Organizational Leadership 7th Annual Middle East Forum on Quality and Safety in Healthcare

March 22, 2018 Doha, Qatar

Derek Feeley President and CEO, IHI Maureen Bisognano President Emerita and Senior Fellow, IHI

ME Forum 2019 Orientation

As part of our extensive program and with CPD hours awarded based

on actual time spent learning, credit hours are offered based on

attendance per session, requiring delegates to attend a minimum of

80% of a session to qualify for the allocated CPD hours.

•Less than 80% attendance per session = 0 CPD hours

•80% or higher attendance per session = full allotted CPD

hours

Total CPD hours for the forum are awarded based on the sum of CPD

hours earned from all individual sessions.

Conflict of Interest

The speaker(s) or presenter(s) in this session has/have no conflict of

interest or disclosure in relation to this presentation.

Our Leadership Challenges

• Building a leadership culture to achieve the results we seek

• Aging, and the increasing burden of chronic disease

• New roles and multigenerational workforces

• Rapid expansion of technology

• Research output at unprecedented levels and speed

• Increasing patient expectations for engagement

• Challenges to dramatically improve safety and flow

• Designing a learning system to decrease variation

Qatar National Health Strategy

Principles • Action and empowerment

– “Come together for the good of our country, and the health of our people, our families, and our patients”

• Teamwork and collaboration

• Patient-centered care

• Accountability and patient safety

• Leadership

• Intelligence

• Empathy

4

Some New Ways to Live the Principles

and Lead to Improved Care

• New leadership ideas

• Innovative models of care

• Accelerating the rate of improvement

5

Concepts Operational Definition

Theory The science of improvement includes system thinking, understanding variation, psychology of change, and the theory of knowledge that are applied to improve the performance of processes, organizations, and communities.

Culture, Behaviors, and Relationships

Series of principles and behaviors based on improvement science and applied to all work including: constancy of purpose, relentless focus on continual improvement, recognizing the need to distinguish random from attributable variation and the difference in how you act, learning through experimentation, inquiry, curiosity, Socratic mentoring, comfort with failure, etc.

Organizational System

A system is an interdependent group of items, people or processes working together toward a common purpose. Processes that are designed to produce quality for the customer and reduce variation and waste. Understanding the system is supported by a vector of measures.

Quality Activities

Include different phases of delivering quality including: planning, innovation, improvement, implementation, and control. Limited quality assurance may be required to meet external regulator requirements.

Leadership Framework

A framework for leadership to focus organizational attention and activity to continually operate and to improve on strategic priorities. This includes establishing the foundation and supporting building will, generating ideas, and supporting execution.

Strategic Execution

Defining a portfolio of strategic priorities with chartered projects that include measurable aims, “evidenced-based” change ideas, and a measurement strategy. Execution is supported with resources, protected time, and integration into daily work.

Content Models, frameworks, and/or change packages developed by subject matter experts, innovation cycles, best practice, or research that provide content and ideas for testing and improvement. Examples: Patient Safety Framework, Joy in Work Framework.

Improvement Approach

The Model for Improvement is an improvement approach to charter aims, measures, and changes for an improvement project and uses the PDSA cycle and time series data to test and improve.

Tools & Methods

The proper application of this science requires integration of a set of improvement methods and tools with knowledge of subject matter to develop, test, implement, and spread changes. Tools include check sheets, cause & effect, process mapping, histograms, pareto, etc.

