quality impact teams in the small organization part 3 – team leader training

Quality Impact Teams

In the small organizationPart 3 – Team Leader Training

Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.

Celebrating WINS


Welcome

Today’s healthcare environment demands greater urgency than ever to improve. Leadership of your QIT must be high-energy and focused

on results! Inspire a sense of urgency in your team to improve our

organization

It’s not enough to accept change; we must be willing to help drive change. Be courageous, and step out of the box to find solutions! Develop your team to be the best employees they can be;

challenge them to think about the future state of our organization


Session Objectives:

An overview of Evidence-Based Leadership Quality Impact Teams: structure and purpose

Review of Quality Impact Team leader roles/ responsibilities

Review of Quality Impact Teams

How to maximize team meeting effectiveness

Introduction to your QIT toolkit


Exercise – 15 minutes

Two heads are better than one!


Understanding the foundational teams of Evidence-Based Leadership– structure & purpose


Execution FrameworkEvidence-Based LeadershipSM

Standardization AcceleratorsMust Haves®

Performance Gap

Objective Evaluation

System

Leader Development

Foundation Breakthrough

STUDER GROUP®:

Aligned Goals Aligned Behavior Aligned Process

Rev 4.8.11


Organizational Steering Committee (Team Chairs and CEO appointed members)

Leadership Development Institute Steering Team *

Executive Team

ED Perception of Care

Measurement *

Outpatient Perception of Care

Inpatient Perception of Care

Physician Collaboration

Workplace of Choice

Communication *

Reward and Recognition

Medical Practice Perception of Care

Standards*

Quality Impact Steering Team *

Social

Communication

Curriculum

Linkage

Logistic

Pillar – Based Leader and Content

Representatives

*Highly Recommended Teams/Functions

- - -Executive Sponsorship and/or Leadership Recommended

Leadership Evaluation (Accountability) Team *

Service Recovery

Connecting the Dots – EBL Team Structure


Accountability

* Reference: The leader evaluation process isdefined in detail in the Leader Evaluation ProcessManual located in the Studer Group Learning Lab.


Alignment

* Reference: Leadership Development Institute Teams/ Functions are defined in detail in the LDI manual located in the Studer Group Learning Lab.


Action

• Chaired by an Executive Sponsor & QIT Champion

• Composed of Individual leaders from each QIT and the team leader of the Leadership Development Team


QIT Steering Committee Membership

Meets every week for the first 4-6 months of the rollout of QITs and then reevaluates frequency, as appropriate

Service as leader may last 12, 18, or 24 months depending on capacity or leader availability

Co-leaders may be used and considered the leader-in-waiting who will assume the team leader role for the next term


QIT Steering Committee Key Actions

Establish a process for recruitment

Oversee and prioritize QIT work to maintain alignment with organizational goals

Coordinate individual team efforts so they do not overlap

Ensure teams have resources to help facilitate implementation of ideas

Hold leaders accountable for consistent, effective execution of individual QIT work


QIT Steering Committee Benefits

A forum to share ideas and challenges to maximize learning across teams.

A safe and environment to identify and help resolve the issues of individual teams.

A gauge to manage the rollout of major team initiatives to effectively take on the right amount of change.


Nine Principles


Purpose, worthwhile work

and makinga difference

®

Creating Momentum—Healthcare Flywheel®

Bottom Line Results

(Transparency and Accountability)

Self-Motivation

Prescriptive To Do’s

WHY


Understanding your role as a QIT leader


So now you are a team leader…


The Why: Quality Impact Teams

Empower to create employee ownership

Engage to show value for employee input

Excite to build momentum in the change

process


The What: The Role of the QIT Leader

Drive the performance of your individual QIT

Serve on the QIT Steering Committee

Model the behaviors expected of all leaders Practice open and honest communication Value everyone’s role Be supportive, but empower team members Project a positive attitude Handle and resolve conflict appropriately Hold effective meetings


The How: The Role of the QIT Leader

Be accountable for holding your team accountable to execute

Quality Impact Steering Team Update Form– Each team leader completes a

summary report of team efforts since the last meeting

– Summaries are sent to the QIT leader before the steering team meeting

– QIT leader emails highlights from each team to the overall leadership team monthly


Individual teams


Getting To Know You!

