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Conflict of Interest Declaration We declare that we have no conflict of interest linked to the work presented. Slide 2 High-Impact Leadership Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org. Slide 3 New Mental Models Volume Patient SatisfactionIncrease Top Line Revenue Complex All-Purpose Hospitals and Facilities Quality Departments and Experts Value Persons as Partners in their Care Continuously Decrease Per Unit Cost Care Organized by Business Model Quality in Daily Work- Everyone Slide 4 High-Impact Leadership Behaviors Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org. Slide 5 High Impact Leadership Slide 6 Sensei Chihiro Nakao If you are dreaming about it you can do it. Slide 7 Slide 8 2014 Virginia Mason Why is Change So Hard? Culture Lack of Shared Vision Misaligned Expectations No Urgency Ineffective Leadership Slide 9 2014 Virginia Mason Compact Expectations members of an organization have that are: Unstated yet understood Reciprocal The give The get Mutually beneficial Set up & reinforced by society and the organization Slide 10 2014 Virginia Mason Autonomy Protection Entitlement Improve safety/quality Implement EHR Create service experience Be patient-focused Improve access Improve efficiency Recruit/retain quality staff Traditional Promise Legacy Expectations Imperatives Clash of Promise and Imperatives Slide 11 2014 Virginia Mason Vision Is Context for Compact Societal needs Local market Competition Organizations strengths STRATEGIC VISION Physicians give : What the organization needs to achieve the vision Organization gives: What helps physicians meet commitment What is meaningful to physicians Slide 12 2014 Virginia Mason Virginia Mason Medical Center Physician Compact Organizations Responsibilities Foster Excellence Recruit and retain superior physicians and staff Support career development and professional satisfaction Acknowledge contributions to patient care and the organization Create opportunities to participate in or support research Listen and Communicate Share information regarding strategic intent, organizational priorities and business decisions Offer opportunities for constructive dialogue Provide regular, written evaluation and feedback Educate Support and facilitate teaching, GME and CME Provide information and tools necessary to improve practice Reward Provide clear compensation with internal and market consistency, aligned with organizational goals Create an environment that supports teams and individuals Lead Manage and lead organization with integrity and accountability Physicians Responsibilities Focus on Patients Practice state of the art, quality medicine Encourage patient involvement in care and treatment decisions Achieve and maintain optimal patient access Insist on seamless service Collaborate on Care Delivery Include staff, physicians, and management on team Treat all members with respect Demonstrate the highest levels of ethical and professional conduct Behave in a manner consistent with group goals Participate in or support teaching Listen and Communicate Communicate clinical information in clear, timely manner Request information, resources needed to provide care consistent with VM goals Provide and accept feedback Take Ownership Implement VM-accepted clinical standards of care Participate in and support group decisions Focus on the economic aspects of our practice Change Embrace innovation and continuous improvement Participate in necessary organizational change Slide 13 2014 Virginia Mason The VMMC Quality Equation Q: Quality A: Appropriateness O: Outcomes S: Service W: Waste Q = A (O + S) W Slide 14 2014 Virginia Mason Our current management system? DC Comics Slide 15 2014 Virginia Mason Daily Management World-Class Management Daily Management: Leaders Have Two Jobs 1.Run your business 2.Improve your business Slide 16 2014 Virginia Mason The FIVE Principle Elements of Daily Management (Standard Work for Leaders) ThisOr This Visual Controls Create linked visual systems that drive action Daily Accountability Process Establish rounding process at all levels Leader Standard Work Leaders routinely complete key activities necessary to run and improve their business Discipline Leaders consistently verify the health of processes and systems Root Cause Analysis Asking why and using data and analysis to attack problems Slide 17 2014 Virginia Mason Leaders Role in Signal Generation Leaders are signal generators who reduce uncertainty and ambiguity about what is important and how to act. Charles OReilly III ThisOr This Slide 18 2014 Virginia Mason Productive range of distress Threshold of learning Limit of tolerance Time Disequilibrium Adaptive challenge Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, 2002, p 108 Distress and Adaptive Work Slide 19 2014 Virginia Mason Front Line Board