Create Energy

2 Differentiators

Strengths Leadership Characteristics

Trust Compassion

Stability Hope

11

5 Sources of Meaning

Society

Company &

shareholders

Customers

Team

experience

Personal

success

____________ %

Improving society

Building the community

Stewarding resources ____________ %

____________ %

____________ %

____________ %

Leading the industry

Increasing share price

Paying dividends

Making it easy for the customer

Providing superior service

Making better quality products

Nurturing high-performing teams

Bolstering sense of belonging

Fostering a caring meritocracy

Achieving personal development

Receiving recognition in my field

Earning a big bonus/stock options

Becoming Multilingual to Build the Will for

Change

13

5 Sources of Meaning

Society

Company &

shareholders

Customers

Team

experience

Personal

success

____________ %

____________ %

____________ %

____________ %

____________ %

Create Trust

Trust and Camaraderie

Adapted from Lencioni

15

Critical Components for Ensuring a Joyful, Engaged Workforce Interlocking responsibilities at all levels

Wellness & Resilience

Physical & Psychological

Safety

Daily Improvement

Meaning & Purpose

Recognition & Rewards

Choice & Autonomy

Participative Management

Happy

Healthy

Productive

People

Camaraderie

& Teamwork

Real Time

Measurement

Physical & Psychological Safety: Equitable environment,

free from harm, Just Culture that is safe and

respectful, support for the 2nd Victim

Meaning & Purpose Daily work is connected

to what called individuals to practice, line of site to

mission/goals of the organization, constancy

of purpose

Autonomy & Choice: Environment supports choice and flexibility in

daily lives and work, thoughtful EHR implementation

Recognition & Rewards:

Leaders understand daily work, recognizing what

team members are doing, and celebrating

outcomes

Participative Management:

Co-production of Joy, leaders create space to hear, listen, and involve before acting. Clear communication and

consensus building as a part of decision making

Real Time Measurement: Contributing to regular feedback

systems, radical candor in assessments

Wellness & Resilience: Health and wellness self-

care, cultivating resilience and stress management, role

modeling values, system appreciation for whole

person and family, understanding and

appreciation for work life balance, mental health

(depression and anxiety) support

Daily Improvement: Employing knowledge of

improvement science and critical eye to

recognize opportunities to improve, regular,

proactive learning from defects and successes

Camaraderie & Teamwork:

Commensality, social cohesion, productive

teams, shared understanding , trusting

relationships

17

Who’s on your boat and do they have the skill and the will needed?

Not aware; left behind; will not take a leap of faith

Opposed to change; strong believer in cur- rent way of doing things and willing to fight for it

Interested in the program but lack skills/ knowledge to contribute fully

Fully supportive of the change program

Castaways (20%) Pirates (10%)

Crew (50%) Captains (20%)

• Take a moment to consider

where your team is on the

boat and who is…

• High skill, high will?

• High skill, low will?

• Low skill, high will?

• Low skill, low will?

What steps can you take to

address each of these folks?

SOURCE: McKinsey & Company, Organization Practice

Leadership to Improve

• What we believe

• What we say

• What we see

• What we do

18

What We Believe

• The leader’s role focuses on creating the energy

for change

• Working with humility to inspire a culture of

safety and trust

• Committing to the best we know for all

• Pushing the limits for a strong future

19

A Healthcare Example

• Jonathan Goble, CEO IU Health North

– “A positive culture is intentional, and evolves by the

commitment, empathy, and creativity of all ..to create

passionate care and impeccable service.”

– Mission: To improve the health of communities, to

support the educational commitments of IU, to nurture

individual spirit and to celebrate the experiences of

life.”

20

IU North’s Vision

• Excellence in care

• A peaceful environment

• Extraordinary service

• The effective blending of technology, compassion and spirit

• A seamless continuum of care, blending community-based

and academic services to grow knowledge and expertise

• A team approach in which the patient and family are the

ultimate priority

21

IU Health North Core Maxims

• Show kindness-Before I do anything, I must first

demonstrate genuine kindness. People don’t

care how much I know unless they know how

much I care.

• Connect fully-I must listen, make eye contact,

and seek to understand my patient’s needs. I will

make every person uniquely appreciated.

22

IU Health North Core Maxims

• Take ownership-I choose to be responsible for

my actions, attitudes and decisions.

• Create joy-I have the power to be positive and

lift the spirits of those around me.

• Do more-I will look for ways to surprise my

patients by doing more than they expect.

23

What We Say

• Build and use your influence

• Bob Waller’s 8 x 8

• Stories of impact

• Listening with curiosity

• “Above the line”

“Key ideas drive cultural change. For every

important message, I deliver it 8 ways, 8

times.”