Name and leadership role

Years with the organization

Why do you love what you do?

What is your Quality Impact Team?


The Teams

Measurement

Standards

Communication

Inpatient Patient Experience

Emergency Department Patient Experience

Outpatient Patient Experience

Service Recovery

Provider Collaboration

Medical Practice

Reward and Recognition

Workplace of Choice

Measurement TeamTo consistently identify and communicate trends in results


Measurement Team Membership Success Factors

A mix of leaders and frontline staff

High performers – a reward and recognition opportunity

People who like data analysis and numbers

People who like to teach data interpretation


Measurement Team – Key Actions

Analyze relevant data to identify strengths and areas for improvement— become vendor report experts

Educate leaders and staff on interpreting data

Distribute and communicate timely data consistently

Track and communicate trends to appropriate leaders

Provide internal benchmarking information

Communicate with Reward & Recognition QIT to identify departments that are performing well


Sample Measurement Report

Location Manager N Overall Clean QuietCourtesy Listen Explain Courtesy Listen Explain New SE Call Bell Toileting Assess Instruct Control Effort

10 West NAME 33 84.38 84.85 78.79 78.79 90.91 84.85 87.88 85.71 80.95 72.73 70.83 85.19 92.86 63.33 73.33 78.79 69.75 East NAME 31 64.52 80.65 70.97 67.74 90.32 83.87 90.32 77.78 36.84 70 63.16 73.33 96.67 68.97 75.86 74.19 67.745 West NAME 22 63.64 77.27 72.73 72.73 77.27 86.36 68.18 76.92 46.15 65 78.57 81.82 95.45 61.11 61.11 59.09 68.186 East NAME 35 67.65 91.43 82.35 79.41 79.41 76.47 66.67 60 30 62.07 55.56 87.1 93.55 61.29 76.67 62.86 61.766 West NAME 11 60 72.73 45.45 72.73 90.91 72.73 72.73 85.71 42.86 22.22 62.5 100 100 70 70 70 45.457 West NAME 54 86.27 92.59 88.89 87.04 90.57 86.79 85.19 94.12 72.73 68.09 64.52 78.43 93.75 64.1 84.62 74.07 73.588 East NAME 25 83.33 96 80 84 87.5 84 92 64.29 50 59.09 83.33 86.96 78.26 47.06 52.94 68 448 West NAME 16 81.25 87.5 75 75 87.5 68.75 81.25 90 60 64.29 66.67 86.67 83.33 57.14 66.67 62.5 43.759 East NAME 45 81.4 93.33 82.22 77.78 91.11 84.09 75.56 88 36 85.37 74.19 94.74 92.11 66.67 87.5 71.11 62.799 West NAME 42 71.43 88.1 78.57 67.5 85.37 75.61 70.73 79.17 45.83 73.68 61.9 75 97.5 56.67 70 66.67 73.17ART 3 WestNAME 42 89.74 97.56 90.48 90.48 92.86 85.71 75 77.78 55.56 74.29 75 71.05 100 59.09 90.91 80 64.29ART 4 East NAME 56 90.2 90.91 80.36 85.71 90.91 87.27 83.93 65 55 69.81 69.7 82 86.54 60 82.22 67.86 57.14ART 5 East NAME 34 82.35 88.24 81.25 72.73 88.24 82.35 67.65 87.5 50 64.29 64.29 81.25 90 66.67 66.67 76.47 54.55ART 5 WestNAME 21 95.24 100 80.95 80 95.24 95.24 76.19 68.75 40 57.14 40 81.25 86.67 76.92 76.92 55 60ART 6 East NAME 31 86.67 93.55 77.42 83.33 96.67 93.1 90.32 88.89 58.82 61.54 64.29 80 93.33 58.33 79.17 70 77.42ART 6 WestNAME 39 80.56 76.32 76.32 74.36 87.18 82.05 71.79 71.43 47.37 55.88 58.33 80.56 94.44 55.56 76.92 71.79 63.16Joint ReplacementNAME 26 88.46 92.31 80 84.62 96.15 84.62 84.62 71.43 38.1 50 72.22 95.65 91.3 62.5 84 57.69 80.77

