derek feeley, ceo trissa torres, svpapp.ihi.org/events/attachments/event-2656/document-5240/...in...
TRANSCRIPT
3/22/2016
1
Joy
Orlando
March 2016
Derek Feeley, CEOTrissa Torres, SVP
17th Annual Summit on Improving Patient Care in the Office Practice and the Community
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Quality Improvement
(when we had 5 smiley faces)
https://vimeo.com/102914044
Why Now?
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The Burning Platform
60% respondents of MD survey are considering leaving practice
70% knew at least one MD who left practice due to poor morale
37% of newly licensed RNs are thinking of leaving their job
13% vacancy rate for RNs
Impact not limited to clinicians
Lucian Leape Institute. 2013. Through the eyes of the workforce: creating joy, meaning and safer health
care. Boston, MA: National Patient Safety Foundation.
Problem Worsening
Mayo Clinic Proceedings, Dec 2015
In 2014 physician survey:
• 54% of physicians report burnout, an increase of 10% from 2011
• Satisfaction with work life balance declined from 48% to 41%
• Little change in trends in working US adults, resulting in increasing disparity
http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/fulltext
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Impact on Business Outcomes
Other industries have demonstrated a relationship between employees engagement and:
Customer satisfaction
Productivity
Profit
Employee turnover
Accidents
Harter JK, Schmidt FL, Hayes TL. Business-unit-level relationship between employee satisfaction, employee engagement and business outcomes: a meta-analysis. J Appl Psychol 2002; 87:268-279
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Burnout Affects Patients
A variety of studies have shown association of provider burnout with:
Lower levels of empathy
Less patient satisfaction
Reduced adherence to treatment plans
Overuse of resources
More mistakes
Bodenheimer, T., Sinsky, C. From the Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine, Inc, 2015
“Workplace safety is
inextricably linked to
patient safety. Unless
caregivers are given the
protection, respect, and
support they need, they are
more likely to make errors,
fail to follow safe practices,
and not work well in
teams.”
L. Leape
Welcome to IHI
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Definition
Joy in Work…intellectual, behavioral, and emotional commitment to meaningful and satisfying work
IHI Framework to Promote Joy in Work is a validated approach with roles for the organization, leaders,
individuals, and all three together
Joy
Gratitude
Hope
Awareness of abundance
Deep satisfaction from serving others
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The path from burnout to joy?
Joy is more than absence of burnout…
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Comprehensible, Manageable and Meaningful
Deming and Joy
“Management’s overall aim should be to create a system in which everybody may take joy in his work.”
– Dr. W. Edwards Deming
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Why would it be any different at work?
2. Understand unique impediments to joy locally
(Physical and psychological safety need to be
assured before camaraderie, choice, equity, meaning)
3. Create an organizational commitment to share
responsibility at all levels (work unit, leader,
individual)
4. Use validated approaches to improve joy
(Resiliency, 3 Leadership Behaviors, Participative
Management, QI)
1. Ask “What Matters to you”
Steps Leading to Joy in work resulting in:↑ Patient experience
↑ Organizational performance↓ Staff burnout
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2. Understand unique impediments to joy locally
(Physical and psychological safety need to be
assured before camaraderie, choice, equity, meaning)
3. Create an organizational commitment to share
responsibility at all levels (work unit, leader,
individual)
4. Use validated approaches to improve joy
(Resiliency, 3 Leadership Behaviors, Participative
Management, QI)
1. Ask “What Matters to you”
Steps Leading to Joy in work resulting in:↑ Patient experience
↑ Organizational performance↓ Staff burnout
What Matters to You?
Imperial College Healthcare, Paediatric Department
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Physical safety
Psychological safety
Equity
Camaraderie
Choice
Meaning
2. Understand unique impediments to joy locally
Impediments to Joy
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23
Era 3 for Medicine and Health Care
Era 1 was the ascendancy of
the profession. It’s values: the
profession of medicine is
noble; it has special
knowledge, inaccessible to
laity; it is beneficent; and it will
self-regulate.
