leadership and the triple aim - rjl.se• of course it is great fun for the whole region jönköping...
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Leadership and the Triple Aim Utvetlingskraft
September 7, 2016 Jonkoping, Sweden
Maureen Bisognano President Emerita and Senior Fellow
• Congratulations surgeons Lina Westman and Niklas Zar from Region Jönköping County with Vitalis Scholarship 2016 for the IT tool care process ! The tool was developed in conjunction with the introduction of so-called standardized care processes in cancer care.
• Of course it is great fun for the whole Region Jönköping County , to be noted . We have done a good job with the care process , where all of our working group should have the credit , says Lina Westman. But it is no coincidence that we are so good at improvement . We are encouraged to work with this type of project and have a very good support from management
• Grattis kirurgerna Lina Westman och Niklas Zar från Region Jönköpings län som fått Vitalis stipendium 2016 för IT-verktyget Vårdförloppet! Verktyget togs fram i samband med införandet av så kallade standardiserade vårdförlopp inom cancervården.
• Det känns förstås jätteroligt, för hela Region Jönköpings län, att det uppmärksammas. Vi har gjort ett bra arbete med Vårdförloppet, där alla i vår arbetsgrupp ska ha credit, säger Lina Westman. Men det är ingen slump att vi är så bra på förbättringsarbete. Vi uppmuntras att arbeta med den här typen av projekt och har ett väldigt bra stöd från ledningen.
The IHI Triple Aim
Leading Innovation Starts at the Top
New ways to think about health and care Engaging and developing our teams Using data to predict, plan, prevent, and improve Improvement skills across the system
New Ways to Think About Health and Care
Leaders see the journey of our patients, handovers, transitions, messages, and understanding Caring for the caregivers How much can we prevent? Flow faults/care faults
Critical Flow Failures & Percent OccupancyPopulation: Main Campus, Including College Hill
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New Critical Flow Failures Average % Occupancy During Month
Last Updated 10/23/2009 by A. Anneken, Division of Health Policy & Clinical Effectiveness
2008-Pre Management
2009-Post Implementation
80
18
Serious Safety Event Rate Wellstar Health System January 2008- February 2010
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SSE'sSSE Rate
Rolling 12 month Serious Safety Events expressed per 10,000 adjusted patient days
February adjusted patient days based on previous 12 months average
SSER February 2010: 0.35 Average Days between events: 18 days (Rolling 12 month) 11 days (CY 08)18 days (CY 07)37 days (CY 06)
55% Reduction SSER 111 days since last event
Medical Staff Leaders required mandatory Safety training for all 1700 All 11,000 employees trained as well
Baby Girl V. 5/12/2008
Mother’s Delay in Tx
Ursula H. 2/12/2008
Fall
Helene C. 9/5/2008
Fall
Jimmy P. 7/07/2008
Fall
Robert S. 10/13/2008
Fall
Baby Boy S. 8/1/2008
Wrong Pt. Procedure
Wade W. 7/16/2008
Delay in Tx
John B. 9/06/2008
Delay in Dx
Florita H. 7/03/2008
Delay in Tx
Joann E. 9/23/2008
Wrong Site Surgery
Joseph R. 9/08/2008
Delay in Dx.
A different look at our baseline
Alvin G. 8/17/2008
Fall
Nicole S. 1/4/2008
Delay in Dx
Ms. L. 2/14/2008
Delay in Tx
Teodur C. 1/29/08, 2/12/2008
Delay in Tx
Tamika M 4/21/2008 Med Error
Nancy H. 6/18/2008 Med Error
Regina D. 12/9/2008
Wrong Site Surgery
Sandra M. 12/10/2008
Post Procedure Death
Mary D. 3/9/2008 Med Error
Margaret H. 2/6/2008
Med Error
Baby Boy G. 3/25/2008 Med Error
Lorena W. 11/10/2008
Post Procedure Death
Cynthia K. 11/10/2008 Delay in Tx
Dale W. 10/12/2008 Med Error
Eugene B. 10/27/2008, 10/28/2008
Med Error, Fall
Kathy W. 12/16/2008
Post Proced Loss of Function
Robert B. 12/2/2008
Post Procedure Death
Chantal E. 6/26/2008
Inapprop Touching
Gary B. 6/13/2008
Fall
Lester J. 9/5/2008
Fall
Calvin P. 4/4/2008
Med Error
Gwendolyn P. 10/28/2008
Wrong Implant
Douglas T. 10/18/2008 Med Error
Mary C. 12/19/2008
Fall
Lance D. 10/30/2008 Delay in Tx
Priscilla W. 8/30/2008
Delay in Tx
Kyle W. 9/13/2008
Delay in Tx
Andrea M. 6/24/2008
Wrong Procedure
Karen G. 8/5/2008
Proced Cx/Delay in Tx
Nicole H. 8/12/2008
Post-proced Cx
Virginia L. 8/12/2008
