Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

A Systematic Framework for the Delivery of Safe, Highly Reliable Care and Habitual Operational Excellence

These slides were created and shared by Dr. Michael Leonard and Dr. Allan Frankel of Safe and Reliable Healthcare in a webinar on November 7, 2018. All slide content is property of Safe & Reliable Healthcare and has been shared with their permission.

--

To be successful, healthcare organizations are increasingly focused on how to deliver high quality healthcare in service of sustainable clinical value, all while also reducing avoidable patient harm. Despite increasingly sophisticated organizational effort, challenges abound: Patients are more complex, diagnoses more numerous, treatments more demanding in their precision, and there is a growing workload that can feel insurmountable. Organizations need an equally precise and diverse set of cultural tools to stay apace.

Drs. Frankel and Leonard will provide a practical, sociotechnical framework that has evolved from their experience in training over 2,500 patient safety officers and working with numerous, world-class health systems over the last two decades. The framework focuses on effective leadership, a culture of safety and continuous learning.

Watch this on-demand video to hear practical methods of assessment, engagement and implementation that can be readily applied in virtually any care setting.

LESSONS LEARNED

* Specific components necessary for the delivery of high value care.
* The critical importance of psychological safety and how to achieve it.
* How to assess any care environment for inherent strengths that can be utilized to enhance learning and mitigate risk.
* Practical tools and behaviors that can be immediately applied in pursuit of habitual, operational excellence.

PRESENTERS
Drs. Frankel and Leonard have been leaders in patient safety and culture for over twenty years. They have held senior operational roles in complex healthcare systems and worked with hundreds of hospitals across the globe, gaining valuable insights that can be readily applied in your organization.

Dr. Frankel is a Founding Partner at Safe & Reliable Healthcare and serves as Senior Faculty at the Institute for Healthcare Improvement.

Dr. Leonard is a Managing Partner at Safe & Reliable Healthcare and Adjunct Professor of Medicine at the Duke University School of Medicine.

Together they have worked extensively to develop practical, comprehensive models that enhance patient and family-centered care, effective leadership, a culture of safety, high reliability, and an environment of continuous learning and improvement.

  • Login to see the comments

A Systematic Framework for the Delivery of Safe, Highly Reliable Care and Habitual Operational Excellence

