Quality from organisational system perspective . Musfer al shalawi K.S.A SMAmember ISQUA member

1. Quality from organisational system perspective. Musfer al shalawi K.S.A SMAmember ISQUA member

2. Why is the organizational system perspective needed? Health Care leaders frequently makes false assumptions: • That individual, medical & health practitioners are the cause of low quality! • Isolated actions are sufficient to improve? quality!!( ) • Efficiency and costing cost in the mean issue? • technology is the solution?!

6. International Comparison of Spending on Health, 1980–2008 value for money Total expenditures on healthas percent of GDP Average spending on healthper capita ($US PPP) Source: OECD Health Data 2010 (June 2010).

7. Access to Doctor or Nurse When Sick or Needed Care/ by Income Same- or next-day appointment Waited six days or more Percent* * Base: Answered question. Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

8. Waited Two Months or Longer for Specialist Appointment, by Income access (Adjusted) percent Note: Percentages adjusted based on logistic regression to control for health status, age, and—in the U.S.—insurance status. Base: Needed to see specialist in past two years. * Indicates significant within-country differences with below-average income (p < 0.05). Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

10. Coordination Problems in the Past Two Years Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

11. Cost-Related Access Problems in the Past Year Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

12. Coordination Problems in the Past Two Years Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

13. Wait Times for Elective Surgery and Specialist Appointments * Base: Needed to see specialist in past 2 years. ** Base: Needed elective surgery in past 2 years. Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

14. Difficulty Getting After-Hours Care Without Going to the Emergency Room * Base: Needed care and answered question. Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

16. "Front Office - Back Office“splits introduce waste • One of the most alarming drivers of failure demand is the managers drive for "Back Office" functions. • Moving work to a central !! back office: • Removes Continuity ? • Creates waste - handovers, rework, duplication? • Lengthens the time to deliver a service ? • Creates yet more failure demand ? In ER more than 50%of the patient deaths and permanent disabilities could have been avoided if more highly integrated, high-functioning teams had been in place

17. Classical approach&Reforming the system • Managers fear anarchy and the loss of "control" • They fail to realize that the system is not exerting control – instead:!! • It is driving public services out of control • It is already anarchic • At best the system is in control of nothing?! • At worst it is damaging service and morale?!

19. All changes do not lead to improvement, all improvement requires change Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.

20. High Reliability Health CareCooperative Relationships Six Domains of Quality Safe Appropriate Acceptable Efficient Patient’s view تطلعات المريض للخدمة Effective Accessible

21. EXPECTATIONCONT • Relieve my pain" – Reduce Don’s pain. • Physical pain • Show your use of state-of-the-art pain management. • Show your pain measurements and results. • Emotional pain • Promise never separate Don from his loved ones, unless he asks. • Answer Don’s questions quickly and until he is satisfied with the answer… • Day or night • Before, during, or after his admission • In person, by email, or by telephone, as he wishes • Truthfully

22. EXPECTATION CONT No Needless Death" – Don’t kill DoN • Eliminating surgical site infections • Eliminating respirator-acquired pneumonia • Eliminating deep vein thrombosis and embolism • Eliminating medication errors • Eliminating blood product transfusions mishaps • Detecting esophageal intubation promptly

23. Effectiveness &Efficiency The External + Internal input should Result in the next 2 factors: Effectiveness /refer to the extent to which an organization achieves what it has get out to achieve [ Actual versus desired out puts]. Efficiency /refers to the ratio between output and inputs.

24. What is a system thinking??Importance of the socio technical system?!. • group of independent comprising a unified whole.The Success of organization depends upon a range of situational variables interrelated elements> • System emphasizing a fair degree of integration and a holistic view • The organization within its external environment (whole is greater than sum of its part)

25. New Challenge, System Approach excellence/ 7s diagram Structure الهيكل ان الامر يتعلق بالدرجة الاولى ,بكيفية حركة عناصر ذلك الاطار داخل المنشأة Strategy الاستراتيجية SharedValues القيم المشتركة Skills المهارات ومصادر القوه Systems النظم Staff الأفراد Style النمط

26. Managing Change Factors influencing organizational design Through processes, relationship dynamics are fundamental if change is to be successful • Decision making process. • Communication. Power Skills / in persuading others to invest time and resources in new (and risky) initiativesInformation about organization plans should be more widespread • Lateral communication should be improved. Cross functional links should be developed • Solving problem techniques. • Skills in managing problem arising from team-working and employee participation

28. the systems thinker asks? What is the demand and capability? What is the purpose of this service from the customers point of view?” • If you want customers to "pull value" from your system, you need to know the nature of the demands that customers place on the system in customer terms What are the types and frequencies of demand? How well does the system respond to demand? It is this measure that gives managers their first shock. Understanding System conditions (Waste is man-made )Remove the causes of waste Management Thinking See what is wrong in current thinking - targets and procedures Recognize that at the heart of a system is a change to MEASURES

29. No measurement, no meaning! • Measure and monitor system performance. • Collect information in a consistent way to inform and monitor system improvements. • Represent each cluster of services and supports that: • Respond to varying levels of risk and harm. • Address problems of similar severity and provide services of similar intensity and specialization.

