leading for improvement and getting results at scale
TRANSCRIPT
Role of Leaders in Getting Results at SCALEThe presenter has
nothing to disclose
November 10, 2015
Responsibilities of Leaders
• Support collaborative team • Develop a plan and guide the spread or scale-
up of improvement beyond the collaborative team (i.e., within and across facilities, care homes, etc.)
Improvement at Collaborative or System Level
RESULTS
Ideas
Will
Execution
Discussion
What have you done to actively support your collaborative team(s)? Have you begun to prepare your facility or
municipality to scale-up improvement from the collaborative team to other sites? Are there other roles that leaders have played
during the collaborative?
Supporting the Collaborative Team
Review their aim and make the connection between their work and the goals for the municipality Set up review meetings at least monthly to discuss
their monthly progress reports; remove barriers to progress Visit the site of the improvement to learn what the
team is doing Promote the team’s work. Talk about the importance
of the team’s work in internal and external meetings – any opportunity that will make the work visible to others
The Scale-up Framework P6
Scale
Idea Leadership, communication, social networks, culture of urgency and persistence
Learning systems, data systems, infrastructure for scale- up, human capacity for scale-up, capability for scale-up,
sustainability
Readiness for Moving up the Sequence
Topic is a strategic initiative within the organization An executive(s) is responsible for the effort A person or team will manage the day-to-day scale-up
activities Pilot site(s) is relatively self-sufficient and has at least
some initial evidence about the positive impact of the change, i.e., has developed the “model” or scalable unit
The Scale-up Framework P8
Scale
Idea Leadership, communication, social networks, culture of urgency and persistence
Learning systems, data systems, infrastructure for scale- up, human capacity for scale-up, capability for scale-up,
sustainability
What is a scalable unit?
Smallest facsimile of the whole system Representative slice of the whole system Contains elements (i.e., people, processes, patients/families, and infrastructure) that are common to the system Produces a result that is representative of the whole system result (i.e., can predict system level improvement based on the scalable unit)
Purpose of Developing the Scalable Unit
Generate the set of interventions (improvements) that will achieve the goal, i.e., change package Test bed the infrastructure capabilities Generate will, interest for spread
The Role of the Collaborative Team in the Framework
Conducts tests that contribute to the development of the scalable unit Helps to make the case for change Makes it easier for others to do the work Develops the messengers
Leader’s Role
Setting the agenda for change Assigning responsibility Providing resources and support Monitoring and guiding the effort Sustaining improvements
Developing an Aim for Scale-up
What improvement(s) will you take to scale:
Target Goals, i.e., whose lives will be different because of your effort? What impact do you expect to have?
Who are the adopters, i.e., who do you need to reach:
Time Frame, i.e., by when?
Creating a Municipal Leadership Team for Scale-up
Provides direction for the scale-up effort; monitors progress Several areas of expertise and/or responsibility to consider for the team include: – the designated municipal leader; – a day-to-day leader of the scale-up effort; – representatives from the pilot site(s) – representatives from the target sites, including leaders from those sites – and others, including facility leadership; clinical expertise; and support
services such as information technology, human resources, and quality improvement.
Change Agent
Executive Sponsor
Adopters Senior
Types of Leadership for Scale-up
Nolan, K; Nielsen, G; Schall, M . "Developing Strategies to Spread Improvements." From Front Office to Front Line: Essential Issues for Health Care Leaders: Joint Commission on Accreditation of Healthcare Organizations, 2005, p. 62..
Role of the Executive Sponsor
Coaches other leaders Supports day-to-day leader – Addresses resource issues – Responds to system issues – Sets expectations
Carries message (sense-making)
Role of the Day-to-day Leader
Assists Executive Sponsor in creating spread plan Guides the execution of the spread plan Leads Spread Team Monitors outcomes and progress and shares with Executive Sponsor Communicates! Both up and down!