Medical Center 608 81.54 89.55 79.9 78.87 89.18 83.83 79.07 78.32 52.33 67.16 67.48 81.9 92.41 61.83 77.11 69.88 64.17

> CMS Benchmark (mean of top decile) 82.55 84.99 84.99 84.99 88.45 88.45 88.45 71.54 71.54 78.08 78.08 89.24 89.24 77.92 77.92 78.1 78.1Between 75%tile and Benchmark 74 81 81 81 84 84 84 65 65 71 70 86 86 73 73 77 66Between Threshold & 75th %tile

< CMS Threshold (50th percentile) 67.33 75.79 75.79 75.79 79.57 79.57 79.57 59.85 59.85 62.21 61.82 82.72 81.93 68.99 68.99 63.54 63.54

HCAHPS (CMS Qualified; Not Case Mix Adjusted)

Jul - Sept 2012 (as of 10/26/12)

Comm RN Comm MD Meds Respon D/C Pain


Sample –Trending

Standards Team Establishing and reinforcing the code of conduct that all employees will uphold.


Standards Team Membership Success Factors

A single leader and the remainder of frontline staff

High performers – a reward and recognition opportunity

Representative of a multidisciplinary cross-section of staff

Creative, “can – do” people

Collaborative team player; enjoys working with people

People who already live the values of the organization


Standards Team – Key Actions

Develop or modify current organizational “Standards of Behavior” to align with and support the values of the organization:

Brainstorm behaviors – what specific actions illustrate our values when people interact in our hallways?

Work with HR to incorporate into the pre-employment and selection process;

Develop a commitment statement for current employees to sign;

Incorporate Standards into new employee orientation and the annual performance review (highmiddlelow®).


Rollout Standards - Booklet

Sample courtesy of University of Utah Hospitals and Clinics

Communications TeamExplaining THE WHY when change is necessary , what it will improve and how it impacts employees

Studer Group


Communications Team Membership Success Factors


Leader from the marketing department

High performers – reward and recognition opportunity

Articulate, strong communicators

Able to express ideas in written form clearly

Highly engaged personality


Coordinate and disseminate information for employees about the journey• Connect to purpose– explain the why

Encourage a “no secrets” culture

Help coordinate quarterly employee forums

Develop communication tools for other QITs

Create and standardize communication boards around the five pillars

Communications Team –Key Actions


Communication Board sample

Inpatient ExperienceTo continuously find ways to exceed the expectations of our inpatients and their family members


IP Team Membership Success Factors



People who work in patient care areas; preferably from all shifts

Good cross-section of support and clinical areas

Creative people


Inpatient Patient Experience Team – Key Actions

Review current results and develop action plans to address opportunities for improvement

Review complaints and grievances from patients to address specific concerns

Support leaders by providing additional resources to implement evidence-based tactics, such as becoming EXPERTS on the HCAHPS Handbook

Creative problem solving and implementation of projects for priority HCAHPS composites

Emergency Department Patient Experience

To exceed expectations in emergency situations with quality clinical care and compassion


ED Team Membership Success Factors



Cross section of all stakeholders that impact the ED patient experience (i.e. Imaging, lab, MedSurg, housekeeping, paramedics, etc.)

Providers


Emergency Department Patient Experience Team –Key Actions

Assess current metrics (patient experience results, dashboard results) and identify

Assist with facilitation of best practice Behaviors

Develop implementation plans that include education, communication, monitoring, and validating execution

Partner with Measurement Team to make appropriate performance data available to leaders and staff

Partner with Reward and Recognition Team to celebrate progress of outcomes


Daily dashboard sample —accountability tool

Emergency Department

ED11: ED Daily Dashboard

WEEKLY MONTHLY

GOALS MON TUE WED THU FRI SAT SUN AVERAGE AVERAGE

PATIENT VISITS

# OF LWBS

% LWBS < 2% (VHA National Average)

LOS FOR DISCHARGED PATIENTS < 138 mins (VHA national average)

MEDIAN TIME FROM ED DISPOSITION TO IP ADMISSION

138 mins (VHA national median)

LEADER ROUNDING: % PATIENTS ROUNDING ON >25%

HOURLY ROUNDING: % COMPLETE >90%

WAITING ROOM ROUNDING: % COMPLETE >90%

D/C PHONE CALLS: % ATTEMPTED % CONNECT

100% eligible

>60%

MONTHLY OVERALL QUALITY OF CARE PERCENTILE RANK

(Department Goal)

Patient Rounds: Numerator = Total # patients rounded on by any leader. Denominator= Total daily census

Hourly Rounds: Numerator= Total # of hours in which rounds are documented. Denominator= Total # hours rooms were occupied in 24 hour period. Calculate by multiplying # of rooms by 24 ( hours), then subtracting # of hours in which rooms were empty.

