence or are they

out of your control? 34. Are there downstream handoffs, what are their needs/requirements to deliver top service (at

the end of your process is a customer – what are their accuracy, timing needs?)? 35. Do you know the bottlenecks of your process? How do you keep it from getting constricted? 36. Is the incoming workload match appropriate schedule and mix of staff?

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Top 10 Ways Managers Can Help Their Solution Session Representative Support is more than lip service

1. Allow them time to do adequate ‘Fact-finding’. They could easily 8 to 12 hours just preparing for the Solution Session event. When asked, ‘What will keep you from coming equipped to the meeting?’ TIME is the overriding response. The Team Leader will be distributing Fact-finding questions.

2. Coverage of the team member’s workload while they do their fact-

finding and subsequent meetings. If they get time off and their workload demands don’t change, it will have the same effect as not giving the time. Get someone to help ‘shoulder’ the work while they are working on the team.

3. Pave the way for them. Each team member will be representing their

clinic/department and the peers of their job description. This is a lot of responsibility, so the more input they gather they more confident they will feel at the session. Offer to help your team coordinate to others. Their success in fact-finding is your success.

4. Do some Solution Session thinking yourself then share your

thoughts with your team representative. Their Fact-finding includes uncovering great ideas that could be performed. It may trigger more thinking on their part.

5. Follow-up weekly to see how they are coming, what they have

accomplished, do they need some extra support from you? Your interest in their success will bring success.

6. Keep up with the Fact-finding questions given your team member.

Also the Team Leader questions/prompts trying to address will be emailed. If the team member comes to the meeting ill-equipped, they let their whole team down.

7. Encourage your representative to check with the development of

ideas already in process in your area. Out of these might be ideas or problems that may be helpful in the Solution session.

8. Praise and encourage them. Let them know how important their

participation is. They will help mold the best practice for all the area they represent. A tall order, but the collective minds and resolve of all the team members will make this happen.

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9. Connect with Team Leader if you are running into difficulty supporting your team member. They have a directly line to Ms Big to make this Solution Session successful.

10. Prepare for involvement in integrating the outcomes of the Solution

Session into the procedures and culture. If departmental change is a battle, organizational change is a war!

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Solution Session Plan color (copy/paste) the percent complete

1. Prework 10 20 30 40 50 60 70 80 90 100a Secure a Team Leader champion to commit to complete processb Valid vision/strategy completed/tested Case for change completedc Secure a supportive, legitimate Mr. Big to champion the Session and implementationd Develop the rules for session engagemente Develop list of prework questions by function if possiblee Send out a Call for Commitment to targeted team candidates (all who influence/effected by output) Criteria: Work as a team, Respect/Speak for peers, More support than drag to solutionf Call one-on-one if response is slow

2. Sensing Session 10 20 30 40 50 60 70 80 90 100a Schedule session with key function candidatesb Meet with Mr. Big - to understand session role and followthrough enforcementc Get candidates to develop lists of questions they want answered from other areasd Create communication plan needed to inform, create moementum, open interdepartent networkinge Encourage/attend departmental data gathering/sensing sessions with functions stafff Fact Finding -- make sure all areas arrive at session with available facts

3. Session Planning 10 20 30 40 50 60 70 80 90 100a Scope size of session based on team ability, session complexity, b Develop the Agenda timing of Mr. Big, CPSI Training, Probing Statements, Action Plan creation and Presentationc Poster the Ground rules, Fact Finding turned in, Purpose, Agendad Prethink the session set up needs: tables, material, fun things, scribing support, post-itse Create walkaway workbooks: tabbed with prework, tools, agenda, training slides, session output, commitments,

4. Session Running 10 20 30 40 50 60 70 80 90 100a Facilitator equipped with CPSI knowledge, Team Leader role defined participant/leaderb Mr Big establishes importance, commitment, support and challenge to have commitable action plan presented in designated timesc Run the folks thru Objective/Fact/Problem/Solution/ActionPlan Finding for both divergent/convergent thinkingd If running multiple teams - schedule collective sessions to report output findingse If team is cohesive -- move to entire group participating in Solution and ActioPlan Findingf If teams can not, then run finding sessions separate. Combine their output at the end.g Schedule Mr Big to return as the action plan is being developedh Team presents their committable action plan to Mr. Bigi Gather all pieces of data and send session summary of finding to team members

5. Implementation Followthrough 10 20 30 40 50 60 70 80 90 100a Team Leader schedule necessary followup session to report on their commitmentsb Develop a strategy for implementation success: Start with we are successful, how did we get there? Then turn into action stepsc Followup on each member commitments, team leader runs interference where needed, Use Mr. Big leverage to push support thrud Keep communication of progress to members to inform/ keep momentum highe Along side each implementation step, pave way for management/culture acceptancef Set D-Day for implementation -- allow for lead ime for training, equipment acquisitiong Create an action item punch list and update weekly for teamh Update culture as as the implementation progresses. Be honest with results.i Bulldog each impediment in the way of success until it happens. People rarely fail, they just quitj As key success factor data comes in, report it to the massesk Personal and organizational confirmation/celebration in use

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Kickoff Script for the Ideal Patient Experience Team Leaders who speak from the heart and prepare their ranks will win the war Ms. Big role • Welcome to the Patient Experience Team, we appreciate your participation. • You are our elite group, Special Forces for customer service. • We are here to do what hasn’t been done before: collectively design how we

want customer service to be experienced. What it looks, like, feels like, works like.