Creating Adoption Mechanisms
Build a communication plan Identify and utilize social networks Foster a culture of urgency and persistence
Purpose of the Communication Plan
Build awareness Move adopters from decision to action Support and mentor adopters
Creating a Communications Plan
What audience(s) do you need to reach? What will be your message(s)? Who will deliver the message(s)? What channels of communication will you use? What story do you have to tell (from the work of the pilot teams) How will you review your communications plan and make adjustments?
Cooper A; Gray J; Willson A; Lines C; McCannon J; McHardy K, Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales, Journal Of Communication in Healthcare, Volume 8, Issue 1 (March, 2015), pp. 76-84.
The WAY in Which We Communicate is Important
SHARE INFORMATION
SHAPE BEHAVIOUR
Personal Touch letters cards postcards
Interactive Activities telephone email visits seminars learning sets modeling
Face-to-face one-to-one mentoring shadowing
Creating Support Structures
Learning system – How people will be connected to learn improvements
Data systems – Identify data, collection methods, method for review and
accountability Infrastructure – Staffing, resources, communication systems, etc.
Capability for scale-up – What improvement skills and training are needed
Sustainability – Creating reliable systems (i.e., the train tracks)
Developing a Measurement Strategy
Iowa Health System
Iowa Health System Adverse Drug Events: % of Sampled Charts with Harm Levels ADEs E-I
Targets: 2002 = 10%, 2003 = 4%
20%
14%
0%
10%
20%
30%
N-01 D-01 J-02 F-02 M-02 A-02 M-02 J-02 J-02 A-02 S-02 O-02 N-02 D-02 J-03 F-03 M-03 A-03 M-03 J-04
% o
Chart1
N-01
D-01
J-02
F-02
M-02
A-02
M-02
J-02
J-02
A-02
S-02
O-02
N-02
D-02
J-03
F-03
M-03
A-03
M-03
J-04
% of Charts
Iowa Health System Adverse Drug Events: % of Sampled Charts with Harm Levels ADEs E-I Targets: 2002 = 10%, 2003 = 4%
0.2
0.14
0.09
0.086
0.1
0.06
0.04
0.06
0.05
0.05
0.03
0.06
0.06
0.1
0.11
0.02
0.1
0.06
0.03
0.04
Iowa Health System ADEs from chart sampling with trigger tool
ADEs/charts
N-01
D-01
J-02
F-02
M-02
A-02
M-02
J-02
J-02
A-02
S-02
O-02
N-02
D-02
J-03
F-03
M-03
A-03
M-03
J-04
% of Charts
Iowa Health System Adverse Drug Events: % of Sampled Charts with Harm Levels ADEs E-I Targets: 2002 = 10%, 2003 = 4%
Iowa Health Falls
&L&F
'Iowa Health Falls'!#REF!
Falls per 1,000 days
Tracking the Spread of Specific Ideas (1 site)
Change
Impl. on Pilot
Exec WalkRounds X 12/19/2003 1/16/2004 1/26/2004 2/2/2004 2/2/2004 Mar-04 Apr-04
Safety briefings X 12/19/2003 1/1/2004 2/9/2004 2/9/2004 2/9/2004
Admit form X 12/2003 2/9/2004 2/10/2004 2/9/2004 2/9/2004
Transfer Reconcilia X 4/7/2004
Adm Reconciliation X 2/22/2003
•Testing •Implementation Started •Implementation Complete
Sample
Change
x
Apr-03
Nov-03
Instructions: 1. Please type in the change you are making as brief bullet narrative (i.e. use new SSI protocol). Use a new row for each major change you are testing. (To insert row, place cursor on the row number directly below last row used and click to highlight that row. Go to insert and click on row. A row will have been inserted.) 2. Place an X in the column related to the component of the change package to which this change is related (high hazard, reconciliation, medication ordering-dispensing-administrant, culture, periop, other). Then place an X or date in the columns related to each of the phase of testing, implementation or spread your team has accomplished with this change. Please note that as you move from one phase to the next (i.e. from "testing" to "implementation begun on the pilot unit") you will have an X or date in more than one column related to the same change. (note: date is preferable when posting this concurrently. Definitions: Testing involves trying a change. When we are testing we are free to try and to discard changes; there is no assumption that the change tested is permanent yet. (Collecting baseline data, meeting, brainstorming, and/or planning to change may be valuable activities but are not tests of change. We do not have a column for these activities.) Implementation is taking a successful change and building it in to the way the entire pilot population or pilot unit does their work. Spread is the process of taking a successful implementation from a pilot unit and replicating that change or package of changes beyond the pilot unit or population into other parts of the organization, into other organizations, or into a new area of focus (i.e. from people with diabetes to people with cardiovascular disease).
