wha improvement forum for june “tapping front-line knowledge” presented by stephanie...
TRANSCRIPT
WHA Improvement ForumFor June
“Tapping Front-line Knowledge”
Presented by Stephanie Sobczak and Jill Hanson
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.
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Today’s Webinar
Agenda
The front line staff perspective Levels of Involvement Strategies for Feedback “Real Time” Improvement
Engaging Front-line Staff
“No one asked me to work on
improvement”
“I’ve been involved in the past, but I got stuck doing
most of the work”
“I was told I have to go
to meetings on my off
time”
Why?• Improved outcomes can only occur with
improved processes – “the work” of the staff.• Staff already know where the waste and
inefficiencies are in their processes.• Care giving staff are the eyes and ears of the
hospital.• “Culture eats strategy for lunch”!
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Setting the Stage for Engagement
Emphasize Teamwork
Emphasize High Reliability
Emphasize Participation
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Teamwork
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Do your front line staff know that teamwork is greatly valued in your organization?
Is it obvious?Is it recognized?Is it praised?
High Reliability
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The key is standardized approaches.
For the work: Use of checklists and written work instructions and systematic methods of communication (such as SBAR)
For the improvement: P-D-S-A or other improvement approach
“Engage the Engaged”How do we know who is engaged?
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Listen carefully to casual conversations:
Who loves working with the older folks? Or babies? Or is a stickler for handwashing?
You could ask directly, “Who wants to help?”
Who reads journals and publications and talks about it?
Who is going back to school?
OR
Who starts their sentences with “You know, we should…”
Wise Words
A new way of doing something only sticks when it can be easily
integrated during the work day
Work on improvement during the work day
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Think This Through….
• What decisions need to be made in a committee or council.
• What can be done in informal feedback huddles– Okay to make decisions on small test of change outside
the meeting.– Discuss results of small test and adapt quickly.
• Ensure transparency through a notebook or whiteboard to document progress or concerns.
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Benefits of Fewer Meetings
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1. Avoids the need to schedule space.2. Allows people to meet as it is convenient for
them, so participation is more likely to happen.
3. Reduces “calendar conflict” problem - the #1 reason for slowing down progress.
4. Changed processes, new tools, etc. are going to work because they are really designed right in the middle of “the work”.
Designing Tests and Trials
A. Begin with the smallest unit of change possible“Rule of 1’s”
B. Plan for easy and efficient collection of feedback from your testers - huddles
C. Spread by a few staff at a timeD. Work out the bugs along the way
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Case ExampleThe Implementation Challenge
A care transitions workgroup of staff from a hospital and two local long-term care centers have developed a new transfer form:
How will they ensure that staff at both facilities actually use the form?
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Don’t Give Up• Use pencil on this form and post-it for all to see.
• Even if testing goes well, keep going until you reach your target number of participants.
• If testing doesn’t go well – back up a step and try again.
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So much better than assuming staff are going to change – then being disappointed when they don’t’.
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Test and Trial Examples
Patient Demonstrates Understanding of Discharge Instructions• Test medication teaching tools
HCAHPS – Patient Satisfaction with Discharge Instructions• Test large-font discharge instructions
Patient Received a Follow-up Phone Call within 3 days• Test new phone call script
Patient is Discharged with a Follow-up App’t scheduled• Test calling a designated primary care nurse to schedule hospital follow-up appointments.
Small tests of change are a guaranteed way to engage staff in
improvement
and
Have better buy-in and sustained results
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Next Month:
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Data driven Improvement Priorities
July 25Noon
From data to information “Data mining” your process measures Data driven decision making
References• Improvement Workbook Section 3
• The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, Langley, Moen, & Nolan
• WHA Quality Center Tools and Templates http://www.whaqualitycenter.org/PartnersforPatients/PfPTools.aspx
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