WHA Improvement Forum For September    “Managing the Improvement Portfolio”  

1. WHA Improvement Forum • For September    • “Managing the • Improvement Portfolio” •   • Tom Kaster & Travis Dollak • Courtesy Reminders: • Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) • Please do not take calls and place the phone on HOLD during the presentation.

3. Managing Multiple Projects – Start with Roles • Institutionalize Accountability *Reference August Improvement Forum Quality and/or Practice councils: • Review the outcomes • Make decisions on what are the priorities • Communicate the priorities house wide • Marshall the resources to do the work Refrain from “doing the work” • Hold clinical areas accountable for their outcomes.

4. Key Responsibilities

5. Unintended consequences If the roles become “murky”…. • Quality is tasked with reporting and doing • Clinical areas are too far removed from their measureable outcomes • Everything is a priority • Eyes are taken “off the ball” – something is missed • Capacity to be agile and adapt to change (i.e. new evidence, rules and regs) is limited.

6. Tools to Prevent “Murky” Roles, Responsibilities, and Competing Priorities • Creates structure and timeframes • Prevents units from being overwhelmed • Aids in accountability • Builds consensus on what needs to be done

7. Sustainability Defined Sustainability – Improvements made will continue and high performance is retained over time, with little regression. Spread – Successful changes in one area are adopted (and improved!) in other areas.

8. Sustainability Defined • Results are better than when started • Variation is reduced

9. Methods for Sustaining • Front line staff was involved from the beginning • Review performance trends with your team- track data and watch for changes • Teach the team to watch for drift and take action • Coach them to not overreact to the “blips”, but to understand what they are. • Plan for how to achieve the AIM (again, if needed). • Maintain roles and accountability.

10. Reviewing Performance Trends – More than the Dashboard • Static red, yellow, green boxes don’t help you predict • Unable to see trends/shifts • Lack ability to provide context *May be appropriate for senior leaders, but not the sole tool to help front line staff improve. *Senior leaders should also see data over time to avoid obsessing on a single data point.

11. A Better Choice – Keep Up a Regular Review of Your Run Charts

12. Now Keep on Top of That for A Dozen Projects Measuring Outcome Data Alone Won’t Solve This Challenge

13. Would you? Proactive Prevention Processes Outcomes Every 3000 Miles

14. Would you? Proactive Prevention Processes Outcomes PaRent and teacher ongoing communication

15. Would you? Processes Proactive Prevention Outcomes Keeping an Eye On Your Outcomes Regular Audits of Hourly Rounding Insuring drift does not happen by auditing KEY processes

16. Bottom Line? Proactive Prevention Processes Outcomes If you wait for the outcome measure to drift… You have lost your improvement momentum The staff has already regressed to past behavior Your training and education efforts were for not Your are back at square one

17. Bottom Line? Proactive Prevention Processes Outcomes If you institutionalize the auditing of key processes… You can catch slips before the momentum is lost You are able to help staff get past the awkward change period and hardwire the new processes You are on top of unforeseen changes You validate your investment

18. The Sustainability Plan

19. Calendaring the Auditing of Key Processes Quarterly: Jan/Apr/ July/Oct Hourly Rounding Prevalence Falls Project Team Regroup Nurse Manager Initiate Quarterly: Feb/May/Aug/Nov VTE: Protocol Prevalence Unit Managers regroup Unit Managers

20. The Spread Matrix

21. When and How to Take Action • HOW • Don’t take over the project • Ask questions • Coach on the improvement methodology • Do offer up resources • Reference roles and responsibilities • Recognize other projects/priorities • Encourage data driven decisions WHEN • Process measures are drifting (trend or shift) • A bad outcome occurs • Teams aren't meeting • Turnover in teams • Team needs coaching on QI concepts • Feedback/help for team • Accountability is not clear

22. What Is Different In This Approach? • More transparent data and accountability • Tools that provide structure (not just lip service) • Greater emphasis on continued measurement • Helps avoid the ‘project mentality’ • Focus on tracking improvement for sustaining success

23. Next Month: October 24

24. References On the Quality Center http://www.whaqualitycenter.org/PartnersforPatients/PFPWave2Materials/PfPImprovementWorkbook/PfPImpWkbkSection6.aspx

25. How do you keep your eye on the ball? Discussion time: Would anyone share what strategies their hospital uses to sustain high performance? Please be sure your phone lines are muted to keep background noise to a minimum. You can select *6 to MUTE and *7 to un MUTE

26. Announcements Partners for Patients – Improvement Leader Fellowship (ILF): • Helps staff boost their QI knowledge to better execute their HEN projects as well as future improvement work your organization may take on.   • Session 4 is October 16, two-hour webinar.  These sessions will blend QI knowledge along with the content of the 10 HEN topics. • Low-risk/low-investment to expose staff to this material without having to arrange travel, staff coverage, etc.  • Each session will provide CEU credits. Questions/More Information – Contact Travis Dollak (tdollak@wha.org) or Tom Kaster (tkaster@wha.org)

27. Thank You! Questions Please complete 3 question survey when closing webinar window.