- Dr. Robert Waller, CEO Emeritus, Mayo Clinic

To Be Happy, Be Curious

• James Ryan’s Five Questions:

1. “Wait, what?” – understanding

2. “I wonder…” – curiosity

3. “Couldn’t we at least…” – mobilize

4. “How can I help?” – asking is key

5. “What truly matters?”

Source: Mineo, Liz. “Want to be Happy? Be curious.” Harvard Gazette. 14 Apr. 2017.

27

28

Humility

New Quality (and Safety) Paradigm

Old way New way

Quality is about compliance. Quality is about continuous, systematic improvement.

Quality is a function of governance. Quality is a shared responsibility.

Data is for assessment. Data is for rapid adjustment.

Power is concentrated (in the hands of the checkers).

Power is distributed to patients and staff at the point of care.

Leadership creates standards.

Leadership creates culture.

Listen to Understand – Not to Respond

“Wide lugs and a short tongue

is best”

Scottish Proverb

Ask and Listen: Heroism is Out, Humility is In!

Schein on Culture

• Culture is a result of what an organization has learned from dealing with problems and organizing itself internally

• Your culture always helps and hinders problem solving

• Culture is a group phenomenon • Don’t focus on culture because it can be a bottomless

pit. Instead, get groups involved in solving problems

What We See

• “Real” rounds

• Journey of a patient

through a time of care

• Spaghetti diagrams

• Commensality

Source: Ron Bialek, Grace L. Duffy, and John W. Moran, The Public Health Quality Improvement Handbook (Milwaukee, WI: ASQ Quality Press, 2009), page 220.

Cede Power

“For every complex problem there is an answer that is clear, simple, and wrong."

H. L. Mencken

NEW PUBLIC MANAGEMENT Targets, sanctions, inspections

QUALITY IMPROVEMENT

MOBILISING SOCIAL ACTION O

utco

me

s

Time

Getting to the Third Curve

Sharing power

Keeping power

Ceding power

PERFORMANCE MANAGEMENT

QUALITY IMPROVEMENT

CO-PRODUCING

Create Ability

AGENCY The ability of an individual or group

to choose to act with purpose

Power

The ability to

act with purpose

Courage

The emotional resources

to choose to act

Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology

Psychology of Change

IHI Psychology of Change Framework

Unleash Intrinsic Motivation

Tapping into sources of intrinsic motivation galvanizes people’s individual and

collective commitment to act.

Co-Design People-Driven Change

Those most affected by change have the greatest interest in designing it in ways that are meaningful and workable to them.

Co-Produce in Authentic Relationship

Change is co-produced when people inquire, listen, see, and commit to one another.

Distribute Power

People can contribute their unique assets to

bring about change when power is shared.

Adapt in Action

Acting can be a motivational experience for people to learn and iterate to be effective.

z z

Activate

People’s

Agency

Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology

Joy in Learning

What do these have in common?

NASA Challenger BP Gulf Spill Mid Staffs NHS

The Cycle of Fear 45

Increase Fear

Kill the Messenger

Filter the Information

Micromanage

Personal Resilience

Networks

From Ideas to Action

• Flow across the system

• Waste and cost

• Safe care

• Joy in work

• Patient-centered redesign

53

Achieving Hospital-Wide Patient Flow

http://www.ihi.org/communities/blogs/why-hospital-flow-is-key-to-patient-safety

54

Does every hospital admission need a

root cause analysis? • “No fault hospitalization”

• Preventable with traditional medical care

• Preventable with attention and intervention in social determinants

• Medical error

• Flow problems

• Staffing challenges

• Communication and handovers

55

Source: Mark Depman, NJEM Catalyst, October 18, 2017

A New Way

• Engineered and designed flow

• Upstreamism

• Outplacing

• Partnering in care

56

16-Bed MICU:

“We need more beds!”

57

Source: Bela Patel, MD and Khalid Almoosa, MD

“We have plenty of ICU beds!”