Supervisor Board Director Board AD Board VP Board COO Board CEO Board VMPS Standard Work for Leaders Slide 20 2014 Virginia Mason Effective Sponsorship Vision of success Set stretch goal Provide resources Remove barriers Fail forward fast Celebrate achievements Slide 21 2014 Virginia Mason Genchi Genbutsu Its all lies Go where the action is Know your people and let them know you Vulnerability is ok Connect the dots Slide 22 2014 Virginia Mason Managerial Courage It will be worth it Patients and staff depend on it Leading change is hard work Skeptics can become champions Slide 23 2014 Virginia Mason Flu Vaccination Fitness for Duty Do we put patient first? Compelling science Staff resistance Staying the course Organizational Pride Slide 24 2014 Virginia Mason VMMC Influenza Vaccination Rates Slide 25 2014 Virginia Mason Ongoing Challenges - Culture Patient First Belief in Zero Defects Professional Autonomy Buy In People are Not Cars Pace of Change Victimization Leadership Constancy Rigor, Alignment, Execution Drive for Results Slide 26 In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists. Eric Hoffer Copyright 2009 Virginia Mason Medical Center. All Rights Reserved. Slide 27 Creating a Culture of Quality and Safety James M. Anderson President and CEO, 1996-2009 Making Excellence a Way of Life Slide 28 2 Slide 29 Cincinnati Childrens (Fiscal 2013) Registered beds598 Operating revenue$1.9 billion Employees13,852; 97 nationalities Research grants$158 million Locations16 Patients from 50 states; 53 countries Department of Pediatrics for the University of Cincinnati College of Medicine 3 Slide 30 Video 4 Slide 31 Tressel Fragile System 15 years of intense work improving quality and safety 34% decrease in hospital-wide mortality 43% decrease in ICU mortality Transparency With families With employees With other institutions With the outside world We need to be able to talk about these things 5 Slide 32 Requirements to Create a Culture of Quality and Safety Vision: Take time to develop it thoughtfully Plans: Focus on what needs to be done, not on trailing results, like financial results Consistent message: Consistent behavior, even when there is increased risk Management process that delivers sustainable outcomes 6 Slide 33 Our Vision: To be the leader in improving child health If we can deliver outstanding results in some areas, why not all? What results are we delivering? How are we measuring them? 7 Slide 34 Creating a Culture 8 Slide 35 Business Units: Participants 1.Physician, nursing and business leaders Shared objectives Single budget 2.Access to senior leadership team 3.Predictable, recurring meetings 9 Slide 36 Business Units: Template Reports Financial Activity over time expressed in numbers Holistic view as a framework for change Non-financial How will we be safer, more accessible, patient-centered, innovative? Focused attention on transformation 10 Slide 37 Other Tools Real time data Strategic planning Transparency High-reliability systems Learning from other high-risk industries 11 Slide 38 Final Thoughts Each part of the organization must perform well for the whole organization to perform to potential Organizational structure reflects priorities Mechanisms must be hard-wired, predictable and must foster agility Institutionalize boundaryless thinking, risk taking, transparency, small tests of change Institution needs a shared, compelling vision and high aspirations 12 Slide 39 Creating a Culture of Excellence Paris, France April 2014 Michael J. Dowling President & Chief Executive Officer North Shore-LIJ Health System Slide 40 40 Slide 41 The System Today Insurance Enterprise CareConnect Clinical Enterprise Educational Enterprise Research Enterprise Inpatient facilities Ambulatory / outpatient Long Term / Home Care Hospice Joint ventures GME / CME Medical School / Elmezzi CLI Discoveries Publications Clinical trials Community Health Enterprise Community benefit Access and education programs Veterans programs Childrens programs Risk Capitation Bundled payments Product offerings Joint product offerings Employer products Population health Partnerships 41 Slide 42 An Integrated System Largest provider of health care in NY State one of the largest employers Major academic teaching center Major commitment to research The Feinstein Institute Single governance not just a collection of distinct, individual entities Administratively and clinically integrated; Service Line approach to care delivery Single system-wide management clinical and administrative Densely populated; competitive and diverse environment Provides full continuum of care Possesses insurance license and capabilities to take risk and sell products 42 Slide 43 Were With You Every Step of the Way 43 Slide 44 North Shore-LIJ Culture Blueprint 44 Slide 45 Behavioral Expectations: Core Competency Model Individual ContributorTeam