Monthly Noon Brownbag Fourth Thursday Every Month

Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month • April 24th 2008Leadership: Strategic Perspective • Quality evolution • Quality Pioneers • Quality Approaches • Organizational aspects • Aligning culture Contact: Skip Valusek MHQP Education Chair skipvalusek@comcast.net

Register your Attendance Hopefully you signed in with your name & organization. • If so: say Hi in the Chat Pod and we’ll capture you in the log. • If not: identify yourself and organization in the Chat Pod to the left of your screen to capture you in the log. If there are more than one attending on your sign-in, tell us how many by saying “Hi (tell us the number of attendees) “

Poll: Who is Attending this Session ? • Rural / Outstate ? • Metropolitan area ? • Organization that has (or serves) both ?

Healthcare system Hospital Clinic or Clinic System Long term care Homecare / Hospice Healthplan A Quality Support Organization Other ? (Identify other in Chat Pod) Poll: Who is attending ?

Poll: What do you hope to gain by participating? • I am a CPHQ and want to obtain CEU’s for recertification. (Note: this is not guaranteed at this time. We are still working on this) • I am a healthcare quality professional and am interested in additional education. • I am a healthcare professional interested in developing quality skills as a core competency. • I am a healthcare professional interested in learning more about healthcare quality.

Brownbag Topics Note: The 2009 dates are now Thursdays rather than the erroneous Sundays.

Leadership & Management : StrategicAgenda April 24th 2008 • Quality evolution • Quality Pioneers • Quality Approaches & Priorities • Organizational aspects • Aligning culture

Historical Perspective/Background/Current Initiatives • World War II Impact • Learned how other countries managed for quality, sending teams abroad • Work force enlisted in quality improve-ment through Quality Circles • Japanese Quality Revolution • United States considered competition from Japan based on price rather than on quality • Price competition declined & quality competition increased • Massive export of Japanese goods, particularly in manufacturing, steel, & electronics 4

Quality EvolutionHistorical Perspective/Background/Current Initiatives • Quality Management Philosophy—IOM defines healthcare quality as the extent to which health services provided to individuals and patient populations improve desired health outcomes. • Total Quality is best defined as an attitude, an orientation that permeates an entire organization, and the way in which an organization performs its internal and external business. Continuous Quality Improvement is a resuscitation of the idea. 3

Agenda • Quality evolution • Pioneers • Quality • Healthcare Quality • Quality Approaches & Priorities • Organizational aspects • Aligning culture

Quality Pioneers Gilbreth & Taylor: Scientific Management; Time & Motion Studies Early 1900’s Shewhart : Statistical process control (SPC) & PDCA/PDSA 1950’s 4-5

Quality Management Pioneers • Deming • Statistician & philosopher of quality & the learning organization • Post World War II USA: rejected Deming • Proposed statistical process control (SPC) techniques • 14 points for business to be competitive • Cease dependence on mass inspection and build quality into the product or service 4. Do not award business solely on price tag 5. Improve constantly the system of production and service 9. Break down barriers between departments • Juran (Dr. Joseph M. Juran, UofM graduate, Juran Center for Leadership in Quality at the Carlson School ) • Emphasized organizational leadership • Ishikawa • Cause & effect diagram (fishbone) • Term “total quality control” 6-7

Healthcare Quality Management Pioneers • First Era • Florence Nightingale- first to call for systematic inquiry • Ernest Codman, Boston Surgeon • Founded American College of Surgeons 1913 • 1917 5-part minimum standard • Hospital standardization program • Second Era (1950’s) • Avedis Donabedian, MD Introduced the Structure - Process - Outcome framework • Third Era (Current) • Donald Berwick, MD • IHI (Institute for Healthcare Improvement) • Paul Batalden, MD • translated Deming’s 14 points into healthcare context • Brent James, MD • applied quality improvement processes directly to patients & clinical outcomes 8-9

Current and Evolving Healthcare Quality Management Approaches • “Re-engineering”—Major hospital initiative in 1990’s: Became associated with downsizing and layoffs, low morale and decreased productivity. But . . . . What are we doing today ? Maybe engineering for the first time ? • Total Quality Management (TQM) • Six Sigma: reduce variation • Lean Enterprise: reduce waste • Rapid Cycle Improvement—IHI developed collaborative approach “Breakthrough Series” to bring about rapid cycle improvements . . . A good fit with PDCA • Continuous Quality Improvement (CQI) Note: Joint Commission is a trace of this evolution as it has transitioned from data/measurement, to trends, to “what are you doing about it ?” 10-11