Medication Safety: Short Report
Barriers and Breakthroughs this Month: (optional) Able to start implementing med recon form as order form thanks to additional testing and a champion.
Your Organization
Spread Planned
Spread Begun
Spread Widely
Spread Complete
Instructions: 1. Please type in the change you are making as brief bullet narrative (i.e. use new SSI protocol). Use a new row for each major change you are testing. (To insert row, place cursor on the row number directly below last row used and click to highlight that row. Go to insert and click on row. A row will have been inserted.) 2. Place an X in the column related to the component of the change package to which this change is related (high hazard, reconciliation, medication ordering-dispensing-administrant, culture, periop, other). Then place an X or date in the columns related to each of the phase of testing, implementation or spread your team has accomplished with this change. Please note that as you move from one phase to the next (i.e. from "testing" to "implementation begun on the pilot unit") you will have an X or date in more than one column related to the same change. (note: date is preferable when posting this concurrently. Definitions: Testing involves trying a change. When we are testing we are free to try and to discard changes; there is no assumption that the change tested is permanent yet. (Collecting baseline data, meeting, brainstorming, and/or planning to change may be valuable activities but are not tests of change. We do not have a column for these activities.) Implementation is taking a successful change and building it in to the way the entire pilot population or pilot unit does their work. Spread is the process of taking a successful implementation from a pilot unit and replicating that change or package of changes beyond the pilot unit or population into other parts of the organization, into other organizations, or into a new area of focus (i.e. from people with diabetes to people with cardiovascular disease).
Medication Safety: Short Report
Spread
Organization:
Exec Walks
Unit Briefings
HFE Briefings
Instructions: 1. Please type in the change you are making as brief bullet narrative (i.e. use new SSI protocol). Use a new row for each major change you are testing. (To insert row, place cursor on the row number directly below last row used and click to highlight that row. Go to insert and click on row. A row will have been inserted.) 2. Place an X in the column related to the component of the change package to which this change is related (high hazard, reconciliation, medication ordering-dispensing-administrant, culture, periop, other). Then place an X or date in the columns related to each of the phase of testing, implementation or spread your team has accomplished with this change. Please note that as you move from one phase to the next (i.e. from "testing" to "implementation begun on the pilot unit") you will have an X or date in more than one column related to the same change. (note: date is preferable when posting this concurrently. Definitions: Testing involves trying a change. When we are testing we are free to try and to discard changes; there is no assumption that the change tested is permanent yet. (Collecting baseline data, meeting, brainstorming, and/or planning to change may be valuable activities but are not tests of change. We do not have a column for these activities.) Implementation is taking a successful change and building it in to the way the entire pilot population or pilot unit does their work. Spread is the process of taking a successful implementation from a pilot unit and replicating that change or package of changes beyond the pilot unit or population into other parts of the organization, into other organizations, or into a new area of focus (i.e. from people with diabetes to people with cardiovascular disease).
