BCPSQC Quality Academy

Date: March 2012

Presented by

Linda Dempster, RN, MA

Projects, Priorities, and

Politics

When looking at improvement

opportunities there are many that could

be of value at any given time.

How do you advocate for a project and

navigate competing priorities?

How do you frame the importance to key

stakeholders?

“This interactive session will explore strategies for

addressing these questions.”

Key Objectives

1. What is a project vs a program?

2. Tips!

3. Strategic Framework

4. Utilize existing strategies and external

drivers

5. Develop key strategic partnerships and

relationships

6. Translation and „politics‟

Elements of a Safety Plan

1. Clearly aligned with strategic plan

2. Aligned with quality framework

3. Measured and monitored over time

4. Uses clear language

5. Sets measures/indicators and targets (SMART)

6. Evaluated formally

7. Influences culture

Source: Draft; CEHQ Working group, 2011

2. TIPS

Practical hints and tips will be interspersed throughout the

presentation

Tip # 1

• You can‟t do anything from a corporate

office

– Get out there!!

– Be visible

– Talk to people and understand the issues so

you can speak abut the priorities for staff

– Use that information to further your cause

PROGRAM VS PROJECT

Understand the fundamental differences between and project or a

program

-identify some key initiatives that have not been

sustained within your organization

Project vs Program

• A project is a temporary endeavor with a

defined beginning and end (usually time-

constrained, and often constrained by

funding or deliverables), undertaken to

meet unique goals and objectives, typically

to bring about beneficial change or added

value. » Wikipedia 2012

Program

• The temporary nature of projects stands in

contrast with business as usual (or

operations), which are repetitive,

permanent, or semi-permanent functional

activities to produce products or services.

» Wikipedia 2012

The Mansfield News Journal,

June 1936 • "If you haven't tried

Sealtest Fresh

Strawberry Ice Cream,

made by Telling's, you're

missing a real treat.

• It's the flavor-of-the

month for June, selected

by the Sealtest Jury”

How did it become sustained?

• "The Illinois Association of Ice Cream

Manufacturers has set up a committee

which will give serious study to a

suggested flavor and flavor-of-the-month

program for 1947."

'program' and 'serious study' suggests that

this phrase was well-entrenched by 1946.

Phrasefinder 2012

Here comes the interactive

piece! • Let‟s take 5 minutes to discuss 1 flavour-

of-the-month

– Someone have an example?

– How long did it last?

– What were some of the factors that caused it

to fade away…..

Interactive session complete!

3. STRATEGIC FRAMEWORK

Use your strategic framework to help frame your program or project

Highlight key points eg patients and staff safety

Care Experience

Quality & Safety: • Use evidence based protocols • Create Regional Programs • Build medication reconciliation

People: • Build capacity & capability • Recruit and retain the

best • Match staffing to volumes

and acuity

Innovation &

Sustainability: • Embed Lean in all our

processes • Best practices • Efficiencies through

Shared services • Performance based

funding • Green care

Care Experience:

• People First

• Patients and Families as Partners

• Optimize the patient experience and outcomes

Regional Program Strategic Framework People First

Better Health for our Communities: • Reduce Inequities • Support primary care initiatives.

Vancouver Coastal Health Strategic Framework

Lens People First

Vision We will be leaders in promoting wellness and ensuring care by focusing on quality and innovation.

Mission We are committed to supporting healthy lives in healthy communities with our partners through care, education and research.

Values Service Integrity Sustainability

Drivers Patient/Community Focus Engaged Team Operational Excellence Financial Sustainability

Go

als

O

bje

cti

ves

Provide the best

quality of care.

Promote better

health for our

communities.

Optimize our

workforce and

prepare for the

future.

Use our resources efficiently to sustain a viable

health care system.

Use a

standardized,

rigorous process to

accelerate the

creation and broad

use of evidenced-

based protocols in

all clinical areas

and programs.

Develop a

regional

program for Mental

Health and

Addiction and

Cardiac Sciences to

improve quality of

care.

Build a regional

medication

reconciliation

system across the

continuum.

Reduce health

inequities in the

populations we

serve through

focused

improvements in

core public health

programs.

Build on VCH

integration

strategies to support

implementation of

the MoHS directive

to deliver integrated

primary care, home

and community care

and community

mental health

services.

Enhance

workforce

utilization and match

staffing to clinical

volumes and patient

acuity.

Recruit and

retain the best

people by fostering

a culture of

excellence,

recognition and

respect.

Build

organizational

capacity by

strengthening

leadership and

management

competencies.

Embed LEAN

thinking at all

levels to fulfill

objectives and to

deliver quality

outcomes.

Develop and

implement best

practices in care

management to reduce

unnecessary days of

stay.

Deliver

administrative and

support efficiencies

through the shared

services organization

and consolidation.

Respond to provincial

patient-centered

funding model.

Develop service

agreements with

funders and service

providers.

Develop and

implement a strategy to

secure increased

capital funding.

Continue our

commitment to “Green

Care” alternatives by

reducing waste and our

carbon footprint.

Respond to

provincial patient-

centered funding

model.

Develop service

agreements with

funders and service

providers.

Develop and

implement a

strategy to secure

increased capital

funding.

Continue our

commitment to

“Green Care”

alternatives by reducing

waste and our carbon

footprint.

