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TRANSCRIPT
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Leading Quality Improvement
Essentials for Managers
Session 2: Understand and Manage Systems
March 3, 2015
These presenters have
nothing to disclose
Janet Porter, PhD
Kathy Duncan, RN
Today’s Host2
Dorian Burks, Project Coordinator, Institute for
Healthcare Improvement, is a current coordinator for
web-based Expeditions. He also contributes to the IHI
work in the Triple Aim and Improvement Capability
focus areas, as well as the Leading Quality
Improvement series. Dorian is a member of the
Diversity and Inclusion Council at IHI, where he and
fellow staff members develop strategies to enhance
IHI’s inclusive culture, both internally and externally.
Dorian graduated from Massachusetts Institute of
Technology in Cambridge, MA where he received his
Bachelor of Science degree in Biology and humanities
concentration in Anthropology.
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Phone Connection (Preferred)3
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All Participants
Poll: Group or Individual?
Are you viewing this session of Leading Quality
Improvement:
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Note: Listserv Communications
Great discussion through our listserv,
[email protected], over the past two weeks!
Our listserv is used for:
– Session communications: pre-work, connection information,
session recordings
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Kathy Duncan, RN8
Kathy Duncan, RN, Faculty, IHI, co-leads IHI's National Learning Network. Ms. Duncan also directs IHI Expeditions, manages IHI's work in rural settings, and provides spread expertise to Project JOINTS. Previously, she co-led the 5 Million Lives Campaign National Field Team and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. She also served as the content lead for the Campaign's Prevention of Pressure Ulcers and Deployment of Rapid Response Teams areas. She is a member of the Scientific Advisory Board for the AHA NRCPR, NQF's Coordination of Care Advisory Panel, and NDNQI's Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the director of critical care for a large community hospital.
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Schedule of Sessions
Session 1 – Coach Versus CommandDate: Tuesday, February 17, 12:00 – 1:00 PM ET
Session 2 – Understand and Manage SystemsDate: Tuesday, March 3, 12:00 – 3:00 PM ET*
Session 3 – Practice Improvement EssentialsDate: Tuesday, March 17, 12:00 – 1:00 PM ET
Session 4 – Build Sustainable SystemsDate: Tuesday, March 31, 12:00 – 3:00 PM ET*
Session 5 – Manage Connections Across SystemsDate: Tuesday, April 14, 12:00 – 1:00 PM ET
* Breakout session: Clinical Managers 12:00-1:00 PM ET, Quality Improvement
Managers 1:00-2:00 PM ET, Allied Health Professions Managers 2:00-3:00 PM ET
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Schedule of Sessions
Session 6 – Identify and Spread Successful ImprovementsDate: Tuesday, April 28, 12:00 – 3:00 PM ET*
Session 7 – Partner with Patients and Families Date: Tuesday, May 5, 12:00 – 1:00 PM ET
Session 8 – Create a Culture of SafetyDate: Tuesday, May 19, 12:00 – 3:00 PM ET*
Session 9 – Empower Teams to Engage in ImprovementDate: Tuesday, June 9, 12:00 – 1:00 PM ET
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* Breakout session: Clinical Managers 12:00-1:00 PM ET, Quality Improvement
Managers 1:00-2:00 PM ET, Allied Health Professions Managers 2:00-3:00 PM ET
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Thank You!
24 folks completed our post-session survey
Here’s what you said:– Presenters should allow time for small group discussion
– Some of you experienced sound issues
– Some wanted more emphasis on the didactic portion
– Encourage small group discussions
– Some were a little disappointed in the structure
– Enjoyed the chat!
– A few suggested that the case study could be last
Janet Porter, MBA, PhD12
Janet Porter, MBA, PhD, a principal with Stroudwater Associates, serves as a strategy, operational, and leadership development consultant to hospitals and physician practices. She has 35 years of experience as a hospital administrator, teacher, consultant, and public health leader.
Dr. Porter served as the Chief Operating Officer of Dana-Farber Cancer Institute; the Associate Dean of Executive Education at the University of North Carolina’s School of Public Health; the Interim CEO of the Association of University Programs in Health Administration (AUPHA); and the Vice President, and then COO of Nationwide Children’s Hospital in Columbus, Ohio. Currently teaching strategic management in the Healthcare Executive MBA program at the University of Miami, Dr. Porter is also an active adjunct professor at the University of North Carolina at Chapel Hill and Ohio State University. Janet received her BS and MHA from Ohio State University, and her MBA and PhD in health care strategy from the University of Minnesota. Janet has completed Intermountain Healthcare System’s Advanced Training Program, is certified in several leadership development tools including Myers-Briggs, Crucial Conversations and StrengthsFinder and serves as a Baldrige examiner. Janet serves on the AARP board of directors and the High-Value Healthcare Collaborative Advisory Board.
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Session 1 Assignment Debrief
Identify one of your key projects or activities and
delegate it to someone else. Use the opportunity as a
chance to develop your staff.
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Today’s Agenda – New Format!