  1. 1. A Systematic Framework for the Delivery of Safety, Highly Reliable Care and Habitual Excellence Allan Frankel, MD Michael Leonard, MD Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  2. 2. Culture HRO Transformation Partner: Safe & Reliable Healthcare IHI Affiliation Senior IHI [Institute of Healthcare Improvement] Faculty and Master Trainers for PSO Course Contributions Contributors to TeamSTEPPS, Crew Resource Management, the IHI Improvement Framework, the Global Trigger Tool, various surveys [SAQ and SCORE], WalkRounds, Boards on Board, and LENS Best Practice Clients Expertise Two decades of measuring and improving culture and reliability across > 1,300 hospitals Core HRO Transformation Team Dr. Michael Leonard Dr. Allan Frankel Terri Christensen, RN Maureen Frye, RN Jean-Ann Wurtz, MPSL Josh Proulx, PEng Contact: kaitlyn@safeandreliablecare.com | 508.981.8156
  3. 3. Our Goal  Provide a practical, systematic framework that can be applied in virtually any care setting  Understand the key components of High Reliability Organizations – effective leadership, a culture of safety and continuous learning and improvement  Offer practical tools and insights that enhance the ability to deliver optimal patient care in an environment of continuous learning and improvement
  4. 4. Framework for Safe & Reliable Care Source: https://www.safeandreliablecare.com/blog/2016/11/29/s-r-sociotechnical- framework-ihi-minicourse Framework is Anchored in 23 Years of Experience Across > 1,300 Hospitals Transparency Leadership Psychological Safety Negotiation Teamwork & Communication Accountability Reliability Improvement and Measurement Continuous Learning Engagement of Patients & Family Leadership Culture Learning System
  5. 5. Safe & Reliable Culture Maturity Model UNMINDFUL Who cares as long as we’re not caught. Chronically Complacent REACTIVE Safety is important. We do a lot every time we have an accident. SYSTEMATIC We have systems in place to manage all hazards. PROACTIVE Anticipating and preventing problems before they occur; Comfort speaking up GENERATIVE Safety is how we do business around here. Constantly Vigilant and Transparent Tipping Point = Psychological Safety Value ©S&R 2018
  6. 6. Poll Slide #1 – Where do you think your organization is on this maturity curve? 5 –Generative 4 - Proactive 3 - Systematic 2 - Reactive 1 - Unmindful Safe & Reliable Culture Maturity Model UNMINDFUL Who cares as long as we’re not caught. Chronically Complacent REACTIVE Safety is important. We do a lot every time we have an accident. SYSTEMATIC We have systems in place to manage all hazards. PROACTIVE Anticipating and preventing problems before they occur; Comfort speaking up GENERATIVE Safety is how we do business around here. Constantly Vigilant and Transparent Tipping Point = Psychological Safety Value ©S&R 2018
  7. 7. Avoidable Patient Harm • 30% of hospitalized patients have something happen to them you and I wouldn’t want to happen to us • 10% are harmed seriously enough to stay in the hospital longer and go home with a disability
  8. 8. Senior Leadership Cyclic flow of information with feedback and organizational learning UNMINDFUL No awareness of safety culture REACTIVE Playing defense – reacting to events SYSTEMATIC Systems in place to manage hazards PROACTIVE Playing offense – thinking ahead, anticipating, solving problems GENERATIVE Organization wired for safety and improvement Systematic engagement with dialogue, support and learning Process for interaction between senior leaders and frontline staff They’re here – something bad must have happened We don’t know or see them
  9. 9. Aligning Leadership with Front line Caregivers is Essential for success Question: The values of facility leadership are the same values that people in the work setting think are important. Benchmarks: 2018 Q1 US Hosp. 25th: 44% 50th: 60% 75th: 74% Percent Positive Percentile(s) n = 149883 responses From 6070 units/department Source Data: Sep 2018 Positive + Neutral = Negative - 44 60 74 0 20 40 60 80 100
  10. 10. Published Tie-Together Cultures that visibly “close the loop” with frontline teams have > 20% better culture, burnout and engagement Source: http://qualitysafety.bmj.com/content/early/2017/10/09/bmjqs-2016-006399 Michigan SCORE survey data with and without closing the loop on ideas and concerns from the frontline Better culture, burnout and engagement measures when WalkRounds feedback is provided
  11. 11. Local Leadership Leaders create high degrees of psych safety and accountability UNMINDFUL No awareness of safety culture REACTIVE Playing defense – reacting to events SYSTEMATIC Systems in place to manage hazards PROACTIVE Playing offense – thinking ahead, anticipating, solving problems GENERATIVE Organization wired for safety and improvement Leaders model the desired behaviors to drive culture safety Training and support exists for building clinical leadership Episodic, completely dependent on the individual clinician Absent for the most part
  12. 12. Reliable feedback is essential for a healthy unit culture Question: In this work setting, local leadership regularly makes time to provide positive feedback to me about how I am doing. Benchmarks: 2018 Q1 US Hosp. 25th: 59% 50th: 73% 75th: 85% Percent Positive Percentile(s) n = 150952 responses From 6069 units/department Source Data: Sep 2018 59 73 85 0 20 40 60 80 100 Positive + Neutral = Negative -
  13. 13. A Wide Variety of Skill Among Local Leaders Absent Burned Out Socially Inept Disinterested Source: Bohmer R, Leading Clinicians and Clinicians Leading, New Eng J Med, April 2013 10% 10%80% Clinically Excellent Well Meaning Socially Adept Inadequately Trained Engaged Knowledgeable In: - Organizational development - Whole system change - Measurement to manage - Relentlessly focused on process - Know culture IS a process
  14. 14. Psychological Safety Primary responsibility of leaders, continuously modeled everywhere UNMINDFUL No awareness of safety culture REACTIVE Playing defense – reacting to events SYSTEMATIC Systems in place to manage hazards PROACTIVE Playing offense –anticipating GENERATIVE HRO – wired for safety and learning Leaders model expect the behaviors that promote psychological safety In some units it feels safe to speak up and voice a concern Personality dependent – it depends who I’m working with Fear based – keep your head down and stay out of trouble