• You are empowered to make changes. We have some moneys for change; I will be there for you to support/enforce/reinforce what you come up with. Areas we cannot change are: uninfluence-able physicians practices. Our greatest leverage will be appealing to their sense of patient good and that their counterparts are doing it. (Others??)

• I am expecting that on Jan 14 in a 4 hour “Solution Session”, you will create the seeds of best practices that will be followed throughout UCP. I will be there to launch you off and I will be there to hear the results. If there are problems along the way, I’m on call.

• Out of this session will come a set of committable action plans, and I will be there to support or push you along.

Team Leaders’ role • A “Solution Session” is what GE calls a Work-Out. It’s a compressed strategy

session where you essentially lock the doors until you come up with a committable action plan. It is their way of busting up the culture and making solid change to keep the corporation healthy. We will have 4 hours to Identify our ‘Messes, Discover the pertinent problems, create ideas and solutions, then turn them into Action steps that stick.

• We are full-fledge participants • We are co-leaders in the session development and project managers of the

implementation • Melinda will more than likely be the process owner that holds us to our

commitments. • During the Solution Session we will be the team leaders – “pushers” of new

thinking • Prior to the session will assist in instilling importance and understanding of

what is needed. • We will check up on progress, visit 1-on-1 if needed. Facilitator’s Role • Consider me the ‘climbing’ guide for a “Solution Session”. One who has

scaled a similar mountain and understands the way. Of course, your mountain has its own challenges.

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• My role is to transfer knowledge on how to stimulate new thinking, accelerate collective change, leave behind a means to repeat and apply this in other areas.

• I will be a coach and background support to Lorie and Melinda as we turn ideas into reality.

Your role: • Prior to the session • Your commitment is intelligence-gathering in the form of fact-finding. You are

deputized for paving the way for change to your counterparts. What are the things you need to know before you can make a decision on behalf of ALL your peers. Remember Ms. Big is there to support you along the way.

• We need as much as your Fact-Finding as you can prepare. This is as much about making a more informed decision than anything else. Here are a ‘starter' list of question you may want to explore before coming to the session. Your use to the teams depends on your ability to ask good question and find good answers. We need your Fact-finding by January 7th – we will share it with the other team members.

• Discover what will make you ‘safe’ in making a collective decision and do what it takes to get there.

• Your role is to collect ahead of the meeting ALL information necessary to help make a collective decision. You will be the “Why?” for testing the existing way and “Why Not?” for the skeptics of a new way.

• Research what are best practices among your peers, what about at other institutions, how did they get there, what were their pitfalls.

• Develop a feedback, feed-forward network. You are speaking for your associates so establish clear communication paths.

• Start now. Waiting to the last minute is an insult to the rest of those on this team. Their success is contingent on your conditioning prior to the meeting. Expect to spend 1 hour for every hour in the session.

• Touch base with Melinda or Lorie if you need help, more info… What to Expect • During the session • Expect ‘different’. We will use climbing analogies. To rush you along, to push

you further, to give you insight. • We need you to stretch. To look beyond the way it is. You are the culture-

busters here. • Think creatively, put on a pure service mindset, unencumbered by what is in

the way. • Expect a fast-paced flurry of thought collection. Pretend the outcome of this

session will keep you from ending up like ENRON. • All fact finding, purpose, vision, ground rules will be posterized around the

room

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• You’ll be split into two rope teams during Mess-Finding, and Problem finding: Lori and Melinda team leaders and participators. The group will be brought back together to compare findings and as a large team (if there is FULL participation) do Solution and Action/Acceptance Finding.

• You will alternate between divergent thinking (spinning out all possibilities) and convergent thinking (recrafting and selecting the best).

• At the end you will prepare a presentation of the solutions to Ms Big. • Most people say they were rushed. It’s supposed to be that way. • Your solutions will be the seeds of subsequent meetings that refine the

solution and list the transition considerations. • It will be the fastest hi-energy 4 hour bonding session you will ever

experience. • After the session • You will meet with knowledgeable folk to finalize the solution,

action/implementation/transition plan. • It may take several meetings to refine. Expect to spend 1 hour for every hour

in the session. • You will pave the way for its success, gaining input, alliances, “Survivor”

strategies. • Prepare for the feedback session to the team. Concise, complete, quick. • Call in Lorie or Melinda if needed. They may join in your meetings because of

how crucial your meeting is to the team. • Don’t short-change the team on ‘Think” time. Unless you have evaluated

your solution and implementation from all angles, you jeopardize all. Closing • You are the minds that can make it happen – you will be the promoters of the

change. You will be the ones who will make it stick. This is the first of many changes that we will engage in. It is either change or be changed. Better to be on the leading edge of change than the receiving edge of change.