- Donald Berwick
Donald M. Berwick, MD, MPP. Era 3 for Medicine and Health Care. JAMA. Published
online March 03, 2016. doi:10.1001/jama.2016.1509
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No slide here – I will just talk
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Race, Ethnicity, and Medical Student
Well-being in the United States
Race, Ethnicity, and Medical Student Well-being in the United State. Arch Intern Med. 2007;167(19):2103-2109. doi:10.1001/archinte.167.19.2103
NHS England Staff Satisfaction Survey
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Staff Experience and Safety & Quality
Good staff management, climate of trust and respect = higher quality
care
The greater the proportion of staff from a black or minority ethnic (BME)
background who report experiencing discrimination at work in the
previous 12 months, the lower the levels of patient satisfaction.
The number of both BME and white staff who are praised by
management after raising a concern is 3% BME 7.2% for white staff.
24% of BME staff compared to 13% of white staff did not raise a
concern for fear of victimization.
West M and J Dawson. NHS Staff management and health service quality.
Coghill, Y. Race Equality in the NHS. Jan 2016 presentation.
Constancy of purpose
Consistency of values
Shared leadership
3. Create an organizational commitment to share
responsibility at all levels (work unit, leader,
individual)
Commitment to Share Responsibility
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Don Berwick31
“The source of energy at
work is not in control, it is
in connection to purpose.”
Constancy of Purpose
• A human face behind
every statistic
• Foundation of Trust
• Stay true and don’t
walk past
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Serious Safety Event Rate
Wellstar Health System January 2008- February 2010
0.00
0.20
0.40
0.60
0.80
1.00
1.20
Jan-
08
Feb-
08
Mar-
08
Apr-
08
May-
08
Jun-
08
Jul-
08
Aug-
08
Sep-
08
Oct-
08
Nov-
08
Dec-
08
Jan-
09
Feb-
09
Mar-
09
Apr-
09
May-
09
Jun-
09
Jul-
09
Aug-
09
Sep-
09
Oct-
09
Nov-
09
Dec-
09
Jan-
10
Feb-
10
Ev
en
t R
ate
0
1
2
3
4
5
6
7
8
9
10
Nu
mb
er
of
Ev
en
ts
SSE's
SSE RateRolling 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
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Trust (Lencioni)
Don’t Walk Past
www.youtube.com/watch?v=QaqpoeVgr8U
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Empathy
Recommit to Quality Improvement
3 Good Things
4. Use validated approaches to improve joy
(Resiliency, 3 Good Things, Participative
Management, QI)
Approaches to Improve Joy
Empathy
The research shows that kindness-oriented care has a more statistically significant impact on outcomes than aspirin for reducing a heart attack.
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Four Aspects of Empathy
Perspective taking
Staying out of judgement
Recognizing emotion in others
Communication
Boss vs Leader (or humility is in)
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HP’s BeWell
Model
Six
Dimensions
that align
with our
overall goal
at the center
of the
diagram
Philosophy of our approach
• Leverage the expertise across our organization
• “The experts are among us”
• Meet colleagues where they’re at
• Involve and engage
• Be flexible and adaptable
• Align with our strategic plan
• Integrate with all cultural efforts
• Keep it visible
• Define and measure success
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Simple Quality Improvement
Overall, IHI is an excellent place to work.
0% 0% 0% 0 2% 2% 1% 1% 0% 0%6% 3% 2% 1% 1% 2% 2% 1% 1% 1%
12%9%
7%3% 3%
6% 5% 5% 3% 2%
52%
45% 51%
42%
53% 42%38%
33% 37%44%
29%
42% 40%
54%
41%48%
54%60% 58%
53%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
May September November January March May July September November January
Strongly Disagree Disagree Not Sure Agree Strongly agree
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I believe IHI is going in the right direction.
1% 1% 1% 0% 0% 0% 1% 0% 0% 0%
10%3% 1% 1% 1% 3% 3%
1% 0% 0%
36%
28%25%
8%18% 11% 9%
9.80% 12% 12%
40%
51%53%
55%
56%
54% 57%
50%
58%
46%
13% 17% 21%
36%
25%32% 29%
39%30%
41%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
May September November January March May July September November January
Strongly Disagree Disagree Not Sure Agree Strongly agree
3 Good Things
Seligman (adapted from www.midmichigan.org/3goodthings)
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Three Takeaways
1. This is not a project – needs to be
integral to our work.
2. The 3 C’s - Coherence, Consistency
and Connection (to purpose).
3. Just Start!
If in doubt……just start