• VAP/ BSI rates Zero - $54,000/$ 35,000

• EC- ICU 53% to 75% in 4 hours • Hospital LOS decreased 1.5 days $$

• Floor codes decreased 50%

• End of Life –ICU stay –decreased 3.3 days

• Mortality decreased by 13%, CMI up 15%,

• Occupancy decreased from 94.5% to 85.5%

• Monthly admissions: from 89.4 to 104.6

• $5.1 Million saved

58

Source: Bela Patel, MD and Khalid Almoosa, MD

James M. Anderson Center

for Health Systems Excellence

Daily Critical Flow Failures

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Psychiatry Patients Placed Outside of their

Primary Unit

James M. Anderson Center

for Health Systems Excellence

System Wide Patient Flow Delays

Confidential proprietary information of Cincinnati Children’s Hospital Medical Center. Do not distribute.

Provider Conferences

Outpatient Consultations

Inpatient Consultations

Diagnostic Testing

Remote Patient Monitoring

Common to Complex- ECHO

Model

Additional Virtual Patient Care

Telehealth at Cincinnati Children’s

Patient Flow| Operational Control Center

Patient Flow| Accelerator Program

Patient Flow

Care

Units

Registration

Pre Admission

MDA

Support

Medical staff

Surgery Center

ER

Surgical Scheduling

Medical Practice

Readmissions

4.10

3.87 3.96 3.86 3.81

3.75 3.64

3.51 3.40 3.28

34 20 36 44 54

74 97 117

147

Decrease length of stay and the virtual beds gain

Length of stay Virtual gain capacity (beds)

The reduction in LOS provided a capacity gain equivalent to 147 virtual beds

Flow

• What innovations have you implemented? What works and what doesn’t?

• Do you need new roles?

• What delays and complications can you improve?

• What leadership driver do you most need to enhance?

64

Eliminate Waste and Managing Value

• “Seeing” waste

• Adding value

• Equipping staff

65

Reducing Harm, Waste and Variation

Reduce Waste

“50%of all resource expenditure in hospitals is quality-associated waste”

- recovering from preventable foul-ups

- building unused or unusable products

- providing unnecessary treatment

- simple inefficiency

Brent James and Lucy Savitz – Intermountain Healthcare

“See” the Waste 68

Trillion Dollar Checkbook

1. Reduce harm & safety events

2. Reduce non-value added operational workplace waste

3. Reduce non-value added clinical workplace waste

4. Solicit staff and clinician ideas

5. Involve patients in identifying what matters most

6. Redesign care to achieve Triple Aim

69

70

BUILDING ON THE WEDGES OF WASTE (Hackbarth/Berwick): REDUCING THE BAG OF $ - A Starting Checkbook for Big & Smaller US Healthcare Waste (starting list - Helen Macfie & Jim Leo) - DRAFT

Primary Drivers / Waste Opportunity

BOLD Goal Relative Ease Priority

Savings Goes To: Average Avoidable Cost per Instance Avoidable Volume, USA Lower Bound Total $$ (CxD) Billions

Upper Bound Total $$ (C x D) Billions

Definitions/Notes Overall Approach/Ideas Barriers and Obstacles to Plan For

P1: Reduce Harm & Safety Events

Infections - reduce hospital acquired

Reduce Infections of 5 HAIs by 40%. Note: Focus on CLABSI, VAP, SSI, CAUTI, CDI.

"EASY" PROVIDER: $5.5 billion SSI = $20,786/case, CLABSI = $45,814/case, CAUTI = $896/case, VAP = $40,144, CDI = $11285/case

65% of CLABSI cases, 55% of VAP cases, 26% of SSI cases, 50% CDI cases, and 70% of CAUTI cases

$4.60 $6.50 IHI/Published cost savings/infection type Toolkits (existing) IHI Campaign, renewed Local systems/design

Renewed attention

Sepsis Reduce Cost by 25% Note: not published but MemorialCare has reduced direct variable cost from $28K/case to $22K/case (21%) for severe sepsis and septic shock cases, while reducing mortality by 55% for patients who are not DNR within first 24 hours of hospital care.