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DDDIIISSSCCCHHHAAARRRGGGEEESSS “R” UUUSSS

Agenda (The faster we come up with an acceptable, commit-able solution, the sooner we get out of here) 8:00a You are Here

• Food-finding 8:15 Howdy

• Mr. Big stresses a case for action • Agenda • Purpose- What are we trying to achieve • Ground Rules/Responsibilities • What To Expect • Instruction Finding • Bathroom Finding

8:35 Mess Finding

• Instruction: • Convergent/Divergent thinking • Harvesting the best, reshaping

• Session • Present back to group • Choose the high peaks we must scale

9:00 Problem Finding

• Possible problems • Prioritize: Hot, medium, mild • Teams Report Out • Regroup and refine problem statements

9:50 You deserve a break today 10:00 Solution Finding • Flurry of ideas that will solve the problems • Sell and select the best • Measurement == How do we know we got there • Present to big group • Be creatively crazy now. 11:00 Action/Acceptance Finding

• Borrow your solutions • Prioritize: gotta haves, oughta haves, other • Assign: Activity Commitment, Who/Completion date • Prep for Mr. Big

11:45 Present to Mr. Big, Celebration, Schedule to First Follow-up 12:05 PARTY Two weeks after this meeting, we will reconvene to show and tell our commitments and finalize implementation pieces.

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Post-it Brainstorming Idea generation is a race against time, not painful evaluation Overview: The Osborn-Parnes creative problem solving technique has an efficient way to generate large numbers of possible ideas; then as a group, come up with a collective agreement on which are the most important. Goals:

1. Rapidly generate many ideas around a topic (Divergent thinking) 2. Cluster ideas into ‘themes’ that to be acted on (Convergent thinking)

Materials: 3x5 Post-it pad for each participant, pens, flip chart per group Participants: Best if placed in groups of 4 to 8 Procedure:

1. Number people off in groups of 6 (ideal). Can be altered to groups of 4 to 8

2. Have them stand around the flip chart, pen in hand 3. Instruct them how to fill out an idea on a post-it

a. As you think of an idea, write it down on a post-it. Try to write it with a subject and a verb

b. As you post the note on the flip chart, call it out for the group to hear

c. Generate as many ideas as rapidly as possible. Real ones, fun ones. In this exercise, quantity is equal to quality.

d. Write one idea per post-it. 4. Frame the specific topic (IMPORTANT) they are to be working on. The

clearer the better. Example “Generate as many criteria as possible about what makes an outstanding team member.

5. Announce to them a short amount of time (2 to 5 minutes) to generate ideas on a specific topic (Divergent thinking).

6. Holler Go! to start them 7. Give a count down each minute to move them along 8. Tell folks if they are explaining their idea, they are not generating. Goal is

numbers, not rationale. 9. As a facilitator, steep up the energy by calling out ideas that might

stimulate thinking. The facilitator’s energy is contagious. 10. Push them to get more ideas. The more ideas on the flip chart the more

to work with. 11. At the end of the idea generation period, stop them. Next, instruct them

collectively to look at their post-its and begin moving/clustering them into common or natural themes. (2 to 4 minutes)

12. Once clustering “head” each cluster with a word or two that characterizes the entire cluster.

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Solution Session use of Osborn-Parnes Creative Problem Solving The secret sauce to a Solution Session Overview: To creative solve a problem, use the previously described post-it brainstorming process for each of the “Finding” sessions below. If the topic is specific and facilitated aggressively, the group can come up with a collective solution and action plan, within 1 to 2 hours. Large cross-functional or institution-wide set of solutions can be completed in 4 hours. Participants: Those with knowledge and stake in the outcome of the solutions 1. Mess/Objective-Finding (Looking at the “mess” or objectives interrelated

issues, challenges, problems, and opportunities to find an area on which to focus). List significant challenges/opportunities, then isolate the main ones

2. Problem-Finding (Discovering a suitably “fuzzy” problem, full of opportunity

or need for unusual and novel solutions and approaches). List of problem statements, then identify the best wording of the central problem. Start statement with “how to…to help folks form how-to statements:

REFRAMING THOUGHT CARD ProblemProblem--FindingFinding

Thought Starters: How to Correct… How to Produce… How to Improve… How to Shift… How to Change… How to Develop… How to Overcome… How to Stop… How to Reduce… How to Exceed… In What Way Might We… How to Do Away With…

©1999 - The School for Innovators

3. Solution-Finding (Converging on a subset of ideas, synthesizing and refining

them into potentially useful solutions, and exploring barriers and approaches to acceptance). Possible solutions derived from the idea finding, then the selection of the best one(s)

4. Action-Finding (Generating and refining potential action steps to move the

solutions through acceptance and into implementation). The action steps needed for successful installation. Most times staff take the solution post-its and add names, resources and target dates to them.