Waiting Room: Rounds Numerator= # of hours in which rounds ins documented. Denominator= 24 ( hours)

D/C Calls: Eligible patients are those treat and released to home. Some diagnoses will be excluded.

Outpatient Experience To exceed expectations in emergency situations with quality clinical care and compassion


OP Team Membership Success Factors



Representation of staff from multiple outpatient Depts., including staff from ambulatory surgery and possibly the ED


Emergency Department Patient Experience Team –Key Actions

Assess current metrics (patient experience results, dashboard results) and identify

Assist with facilitation of best practice Behaviors

Develop implementation plans that include education, communication, monitoring, and validating execution



Service recoveryFinding solutions when we fail to execute effectively


Service Recovery Team Membership Success Factors



People who enjoy interacting with customers

Compassionate, nonjudgmental and engaging

Levelheaded during emotionally-charged situations

A representative from Risk Management

Patient Services Representative, if applicable


Outpatient Patient Experience Team –Key Actions

Review current results and develop action plans to address key areas to drive results

Review complaints and grievances from patients to address specific concerns

Share thank-you letters and other stories from patients that recognize employees

Identify best practice approaches

Facilitate implementation of evidence-based tactics

Provider CollaborationTo improve the level of service to— and partnership with providers


Provider Collaboration Team Membership Success Factors

At least one physician and senior executive member or sponsor

High performing staff that work consistently with physicians from multiple disciplines (i.e. nursing, IT, physician liaison, physician recruiter, etc.)


Provider Collaboration —Key Actions

Remove barriers for physicians to providing quality service to patients and their families

Identify opportunities to strengthen a sense of partnership with physicians

Open communication channels between physicians/providers, admin leaders, nursing and administration

Help develop additional tools for the organization to use to reward and recognize physicians

Promote the value of physicians to the organization


Provider recognition and feedback tools

Medical PracticeBuilding patient loyalty with exceptional clinical experiences


Medical Practice Team Membership Success Factors

A mix of leaders and frontline staff from multiple disciplines (i.e., nursing, reception, housekeeping, valet services, volunteers, etc.)


High-energy, solution focused employees

Providers, nurse practitioners, and/or medical assistants


Medical Practice Patient Experience Team –Key Actions

Review current results for trends

Identify best practice approaches to address gaps

Facilitate training and rollout of best practice tactics

Assess the effective execution of tactics



Reward &RecognitionBehavior that gets positively rewarded and recognized gets repeated


Reward & Recognition Team Membership Success Factors

A mix of leaders and frontline staff to represent multidisciplinary group of employees


High-energy, creative people that enjoy celebrating others

Out-of-the-box thinkers


Assess organizational recognition programs already in place, make improvements as needed

Develop or enhance a hospital-wide reward and recognition process that enables real-time feedback about specific, desired behaviors (Legends, Champions, Heroes etc.)

Ensure Reward & Recognition is happening at all levels and locations of the organization

Reward and Recognition Team –Key Actions

Workplace of choiceOrganizational performance that successfully blends culture with strategy


Workplace of Choice Team Membership Success Factors

Under the direction of the senior team

A mix of leaders and frontline staff that represents all levels of employment


Human resources representatives

Employee recruiters


Workplace of Choice Team –Key Actions

Review of existing policies and procedures that affect employee recruitment, selection, and retention

Implementation and follow-up communication for the employee engagement survey

“Bright Idea” program development

Tool development to support an effective employee orientation system

Complete applications for Best Places to Work Awards at the local, state, and national level.


Exercise– 10 minutes

What type of environment would you like to help create by this time next year, and what is your specific QIT’s role in helping to create that environment?