30. Three-level Design of Safe and Reliable Systems of Care: • Design the system to prevent failure (A breakdown in operation or function) • Design procedures to make failures visible when they do occur so that they may be intercepted before causing harm • Design procedures for mitigating the harm caused by failures when they are not detected and intercepted

31. Leadership Top Down Bottom UP Approachwho decides the priorities? on what basis?. Once the top personnel have shown their commitment the base will follow. As with the baby shown here, the bottom does not come up until the top has gone down!!! Ha ha.

32. Human resources • Peoples' behavior is a function of their system • All changes do not lead to improvement, all improvement requires change • The involvement of right people !! • "Truth" is more important during periods of change and uncertainty than "good news." • Trust is earned by those who demonstrate consistent behavior and clearly defined values.

34. TASK ORIENTED STRUCTURE? • Whole is more than a sum of its parts. Interactions between parts create emergent phenomena. All aspects affect all others • Optimization of the whole requires a clear understanding of the goal of the overall system, as well of interactions among the subsystems.

35. Organizational culture (CONTIUED) • Become“learning organizations”that are “skilled at creating, acquiring, and transferring knowledge, and at modifying [their] behavior to reflect new knowledge and insights” • Facilitate education of healthcare organizations regarding the importance of the integrity

37. Approach Patient Centered- Process Integration Cycle Barrier Physician Reevaluate both how they are organized and how their work processes have been designed and controlled Laboratory X Ray A movement from a “supply-side” rationale toward a “demand-side”. Barrier Reception

38. ORGANIZATIONAL COMMUNICATION FORMAL INFORMAL Nonverbal Communication Vertical Horizontal Formal Information Systems Electronic Management by Wandering Around Upward Managerial Approach Operational Approach The Grapevine Downward Telecommuting Communication Networks

40. Communications 88% Instantly turn to Physician to validate information they got online 88% Instantly turn to other source to validate information they got from another Doctor Communication focus has been about the patient not with the patient.

41. Patient CenteredFoster teamwork/ open communication • “Rational Coordination”Frequent, Timely, Accurate Communication along with Shared Goals, Shared Knowledge, Mutual Respect and Problem Solving. This is a win lose situation. All pulling together toward one goal.

42. decision-making autonomyPatient Empowerment • Involve the patient in discussion, decision making. • Trust the patient needs to have the intellectual ability to understand and choose between alternatives and make decisions about their own care plan.

43. Conclusion

44. Responsibility for the community Involvement of Employees Building • Partnerships with customers We need genuine Management revolution Management Of processes of facts Continuous Learning Leadership & consequence of goals focus on Customers needs Orientation on Results//outcome S

45. Working together towards an improved serviceSmarter –not harder. THANK YOU Quality Counts

46. Prepared By: Mr. Musfer Al-Shalawi

47. THE SOFT'S Strategy The plan of action which allows it to allocate itresources in order to get from her to her. Structure /The way the boxes or clusters fit together. System/The way information moves around and is collected by forms, computers or networks. Staff /The array of people and the kinds of people that work at the organization. Skills/The distinctive competences of the organizations. Shared Values /The set of beliefs , principles and priorities which characterize the organization Style/The way things are done / Power/Role/Task/Persons. The system works as long as all work together. If one breaks off the others can not

48. Why is the organizational system perspective needed? Health Care leaders frequently makes false assumptions: • That individual, medical & health practitioners are the cause of low quality! • Isolated actions are sufficient to improve quality!!( ) • How effective • Why does some organization are more effective than others • Are there any other ways to

49. VARIBLES AFFECTINGAPPROPRIATE ORGANIZATIONSTRUCTURE Stability of environment Differences in of the organization Most appropriate Organization structure Objectives' of organization Size of Organization Tasks involved Management Style Culture Characteristic of Work force

50. the systems thinker asks? What is the demand and capability What are the types and frequencies of demand? How well does the system respond to demand? It is this measure that gives managers their first shock. Understanding System conditions (Waste is man-made )Remove the causes of waste Management Thinking See what is wrong in current thinking - targets and procedures Recognize that at the heart of a system is a change to MEASURES