LeaderOperational/Strategic Leader Competency #1 Execution: Displays technical and functional expertise. Takes ownership of work, structures job tasks and maintains appropriate pace in handling multiple deadlines to achieve excellence by: Behavioral Demonstration Completing assigned tasks accurately and within established timeframes and budget, and adopting a resourceful and results- driven approach. Ensuring team performance in achieving excellence through organizing resources, adjusting for complexities, measuring results, and planning for improvements. Creating a culture of excellence and accountability through motivation of talent, translation of strategy into reality, exercising sound judgment, and aligning communication, people, processes and resources. Competency #2 Organizational Awareness: Understands how to overcome obstacles and ably works through the realities of a large healthcare organization. Applies best approaches to achieve business goals by: Behavioral Demonstration Collaborating with peers, managers and internal/external customers to solve problems in formal and informal settings and within the guidelines of key policies and practices. Displaying superior understanding of group behavior and organizational politics, culture and operations, and exhibiting strong decision-making skills that align to key business priorities and objectives. Understanding the competition, creating solid cross-functional partnerships, and successfully navigating the organizations culture to obtain the buy-in necessary to drive critical business outcomes. Slide 46 Individual ContributorTeam LeaderOperational/Strategic Leader Competency #3 Enable Change: Willingly adapts to shifting business needs and seeks opportunities to champion new processes and ideas. Anticipates and responds to change to improve work outcomes by: Behavioral Demonstration Seeking and acting on feedback to identify improvement opportunities, displaying enthusiasm for expanding ones knowledge and scope, and thinking differently to find new solutions. Regularly offering feedback, analyzing successes and failures to identify improvement opportunities, and planning for and creating avenues to implement process enhancements within the team. Creating a climate that embraces new and different solutions, removing barriers that limit change, maintaining a global line of sight, and gaining commitment and partnership from others to execute change plans. Competency #4 Developing Self: Takes consistent action to increase knowledge and skills. Embraces challenging assignments and seeks learning opportunities to enhance performance by: Behavioral Demonstration Exercising self-accountability for becoming a subject matter expert within ones own job role, seeking performance-related feedback, and identifying learning opportunities to explore with ones manager. Slide 47 Behavioral Expectations: Core Leadership Competency Model Team LeaderOperational/Strategic Leader Leadership Competency #1 Managerial Courage: Acts with conviction to make the right decisions for the right reasons. Exercises sound judgment and takes action to preserve the integrity of the organization by: Behavioral Demonstration Adhering to a strict ethical and moral code in all business decisions and dealings with people, delivering critical messages honestly and effectively, displaying the ability to make difficult decisions in a timely manner, rewarding those who display desirable behaviors, and holding direct reports accountable for poor performance. Also ensures direct reports are compliant with mandatory trainings, educational processes and system initiatives. Empowering and standing behind direct reports and others to make ethical decisions, removing political barriers that may limit or prevent positive change, and implementing practices to ensure that employees in assigned area(s) are held accountable for their behavior and performance at all levels. Additionally ensures all employees in area(s) of responsibility comply with mandatory training, educational requirements and system initiatives. Leadership Competency #2 Motivating and Inspiring Others: Leverages and embraces diversity and shares wins and successes. Motivates and energizes others to achieve high-level results by: Behavioral Demonstration Celebrating the efforts and achievements of individuals and teams, creating a feeling of belonging within the team, conveying confidence in the ability of others to make valuable contributions, and ensuring that team members have the skills, support and resources necessary to produce the desired results. Also ensures direct reports are rewarded/recognized for good performance, and that, when appropriate, consequences are delivered to drive the right behaviors. Creating opportunities to promote team successes at department and system levels, managing with an open door