Delay in Tx
Cynthia M. 10/27/2008 Med Error
Shirley H. 12/23/08
Post Proced Death
Beverly S. 2/4/09
Med Error
Dorothy R. 1/28/09
Delay In Treatment
Leading a 50% Reduction in events from baseline
Sharenda W. 2/15/09
Med Error
Edward R. 4/23/09
Wrong Side Procedure
Robert D. 5/12/09
Post Procedure Death
Donna S. 6/4/09
Retained foreign object
Lilliam C. 4/3/09
Retained foreign object
Juanita A. 5/14/09
Delay In Treatment
Yoland C. 7/7/09
Delay in Treatment
Michael F. 8/20/09
Retained foreign object
Peggy P. 7/1/09 Burn
Loueene D. 9/23/09
Fall
Karen C. 9/28/09
Delay In Treatment
Brenda R. 10/14/09
Delay In Treatment
James H. 10/25/09
Post Procedure Death
Monroe K. 5/18/09
Post Procedure Death Alma M. 11/6/09
Fall
Johnny B. 11/9/09
Fall
Jerry Y. 11/7/09
Fall
Willie B. 11/5/09
Med Error
Pauline M. 11/2/09
Fall
Rachel M. 11/3/09
Delay in Treatment
Scott G. 9/5/09
Delay in Treatment
Results thus far
No Names Yet!
Over 136 Days since last event!
Engaging and Caring for Our Teams
Different expectations across generations Team-building as a core leadership focus
Multigenerational Teams
Traditionalists (71 to 88 years old): loyal
Baby Boomers (56 to 70 years old): optimists
Generation X (36 to 55 years old): questioning
Gen Y, Millennials (21 to 35 years old): realistic
Gen Z, iGen (20 years old and younger): balanced
Changes the Next Generation Expects from Healthcare
“Live for the moment” – Don’t see regular check-ups and testing as part of their health
and wellness “Dr. Who?” – Seek advice and care from many sources; we’ll need new ways
to connect Holistic health – Use meditation, massage, nutrition, exercise, and medicines
Track me, treat me – Less concerned about privacy and expect us to track and
connect to care
Multiethnic Teams
Develop understanding and appreciation of cultures – Cultural “lunch and learns” – Ethnographic cases – Reflection sessions, and asking “what matters to
you?”
Multiprofessional Teams
The new medical school- starting with a multiprofessional focus This meeting is an example of your commitment Build “curriculum” of language and approaches that need resolution
Using Data to Predict, Plan, Prevent, and Improve
Data to predict
Four leadership questions
An Example from Health Care Northwell Health Center for Emergency Medical Services
Northwell Health Center Provides ambulance service in the 1700 square miles of New York City, Nassau and Suffolk Counties. Employs more than 500 Emergency Medical Technicians and Paramedics who operate over 40 response units each day transporting over 55,000 patients annually.
Four Leadership Questions Do you know how good you are?
Do you know where you stand relative to the best?
Do you know where the variation exists?
Do you know the rate of improvement over time?
Improvement Skills Across the System, Especially in the
Community
Confidential & Proprietary
What Improvement Skills are Needed for Each Role?
Experts Operational
Leaders (Executives)
Change Agents (Middle Managers, Stewards, project leads)
Everyone
(Staff, Supervisors,
UBT lead triad)
• Setting goals and measures
• Identifying problems • Mapping process • Testing change • Simple waste
reduction • Simple
standardization • Team behaviors
• Setting goals and measures • Identifying problems • Mapping process • Sequencing tests of change • Simple understanding variation • Implementation and spread • Simple waste reduction • Simple standardization
• Setting direction and big goals • Results leadership • Portfolio selection and
management • Managing oversight of
improvement • Being a champion and
sponsor • Understanding variation to
lead • Managing implementation and
spread
• Analysis, prioritization of portfolios
• Deep statistical process control
• Deep improvement methods
• Leadership team advisory re portfolio selection, process
• Effective plans for implementation and spread
Live Algoma 100 Million Healthier Lives community High school students took IHI’s open online course on quality improvement and conducted improvement projects The high school students then taught 6th grade students QI, and helped them run projects
Tack!
Maureen Bisognano President Emerita and Senior Fellow Institute for Healthcare Improvement 20 University Road, 7th Floor Cambridge, MA [email protected]