"EASY" PROVIDER

Sepsis attributable hopsital costs at index hospitalization and 90 days post discharge: $32,900/pt surgical, $5,800/pt nonsurgical.

20-25% reduction in sepsis cost/case Note: we have not yet quantified impact of reducing actual cases coming in from the community

$4.50 $5.60 Surgical v non-surgical patients with sepsis

Toolkits (surviving sepsis) IHI "Campaign", renewed Local systems/design Community education - earlier recognition

Renewed attention; Community Partnerships

Improve Medication Reconciliation and Reducing Readmission

Focus: Improve clinical Medication Reconciliation across Continuum of Care to "90"%

MEDIUM PAYOR Between $10,100 and $14,200 in payments per readmission

27% reduction in all-cause readmission rate after implementation of medication reconciliation program

$14.50 $20.30 Improve "good" reconciliation within 48-72 hours of transfer to alternate level of care (focus on home first)

Uniform criteria needed Standardized approach needed

Provider resources Systems/documentation (EHR records)

Opioid Use Reduction Reduce Dispensed Opioids by "20-40"% Ex: Reduce opioid Rx for opiate-naïve patients at discharge or new outpatient Rx to <7 day supply (if they need it at all. Note: Does not include reduced cost from avoided opioid dependence with associated chronic care costs (excluding overdose).

MEDIUM PROVIDER $4,006 per opioid poisoning event (includes ED, OP, ambulatory, and nalaxone costs) -------------------------------------$15,935 all-cause medical cost differential per patient between 1 year before initial opioid precription and 1 year post initial precription (among chronic opioid users)

22% reduction in morphine milligram equivalents (MME) per person (Oregon Health Authority) with associated 38% reduction in poisoning events --------------------------------------------------- 11% of 8 million chronic opioid users that received potentially innapropriate prescription

$12.20 $19.40 Reduce prescriptions - both # of Rx and quantity per Rx

Provider education to reduce # and quantity Reporting for MME ordered

Current supply Provider buy-in

Overdiagnosis Reduce Cost to Top 5-10 Diagnoses by 25% (breast cancer screening, pre diabetes, ckd, asthma, hypertension, CDI)

HARD PAYOR $345 per mammogram; $6283 per CKD case; $2560 per hypertension case; $511 per pre-diabetes case; $4166 per asthma case, $750 (drug costs) per CDI case (claims data)

Assumed 25% reduction across all cases/tests

$67.80 $67.80 Overdiagnosis: pick top 5 or 10 diagnoses; assume 25% reduction; find average cost of treatment

Advocacy - NNTH/B, publication bias Education; Campaign Local systems/design

Belief, Inertia

What is Muda?

• Muda (無駄) is a Japanese term for anything that is wasteful and doesn't add value. It is also a key concept in the Toyota Production System. Waste reduction is an effective way to increase profitability.

• A process adds value by producing goods or providing a service. A process also consumes resources. Waste occurs when more resources are consumed than are necessary to produce the goods or provide the service.

1. Standardize Model

Map Process

Understand variation

Redesign process

Do you

have a

standard

care

model?

No

Yes

2. Optimize Efficiency

Track the costs of the care

process

Reduce waste, improve

performance

Key Concepts • Simplification

• Coordination

• Substitution

• Improved

decision-making

A Framework to Continuously

Improve Value by Reducing

Cost & Improving Quality

3. Leadership

Decision

Making

Check Continuously: Is quality high and

consistent?

Is staff engagement high?

What is the impact on job

satisfaction?

IHI R&D, 2016

Hamad Medical Corporation – 9 teams 74

Initia

l P

ilot

Heart Hospital:

Cardiac step-down

F

irst sp

rea

d u

nits

Heart Hospital:

Cardiac ICU + imaging

Se

co

nd

sp

rea

d p

ha

se

Six additional teams in four sites

Results, cont. 75

UCL

LCL

0

2000

4000

6000

8000

10000

12000

14000

16000

1 2 3 4 5 6 7 8 9

10

11

12

13

14

15

16

17

18

19

20

21

Overtime cost (RNs) Measure

Improved

scheduling

Waste

• Do you have a means to “see” waste in your

system?

