converting resistance to buy-in: virginia mason health ... · melissa lin, ms, cphq, lssbb virginia...

Webinar SeriesSepsis: Across the Continuum of Care

Converting Resistance to Buy-in: Virginia Mason Health

System Sepsis Power Hour

Speaker:Melissa Lin, MS, CPHQ, LSSBBVirginia Mason Institute

Sepsis Alliance gratefully acknowledges the support provided for the Sepsis: Across the Continuum of Care webinar series by bioMérieux

SEPSIS ALLIANCE MISSIONTo save lives and reduce suffering by raising awareness of sepsis as a medical emergency

Sepsis Alliance | Sepsis.org

© 2017 Virginia Mason Institute

Converting Resistance into Buy-in: Sepsis Power Hour at

Virginia Mason Health System

Melissa Lin, MS, CPHQ, LSSBB


Learning Objectives

• Identify how technical change vs. adaptive change impacts your workplace

• Explain the urgency around mortality due to sepsis at Virginia Mason Health System that led executive leadership to evaluate and improve sepsis protocol.

• Describe how 2 Key Elements of Success converted staff/clinical resistance to staff empowerment, engagement, and just-in-time care delivery to septic patients

• Discuss the importance of communication and accountability through cross-functional team management to ensure quality care delivery and sustainability of the new Sepsis Power Hour protocol at Virginia Mason Health System

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Levels of Resistance

Level 1: I don’t get itInformation – facts, figures, ideas

Level 2: I don’t like itEmotional reaction to the change

Level 3: I don’t like youTrust and confidence

5Source: Maurer, Rick. “Beyond the Wall of Resistance.” Bard Press, 2010.


Distress and Adaptive Work

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Ronald A. Heifetz

Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.


1. Get on the balcony2. Regulate distress3. Give the work back4. Protect all voices

Leading Adaptive Change

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Heifetz, Ronald A. and Marty Linsky. Leadership on the Line. Harvard Business School Press. 2002; 108.


How do you see the correct current state?

Get on the Balcony

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Urgency and Sepsis• There are more than 18 million cases of sepsis worldwide each

year, and it kills more than 258,000 Americans annually. 1,2

• Sepsis is the primary cause of death from infection. 2

Patients diagnosed with sepsis are estimated to have a mortality rate of 28 to 50 percent.3

• Patients with initially less severe sepsis make up the majority of sepsis deaths. In one study, septic shock was not present in 68 percent of patients who died from sepsis.4 Improving standardized care for patients with less severe sepsis could drive future reductions in hospital mortality.

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1 Slade, Elizabeth, Pritpal S Tamber, and Jean-Louis Vincent. "The Surviving Sepsis Campaign: Raising Awareness To Reduce Mortality." Critical Care 7.1 (2003): 1. Web. 10 July 2017.

2 Adapting To The CMS Sepsis Bundle | Healthleaders Media". Healthleadersmedia.com. N.p., 2017. Web.

3 Angus, Derek C. et al. "Epidemiology Of Severe Sepsis In The United States: Analysis Of Incidence, Outcome, And Associated Costs Of Care". Critical Care Medicine 29.7 (2001): 1303-1310. Web.

4 Liu V, Escobar GJ, Greene JD, et al. Hospital Deaths in Patients With Sepsis From 2 Independent Cohorts. JAMA. 2014;312(1):90. doi:10.1001/jama.2014.5804.


Sepsis Urgency at Virginia Mason Health System

• Sepsis was the major cause of mortality in our institution with 2276 deaths from 2008-2014.

• Sepsis was responsible for 47% of the total mortality cases over this 7 year time period.

• Sepsis survivors experience:– Longer lengths of stay with high utilization of precious

healthcare resources– Higher rates of readmission– Long term injury and effects of the disease which could

be life altering

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– John Kotter

“People change what they do less because they are given analysis that shifts their thinking than because they are shown a

truth that influences their feelings.”


How do you know when to raise the heat?

Regulate Distress

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Distress and Adaptive Work

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Ronald A. Heifetz

Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.

© 2015 Virginia Mason Medical Center

Virginia Mason Strategic Plan


Setting an Aggressive Standard

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< 1 hour

Researchers have found that each hour of delay in administering antibiotics results in an average decrease in survival of 7.6 percent. 1

1 Adapting To The CMS Sepsis Bundle | Healthleaders Media". Healthleadersmedia.com. N.p., 2017. Web.

2 Liu et al. Hospital Deaths in Patients With Sepsis From 2 Independent Cohort. JAMA July 2014

Additionally early sepsis was targeted because two-thirds of those who die do not have sepsis on arrival.2


Give the Work Back

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Edgar Schein

“It can be argued that the only thing of real importance that leaders do is create and manage culture; that the unique talent of leaders is their ability to understand and

work with culture.”