Medication Safety: Short Report
1 X X X X X Coumadin
2 X X X X X PCAs 3 X X X Plan 4 X X Plan X X 5 X X Plan Plan X
Lovenox Heparin
7 X Plan Plan X 8 X Plan X X X
X Plan
6 X X
Culture
Culture
Culture
FMEA
Reconciliation
X = At least one unit implementing the change
Plan = Plans are underway or early testing, but no implementation has begun
Month:
MARCH
Site
X = At least one unit implementing the change
Plan = Plans are underway or early testing, but no implementation has begun
All charts
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Displaying the Spread of Multiple Ideas
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Exec Walk Arounds
0
1
2
3
4
5
6
7
8
9
10
Dec-01 Jan-02 Feb-02 LS2
Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Setp 02 Oct-02 Nov-02
Fa ci
lit ie
s pa
rt ic
ip at
in g
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Hazard Areas - At Least 1 per facility
0 1 2 3 4 5 6 7 8 9
10
Dec-01 Jan-02 Feb-02 LS2
# IH
S fa
ci lit
ie s
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Unit Briefings
0
Facilities participating
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Exec Walk Arounds
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Chart4
jun-01
jul-01
aug-01
sep-01
okt-01
# IHS facilities
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Hazard Areas - At Least 1 per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Chart1
jun-01
jul-01
aug-01
sep-01
okt-01
# facilities using in 1+ or more units
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Unit Briefings
0
1
2
2
2
4
4
4
8
9
9
9
9
9
9
9
9
9
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Chart1
jun-01
jul-01
aug-01
sep-01
okt-01
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
The Scale-up Framework P29
Scale
Idea Leadership, communication, social networks, culture of urgency and persistence
Learning systems, data systems, infrastructure for scale- up, human capacity for scale-up, capability for scale-up,
sustainability
Responsibilities of Leaders
Discussion
The Scale-up Framework
Purpose of Developing the Scalable Unit
The Role of the Collaborative Team in the Framework
Leader’s Role
Creating a Municipal Leadership Team for Scale-up
Dias nummer 16
Creating Adoption Mechanisms
Creating a Communications Plan
Creating Support Structures
Iowa Health Progress Report to Leadership
Displaying the Spread of Multiple Ideas
The Scale-up Framework
November 10, 2015
Responsibilities of Leaders
• Support collaborative team • Develop a plan and guide the spread or scale-
up of improvement beyond the collaborative team (i.e., within and across facilities, care homes, etc.)
Improvement at Collaborative or System Level
RESULTS
Ideas
Will
Execution
Discussion
What have you done to actively support your collaborative team(s)? Have you begun to prepare your facility or
municipality to scale-up improvement from the collaborative team to other sites? Are there other roles that leaders have played
during the collaborative?
Supporting the Collaborative Team
Review their aim and make the connection between their work and the goals for the municipality Set up review meetings at least monthly to discuss
their monthly progress reports; remove barriers to progress Visit the site of the improvement to learn what the
team is doing Promote the team’s work. Talk about the importance
of the team’s work in internal and external meetings – any opportunity that will make the work visible to others
The Scale-up Framework P6
Scale
Idea Leadership, communication, social networks, culture of urgency and persistence
Learning systems, data systems, infrastructure for scale- up, human capacity for scale-up, capability for scale-up,
sustainability
Readiness for Moving up the Sequence
Topic is a strategic initiative within the organization An executive(s) is responsible for the effort A person or team will manage the day-to-day scale-up
activities Pilot site(s) is relatively self-sufficient and has at least
some initial evidence about the positive impact of the change, i.e., has developed the “model” or scalable unit
The Scale-up Framework P8
Scale
Idea Leadership, communication, social networks, culture of urgency and persistence
Learning systems, data systems, infrastructure for scale- up, human capacity for scale-up, capability for scale-up,
sustainability
What is a scalable unit?
Smallest facsimile of the whole system Representative slice of the whole system Contains elements (i.e., people, processes, patients/families, and infrastructure) that are common to the system Produces a result that is representative of the whole system result (i.e., can predict system level improvement based on the scalable unit)
Purpose of Developing the Scalable Unit
Generate the set of interventions (improvements) that will achieve the goal, i.e., change package Test bed the infrastructure capabilities Generate will, interest for spread
The Role of the Collaborative Team in the Framework
Conducts tests that contribute to the development of the scalable unit Helps to make the case for change Makes it easier for others to do the work Develops the messengers
Leader’s Role
Setting the agenda for change Assigning responsibility Providing resources and support Monitoring and guiding the effort Sustaining improvements
Developing an Aim for Scale-up
What improvement(s) will you take to scale:
Target Goals, i.e., whose lives will be different because of your effort? What impact do you expect to have?