• How are you balancing top-down versus bottom-up

solutions?

• How can you further build the will for change here?

• What leadership driver do you most need to

enhance?

76

Safe Care

• Understanding safety performance now and

improving

• Seeing diagnostic error

• Looking across the system

77

Diagnostic Errors

• Affect 1 in 20 adults

• Leading cause of malpractice claims

– 29% of total suits from 1986-2010

• Leads to delays in treatment and increases cost

of care

Source: https://www.modernhealthcare.com/article/20190126/NEWS/190129972/coalition-tackling-diagnostic-errors-gains-some-

traction

Six Barriers to Accurate Diagnosis

1. Poor communication during care transitions

2. Lack of measures and feedback

3. Limited support to help with clinical reasoning

4. Limited time

5. It’s complicated

6. Lack of funding for research

Source: The Society to Improve Diagnosis in Medicine. https://www.improvediagnosis.org/new_posts/40-healthcare-organizations-

launch-unprecedented-effort-to-improve-accuracy-and-timeliness-of-diagnosis/

79

Increased Fall Risk

• Number of fall related ED visits by people 65+ increased by 38% in California between 2010 and 2015

• Fall related medical costs total more than $31 billion each year nationally

• Problem will be further exacerbated as baby boomers age

Source: Gorman, Anna. "ER Visits Linked To Falls Spike Among California Seniors." California Healthline. 15 Feb. 2017.

80

CAPABLE

• “Community Aging in Place, Advancing Better Living for Elders” – Emphasizes helping older adults maintain independence through environmental

adaptations and interventions

– Team of nurse, occupational therapist, and handyman

• Common fixes: – Installing or fixing railings or grab bars

– Improving lighting

– Installing non-skid treads in tubs and showers

– Repairing trip hazards, like holes or tears in carpet, or broken times

• 79% of initial participants reported fewer activity of daily living

limitations

Source: Szanton, S.L., Wolff, J.L., Leff, B., Roberts, L., Thorpe, R.J., Tanner, E.K., Boyd, C.M., Xue, Q.L., Guralnik, J., Bishai, D., Gitlin, L.N.: Preliminary data from

community aging in place, advancing better living for elders, a patient-directed, team-based intervention to improve physical function and decrease nursing home

utilization: the first 100 individuals to complete a centers for medicare and medicaid services innovation project. J. Am. Geriatr. Soc. 63(2), 371–374 (2015).

81

CAPABLE

• Roughly $3,000 in program costs yields approximately $10,000 in savings in medical costs.

• Participants showed reduced symptoms of depression, fewer difficulties with Activities of Daily Living, and improved motivation.

Source: Szanton, S.L., Wolff, J.L., Leff, B., Roberts, L., Thorpe, R.J., Tanner, E.K., Boyd, C.M., Xue, Q.L., Guralnik, J., Bishai, D., Gitlin, L.N.: Preliminary data from

community aging in place, advancing better living for elders, a patient-directed, team-based intervention to improve physical function and decrease nursing home

utilization: the first 100 individuals to complete a centers for medicare and medicaid services innovation project. J. Am. Geriatr. Soc. 63(2), 371–374 (2015).

82

How do you “see” harm in hospital

care?

• Do you have a dosing formula and a method to share

best performance quickly and to all?

• Have you shared the story (like Gilbert), the

extrapolation, the human cost, and the financial cost?

• Can you measure harm across the system?

• What’s the leadership driver you most need to enhance?

85

Deming and Joy in Work

“Management’s overall aim

should be to create a system

in which everybody may take joy in his

work.”

– Dr. W. Edwards Deming

87 The Burning Platform

Source: www.nam.edu/perspectives

Measurement

IHI Organizational Diagnostic

Joy in Work

• Have you used your data to predict and plan for a vibrant workforce?