The Virginia Mason Production System

Sense of Urgency

Visible and Committed Leadership

Aligned Expectations

OneManagement

System

Technical and Human Dimensions

of Change

Shared Vision


VMPS Methods and Tools


Early Sepsis Recognition and Treatment

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Sepsis Power Hour

•Identify Sepsis

•Check Lactate

•Draw Blood Cultures

•Start Bolus

RN Work

•Confirm Sepsis

•Start Antibiotics

•Complete Bolus

MD Work•Prioritize Antibiotics

•Dose and Prepare

•Deliver

Pharmacy Work

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< 60 minutes< 30 minutes


SNIP: Sepsis Nurse Initiated Protocol

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Protect All Voices

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Peter Drucker

“Culture eats strategy.”


Respectfully Promoting Change

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People don’t change all at once.Time is important.

Rogers, Everett M. Diffusion of innovations (1st ed.) New York: Free Press of Glencoe, 1962.

Chasm

Innovators2.5%

Early Adopters13.5%

Early Majority34%

Late Majority34%

Laggards16%


Respectfully Promoting Change

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2 Key Elements of Success

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Empower your care team to take immediate action.

Rapidly bring services directly to the patient.


Communication and Accountability

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Registered Nurse Nursing Assistant Phlebotomist

Provider Pharmacist Project Manager


Maintaining the Gains

• Engaged leaders

• Monthly data tracking

• Individual follow-up

• Revisiting the message

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Project Manager Oversight

“Dr. Calderon,

Thank you for using the order set and ordering antibiotics STAT! The patient received antibiotics in 31 minutes, well under our 60 minute target.

Thanks again,Sepsis Guiding Team”

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Provider Perspective

• “I was having a pretty chaotic night and the order set and process made things easier.”

• “The system worked perfectly for this patient!”

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Sepsis Power Hour at Virginia Mason

32https://youtu.be/p_peptJgp-4

https://youtu.be/p_peptJgp-4


Results at Virginia Mason Medical Center

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Lead Time Reduction Sepsis Mortality Rates (2011 versus 2016)


Sepsis Power Hour Bundle

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© 2017 Virginia Mason Institute35

The Sepsis Power Hour solution https://www.virginiamasoninstitute.org/sepsis-power-hour/

Learn about additional trainings and services www.VirginiaMasonInstitute.org

Email us [email protected]

To Learn More About our Sepsis Solution

https://www.virginiamasoninstitute.org/sepsis-power-hour/

http://www.virginiamasoninstitute.org/


Social MediaConnect with us

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-Sensei Takumi Nakao

“Change work cannot only be about kaizen, it has to be about heart, too.”


Ask your questions via the question tool.Question and Answer Session

A lean journey is a learning journeyTM


SEPSIS AWARENESS MONTH

Sepsis Awareness Month™• Launched in 2011 by SA• State designations• Community events• Sepsis Superhero™ Challenge• Toolkits for healthcare providers

• Printable Posters and Infographics• Digital and Social Media tools• Ideas to get involved• Template messaging

www.SepsisAwarenessMonth.org

http://www.sepsisawarenessmonth.org/

• Annual celebration of sepsis

leadership across the country

• September 12, 2019

• Marquee New York City


Register: www.sepsiswebinar.org

Unlocking the Potential of Artificial Intelligence in Sepsis CareAugust 7 at 2 pm ET

Sepsis Alliance gratefully acknowledges the support provided for the Sepsis: Across the Continuum of Care webinar series by bioMérieux and this webinar by Jvion

Speakers:

Michael H. Hooper, MD, MScVice President Medical AffairsSentara Norfolk General HospitalAssociate Professor of Medicine Eastern Virginia Medical School

Scott D. Stewart, BS, LSSBB, PMP, CSMClinical Process ImprovementSenior EngineerSentara Healthcare

GE Healthcare Sponsor Innovation Webinar


Can We Solve Sepsis Together with GE?Interactive Augmented Intelligence for Sepsis Medical CareAugust 22 at 2 pm ET

Sepsis Alliance gratefully acknowledges the support provided for this webinar by GE Healthcare

Speaker:

Jeff Hersh, MD, PhDChief Medical Officer GE Healthcare

http://www.sepsiswebinar.org

Sepsis: Common, Lethal, and Unrecognized

Date: August 27 at 2 pm ET

Speaker: Angel O. Coz, MD, FCCPAssociate Professor of Medicine University of KentuckyPulmonary and Critical Care Specialist Lexington Veterans Affairs Medical Center

Register: www.sepsiscoordinatornetwork.org



The Blind Spot of Antibiotic Stewardship: Antibiotic Overuse at DischargeSeptember 24 at 2 pm ET

Sepsis Alliance gratefully acknowledges the support provided for this webinar by Thermo Fisher Scientific

Speaker:

Valerie Vaughn, MD MScAssistant Professor University of Michigan Medical School and Ann Arbor VA Healthcare System

Sepsis: Across the Continuum of CareWebinar series

The information in this webinar is intended for educational purposes only. The presentations and content are the opinions, experiences, views of the specific authors/presenters and are not statements of advice or opinion of Sepsis Alliance. The presentation has not been prepared, screened, approved, or endorsed by Sepsis Alliance.

Sepsis Alliance gratefully acknowledges the support

provided for the Sepsis: Across the Continuum of Care webinar series by bioMérieux

converting resistance to buy-in: virginia mason health ... · melissa lin, ms, cphq, lssbb virginia...

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