Who are the adopters, i.e., who do you need to reach:
Time Frame, i.e., by when?
Creating a Municipal Leadership Team for Scale-up
Provides direction for the scale-up effort; monitors progress Several areas of expertise and/or responsibility to consider for the team include: – the designated municipal leader; – a day-to-day leader of the scale-up effort; – representatives from the pilot site(s) – representatives from the target sites, including leaders from those sites – and others, including facility leadership; clinical expertise; and support
services such as information technology, human resources, and quality improvement.
Change Agent
Executive Sponsor
Adopters Senior
Types of Leadership for Scale-up
Nolan, K; Nielsen, G; Schall, M . "Developing Strategies to Spread Improvements." From Front Office to Front Line: Essential Issues for Health Care Leaders: Joint Commission on Accreditation of Healthcare Organizations, 2005, p. 62..
Role of the Executive Sponsor
Coaches other leaders Supports day-to-day leader – Addresses resource issues – Responds to system issues – Sets expectations
Carries message (sense-making)
Role of the Day-to-day Leader
Assists Executive Sponsor in creating spread plan Guides the execution of the spread plan Leads Spread Team Monitors outcomes and progress and shares with Executive Sponsor Communicates! Both up and down!
Creating Adoption Mechanisms
Build a communication plan Identify and utilize social networks Foster a culture of urgency and persistence
Purpose of the Communication Plan
Build awareness Move adopters from decision to action Support and mentor adopters
Creating a Communications Plan
What audience(s) do you need to reach? What will be your message(s)? Who will deliver the message(s)? What channels of communication will you use? What story do you have to tell (from the work of the pilot teams) How will you review your communications plan and make adjustments?
Cooper A; Gray J; Willson A; Lines C; McCannon J; McHardy K, Exploring the role of communications in quality improvement: A case study of the 1000 Lives Campaign in NHS Wales, Journal Of Communication in Healthcare, Volume 8, Issue 1 (March, 2015), pp. 76-84.
The WAY in Which We Communicate is Important
SHARE INFORMATION
SHAPE BEHAVIOUR
Personal Touch letters cards postcards
Interactive Activities telephone email visits seminars learning sets modeling
Face-to-face one-to-one mentoring shadowing
Creating Support Structures
Learning system – How people will be connected to learn improvements
Data systems – Identify data, collection methods, method for review and
accountability Infrastructure – Staffing, resources, communication systems, etc.
Capability for scale-up – What improvement skills and training are needed
Sustainability – Creating reliable systems (i.e., the train tracks)
Developing a Measurement Strategy
Iowa Health System
Iowa Health System Adverse Drug Events: % of Sampled Charts with Harm Levels ADEs E-I
Targets: 2002 = 10%, 2003 = 4%
20%
14%
0%
10%
20%
30%
N-01 D-01 J-02 F-02 M-02 A-02 M-02 J-02 J-02 A-02 S-02 O-02 N-02 D-02 J-03 F-03 M-03 A-03 M-03 J-04
% o
Chart1
N-01
D-01
J-02
F-02
M-02
A-02
M-02
J-02
J-02
A-02
S-02
O-02
N-02
D-02
J-03
F-03
M-03
A-03
M-03
J-04
% of Charts
Iowa Health System Adverse Drug Events: % of Sampled Charts with Harm Levels ADEs E-I Targets: 2002 = 10%, 2003 = 4%
0.2
0.14
0.09
0.086
0.1
0.06
0.04
0.06
0.05
0.05
0.03
0.06
0.06
0.1
0.11
0.02
0.1
0.06
0.03
0.04
Iowa Health System ADEs from chart sampling with trigger tool
ADEs/charts
N-01
D-01
J-02
F-02
M-02
A-02
M-02
J-02
J-02
A-02
S-02
O-02
N-02
D-02
J-03
F-03
M-03
A-03
M-03
J-04
% of Charts
Iowa Health System Adverse Drug Events: % of Sampled Charts with Harm Levels ADEs E-I Targets: 2002 = 10%, 2003 = 4%
Iowa Health Falls
&L&F
'Iowa Health Falls'!#REF!
