High Reliability Value Improvement Learning Organization

1 High Reliability SL16. +. Value Improvement =. #IHIFORUM. Learning Organization Glenda JL Battey, PhD, Program Director High Reliability Sheri Feeney, CFO Clinical Institutes Douglas Meyer, MA, Director Talent Development Liga Mezaraups, BSN, MHA, Chief Nursing Officer Linda Severs, OTR/L, MPA, Lean Six Sigma Black Belt 2018 Providence St. Joseph health Presenter Disclosure P2. The presenters, Glenda JL Battey, Sheri Feeney, Douglas Meyer, Liga Mezaraups, and Linda Severs have no relevant financial or nonfinancial relationship(s) within the services described, reviewed, evaluated, or compared in this presentation. 2018 Providence St. Joseph health Reflection & Safety Message #IHIFORUM. 2018 Providence St. Joseph health 3. Session Objectives Learn how High Reliability Organization (HRO) and Clinical Value Improvement (CVI) are integral to Providence St.

2 Joseph health 's strategic plan and leadership development Identify successful elements and challenges of implementation and spread of our high Reliability behaviors Demonstrate how HRO behaviors are the foundation for daily Improvement across a large Organization Apply Clinical Value Improvement to enable employees to improve their job, quality, and affordability #IHIFORUM. 2018 Providence St. Joseph health 4. Today's Journey Approx. Time Topic 20 min Objectives, Goals, & Get to Know Each Other 20 min High Reliability Organization Journey 30 min Activity: Learning Board 20 min Clinical Value Improvement Journey 30 min BREAK. 20 min One Hospital's Story 60 min Activity: Problem Deep Dive 10 min Closing #IHIFORUM. 2018 Providence St. Joseph health 5. Getting To Know Us #IHIFORUM.

3 2018 Providence St. Joseph health 6. Who is Providence St. Joseph health ? States served: Alaska California Montana New Mexico Oregon Texas Washington #IHIFORUM. 2018 Providence St. Joseph health 7. PSJH Mission, Vision, Values, Promise, &. Strategy MISSION. As expressions of God's healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, Vision especially those who are poor and vulnerable. health for a Better World Values Promise Compassion Dignity Justice Excellence Integrity Know Me, Care For Me, Ease My Way #IHIFORUM. 2018 Providence St. Joseph health 8. PSJH Clinical Strategy: HRO is Foundation 9. 2018 Providence St. Joseph health PSJH High Reliability Learning Organization Journey CVI. CVI Ministry Caring Executive Caring Reliably Reliably Toolbox Harm for review Leader Toolbox Everyone study Serious Safety Event reviews #IHIFORUM.

4 2018 Providence St. Joseph health 10. How to Achieve Characteristics of HRO. Preoccupation with Failure Reluctance to Simplify Interpretations Sensitivity to Operations Commitment to Resilience Deference to Expertise Sources: Federico, F (2018). Is your Organization highly reliable? Healthcare Executive. Frankel A, Haraden C, Federico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017. (Available on ). #IHIFORUM Wieck, KE., & Sutcliff, KM. (2007). Managing the Unexpected: resilient performance in an Age of Uncertainty. Jossey-Bass. 2018 Providence St. Joseph health 11. Initial Diagnostic Study Summary How Data: Individual Errors Lack of Critical Thinking 37%.

5 Lack of Knowledge & Skill 19%. Lack of Attention on task 14%. Non-Compliance 14%. Lack of Info processing 13%. Normalized Deviance 3%. Moderate to Severe Harm = 785 events Individual Acts coded = 1019. PRIVILEGED & CONFIDENTIAL CLIENT INFORMATION protected from discovery as pursuant to state statutes of Providence St Joseph health . Diagnostics performed by Press Ganey/Healthcare Performance Improvement , LLC in collaboration with PSJH. #IHIFORUM. 2018 Providence St. Joseph health 12. Initial Diagnostic Study Summary Why Data: System Failures allowing errors Culture 49%. Process 21%. Policy & Protocol 14%. Structure 10%. Technology & Environment 6%. Moderate to Severe Harm = 785 events System Failures Acts coded = 1522. PRIVILEGED & CONFIDENTIAL CLIENT INFORMATION protected from discovery as pursuant to state statutes of Providence St Joseph health .

