Presentation Transcript

1. The Power of Culture: Where are We at and How Can We Influence it?

   March 4, 2011 Debbie Barnard, MS, CPHQ Victoria Inn Winnipeg, Manitoba
2. You may have heard Culture eats strategy for lunch Best laid plans often submits to cultural limitations An organization cannotsustain results in a culture that cannot support it
3. First things first You cannot change:: What you do not know What you don’t understand
4. How does transformation occur? To change culture ……………. The organization works through and with the existing culture to transform the organization
5. Role of Culture Acts like the “glue” Compass Common ground Sense of Order Continuity and unity Collective commitment Social system stability
6. Culture is always local: Micro-system - unit, department, even shift Facility/Hospital It will affect your clinical and operational outcomes Culture gremlins that will bring “new” issues include: New Manager, New Location, New Technology From the Experts 7
7. Knowing & Understanding We can measure this “animal” Sexton’s work Ginsburg at al Accreditation Canada’s recommended tool AHRQ – publicly available tool and database
8. AHRQ Dimensions Overall perceptions of safety Frequency of events reported Supervisory Leadership Organizational learning—continuous improvement Teamwork within units Communication openness Feedback & communication about error Nonpunitive response to error Staffing Hospital management support for patient safety Teamwork across hospital units Hospital handoffs & transitions PLUS: Patient safety “grade” # of events individuals reported in last 12 months MSI Dimensions Valuing Safety in the Organization Supervisory Leadership Fear of Repercussions State of Safety Areas Measured Source: Ginsburg et al
9. Importance of coming to the right conclusion The Economist
10. As John Maynard Keynes once noted ……. “ The hardest thing is not to get people to accept the new ideas, it is to get them to forget the old ones.” And thus ….. When in conflict, Culture will eat Strategy for lunch ---- EVERYTIME Paraphrased from Mark Bard, MD Why Focus on Culture ………. Improvement for Our Patients
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12. Let’s Play Bingo
13. Bingo Rules You must have all conditions present, before you can give yourself credit The criteria must match your entire organization not just your individual unit or service You must laugh and have some fun as we play!
14. Motivation for Change What answer would you most likely get at your organization? Org. Culture #1: “That’s not my job, go away.” Org. Culture #2: “Sorry, that’s not my job, go see [someone else].” Org. Culture #3: “That’s not my everyday job, but let me see how I can help you.”
15. Strategies to ↑ Quality & Safety Measurement Reliable, Valid, Cost Effective & Accepted Timely System Tools & Change Strategies Improvement, System Thinking, Redesign Processes, Rapid Cycle, Near Miss Culture Non-blaming, To err is human, Learning, Leadership Baker, G.R. & Norton, P. (2002). Patient Safety and Healthcare Error in the Canadian Healthcare System: A systematic review and analysis of leading practices in Canada with reference to key initiatives elsewhere. Ottawa: Health Canada. p. 158. Retrieved from: http://www.hc-sc.gc.ca/hcs-sss/pubs/care-soins/2001-patient-securit-rev-exam/index_e.html
16. Leadership Commitment Clearly stated and enacted constancy of purpose—a deep understanding of the vision and mission Regular review of key indicator data Decisions made on data rather than hunches or opinions Long range view supports search for root causes and permanent solutions rather than quick fixes
17. Set Priorities and Communicate Clearly
18. CASE STUDY Jönköping
19. Source: System thinking and spreading knowledge, Bojestig M., Henriks, G., Provost L. IHI European Forum, Prague 2006 Le Palais des Congrès – Paris - France - Anthony Staines
20. Jönköping – factors that foster improvement A strong emphasis on improvement culture Quality seen as holistic – applied to every department, every activity – quality as a business strategy Investment in becoming a learning organization Quality should be exciting, fun Emphasis on bottom-up Long-term view - stability Le Palais des Congrès – Paris - France - Anthony Staines
21. “The real act of discovery is not in finding new lands, but in seeing with new eyes”.Marcel Proust (1871-1922)
22. What does it mean to buildcapacity for QI? Understanding what we know and don’t know about QI • Determining how to close the gap between where we are and where we want to be • Building how good by when goals • Deciding who needs what (dosing) • Developing curriculum content • Creating a plan for execution and spread • Allocating resources to work on building capacity S + P = O
23. Sexton Tools
24. Safety Culture Debriefing & Action Tool Safety Culture Debriefing & Action OBJECTIVE: Use the Debriefing Guide to conduct a 30-60min structured discussion & produce a specific data-driven next step to improve the local environment in this unit. Debriefing Guide: Review SAQ results with particular attention to items with less than 60% agreement. Which item(s) seem most relevant (items/why)? Which item is of particular concern to this unit right now due to recent events or activities (item/score/why)? Share examples of how this item reflects your events or experiences in this unit? Envision an ideal unit: what would it look like if 100% of the caregivers in this unit agreed strongly with the SAQ item (provide specific behaviors, processes, norms, policies)? Agree on one actionable step toward the ideal unit (agree on the task; the person responsible; the follow-up date; the external committee or leader to whom this plan is disclosed)? Adapted from: Sexton, Paine, et al. A Checkup for Safety Culture in “My Patient Care Area,” JtComm J Qual Patient Saf. 2007 Nov;33(11)
25. Learning From Defects Root Cause Lite for ICU: Learning from Defects OBJECTIVE: Conduct a 30-60min discussion of the defect in the context of the systems in which it occurred, to facilitate mutual interpretation and agreement upon actions to reduce the likelihood of it recurring in this ICU. Briefly describe the defect. What contributed this occurrence?: □ ICU environment (staffing levels, workload, equipment, mgt support, physical environment [space or noise], failure to follow policy/procedure) □ Institutional time pressures, acuity □ Departmental pharmacy, lab, etc. □ Training & Education: caregiver knowledge, skills or competence; failure to follow established protocol; supervision □ Patient condition: complexity, agitation, language □ Caregiver fatigue/attitude/motivation □ Task: availability of protocols and accurate test results □ Verbal or written team communication: during handoffs, routine care, crises □ IT: CPOE/EMR How will you prevent recurrence? The purpose of this tool is to provide a structured approach to help care givers and administrators identify the factors and systems that contributed to the defect, and follow-up to ensure safety improvements are achieved. Defectsare any clinical or operational events or situations that you would not want to happen again. These could include incidents that you believe caused patient harm or put patients at risk for significant harm. Investigation Process I. Provide a clear, thorough, and objective explanation of what happened. II. What factors contributed (negatively or positively). III. How did these factors, in combination, contribute to the defect in a way that could happen again with different caregivers. IV. How will you prevent this defect from happening again to other caregivers in this ICU? List what you will do, who will lead the intervention, when you will follow up on the intervention’s progress, and how you will know risk reduction has been achieved. Adapted from: Pronovost et al. JtComm J Qual Patient Saf. 2006 Feb;32(2):102-8. -and- Pronovost et al. Crit Care Med. 2006 Jul;34(7):1988-95.