Falls per 1,000 days
Tracking the Spread of Specific Ideas (1 site)
Change
Impl. on Pilot
Exec WalkRounds X 12/19/2003 1/16/2004 1/26/2004 2/2/2004 2/2/2004 Mar-04 Apr-04
Safety briefings X 12/19/2003 1/1/2004 2/9/2004 2/9/2004 2/9/2004
Admit form X 12/2003 2/9/2004 2/10/2004 2/9/2004 2/9/2004
Transfer Reconcilia X 4/7/2004
Adm Reconciliation X 2/22/2003
•Testing •Implementation Started •Implementation Complete
Sample
Change
x
Apr-03
Nov-03
Instructions: 1. Please type in the change you are making as brief bullet narrative (i.e. use new SSI protocol). Use a new row for each major change you are testing. (To insert row, place cursor on the row number directly below last row used and click to highlight that row. Go to insert and click on row. A row will have been inserted.) 2. Place an X in the column related to the component of the change package to which this change is related (high hazard, reconciliation, medication ordering-dispensing-administrant, culture, periop, other). Then place an X or date in the columns related to each of the phase of testing, implementation or spread your team has accomplished with this change. Please note that as you move from one phase to the next (i.e. from "testing" to "implementation begun on the pilot unit") you will have an X or date in more than one column related to the same change. (note: date is preferable when posting this concurrently. Definitions: Testing involves trying a change. When we are testing we are free to try and to discard changes; there is no assumption that the change tested is permanent yet. (Collecting baseline data, meeting, brainstorming, and/or planning to change may be valuable activities but are not tests of change. We do not have a column for these activities.) Implementation is taking a successful change and building it in to the way the entire pilot population or pilot unit does their work. Spread is the process of taking a successful implementation from a pilot unit and replicating that change or package of changes beyond the pilot unit or population into other parts of the organization, into other organizations, or into a new area of focus (i.e. from people with diabetes to people with cardiovascular disease).
Medication Safety: Short Report
Barriers and Breakthroughs this Month: (optional) Able to start implementing med recon form as order form thanks to additional testing and a champion.
Your Organization
Spread Planned
Spread Begun
Spread Widely
Spread Complete
Instructions: 1. Please type in the change you are making as brief bullet narrative (i.e. use new SSI protocol). Use a new row for each major change you are testing. (To insert row, place cursor on the row number directly below last row used and click to highlight that row. Go to insert and click on row. A row will have been inserted.) 2. Place an X in the column related to the component of the change package to which this change is related (high hazard, reconciliation, medication ordering-dispensing-administrant, culture, periop, other). Then place an X or date in the columns related to each of the phase of testing, implementation or spread your team has accomplished with this change. Please note that as you move from one phase to the next (i.e. from "testing" to "implementation begun on the pilot unit") you will have an X or date in more than one column related to the same change. (note: date is preferable when posting this concurrently. Definitions: Testing involves trying a change. When we are testing we are free to try and to discard changes; there is no assumption that the change tested is permanent yet. (Collecting baseline data, meeting, brainstorming, and/or planning to change may be valuable activities but are not tests of change. We do not have a column for these activities.) Implementation is taking a successful change and building it in to the way the entire pilot population or pilot unit does their work. Spread is the process of taking a successful implementation from a pilot unit and replicating that change or package of changes beyond the pilot unit or population into other parts of the organization, into other organizations, or into a new area of focus (i.e. from people with diabetes to people with cardiovascular disease).