6 Diagnostics performed by Press Ganey/Healthcare Performance Improvement , LLC in collaboration with PSJH. #IHIFORUM. 2018 Providence St. Joseph health 13. Caring Reliably Be Compassionate, Be Safe, Be Reliable Serious Safety Event Rate: Inpatient only, as of Sept 2018. #IHIFORUM. 2018 Providence St. Joseph health 14. Building Frontline Ownership What if policies, procedures, checklists DON'T MAKE SENSE. ??? Learning Boards New Working Solved Department Huddles Daily departmental huddle agenda BACK Significant safety or quality issues from yesterday AHEAD Anticipated safety or quality issues for today up on Start-the-Clock Safety Critical Issues #IHIFORUM. 2018 Providence St. Joseph health 15. Two Views of Waste Micro Macro Overproduction Overtreatment Transportation Failures of care delivery Motion Failures in care coordination Waiting Administrative complexity Processing Pricing failures Inventory Fraud and abuse Defects Source: Berwick, Dm & Hackbarth, AD (2012).

7 Eliminating Waste in US HealthCare. JAMA 307 (14). #IHIFORUM. 2018 Providence St. Joseph health 16. IHI Leadership Alliance Waste Driver Diagram #IHIFORUM. 2018 Providence St. Joseph health 17. Simulation: Problem Identification New Working Solved #IHIFORUM. 2018 Providence St. Joseph health 18. PSJH Clinical Strategy: High Value is the Aim #IHIFORUM. 2018 Providence St. Joseph health 19. The Value Equation Value = Outcomes/Cost 2018 Providence St. Joseph health 20. Develop the Whole Leader Clinical Leadership Business Leadership Do Right by my Patients Do Right by the Organization High Reliability Behaviors Thought Leader Tones, Tools - Business Acumen Leadership behaviors - Strategic Thinking Compassionate Care - Innovative Mindset Goal-aligned care Results Leader Clinical Value Improvement - Enhances the Patient and Customer Value = outcomes/costs Experience Change Management - Organizational Agility Scale, Spread, Sustain Team-based care People Leadership Do Right by the Caregiver Inspirational Leader - Mission Focused - Courageous Presence - Servant Leader People Leader - Coaches and Develops Others - Builds Diverse and Inclusive Talent - Partner and influence Effectively - Steward of Engagement #IHIFORUM.

8 2018 Providence St. Joseph health 21. Clinical Value Improvement | 2018-20 at a glance #IHIFORUM. 2018 Providence St. Joseph health 22. Clinical Value Improvement Tiered Value Improvement Model Vision Executives Executive Lead Value Improvement at micro, meso, and macro levels Apply skills of scale, spread, and sustainability CVI. Set vision of the Learning Organization in delivering Value Lead Clinical Directors/Senior Medical Directors Statistical process control (run/control charts). Understanding/applying variation in Improvement Ministry CVI. Able to scale & sustain improvements Teach/coach other leaders Manage Managers/Unit Leaders/Medical Directors HRO Leader Toolbox IHI Open School Quality modules Coaching for Improvement Inject CVI/Leader tools into existing forums All Caregivers & Providers Do HRO Toolbox for Everyone HRO Toolbox &.

9 Eight wastes in healthcare CVI skills JIT CVI skills at Huddles/ Learning Boards #IHIFORUM 23. 2018 Providence St. Joseph health Clinical Value Improvement Southern California Executive Program Curriculum Learning objectives: Equip Ministry level CMOs, CNOs and CFOs/COOs to: Set the vision of the Learning Organization to deliver Value ; craft and lead the strategic Improvement agenda Ready mid-level leaders to Manage the Improvement agenda; coach and train Apply skills of scale, spread, and sustainability What is our aim? What is Value ? How can the Foundations Business Pebble in the Pond Organization and How will we know What are the community a change is an business drivers of structure be used Improvement ? cost? to facilitate What changes can How do we create spread?

10 We make that will and measure How will I help result in Value ? other leaders Improvement ? inspire Organization -wide adoption? #IHIFORUM. 2018 Providence St. Joseph health 24. Clinical Value Improvement Southern California Executive Program Target Audience: 65 Ministry level CMOs, CNOs, CFOs/COOs, and CQOs Learn Prepare Sustain Value Proposition: Equip Purpose: Assess readiness;. Purpose: Decide on the Ministry level CMOs, CNOs to what extent is the strategic Improvement and CFOs/COOs to set and Organization ready spread topic, overall measures of lead a strategic and sustain improvements? success, and projects Improvement agenda Are the people ready? . Formal 120 day program we are here Lessons to date: The backstory = a dynamic, fruitful and sometimes messy endeavor to unify the structure in SoCal The big idea = to use CVI as a catalyst for coming together as a Region SoCal is in the middle of this journey, and the teams are wrestling with what it means to be one.