• How are you doing on psychological safety, meaning, sense of control and recognition?

• How are you building effective teams and creating cameraderie?

• Which of the leadership drivers are most relevant here?

92

New Ways to Codesign Care with

Patients and Families

93

Patient-Centered Redesign – Self Dialysis

• Self-dialysis transformation began in 2005 at Ryhov Hospital in Jönköping, Sweden

• Christian asked about doing his own dialysis, then taught another patient, and the program grew

• Now 70% of dialysis patients at the hospital perform their own treatments

• Self-dialysis is performed at 50% of costs of other hemo-dialysis units

Waco, Texas

• Patients were taught to self-administer care at the CTNA clinic

• In 2016, almost 40% of CTNA’s 751 patients performed their own

dialysis

• They also experienced fewer hospitalizations and a lower mortality

rate

• Staff burden shifted from performing each step of dialysis to serving

as coaches and supporters of patients performing self-care

95

Source: https://hbr.org/2017/06/the-value-of-teaching-patients-to-administer-their-own-care

My Dialysis, My Choice

The patient starts by

selecting a few values

that matter most to them

when choosing a

treatment plan

Then detailed information

is provided to help the

patient rate treatment

options according to how

well they match each

chosen value

Source: mydialysischoice.org

My Dialysis, My Choice Based on the patient’s rankings on each value, the

results are compiled to help them decide which dialysis

treatment option is best for their lives and health

Source: mydialysischoice.org

Royal Free Hospital, London

“Maximising kindness and friendship towards patients through systematic staff development, environmental design and clinical practice.”

98

Key Results

• Unit length of stay reduced by 2.6 bed days

• 26% reduction in readmissions

• 49 % of patients initially labelled as ‘now needs nursing

home’ converted to ‘return to their previous home’

99

June 4, 2014

Brazil Scotland Norway

Italy Denmark BC Canada

Global Reach of WMTY

Kindness Bundle

• Opening and closing interactions with patients in a structured way

• Warm personal introduction – “What would you like me to call you?”

• Shared decision making – “What matters to you?”

– “What about today? What would make today a good day?”

• Warm close-out – “Is there anything we can do to make you more comfortable?”

Source: Galina Gheihman, MD and Cynthia Cooper, MD

Basic Acts of Kindness Can Lead To

• Faster wound healing

• Reduced pain, anxiety and blood pressure

• Shorter hospital stays

105

Source: Berry, L. (2018, April 8). Some basic acts of kindess found to help patients dealing

with cancer. The Washington Post. Retrieved from https://www.washingtonpost.com/

Basic Acts of Kindness

• Deep listening

• “What’s the matter?” “What matters to you?”

• Empathy

• Anticipatory kindness based on patient’s situation and stressors

• Generous acts

• Can offer a renewing buffer to emotional fatigue and stress

• Timely care

• Institutional commitment to being on time

• Gentle honesty

• Guide patients to intrinsic hope

• Support for family caregivers

• Prepare, empower, and assist a patient’s family

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Source: Berry, L. (2018, April 8). Some basic acts of kindess found to help patients dealing

with cancer. The Washington Post. Retrieved from https://www.washingtonpost.com/

What are the leadership opportunities to build

and optimize patient-centered redesign?

• Have you launched ‘What Matters to You’ Day (June 6,

2019)?

• How do you hear the voice of patients and families in design?

• Does your culture support shifting the balance of power?

Using all of the assets of patients and families?

• Which of the leadership drivers are most important here?

Report out

• We heard

• We learned

• We’ll lead differently by……..

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شكرا Maureen Bisognano

President Emerita and

Senior Fellow

Institute for Healthcare

Improvement

53 State Street, 19th Floor

Boston, MA 02109

mbisognano@ihi.org

Derek Feeley

President and CEO

Institute for Healthcare

Improvement

53 State Street, 19th Floor

Boston, MA 02109

dfeeley@ihi.org