Medication Safety: Short Report
Spread
Organization:
Exec Walks
Unit Briefings
HFE Briefings
Instructions: 1. Please type in the change you are making as brief bullet narrative (i.e. use new SSI protocol). Use a new row for each major change you are testing. (To insert row, place cursor on the row number directly below last row used and click to highlight that row. Go to insert and click on row. A row will have been inserted.) 2. Place an X in the column related to the component of the change package to which this change is related (high hazard, reconciliation, medication ordering-dispensing-administrant, culture, periop, other). Then place an X or date in the columns related to each of the phase of testing, implementation or spread your team has accomplished with this change. Please note that as you move from one phase to the next (i.e. from "testing" to "implementation begun on the pilot unit") you will have an X or date in more than one column related to the same change. (note: date is preferable when posting this concurrently. Definitions: Testing involves trying a change. When we are testing we are free to try and to discard changes; there is no assumption that the change tested is permanent yet. (Collecting baseline data, meeting, brainstorming, and/or planning to change may be valuable activities but are not tests of change. We do not have a column for these activities.) Implementation is taking a successful change and building it in to the way the entire pilot population or pilot unit does their work. Spread is the process of taking a successful implementation from a pilot unit and replicating that change or package of changes beyond the pilot unit or population into other parts of the organization, into other organizations, or into a new area of focus (i.e. from people with diabetes to people with cardiovascular disease).
Medication Safety: Short Report
1 X X X X X Coumadin
2 X X X X X PCAs 3 X X X Plan 4 X X Plan X X 5 X X Plan Plan X
Lovenox Heparin
7 X Plan Plan X 8 X Plan X X X
X Plan
6 X X
Culture
Culture
Culture
FMEA
Reconciliation
X = At least one unit implementing the change
Plan = Plans are underway or early testing, but no implementation has begun
Month:
MARCH
Site
X = At least one unit implementing the change
Plan = Plans are underway or early testing, but no implementation has begun
All charts
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Displaying the Spread of Multiple Ideas
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Exec Walk Arounds
0
1
2
3
4
5
6
7
8
9
10
Dec-01 Jan-02 Feb-02 LS2
Mar-02 Apr-02 May-02 Jun-02 Jul-02 Aug-02 Setp 02 Oct-02 Nov-02
Fa ci
lit ie
s pa
rt ic
ip at
in g
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Hazard Areas - At Least 1 per facility
0 1 2 3 4 5 6 7 8 9
10
Dec-01 Jan-02 Feb-02 LS2
# IH
S fa
ci lit
ie s
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Unit Briefings
0
Facilities participating
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Exec Walk Arounds
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Chart4
jun-01
jul-01
aug-01
sep-01
okt-01
# IHS facilities
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Hazard Areas - At Least 1 per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Chart1
jun-01
jul-01
aug-01
sep-01
okt-01
# facilities using in 1+ or more units
Iowa Health System: 10 Hospitals in Iowa and Illinois System-wide Diffusion - Unit Briefings
0
1
2
2
2
4
4
4
8
9
9
9
9
9
9
9
9
9
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Chart1
jun-01
jul-01
aug-01
sep-01
okt-01
All charts
0
0
0
0
0
1
3
7
7
8
8
8
10
10
10
10
10
10
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Hazard Areas - At Least 1 project per facility
1
1
1
1
1
3
3
3
6
6
6
6
6
6
6
7
8
FMEA
jun-01
jul-01
aug-01
sep-01
okt-01
3
4
4
4
4
4
5
5
5
5
5
6
7
8
8
9
9
9
Reconciliation
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
System-wide Diffusion - Unit Briefings
System-wide Diffusion - Percentage penetration of unit briefings -aggregate state wide
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
Jun-01
Jul-01
Aug-01
Sep-01
Oct-01
The Scale-up Framework P29
Scale
Idea Leadership, communication, social networks, culture of urgency and persistence
Learning systems, data systems, infrastructure for scale- up, human capacity for scale-up, capability for scale-up,
sustainability
Responsibilities of Leaders
Discussion
The Scale-up Framework
Purpose of Developing the Scalable Unit
The Role of the Collaborative Team in the Framework
Leader’s Role
Creating a Municipal Leadership Team for Scale-up
Dias nummer 16
Creating Adoption Mechanisms
Creating a Communications Plan
Creating Support Structures
Iowa Health Progress Report to Leadership
Displaying the Spread of Multiple Ideas
The Scale-up Framework