Leadership Insights: What makes a good leader? Elements for a - - PDF document

Leadership Insights: a Culture of Safety

Estes Park Institute Della M. Lin, M.D. November, 2011

Outline

 What makes a good leader?  Elements for a culture of safety

• Pitfalls using certain tools as a leader

 Culture of Safety Survey  Leadership Walkarounds

• Leading listening 3.0/ 4.0

 Developing a “leadership trigger tool”

What makes a good leader?

What makes it hard?

“Culture of Safety” Survey Questions

 When a safety issue is involved, I can challenge

decisions without fear of negative consequence

 My supervisor puts a high priority on safety

through actions and not just empty slogans

 Operational pressures do not lead to cutting

corners where safety is concerned

 There is usually sufficient staff in my unit to

perform my job safely

 After an adverse event or near miss,

management is more concerned with correcting the hazard than assigning blame/ issuing discipline

BP Oil Refineries Independent Review Panel January 2007

Pitfall # 1 Relying on the results of a Culture of Safety Survey

Attributes of a Safe Culture

 Preoccupation with Failure  Reluctance to Oversimplify  Sensitivity to operations  Commitment to Resilience  Deference to Expertise

Churchill Audit

“ I ought to have known, My advisors ought to have known, I ought to have been told, I ought to have asked” Why didn’t I know? Why didn’t my advisors know? Why wasn’t I told? Why didn’t I ask?

Attributes of a Safe Culture

 Preoccupation with Failure  Reluctance to Oversimplify  Sensitivity to operations  Commitment to Resilience  Deference to Expertise

Danger in oversimplification: “measuring” patient safety…

Sensitivity Specificity Voluntary Reporting 0% 100% AHRQ Patient Safety Indicators (PSI) 8.5% 98.5% Utah/ Missouri Adverse Event Classification 46.6% 90.2% IHI Global Trigger Tool 94.9% 100%

Classen,D et. Al. Health Affairs, April 2011, 30: 4, pp. 581-589

Improvement in Outcome in Heart Failure Patients

 7 million patients  Mean age 80  52% HTN, 38% DM, 37% COPD

 LOS dropped from 8.8 to 6.3 days  Hospital mortality dropped: 8.5 to 4.3 %  30 day mortality dropped: 12.8 to 10.7%  30 day readmission increased: 17.1-20.1%  Post-discharge mortality increased: 4.3-6.4%  Discharges to SNF increased 13-20%

JAMA 2010 303 (21): 2141-7

Short term

Attributes of a Safe Culture

 Preoccupation with Failure  Reluctance to Oversimplify  Sensitivity to operations  Commitment to Resilience  Deference to Expertise

What is our Problem-Solving Culture ?

COST of the PROBLEM Leader Responsiveness

I m provem ent Culture Embrace Wisdom Resilience Cynical Culture Squeaky Wheel “Club Culture” Satisficing Culture “Good Enough” Heroes First needle in a haystack Problem Patching Culture Workarounds Burnout

Pitfall #2 Prescriptive Leadership Walkarounds

Attributes of a Safe Culture

 Preoccupation with Failure  Reluctance to Oversimplify  Sensitivity to operations  Commitment to Resilience  Deference to Expertise

Tension of Execution and Learning Culture

• Focus on

improvement

• Break past the

numbers

• Improve the

low performers

• Diagnose why

errors occur

• Learn from the

customer

• Monitor and

evolve the plan

• Focus on

deliverables

• Make the

numbers

• Remove the

low performers

• Fix what is

broken

• Listen to the

customer

• Execute

against the plan Learning Culture Execution Culture

Attributes of a Safe Culture

 Preoccupation with Failure  Reluctance to Oversimplify  Sensitivity to operations  Commitment to Resilience  Deference to Expertise

Level 1.0 : Downloading

Otto Sharmer: Theory U Otto Sharmer: Theory U

Level 2.0: Debate

Otto Sharmer: Theory U

Level 3.0: Dialog

Otto Sharmer: Theory U

Level 4.0 Generative Creativity

If you were Churchill, what would you want to know every day?

Leadership Trigger Tool?