policy, ensuring assigned area(s) understand how each contributes to the larger goals of the organization, and continuously taking inventory to ensure assigned area(s) are equipped with the resources necessary to achieve superior results. Additionally empowers leaders in area(s) of responsibility to reward employees for good performance and to deliver consequences, as appropriate, to drive the right behaviors. Slide 48 Team LeaderOperational/Strategic Leader Leadership Competency #3 Strategic Agility: Seeks opportunity to gain/share expertise with other areas to create innovative strategies. Exercises both narrow and broad perspective to ensure business success by: Behavioral Demonstration Demonstrating complete understanding of departments workflow, operations and necessary skill sets, leveraging the talents of the team to brainstorm and anticipate future consequences and solutions, and partnering with other areas to share knowledge and influence strategy development outside of normal defined scope. Ensuring operations of assigned area(s) align with the larger organizational goals, establishing formal and informal processes for high performers to become involved in cross-organizational improvement efforts, and leveraging connections with other organizational leaders to develop and execute breakthrough strategies that impact organizational operations on multiple levels. Leadership Competency #4 Developing Others: Continuously seeks opportunity to develop the capabilities of others. Provides challenging stretch assignments and tasks to enhance departmental performance by: Behavioral Demonstration Holding frequent performance and development discussions with direct reports, providing diverse opportunities for team participation in projects outside of normal defined scope, and shaping team roles to leverage skills, build capabilities and foster team collaboration. Developing high performers through mentorship and coaching, creating opportunities for joint problem-solving and cross-functional learning through shared projects, and embracing feedback for ones own improvement. Slide 49 Behavioral Expectations: Core Values 49 Individual ContributorTeam LeaderOperational/Strategic Leader Core Value #1 Customer Experience: Addresses the needs of customers to exceed expectations by: Behavioral Demonstration Building relationships with customers while understanding and reacting to their concerns and expectations daily. Maintaining relationships with customers and developing practices to ensure customer satisfaction within assigned area. Expanding departmental relationships with customers and identifying opportunities to increase customer satisfaction through cross- department collaboration. Core Value #2 Integrity: Acts honestly and ethically to promote excellence at all levels by: Behavioral Demonstration Respecting others at all times, serving as a role model, and adhering to privacy and confidentiality practices. Leading by example, protecting confidentiality, and ensuring all team members are empowered to make decisions in the best interests of the organization. Acting as a leader of leaders to ensure assigned area(s) are held accountable for acting in the best interests of the organization at all times. Core Value #3 Excellence: Promotes quality in work performance to achieve business outcomes by: Behavioral Demonstration Producing results of the highest standards while demonstrating passion for the job, function, department and organization. Ensuring the team collaboratively produces results of the highest standards and fostering a work environment that recognizes and celebrates successes. Ensuring assigned area(s) produce results of the highest standards and identifying/executing opportunities to bring quality to the next level. Slide 50 50 Individual ContributorTeam LeaderOperational/Strategic Leader Core Value #4 Teamwork: Inspires others to work together to achieve organizational goals by: Behavioral Demonstration Helping others to succeed and collaborating to identify and solve problems with the whole team. Helping direct reports and others succeed through team- building, mentoring, coaching and fostering an environment of workforce engagement. Helping those in assigned area(s) to succeed through mentoring and creating practices and processes that reinforce teamwork and engagement at every level. Core Value #5 Caring: Demonstrates empathy toward others to promote an environment of trust by: Behavioral Demonstration Treating everyone with compassion and sincerity regardless of background, appearance or orientation. Fostering two-way dialogue with customers and direct reports to explore concerns and ideas, and creating a work atmosphere where each employee feels valued. Establishing practices to ensure a workplace and customer environment where all individuals feel confident that their concerns and