  15. 15. Poll Slide #2 – Do you know of a patient who has experienced serious avoidable harm because someone was hesitant to speak up? 1 - Yes 2 - No
  16. 16. Safe, Optimal Care Requires Psychological Safety Question: In this work setting, it is not difficult to speak up if I perceive a problem with patient care Benchmarks: 2018 Q1 US Hosp. 25th: 58% 50th: 69% 75th: 80% Percent Positive Percentile(s) n = 145455 responses From 5911 units/department Source Data: Sep 2018 58 69 80 0 20 40 60 80 100 Positive + Neutral = Negative -
  17. 17. SCORE Survey Data to Predict & Proactively Avoid Wrong Site Surgeries and Retained Foreign Bodies Across 13-Hospital System Source: SAQ/SCORE Survey data from 13 hospital with 92% overall response rate Insight 1. Surgical Never Events occur when Nurses and Surgeons have different perceptions of Safety Climate 2. > 92% response rates = “I believe this data” 3. Baylor study: in 70% of RFOs, someone felt something but didn’t feel comfortable saying something
  18. 18. SCORE Survey Measures Correlate to Patient & Personnel Safety Insight 1. Unit levels cultures often vary > 4x within a site 2. Healthier cultures produce better outcomes for patients and personnel. 60% positive responses are “tipping point” 3. Linkage to outcomes and 88% response rate = “I believe this data” 4. AHRQ did not correlate to outcomes across > 1,000 hospitals [paper here] Source: Teamwork Climate Domain from SAQ/SCORE Survey from > 400 bed hospital with 88% overall response rate Where would you want to be a patient? A staff member? A manager?Real example from 400-bed hospital
  19. 19. Teamwork Domain Source Data: June 2016 • 31% hesitant to speak up • Dealing with difficult colleagues is common • Communication failures within units and across units are pervasive
  20. 20. Senior Leadership Local Leadership Psychological Safety Effective Teamwork Burnout & Resilience
  21. 21. Question: People in this work setting are burned out from their work Benchmarks: 2018 Q1 US Hosp. 25th: 60% 50th: 43% 75th: 27% Percent Positive Percentile(s) n = 151305 responses From 6079 units/department Source Data: Sep 2018 27 43 60 0 20 40 60 80 100 Positive + Neutral = Negative -
  22. 22. Influencing Factors in Burnout and Resilience • Do I feel valued by the organization? • Do I have a voice? • Do I feel supported in the work I do? • Do I have the tools and resources to do my job?
  23. 23. The End In Mind: Mayo Clinic Unit Culture From a conversation with a Senior Trauma Surgeon responsible for a Trauma Surgery Floor and ICU regarding the application of the HRO concepts in his Units: “Before we started this program my biggest concern when I went home in the evening was that I didn’t know what I didn’t know. Now the nurses and staff are comfortable about speaking up about their concerns, and as a result, I know what I need to know to help the services run smoothly and safely. I go home in the evening with greater assurance that we are on track.” Physician Impact 1.5% ↓ Average Length of Stay 20% ↑ Psychological Safety 14% ↑ Culture Improvement 7% ↓ Burnout vs 11% ↑ across US 50% ↓ Adverse Events
  24. 24. Goal: Self Reflecting Improvement Capable Transparency Leadership Psychological Safety Negotiation Teamwork & Communication Accountability Reliability Improvement and Measurement Continuous Learning Engagement of Patients & Family Leadership Culture Learning System Pulling It All Together
  25. 25. Transparency Leadership Psychological Safety Negotiation Teamwork & Communication Accountability Reliability Improvement and Measurement Continuous Learning Engagement of Patients & Family Leadership Culture Learning System Self Reflecting Improvement Capable
  26. 26. Transparency Leadership Psychological Safety Negotiation Teamwork & Communication Accountability Reliability Improvement and Measurement Continuous Learning Engagement of Patients & Family Leadership Culture Learning System
  27. 27. Framework for Clinical and Operational Excellence Transparency Leadership Psychological Safety Negotiation Teamwork & Communication Accountability Reliability Improvement and Measurement Continuous Learning Engagement of Patients & Family Leadership Culture Learning System Source: https://www.safeandreliablecare.com/blog/2016/11/29/s- r-sociotechnical-framework-ihi-minicourse
  28. 28. Anatomy of Healthcare Systems and Hospitals • Each work setting’s capacity is determined by the strength of its framework components • Each healthcare system’s capacity is determined by the strengths of its serial work settings
  29. 29. Operationalizing HRO Using Real-Time Learning Boards [LENS]
  30. 30. Why Real-Time Learning Boards? Key Design Features: 1 – Psychological Safety 2 – Continuous Real Time Improvement 3 – Make Collaboration Fun! 4 – Efficient Intuitive Workflow 5 – Join By Video From Anywhere 6 – Full Data Analytics Suite to Measure 7 – Communicate Within and Across Units Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  31. 31. Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  32. 32. Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  33. 33. Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  34. 34. Issues and Good Ideas uploaded from staff in real time since the last huddle………. Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  35. 35. Connecting on key topics, during and between huddles Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  36. 36. Teamwork: Huddles Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  37. 37. Participatory and Effective Communication Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  38. 38. Proprietary and Confidential – Safe & Reliable Healthcare LLC 2018 ©
  39. 39. LENS Impact and User Feedback • Increased efficiency – Nurse Managers spend ~ 75% less time • 2-3x more engagement and completed projects [“Aims”] • More consistent communication and transfer of info. Between shifts • Facilitates conversations aimed at improving psychological safety vs.
  40. 40. Summary Questions & Comments
  41. 41. Poll Slide #3 – Would you like to learn more about Health Catalyst products or professional services? 1 - Yes 2 - No
  42. 42. Q&A
  43. 43. Thank You!

×