Seven Leadership Leverage Points for Organization-Level Improvement in Health Care

1. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care Presented by: Robert L. Colones, MBA President and Chief Executive Officer Florence, South Carolina

3. A Quality Leadership Challenge We have become good at making improvement happen for one condition, on one unit, for a while. We have not learned how to get measuredresults, quickly, and ‘sustainably’, across many conditions for the whole organization. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care

4. ‘Give me a lever long enough, and I shall move the world.’ ARCHIMEDES The leverage points are offered as a sort of hypothesis … If leaders are to bring about system-level performance improvement, they must channel attention to and take action on these points. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care

5. 1 Establish and Oversee System-Level Aims for Improvement at the Highest Board and Leadership Level Seven Leadership Leverage Points for Organization-Level Improvement in Health Care

6. 1 - System-Level Aims for Improvement

7. 1 - System-Level Aims for Improvement

8. 2 Develop an Executable Strategy to Achieve System Level Aims at Highest Level of Leadership Seven Leadership Leverage Points for Organization-Level Improvement in Health Care

9. 2 – Executable Strategy: Four Critical Steps • A few, focused breakthrough quality and safety aims • Senior Team develops a ‘rational portfolio of projects’ with scale and pace to achieve breakthrough aims • Key projects are resourced with leaders and infrastructure • Senior Team monitors and responds

10. 2 – Executable Strategy Reliability Theory Quality as a Core Value Core Success Factors Physician & Executive Engagement Prioritization Change Theory Improvement Methodology

11. 2 – Executable Strategy: Quality is a Core Value Service Science Safety Executive Team Engagement Physician Leadership “Just Culture”

12. 2 – Executable Strategy: PrioritizationA few, focused breakthrough quality and safety aims

13. 2 – Executable Strategy: CEPrioritizationA few, focused breakthrough quality and safety aims

14. 2 – Executable Strategy: CEPrioritizationA few, focused breakthrough quality and safety aims The total potentially avoidable days are distributed across numerous DRGs, but 45% of days are in the top twenty DRGs. High Opportunity DRGs: Potentially Avoidable Days 422 2.12 DRG 106 CABG with Cath 732 0.61 DRG 116 PTCA with Stent/Pacemaker 174 1.96 DRG 107 CABG without Cath 112 2.63 DRG 144 Other Circulatory Dx 588 0.43 DRG 143 Chest Pain 82 2.98 DRG 075 Major Chest Procedures 296 0.75 DRG 209 Major Joint and Limb Procedures 132 1.63 DRG 475 Resp. System with Vent 206 0.97 DRG 174 GI Hemorrhage 114 1.69 DRG 122 Circulatory Disorder with AMI 78 2.34 DRG 493 Laparoscopic Cholecystectomy 232 0.75 DRG 121 Circulatory disorder AMI 42 4.03 DRG 385 Neonates 56 2.88 DRG 239 Path Fx and MS Malignancy 130 1.21 DRG 005 Extracanial Vascular Procedures 170 0.84 DRG 298 Nutritional and Metabolic-Peds 320 0.41 DRG 088 COPD 156 0.81 DRG 316 Renal Failures 96 1.23 DRG 026 Seizures and Headache-Peds 84 1.4 DRG 110 Major Cardiovascular Procedure Example Data Total Days Opportunity: 10,543 days

15. 2 – Executable Strategy: CEPrioritizationA few, focused breakthrough quality and safety aims EXAMPLE

16. 2 – Executable Strategy: OE PrioritizationA few, focused breakthrough quality and safety aims Creating Efficiency of Work: Operational Effectiveness • Deployment of “Lean” methodology • Eliminate waste or non-value added work • Make processes flow smoothly • Involve staff in redesign of work

17. 2 – Executable Strategy: OEPrioritizationA few, focused breakthrough quality and safety aims

22. 2 – Executable Strategy: OE RIE Results from Cardiac Value Stream – Nursing Documentation Time Saved fromto Pre-population of fields 60.0 minutes 12.0 Electronic documentation 40.0 12.0 Peds Questions 10.0 0.5 ED TBA paperwork 40.0 0.0 Room orientation 20.0 0.0 Speech screens 10.0 3.0 Diabetic bundle/flow sheet 4.4 1.4 Plans of care 24.0 8.0 Plus other … Total Time Savings: Admission History, 60 minutes per patient admitted to 27 minutes; Plan of care, 24 minutes to 8 minutes

23. 2 – Executable Strategy: Four Critical Steps • A few, focused breakthrough quality and safety aims • Senior Team develops a ‘rational portfolio of projects’ with scale and pace to achieve breakthrough aims • Key projects are resourced with leaders and infrastructure • Senior Team monitors and responds

24. Clinical Effectiveness -Teams are Physician-Led -Work for 3 months at 2 week intervals -4 to 5 Physicians -Care Manager RN, MSN -Educator -Implementer -Multi-disciplinary Team -VP Champion Operational Effectiveness Team Leader Work for 6 to 12 months in VSA, @ 1 RIE/month OE Facilitator with certification in ‘lean’ 9 members with 3 in the area of focus, 3 up/downstream, and 3 ‘fresh eyes’ VP Champion 2 – Executable Strategy:Key Projects Resourced with Leaders, Infrastructure

25. 2 – Executable Strategy: Key Projects Resourced with Leaders, Infrastructure 1. Establishing a Sense of Urgency 2. Forming a Powerful Guiding Coalition 3. Creating a Vision 4. Communicating the Vision 5. Empowering Others to Act on the Vision 6. Planning and Creating Short-Term Wins 7. Consolidating Improvements and Producing Still More Change 8. Institutionalizing New Approaches • John Kotter, Leading Change

26. ‘The currency of leadership is attention.’ J. Reinertsen, MD Formal & Informal resources focus on the aims Inside: calendars, meeting agendas, project reviews, performance feedback and compensation systems External: Transparency 2 – Executable Strategy:Monitor and Respond

27. 2 – Executable Strategy:Monitor and Respond

28. STOP START Focus on “Ideal” & rate of improvement Focus on benchmarks Rely on people/Process Technology serves P&P Relying on technology Running the organization on “principles” Thinking “tools” & “best practices” Leading from the front, constant reinforcement Delegating leadership

29. STOP START Few, visual, focused metrics that matter Dozens of metrics Internal focus (specialty, unit, role…) Patient centered, Value Steam focus Lead through Principles, Standard work. Managing by Control Improving what we know …greater complexity Lead transformation …start with simple

30. STOP START Experts collect data, Design/manage projects Access knowledge & Creativity of workforce Double digit gains in vital areas Incremental improvement Bottom up execution Agile and adaptive Top down execution Rigid command & Control The “fitness” mentality The “fix” mentality