Each leader will be given a partner

Each leader should spend 5 minutes thinking aloud and brainstorming ideas about the proposed question

Be prepared to take notes and report out what your partner said about the type of environment they would like to help create and what their team will do to accomplish that


BREAK!


Recruiting Your Team


Team Development

What is a Team?A collection of individuals guided by a common purpose, striving for the same results.

Goals of a Team:

Foster togetherness in the workplace while creating a better work environment for all

Use the talents of a diverse group of people to solve problems


Recruitment Strategies

Ensure diversity and representation from all affected departments

Roll out to managers first to ensure middle management alignment and support

CEO delivers introduction message to demonstrate importance of role

Middle manager signs commitment letter to support member’s participation on team


Options for Recruiting Team MembersMethod Recruitment Process Pro Con

Hand Selection

Managers are asked by the SteeringCommittee to “hand-select” team members by submitting 3-5 names of top performers in their areas from various shifts and explain the “why” behind the choice. The Quality Impact Team Steering Committee identifies which employees they would like to serve on a particular team based onstrengths (i.e., communicator, numbers oriented, great attitude, etc.)

• Engages managers in the• process• Quick option to fill team• Recruits winners because

candidates are hand selected by leaders who know the employees’ capabilities and strengths

• Eliminates low performer• involvement• May generate skepticism about

selection process• People feel obligated because they

did not volunteer• Risk of asking the same “go-to”

people; potential for burnout

“NFL” Draft

Managers are asked by the SteeringCommittee to submit 3-5 names of top performers in their areas from various shifts and explain the “why” behind the choice. The names are placed on sticky notes based on strengths; for example, communicator, numbers-oriented, great attitude, etc. The team leaders take turns selecting members based on strengths for their team through an NFL draft format, including trading

• Engages managers in the process• Quick and FUN• Recruits winners because

candidates are hand-selected by managers who know the employees’ capabilities and strengths

• Eliminates low performer involvement

• Eliminates low performer• involvement• May generate skepticism about

selection process• People feel obligated because they

did not volunteer• Risk of asking the same “go-to”

people; potential for burnout

Volunteers A communication is sent to staff members letting them know that the organization is actively seeking volunteers to join identified teams. A short explanation of the different teams, their requirements and time commitments, and guidelines on how teammembers will be chosen must be provided. Also communicate that just because one volunteers does not mean they will automatically be chosen to join a team. There may still be a selection process, a setof criteria that must be met, and/or an application to complete. An example of criteria might be that an employee is “free of corrective action.”

• Quick option to fill team dedicated, driven, and passionate team members (because they volunteered and were not pressured to join)

• May generate diversity of skills and talents

• May not receive enough volunteers• Removes recommendation from• managers, meaning they may not

agree with or approve of• certain staff participating


Recruiting sheet with short description of each team

***Other resources/ details for teamsavailable in the Quality Impact Team Manual


QIT Participant Qualities

High Performer“Out of the Box” ThinkerPositive AttitudeTrustworthyReliable Committed/LoyalEnthusiastic


Expectations of QIT Members– change agents

Model new behaviors; manage-up the benefits of change to coworkers by explaining why it is necessary

Work to improve communication and teamwork between departments

Perpetuate a culture of appreciation and recognition

Be empowered, creative, engaged and an “owner”

Seek ideas and solutions from peers

Facilitate training of new behaviors


Recruiting Tips

Select members for talent, retain based on performance

Set expectations by clearly defining what you want your team to achieve

Role model the behaviors you want to see in your team members


Too Many Volunteers?

Screen for best fit

Ask other leaders if they need team members

Engage all to be on and consider job sharing, especially for shift and clinical workers

Select your team and send each person that was not chosen a letter from the CEO recognizing their interest and commitment to help improve the organization


Welcoming your team


Demonstrate Appreciation

Ask the CEO for a welcome letter to your team members

Provide a celebration gift/continental breakfast for the group

Personally say “thank you” to each member privately

Have Fun…..