1.1

1.2

1.3

2.1

2.2

3.1

3.2

4.1

4.2

4.3

4.4

4.5

4.6

4.7

3.3

17

Quality Dimension: Safety

Safety

Hospital Infections

· ↓ MRSA · ↓ C. difficile

· ↓ BSI in ICU · ↓ SSI

HSMR · ↓ Mortality Rates

In-hospital complications (>1

GTT)

Staff Safety & Engagement

Initiatives & Accountability

for ↓ HAIs

• CC Council and IC ; strategies

to reduce BSI .

•NSQIP being implemented

• Antimicrobial Stewardship

•Bedpan decontaminator

project

•

• Initiatives & Accountability

for ↓ HSMR

• Reducing HF, COPD, Stroke

initiatives with Councils

Initiatives & accountability

for ↓ In-hospital

Complications

• Regional Falls initiative

•LEAN and HH at Richmond

• Med. Rec. programs

•

• Initiatives & Accountability

for ↑ Staff Safety &

Engagement

• MSI programs

• All managers and directors in

Fall 2011.

• Collaborative Practice- LEAN

•

Big Dot Measures of Safety

Measurable

Goals of Safety

Initiatives and Change Concepts

· ↑ SSCL Usage · ↑ HH Compliance

· ↑ VTE · ↓ Falls

· ↓ Hip Fractures · ↓ Pressure Ulcers

· ↑ Staff Safety and Engagement Survey · ↓ MSI Rates

Tip #2

Consider adding to your title.

Some examples:

Agent of Tremendous Change

The Connector

4. UTILIZE EXISTING

STRATEGIES

Examine what is already going on out there and determine whether

your initiative is a good fit.

Consider other drivers

• External drivers

– AC

– Health Canada

– MOH

Just a few

Can you fit your program here?

• Internal Drivers

– Beyond strategic

directions;

– Data is showing you

have to do something

about it urgently

– Significant risk to

patients and/or staff

“Knowing is not enough. We must

apply.”

Johann Wolfgang von Goethe

Develop internal partnerships

• Eg.

Safety and Engagement

Strategy

• Survey

• Added safety culture

questions

• Significant correlation

• Action planning

• Supported each other

but also further

embedded safety and

engagement across

the organization

Team Engagement Strongly Connected with Safety

Items S

afe

ty I

tem

s In

de

x

GrandMean

23 Copyright © 2011 Gallup, Inc. All rights reserved.

Safety questions and

engagement are

highly correlated

Pearson cor. = 0.85

Tip #3 Leadership Style

• Consider your own style.

• Build internal capacity for sustainability

• Embrace diversity!!

“Leaders make followers;

Great leaders make Leaders”

3. TRANSLATION AND

POLITICS

How do you translate your program or project for various audiences

and maneuver the politics?

WINSTON CHURCHILL

“However beautiful the strategy,

you should occasionally look at

the results”

28

Annual Evaluation

-another key strategy for your plan

Example:

Surgical Safety Checklist

Surgical Safety Checklist

Surgical Team in Action

32

SSCL Compliance SSCL: Compliance on All 3 Components by Facility

0

10

20

30

40

50

60

70

80

90

100

Fiscal Period

Per

cen

tag

e C

om

plia

nce

VGH 14 13 14 15 15 15 19 30 28 31 40 40 47 56

UBCH 51 72 79 76 68 70 66 78 57 56 53 59 75 65

RH 1 14 46 45 50 51 56 49 54 54 50 57 64 63

LGH 0 9 6 15 25 54 82 89 82 79 79 76 84 79

SGH 0 0 0 0 0 0 84 96 96 97 100 100 100 96

SMH 0 0 0 0 0 0 10 57 56 61 51 59 80 70

PRGH 0 0 0 0 0 0 0 0 9 42 56 50 85 89

P6 P7 P8 P9 P10P11P12P13P1 P2 P3 P4 P5 P6 P7 P8 P9 P10P11P12P13

2010-11 2011-12

Tip #4

• Can you „read‟ the room?

Good Catches Identified by

Electronic Survey Responses

36 Good Catches / Close Calls

Summary of themes:

• Antibiotics **

• Surgical site and side

• Wrong patient

• DVT prophylaxis

• Equipment, Implants not available

• Blood type and product availability

Q8. Would you want the Surgical Safety

Checklist used if you were having

surgery?

Translate your program

• Use a variety of methods to translate your

program to others within the organization:

– Health economic evaluation-

– Reporting to various audiences-

Tip #3 SBAR is your friend

S- Situation

B-Background

A-Assessment

R-Recommendation

(you are the expert and they want to hear

your recommendation!)

Use it to frame your request

• S- Situation

• B-Background

• A- Assessment

• R-Recommendation

38

Finance;

Calculation of total # cases

UTI is the most common HAI at VCH with 18,900 cases over the last 4 years

39

Cost per Healthcare acquired

infection in VCH

40

Infection Control Program

Cost Benefit

Summary of Objectives

1. What is a project vs a program?

2. Tips!

3. Strategic Framework

4. Utilize existing strategies

5. Develop key strategic partnerships and

relationships

6. External drivers

7. Translation and „politics‟

Final Tip!!

Communicate, communicate, communicate

BUT IT HAS TO BE

Clear, clear, clear

I’ll be gone out of town for a month,

would you water my plants???

45

Thank you!