ideas will be heard and addressed. Core Value #6 Innovation: Generates creative solutions to positively impact business goals by: Behavioral Demonstration Displaying openness to and suggesting new ideas, challenging the status quo, and respecting the creative influence of others. Encouraging the formation of new ideas and promoting an environment where impactful suggestions are recognized and considered for implementation. Establishing a work environment that welcomes new ideas and assisting assigned area(s) with implementation of ideas through use of leadership and influence. Slide 51 Making the Workforce Your Competitive Advantage 51 Workforce Engagement: Creating a multi-dimensional, trust-based relationship with the workforce Recognize Value Provide Growth Offer Reinforcement Solicit Feedback Display Caring Recognizing the value of the workforce Providing opportunities for growth and development How each employees work contributes to the organizations goals Soliciting input from the workforce & involving employees in collaborative decision-making Caring for all workforce members and their families Leadership Loyalty Ensuring leadership is accessible and loyal to our employees Two-Way Communication Clear communication channels between managers and employees Respect Diversity Promote inclusion Performance Management Linking vision, goals and values to individual performance Slide 52 The Center for Learning & Innovation: Organizational Structure 52 ORGANIZATIONAL DEVELOPMENT BEGINNINGS LEADERSHIP DEVELOPMENT COACHING WORKFORCE DEVELOPMENT CHANGE MANAGEMENT FACILITATION CUSTOMIZED SESSIONS PATIENT SAFETY INSTITUTE SIMULATION BASED EDUCATION INTER- PROFESSIONAL TEAM EDUCATION CLINICAL SKILLS EDUCATION EDUCATIONAL RESEARCH PHYSICIAN LEADERSHIP INSTITUTE PHYSICIAN BEGINNINGS LEADERSHIP DEVELOPMENT DEPARTMENT SPECIFIC EDUCATION DEPARTMENT TEAM BUILDING CLINICAL EDUCATION AT PATIENT SAFETY INSTITUTE SCHOLAR PIPELINE ADMINISTRATIVE FELLOWSHIPS MEDICAL SCHOLARS PIPELINE PROGRAM NEW YORKERS FOR CHILDREN PROGRAM INSTITUTE FOR HEALTH PROFESSIONS IS 59 PARTNERSHIP DOMESTIC AND INTERNATIONAL INTERNSHIPS EMERGENCY MEDICAL INSTITUTE PARAMEDIC EMERGENCY MEDICAL TECHNICIAN ADVANCED EMT AEMT & EMT RECERTIFICATION ACLS/BLS CONTINUING MEDICAL EDUCATION HOFSTRA NORTH SHORE LIJ SCHOOL OF MEDICINE EVALUATION AND ASSESSMENT CLINICAL SKILLS EDUCATION CLINICAL SIMULATION BIOSKILLS EDUCATION CENTER ATTENDING AND RESIDENT PHYSICIAN PROGRAMS CONTINUING MEDICAL EDUCATION HYBRID SIMULATION VENDOR SPONSORED PROGRAMS CLINICAL TRANSFORMATION LEAN / SIX SIGMA PROGRAM PROGRAM / PROJECT MANAGEMENT EHR CONTENT DEVELOPMENT CLINICAL COLLABORATIVES INDUSTRIAL ENGINEERING Slide 53 Knowledge What do people need to know that is different? Actions What do people need to do that is different? Beliefs What do people need to believe that is different? Networks What networks need to be different? Self awareness Team leadership tools Strategic thinking Influencing and network techniques Innovation tools Lead high performing teams Demonstrate increased self awareness of strengths and potential derailers Drive strategy development and market knowledge Leaderships impact on strategic results and value Engagement and play to your strengths Drive the industry, company and self forward Collaborative medicine Program participants and alumni Support teams and resources In order for education to make a business impact, it needs to focus on the four core elements of learning. The Business needs to design educational processes that help build capabilities that drive change with knowledge, actions, beliefs and networks. How Leadership is Built: Leadership Capabilities 53 Slide 54 12 Principles of Leadership 54 1.Be authentic, accountable and caring 2.Be humble and recognize the power of team 3.Energize your culture every day 4.Paint the picture 5.Create systems behind the smiles 6.Be positive and enthusiastic 7.Grow talent including your own 8.Communicate and engage 9.Foster an environment of low fear and high trust 10.Celebrate innovation and risk taking 11.Recognize, recognize, recognize 12.Ethics are everything Slide 55 55 A Sample of Specific Strategies Beginnings Selection, recruitment, on-boarding Setting expectations early Talent development and management Creating multiple opportunities for learning and growth Identification of emerging leaders and high potentials Focus on opportunities at all levels of the organization, not just the top Succession planning Cross-fertilize and promote transparency Slide 56 56 Maximize the use of simulation Real life experiences that enhance teamwork, communication and skill Engagement and input Allow free flow of ideas from all parts of the organization Recognition and reward Feedback closing the loop Slide 57 57 Perfection is not attainable, but if we chase perfection we can catch excellence. - Vince Lombardi