Training Your Team

Print your individual team section from the QIT Manual and provide a copy to each team member

Connect the dots between your team’s purpose and how it will improve the organization

Set clear expectations for their participation

Create a sense of excitement for your team by being excited yourself

Engage senior leaders to participate in your training


Maximize effectiveness of your meetings


5 Tips to Maximize Effectiveness In Meetings

1. Purpose: develop a detailed team charter

2. Action: execute a rollout/90-Day Plan

3. Focus: follow a clearly written agenda

4. Accountability: follow-up and follow through

5. Assess: evaluate meeting value in real-time


1. Team charter– purpose

Number of members and membership criteria

Length of commitment

Team meeting frequency

Team’s mission

Team’s objectives/goals

Measures of effectiveness

Tool: Team Charter (Section A6- pg. 56)


2. Roll Out Plan– action

Align goals to the hospital’s priorities to improve

Focus on 1 or 2 core activities to execute

Clearly define action steps

Focus on outcomes: what should improve as a result of your action?

Tool: Rollout Plan (Section A6- pg. 58)


3. Team Agenda– focus

Delivered 24-48 hours prior to meeting

Includes team members’ names next to assigned agenda item

Includes time allotment for each topic

Includes ground rules

Tool: Team Agenda (Section A6- pg. 57)


4. Meeting Behaviors– accountability

Assign members the following tasks at each meeting: Facilitator – Team Leader Timekeeper – Stay on time Weed whacker – Stay on track/target Scribe – Provide minutes; prepare agenda for

next meeting


Meeting expectations– accountability

Ground Rules – established by the team50 Minute Meetings: start /end on timeCome prepared; do homeworkBe Present (actively engaged)Each gets their say, not necessarily their waySilence equals agreement Members respect confidentiality of teamNo sidebarsOnce we agree, we will speak with one voice


When Bad Meetings Happen…

What makes a meeting ineffective?


No Accountability


Minutes – accountability

Review decisions, and put assignments by name in the minutes so the team has a historical record.

Establish your “next step” from the rollout plan to decide how to implement decisions made and what communication is necessary.

List who was present and who was absent (excused/unexcused)

Note the next meeting’s time and location

Deliver minutes within 2 business days to each member


5. Evaluations – assess

Evaluations Align to the organization’s patient satisfaction

tool for numbers and/or key words VERY Good (5) Good (4) Fair (3) Poor (2) Very Poor (1)


Your toolkit


Quality Impact Teams Manual

Articles, tools, videos


Quality Impact Teams Manual

Your responsibility

Read your section

Understand how your individual QIT aligns with the other QIT

Clearly communicate the purpose of QIT to your team members


Quality Impact Team Manual – OVERVIEWSECTION A

QUALITY IMPACTOVERVIEW AND

FOUNDATION

Section A1Studer Group Foundation

Section A2Quality Impact

Overview

Section A3Quality Impact

Leadership

Section A4Recruiting Frontline

Staff for Teams

Section A5Training for

Teams

Section A6Maximizing Your Team’s

Effectiveness

SECTION BQUALITY IMPACT

FUNCTION AND TEAMS

Section B8ED Perception of

Care

Section B3Measurement

*

Section B7Outpatient Perception

of Care

Section B6Inpatient Perception

of Care

Section B4Physician

Collaboration

Section B5Workplace of

Choice

Section B2Communication

*

Section B10Reward and Recognition

Section B9Medical Practice

Perception of Care

Section B1Standards

*

SECTION CSTUDER GROUP RESOURCES &

GLOSSARY

Section C1Studer Group

Resources

Section C2Studer Group

Glossary

A B C

Section B11Service

Recovery


Expectations

Mandatory Assignments (Due by x) Review all of Section A and your specific team’s section in the

Quality Impact Teams manual Train your Team (example training agenda – pg. 43)

*must practice/review your training with steering team leader before implementation

Schedule recurring Team meetings (standardized form on pg.45) Create a Team Charter (standardized form on page 55) Create a Meeting Agenda (standardized form on pg.57) Create your 90 day/rollout plan (standardized form on pg.58)

Mandatory Assignment (recurring)Quality Impact Steering Team Update form

*must send completed form to QIT steering team leader 24 hours before meeting

Recommended Assignment: Review the complete QIT manual


“Culture outperforms strategy every time, and culture with strategy is unbeatable!”

—Quint Studer


COPYRIGHT © STUDER GROUPPlease do not quote or disseminate without Studer Group authorization

“Always bring it back to values . . .”

Quint Studer

quality impact teams in the small organization part 3 – team leader training

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