21st Annual National Forum on Quality Improvement in Health Care

1. 21st Annual National Forum on Quality Improvement in Health Care Establishing the microsystem: The key to performance improvement at the front line John August, Executive Director, Coalition of Kaiser Permanente Unions Barbara Grimm, Senior Vice President, Kaiser Permanente

3. Context for Change “None of the health care reform proposals to date have addressed the workforce and workplace side of health care, and we need to do that if we’re going to improve quality and control costs.” Tom Kochan Institute for Work and Employment Research, Sloan School of Management, MIT

4. Context for Change Global economic meltdown

5. Context for Change Cost distribution of care 35% 1% Population Cost

6. Frontline Engagement Highly engaged employees: Are twice as likely to be top performer Exceed performance expectations in ¾ of cases Miss fewer days of work due to illness More readily identify with the organization and its customer More often recommend the organization to friends as a place to get care

7. Patient satisfaction more closely related to staff interactionthan to health outcomes. Frontline Engagement

8. Frontline Engagement “The health care revolution begins with each of us starting to think differently about our role as a leader in change.” Helen Bevan National Health Service

9. Traditional Change Efforts Voluntary Compelled External Internal

10. Transformational Change Efforts Voluntary Compelled External Internal

11. Engagement Improves Quality .9 .8 Increase in rates .7 Adult immunization Breast cancer screening Lipid screening Asthma monitoring Child immunization .6 Source: Adam Seth Litwin, MIT Institute for Work and Employment Research Working Paper, January 2008 2.5 3 2 3.5 Involvement in Labor Management Partnership

12. Unit-Based Teams A natural, local work group made of workers, physicians and managers, who work collaboratively to solve problems, improve performance and enhance quality for tangible results.

13. Value Compass

14. Safe Learning Environment “Execution-as-learning [is] a radically different organizational mindset… [where people] give tough feedback and have difficult conversations—which demand trust and respect—without the need to tiptoe around the truth.” Amy C. Edmondson Harvard Business School

15. Microsystem Milestones UBT Growth: 58,000 Employees in 2,050 teams Page 19

16. FRAMING TEACHING SYSTEMS THINKING REDESIGN RAPID IMPROVEMENT MODEL INTEGRATING the political, social, historical, economic and market context the business, nationally, regionally, locally and patient-centered care of the workplace to one of psychological safety and problem-solving Plan, do, study, act on small tests of change, repeated until find sustainable improvement initiatives at the frontline to streamline improvements How UBTs Work

17. Cancer Screening Home as Hub/Medical Home TransformingQuality & Service Sample UBT Projects Supporting Those Goals # of Projects % Teams Getting Results Key Goals 147 60% 162 61% • Diabetes Control 52% 21 • Patient Safety • Patient Satisfaction 409 79%

18. How They Work What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Do Study Model for Improvement developed by Associates in Process Improvement ( http://www.apiweb.org)

19. Platform for Performance Increases for employees in Colorado UBTs

20. What They’ve Done Fewer Readmissions in California 30-day readmission rates for heart failure % HF patients readmitted BEST in Region

21. What They’ve Done VIDEO: BALDWIN PARK OR THROUGHPUT (7:20) http://www.lmpartnership.org/news/multimedia/ubt_baldwin_park/index.html

22. Summary • Understanding context • Frontline engagement • Systems thinking • Performance improvement tools • Continuous learning and honest dialogue • Clear goals and metrics • Relentless patience