26. Senior Leader Partnerships & Patient Safety Leadership WalkRounds™ Senior Leader & Unit Partnerships OBJECTIVE: remove barriers, enhance trust so their issues are surfaced and addressed, allow learning and improvement with a local ownership of this process (i.e., “not here to blame or audit”). STRATEGIES (to surface barriers): Review recent incident reports: SAQ results: were Culture Checkup Tool actions taken? Learning from Defects using Root Cause Lite: (What happened, Why did it happen, what have you done to reduce the likelihood of it happening again, and with whom did you share the lessons learned?), Follow up on actions to address issues from previous visits SAMPLE QUESTIONS: “How will the next pt in this clinical area be harmed?” “Was a pt recently harmed because of less-than-safe care?” “What can this unit do on a regular basis to improve safety?” Evidence shows that the % of caregivers exposed to rounds over time should be maximized (via # rounds & connecting with different caregivers each visit) Senior Leader Partnerships with a specific clinical area are related to and also known as methodologically rigorous Patient Safety Leadership WalkRounds™ Target care areas in which less than 60% of caregivers report good safety climate Build trust and rapport between frontline and a senior leader through regular (monthly or more frequent) rounds, speaking with different caregivers each visit Who makes a good “senior leader” for this?: Select a leader, typically VP or higher, that is approachable, comfortable walking through clinical areas and discussing complicated problems, and able to bring both operational perspective and resources to the unit in order to remove barriers and facilitate needed changes identified by caregivers. Ask about culture, staff safety assessment, event reporting, last month’s defect analysis, other outcomes The percent of caregivers exposed to rounds over time should be maximized Adapted from: Thomas et al. BMC Health Serv Res. 2005; Jun 8;5(1) -and- Frankel et al. JtComm J Qual Patient Saf. 2005 Aug;31(8)
27. Senior Leader Partnerships & Patient Safety Leadership WalkRounds™ QUESTIONS: “What did we do that harmed a patient?” “How will we harm the next patient?” “What doesn’t work well?” “Do some Ethnic groups get better care here than others?” “Do we disclose information to patients?” “How well does teamwork occur on this unit?” Senior Leader Partnerships with a specific clinical area are related to and also known as methodologically rigorous Patient Safety Leadership WalkRounds™ Target care areas in which less than 60% of caregivers report good safety climate Build trust and rapport between frontline and a senior leader through regular (monthly or more frequent) rounds, speaking with different caregivers each visit Who makes a good “senior leader” for this?: Select a leader, typically VP or higher, that is approachable, comfortable walking through clinical areas and discussing complicated problems, and able to bring both operational perspective and resources to the unit in order to remove barriers and facilitate needed changes identified by caregivers. Ask about culture, staff safety assessment, event reporting, last month’s defect analysis, other outcomes The percent of caregivers exposed to rounds over time should be maximized Adapted from: Thomas et al. BMC Health Serv Res. 2005; Jun 8;5(1) -and- Frankel et al. JtComm J Qual Patient Saf. 2005 Aug;31(8)
28. Optimal Profile Alignment of strategy, performance measurement and improvement work Capability & Capacity Development Intentional Use of QI/Process Improvement Tools Defined improvement model e.g. PDSA Communication of the organization play book Collaborative Care Model/ Teamwork
29. Bingo Results
30. Take Home Points Improving Quality: You should know your culture to be effective stewards of limited quality resources Culture is local – work unit culture trumps hospital culture, and is related to clinical and operational outcomes Culture Critters that introduce new Chaos: New Manager, New Location, New Technology Patient safety and quality with methodological rigor is a pioneering effort – the science of safety is racing to keep pace Be ready to answer the question: “Are We Safer?”
31. If Disney Ran Your Hospital: 91/2 Things You Would Do Differently Employees say, “I love to work here.” Managers say, “I love the people I work with.” Caregivers say, “I love our patients.” Patients and families say, “We love this hospital.” Our outcomes - Best in class!
32. The Power of Culture: Where are We at and How Can We Influence it? Questions March 4, 2011 Debbie Barnard, MS, CPHQ Victoria Inn Winnipeg, Manitoba E-mail: debbbarn@telus.net