wha improvement forum for september “managing the improvement portfolio”
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WHA Improvement ForumFor September
“Managing the Improvement Portfolio”
Tom Kaster & Travis Dollak
Courtesy Reminders: •Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) •Please do not take calls and place the phone on HOLD during the presentation. 1
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Today’s Webinar
Agenda
Method’s for sustaining great outcomes
Monitoring multiple projects
Taking action when its needed
• Institutionalize Accountability *Reference August Improvement Forum
Managing Multiple Projects – Start with Roles
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Quality and/or Practice councils:• Review the outcomes• Make decisions on what are the priorities• Communicate the priorities house wide• Marshall the resources to do the work
Refrain from “doing the work”
• Hold clinical areas accountable for their outcomes.
Key Responsibilities
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Group Tasks
Quality Council -Regular review of outcome data (dashboard)-Analyze the big picture and key improvement needs-Allocate resources
Improvement Manager -Coach teams and frontline staff on improvement methodology-Provide data support-Assign Team Leads-Aid in improvement team selection, structure and objective development
Team Leaders -Organize team functions-Direct small tests of change-Analyze outcome and process measures-Liaison between team and Improvement manager-Aid in spread
Team Members -Conduct small tests of change-Provide real time feedback-Capture process measures-Advocate for process improvements
Unintended consequences If the roles become “murky”….• Quality is tasked with reporting and doing• Clinical areas are too far removed from their
measureable outcomes• Everything is a priority• Eyes are taken “off the ball” – something is missed• Capacity to be agile and adapt to change (i.e. new
evidence, rules and regs) is limited.
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Tools to Prevent “Murky” Roles, Responsibilities, and Competing Priorities
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•Creates structure and timeframes•Prevents units from being overwhelmed
•Aids in accountability•Builds consensus on what needs to be done
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Sustainability Defined
Spread – Successful changes in one area are adopted (and improved!) in other areas.
Sustainability – Improvements made will continue and high performance is retained over time, with little regression.
Sustainability Defined
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1. Results are better than when started2. Variation is reduced
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Methods for Sustaining
1) Front line staff was involved from the beginning2) Review performance trends with your team- track
data and watch for changes3) Teach the team to watch for drift and take action4) Coach them to not overreact to the “blips”, but to
understand what they are.5) Plan for how to achieve the AIM (again, if needed).6) Maintain roles and accountability.
Reviewing Performance Trends – More than the Dashboard
• Static red, yellow, green boxes don’t help you predict
• Unable to see trends/shifts• Lack ability to provide context*May be appropriate for senior leaders, but not the sole tool to
help front line staff improve. *Senior leaders should also see data over time to avoid
obsessing on a single data point.
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A Better Choice – Keep Up a Regular Review of Your Run Charts
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Now Keep on Top of That for A Dozen Projects
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Measuring Outcome Data Alone Won’t Solve This Challenge
Would you?
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Outcomes ProcessesProactive Prevention
Would you?
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Outcomes ProcessesProactive Prevention
Would you?
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Outcomes ProcessesProactive Prevention
Insuring drift does not happen by auditing KEY processes
Keeping an Eye On Your Outcomes
Regular Audits of Hourly Rounding
Bottom Line?
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Outcomes ProcessesProactive Prevention
If you wait for the outcome measure to drift…
1.You have lost your improvement momentum2.The staff has already regressed to past behavior3.Your training and education efforts were for not4.Your are back at square one
Bottom Line?
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Outcomes ProcessesProactive Prevention
If you institutionalize the auditing of key processes…
1.You can catch slips before the momentum is lost 2.You are able to help staff get past the awkward change period and hardwire the new processes3.You are on top of unforeseen changes 4.You validate your investment
The Sustainability Plan
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Calendaring the Auditing of Key Processes
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Quarterly: Jan/Apr/ July/Oct
Hourly Rounding Prevalence
Falls Project Team Regroup
Nurse Manager Initiate
Quarterly:Feb/May/Aug/Nov
VTE: Protocol Prevalence
Unit Managers regroup
Unit Managers
The Spread Matrix
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When and How to Take ActionWHEN
• Process measures are drifting (trend or shift)
• A bad outcome occurs• Teams aren't meeting• Turnover in teams• Team needs coaching on QI
concepts • Feedback/help for team• Accountability is not clear
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HOW• Don’t take over the project• Ask questions• Coach on the improvement
methodology• Do offer up resources• Reference roles and
responsibilities• Recognize other
projects/priorities• Encourage data driven decisions
What Is Different In This Approach?• More transparent data and accountability• Tools that provide structure (not just lip service)• Greater emphasis on continued measurement• Helps avoid the ‘project mentality’• Focus on tracking improvement for sustaining
success
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Next Month: October 24
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Review Survey Results
References
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http://www.whaqualitycenter.org/PartnersforPatients/PFPWave2Materials/PfPImprovementWorkbook/PfPImpWkbkSection6.aspx
On the Quality Center
How do you keep your eye on the ball?
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Discussion time:Would anyone share what strategies their
hospital uses to sustain high performance?
Please be sure your phone lines are muted to keep background noise to a minimum. You can select *6 to MUTE and *7 to un MUTE
AnnouncementsPartners for Patients – Improvement Leader Fellowship (ILF):• Helps staff boost their QI knowledge to better execute their HEN projects
as well as future improvement work your organization may take on. • Session 4 is October 16, two-hour webinar. These sessions will blend QI
knowledge along with the content of the 10 HEN topics.• Low-risk/low-investment to expose staff to this material without having to
arrange travel, staff coverage, etc. • Each session will provide CEU credits.
Questions/More Information – Contact Travis Dollak (tdollak@wha.org) or Tom Kaster (tkaster@wha.org)
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Thank You!Questions
Please complete 3 question survey when closing webinar window.
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