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Keeping the Team Engaged: Making Things Stick
- N. Adam Brown, MD, MBA, FACEP
Senior Vice President, Envision Healthcare- MidAtlantic
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Keeping the Team Engaged: Making Things Stick N. Adam Brown, MD, - - PowerPoint PPT Presentation
Keeping the Team Engaged: Making Things Stick N. Adam Brown, MD, - - PowerPoint PPT Presentation
Keeping the Team Engaged: Making Things Stick N. Adam Brown, MD, MBA, FACEP Senior Vice President, Envision Healthcare- MidAtlantic Raleigh, NC - February 13 th , 2018 2 3 4 5 The Red Queen Effect It takes all the running you can do, to
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The Red Queen Effect
It takes all the running you can do, to keep in the same
- place. If you want to
get somewhere else, you must run at least twice as fast as that.
- The R
he Red ed Q Que ueen
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LWBS Reduction Decrease LOS 4/5 Decrease LOS Admit Decrease Door2Doc Decrease Readmissions Decrease INC
Current Projects
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Agenda
Behavioral Psychology ABCs Coaching Cases
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4 Things to Know about Behavior to be Successful (2 Statements / 2 Actions)
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Thing #1 Behavior drives process and
- utcomes.
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Thing #2 Behaviors are learned and conditioned through positive and negative reinforcement.
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Thing #3 Identify critical behaviors in the process.
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Make critical behaviors…
Simple Clear Real Happen Stick
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Behavior Sanity Check Is the desired behavior high impact? Is the behavior one in which the team should not deviate?
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What are critical behaviors for your projects? (Take 3 Minutes)
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Thing #4 Align behaviors to align culture.
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4 Things in Review about Behavior Drive Process Reinforced Must be identified When aligned Culture Change
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ABCs: Applied Behavior Analysis
Antecedent Behavior Consequence
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ABCs: Applied Behavior Analysis
Antecedent Behavior Consequence
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ABCs: Applied Behavior Analysis
Antecedent Behavior Consequence
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ABC Model
GOALS METRICS TARGETS and Other Prompts (Environment)
CRITICAL ACTIONS (Decision Point) OUTCOMES ACHIEVED and Other Anchors
DRIVE PROMPT
ANTECEDENT BEHAVIOR CONSEQUENCES
DRIVE
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ABC Model
GOALS METRICS TARGETS and Other Prompts (Environment)
CRITICAL ACTIONS (Decision Point) OUTCOMES ACHIEVED and Other Anchors
DRIVE PROMPT
ANTECEDENT BEHAVIOR CONSEQUENCES
DRIVE
ANCHOR
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Angry Patient v. Nurse Rachet
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Visual Management Boards Daily, public tracking of specific behavior and desired outcome.
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Visual Management Board
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Visual Management Board
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Visual Management Board
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Behavioral Consequences via Coaching Positive or corrective feedback Modifies or maintains direction Send desired message Allows behavior modification via feedback Avoids “command and control”
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Behavior Gap Required Behavior Actual Behavior
Mind the Gap
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Managing Performance Gaps
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Developing Coaching Contracts
- Identify the Behavior Problem
- Measure baseline
- Pinpoint Specific Actions
- Identify triggers for behavior
- Define consequences of behavior
- Define clear targets and outcomes
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Checklist for Feedback
Give objective specifics Convey with good intentions Focus on actions Deliver ASAP Avoid linking Understood?
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Overcoming Resistance
Understand the why Communicate need for change Get involved early Create opportunity for small, meaningful change Provide support Be patient Liberation may be necessary
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“Collette Reardon”
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“Collette Reardon”
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1 patient 3 hospitals 2 hours
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2 Problems in 2015
Dilaudid Overuse
Opioid Prescription Overuse
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The ABCs of Opioid Administration
Antecedent Behavior Consequence
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Change the Antecedent
Defined the Problem Scripting Support Alternatives
- Ketamine, Fentanyl, Toradol
Supported by hospital, nursing, and physicians Patient support/expectations
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The ABCs of Opioid Administration
Antecedent Behavior Consequence
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Monitored the Behavior
Communicate frequently desired behavior and support Immediate feedback Track Results Celebrate Successes
The Candy Man
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IV 2mg Vial Dilaudid Use at Baseline
November 2015 December 2015 Sentara NoVA (45k) 375 310 Sentara LR (35k) 310 180
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5 10 15 20 25 30 35 40 45 January Feb March April May June July August September October November December January Feb March April May June July August September October November December 2016 2017
2mg Hydromorphone Vials Orders at SNV
Count
<16mg “D” Monthly
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20 40 60 80 100 120 January Feb March April May June July August September October November December January Feb March April May June July August September October November December 2016 2017
2mg Hydromorphone Vial Orders from SLR
Count
<18mg “D” Monthly
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The Ripple Effect for Opioid Prescriptions
22% Reduction
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The Red Queen Effect
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Set Behaviors Measure (VMB) Coach Celebrate Wins