Welcome & Introductions
Session 1 Evaluation Survey
Action Period Assignment Review
Systems Thinking and Problem Identification
The Rose Hearn Case Study
Action Period Assignment
Closing & Next Steps
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Today’s Objectives
I. To develop systems thinking
II. To learn to see problems
III. To learn tools for identifying and illustrating problems
IV. To think through problems systematically
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Systems Thinking
The process of understanding the relationship of parts of
a system and how they influence each other
Systems have inter-connected parts and flows within a
boundary
Understanding systems is key to understanding
problems and solving them
Systems can be understood by employing tools to
illustrate the relationships between the parts and the
links between the parts
The Rose Hearn case
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Seeing a Problem:
Reducing Wait Time at Dana-Farber
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Reducing Wait Time at Dana-Farber18
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What is a Problem?
Something unexpected. A variation from expectation
What is the expectation?
– Standard work
How often do problems happen?
You can’t know the abnormal until you
know the normal
Variation
– Hides Problems until they are big problems
– Creates Waste
– Creates Problems
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Asking The 5 Why’s
Why?Why?
Why?Why?
Why?Why?
Why?Why?
Why?Why?
Fluid was building up in the patients lungs and they
were having worsening shortness of breath and could
not sleep
The sodium content was building up in the
body causing the fluid retention
The patient was either ingesting too much sodium or
the diuretics weren’t working well enough
The patient lacked the knowledge and
support to manage his diet and drug regimen
The patient education
process was ineffective
and the support systems
don’t exist
Ask Your Team
If anything was solvable, what problem would you solve
that would have the greatest impact on patient care?
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Team – Based Problem Identification
What tools do you use with your team to
identify, uncover or illustrate problems?
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• Two weeks of observation pre-work
• Split into 8 teams and walked the value stream
• Collected voice of the customer and identified process waste
• Documented waste and re-work in the process and mapped a high level current state value stream map
Picture
Value Streams
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Root Cause Analysis25
Fishbone Diagrams26
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Pareto Chart27
Scorecards
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Satisfaction Financial Quality Growth
Outcome Metrics
Reason For Miss
A3s
Process
Metrics
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The Value of Measuring
“You measure what you value. Conversely, you value
what you measure.” Brent James
“We tend to overvalue the things we can measure and
undervalue the things we cannot.” John Hayes
“Measurement is the first step that leads to control and
eventually to improvement. If you can’t measure
something, you can’t understand it. If you can’t
understand it, you can’t control it. If you can’t control it,
you can’t improve it.” H. James Harrington
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Examples of Tools
Affinity Diagram
Brainstorming
Control Charts
Fishbone Diagrams
Flow Chart
Gantt Chart
Histogram
Matrix Diagram
Pareto Diagram
Radar Chart
Scatter Diagram
Value Stream Map
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The A3 Approach
Questions/Discussion32
Raise your hand
Use the chat
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The Rose Hearn Case (CM)
Describe the most important clinical strategies that can
help to prevent a highly contagious illness from
spreading throughout the hospital.
Who do those clinical strategies impact throughout the
hospital?
The nurse manager in this case is very experienced.
How might that experience help her to effectively handle
any complications that could arise in such a case? If
Rose’s illness spreads to any other patients, how might
the nurse manager respond and what other processes
might she call into play?
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The Rose Hearn Case (QIM)
What are some of the quality improvement steps that
you might implement for best outcomes to prevent a
highly contagious illness like the one Rose has from
spreading throughout the hospital?
What type of outcome measurements and monitoring
processes might be helpful to apply to this type of
situation to ensure that everyone is doing their job in the
safest and most efficient way?
How might the information you track help to direct
changes, both within specific departments and also
within the broader organizational setting?
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The Rose Hearn Case (AHPM)
What are some of the transmission-based precautions that allied health professional managers can take to protect staff who could potentially come into contact with a highly contagious illness? What other steps can also keep the illness from spreading to other patients?
How can allied health managers ensure that the lines of communication within the hospital extend to all of their departments, and how might their inclusion in the patient-care process help to ensure best outcomes?
What are a few of the safeguards that allied health professional managers might implement to ensure that changes to their processes don’t negatively affect other systems?
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Conclusions
In order to solve problems, you need to see them as
problems.
Working teams using tools increases your likelihood of
solving problems.
Everyone operates within patient care systems that
connect with each other.
To improve quality, you need to understand those
connections and plan accordingly.
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References
Learning to See: Mike Rother & John Shook
A3 Problem Solving for Healthcare: A Practical Method for Eliminating Waste by Cindy Jimmerson
The Fifth Discipline Fieldbook: Strategies and Tools for Building a Learning Organization by Peter Senge
Action Period Assignment
Identify with your team a problem that you would like to
tackle and explain what tool(s) you will employ to
measure and better understand the problem.
– Describe this on the listserv, [email protected], in 250 words or
less.
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Communications
All sessions are recorded
Materials are sent one week in advance
Listserv address for session communications:
If you’d like to be re-added, add colleagues or change
your subscription to a daily digest, email us at
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Next Session
Session 3
Practice Improvement Essentials
Jill Duncan, RN, MPH
Tuesday, March 17th, 12:00 – 1:00 PM EST
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Thank You!41
Kathy Duncan
Dorian Burks
Please let us know if you have any questions or feedback following today’s session.