IOM Priorities • To Err is Human: Building a Safer Health System (2000) • Patient safety and harm • Patients suffer harm due to 3 types of quality issues • Underuse: don’t receive beneficial services • Overuse: Receive treatment without benefit • Misuse: Appropriate service provided poorly • Crossing the Quality Chasm (2001) • All healthcare constituencies commit to national statement of purpose for healthcare system • Adopt new set of principles to guide redesign of care processes • Identify priorities to focus initial efforts • Design & implement more effective support processes • Create environment to support evidence based practice, facilitates information technology, align payment incentives, & prepares workforce 14-15

Priorities/Aims for 21st Century Healthcare System • Healthcare at a minimum should be: • Safe • Timely • Effective • Efficient • Equitable • Patient-centered • Systems thinking • Evidence-based medicine • Public Reporting • Reward for successful outcomes • CMS • Leapfrog • Pay for performance 14-15

Organizational Aspects3 (of many) Frameworks for Improving Healthcare Systems • IOM S T E E E P • Baldrige National Healthcare Criteria for Performance Excellence • Category 1: Leadership • Category 2: Strategic Planning • Category 3: Customer & Market Focus • Category 4: Measurement, Analysis & Knowledge Management • Category 5: Workforce Focus • Category 6: Process Management • Category 7: Results • MAGNET for Nursing 81 9

SWOT Analysis is Common Strategic Component Internal External Advantages Strengths Opportunities Disadvantages Weaknesses Threats

Leadership: The Board’s Role in Quality Improvement • The board bears ultimate responsibility for : • setting policy; • financial & strategic direction; • quality of care; & • with management & medical staff, sets priorities for TQM/QI. • Six broad categories of responsibilities • Organization • Public policy & external relationships • Strategic planning • Resource management • Human resource development • Education & research 89 22

Agenda • Quality evolution • Quality Pioneers • Quality Approaches • Organizational aspects • Aligning culture

Poll What do you believe ? Pick the one that is the principal motivator for change. • “What gets measured matters” • “Not everything that matters can be measured”. • “What gets rewarded matters.”

Assessing Culture of Quality • Does leader pay attention to, measure, & control quality regularly? • Are scarce resources allotted to QI? • Are behaviors supporting QI rewarded? • Is active involvement in QI activities a measure of status? • Do staff members discuss QI? • Is prevailing QI attitude positive? 92 26

Aligning Culture to Support Quality • Strengthening Culture for QI • Leaders • Make QI everyone’s responsibility • Have annual budget for QI • Make QI part of strategic planning • Reward behaviors supporting QI • Attention to visible culture elements • Old negative stories replaced • Celebrate QI successes 92-93 27

Poll Is Your Quality/PI plan : • Integrated into the annual budgeting plan so both are produced at the same time ? • Developed and delivered months after the annual budget is approved . . . . i.e. everyone has to scavenge for resources ? • What’s a PI Plan ?

Benedictine Health System Strategic Planning(From the April 16th MCQ Annual Quality Awards) FocusAlignExecuteReview SWOT GOALS Specific Measurable Achievable Results-oriented Timely ACTION PLANS RESULTS

Aligning Rewards to Support Quality • Determine priorities & values; prioritize behaviors to be rewarded • Identify criteria or milestones • Establish recognition budget • Determine accountability • Develop procedures & features • Obtain feedback from employees • Modify program based on feedback 107-111 57

Incorporate PI/QI into Employee Performance Appraisal System • Be certain employees have skills to perform well • Gap assessment: Know what outcomes employees perceive as important and match them with strategic goals • Have clear policies about what levels of performance are rewarded • Set up effective feedback & reward system • Establish role of Executive Sponsor and Champions of Change 107-111 57

Poll • Where is your leadership today regarding their involvement with CQI and quality as a core competency ? • Not Involved • Quality is a department • Quality is lean, six-sigma and measurement • Quality is in every facet of the organization with a big toolbox • Our CEO is the champion for quality & change • Our CEO is the champion for CQI & change and has an effective prioritization process • If not at the top of the spectrum, what is happening to move your organization in that direction?

Questions ?Type them in the Chat Pod

Next Session May 22:Leadership: Operational • Managing professional staff • [Risk, Utilization, & Case] Management • Teams • Continuous readiness

ReminderRegister your Attendance ?? Hopefully you signed in with your name & organization. • If so: say Hi in the Chat Pod and we’ll capture you in the log. • If not: identify yourself and organization in the Chat Pod to the left of your screen. If there are more than one attending on your sign-in, tell us how many by saying “Hi (tell us the number of attendees) “ Thank you for joining us in this informal quality forum !!!

Interest in CPHQ Prep Class in March 2009 ? • Poll: Given what you know today, would you take the concentrated class (1.5 days) ? [Yes No] • Poll: If you answered yes, would you want it in: • Twin Cities • Brainerd area • Winona • Poll: There would be a registration fee to pay for the cost of the course. What’s the maximum registration fee you would be willing to pay? [$100 $150 $200 ]

Monthly Noon Brownbag Fourth Thursday Every Month