Sniff the Cheese Jim Hornell March 1, 2013 Handwriting on the wall - - PowerPoint PPT Presentation

Sniff the Cheese

Jim Hornell March 1, 2013

Handwriting on the wall

• They keep moving the cheese
• Get ready for the cheese to move
• Smell the cheese often so you know if it is getting old
• Quicker you let go of old cheese,

the sooner you enjoy new cheese

• Move with the cheese
• Savor the adventure & enjoy the taste of new cheese
• They keep moving the cheese !

Leadership

The first role of a leader is to define reality

Health Care is a massive business

Largest scientific enterprise in history of our species Also an act of love/compassion/comfort for people we don’t know Locally – 1500 employees; $155m+

Challenges in health care in the 21 st. century:

• Safe
• Sustainable
• Affordable
• High Quality
• Accountable
• Coordinated
• Linked
• Holistic
• Confident

“Medicine used to be simple, ineffective and relatively safe. Now it is complex, effective, and potentially dangerous!”

Sir Cyril Chantler

Anatomy of Health Care Environment

• Most complex, difficult to manage org in the world
• Multiple practicing professionals and experts merged

into a single organization

• Medical mystique
• Different cultural backgrounds & values [Gen Y]
• Divergent perspectives towards goals & objectives
• Sophisticated, expensive ever-changing technology
• Competition for limited resources in a service industry

with an infinite capacity to consume

Anatomy Continued…

• Demand is random, unpredictable and often supply

generated

• Increasingly turbulent external environment
• Increasing public expectations [quality, safety, availability,

speed, outcome]

• Public misinformed about the factors that can have a

significant impact on the health status of the population

• Criteria/indicators for measuring outcomes & results not

well developed nor agreed upon

Sniff the cheese!

Search for markers.

BCHS - Surveys are Us!

• Accreditation Canada:

– Worklife Pulse Report, Patient Safety Culture Report

• NRC Picker:

– national, OHA/MOH Patient Satisfaction

• Metrics@Work:

– Employee & Physician Engagement Survey

• Polarity Associates – strategic planning
• Survey Monkey – Transitions, Board
• Departmental – 100% departments with 40% response
• Feedback Pro – compliments & complaints tracked
• Social Media

General comments on surveys

• Draws attention & encourages dialogue
• Takes emotions out
• Hard to argue with yourself!
• Sets a tone [beware the cynics – we have earned it!]
• Provides a platform for learning, reflection and action
• Establishes a baseline
• Planning tool [pre & post implementation of project (smoke free property):

feedback concerns, barriers upfront v. reactive]

• Guides through transition – helps OD speak to bosses
• Opportunity to adjust or be proactive
• Technology [done at home]

Surveys - Barriers

• Staff concerns:

– Confidentiality [shared links] – Brevity [little bites] – Curiosity [how to be used?] – Motivation [incentives]

• Fatigue – too many!
• Accountability [genuine – don’t ask my opinion if you are not going to use it]
• Accessibility :

– Want paper – Access to hardware – On company’s dime

• Practicality [don’t get too fancy & not have resources/steam to interpret & act]
• Readiness – leaders rationalize results ; tough to take

Slide 13

Presentation by: John Yardley, Ph.D., President, Metrics@Work

Br Brant ant Community Community Healthcar Healthcare System e System 2011 2011 Employee Survey Results

Senior Management Presentation June 28th, 2011

Slide 14

BCHS Bullying Frequency

Supervisors, Managers, Senior Management as Perpetrator Coworker as Perpetrator

Using this standard 14.0% nearly 1 in 7 is a victim of a Bully Coworker Using this standard 7.3% approx. 1 in 13 Is a victim of a Bully Boss

• 1. “Once a week” and “daily” considered to be at a level where psychological health is

likely to become impaired (Leymann, 1990; Mikkelsen & Einarsen et. al., 2002)

• 2. At that level “bullying” from a Coworker is nearly three times as frequent (N=114

victims) compared to from a Person In Authority (N= 57 victims)

• 3. More opportunity (time and numbers) for Coworker, so not directly comparable

Mixed Messages

• High employee engagement,
• Enviable safety record
• Financially stable
• High quality care & providers, yet low % would

recommend ???

• High wait times, complaints & loss of incentive$
• Top heavy
• Staff & provider frustration, bullying, haves & have nots
• Some broken and old processes, provider-centric, work

arounds

Strategic Planning

• Significant consultations, environmental scans
• Turbulent and uncertain environment:

– LHIN – MOH funding regime – IPC

• Ear to the ground – high performing
• rganizations

BCHS True North

BCHS…Your partner in lifetime health

Patien ient t Firs rst

 No adverse events  No waiting  100% patient satisfaction  Leading practices

Gre reat Place ce to W

• Wor
• rk

 No injuries/harm  Developing top talent  Seeking better ways together

Us Using ng Res esou

• urc

rces es Wisel ely

 Zero waste  Innovation  Data driven decisions

The Challenge

• The existing healthcare model is no longer

sustainable

– There is no more money – Our patients are not satisfied – Providers are frustrated

• So how can we deliver better quality outcomes

and experiences for patients, as well as better experiences for staff, with fewer resources?

“Every system is perfectly designed to get the results it

• gets. If we want better outcomes,

we must change something in the system. To do this we need to understand our systems” …Don Berwick, IHI

“ Faced with the choice of changing one’s mind or proving that there is no need to do so; almost everyone gets busy on the proof ”

A leader’s job is to look into the future & see the organization not as it is, but as it should be!

Pe Perfor rformance mance Ex Excellenc ellence at BCHS

Healthcare Benefits of Taking the Journey of Lean

• Less waste leads to better patient outcomes with shorter stays
• Decrease in incidents causing medical harm
• Focus changes from being about money (whose cost centre is this

from?) to the patient experience (patient-first)

• For employees - a collaborative team focus, a no-blame culture and

a spirit of improvement

The Toyota Lean Example

“Brilliant process management is our strategy. We get brilliant results from average people managing brilliant processes. We observe that our competitors often get average (or worse) results from brilliant people managing broken processes.” Underpinned with a management system that develops every employee into a problem solver

5% 40% 55%

Non Value Added but Necessary:

Any work carried out, which is necessary under current conditions but not something the patient (funder) would willingly pay for. Transcription / dictation

Non Value Added:

Activities that the patient (funder) would not want to pay for if they knew they were happening. Searching for equipment / supplies, redrawing blood

PATIENTS FOCUS ON WHAT IS OF VALUE TO THEM!

Value Added:

Activities that the patient (funder) would be willing to pay for. Med administration, Tests performed, Test results

The Three Divisions of Work

What is a Value Stream?

• Value Stream

– all the activities and actions (value added and non-value added, information and material) that are required to bring a patient through the essential requirements needed

Value Stream

(labour, equipment, supplies, support services, facilities)

Value Stream Improvement

Operating Room Supply Chain Project

• Goal

– Optimize the flow of materials that support the Operating rooms while minimizing the inventory levels.

• Project Pillars

– Improved Communication – Improved Flow of Materials – The Right Person Doing the Right Job

Value Stream Improvement

• Before
• After

Value Stream Improvement

• Before
• After

Errors – MDR & Stores

Returned Items to Stores

Nursing Dollars on Supplies

System Improvement

• Seeing the hospital as a collection of value streams,

not departments

Changing our structure to better reflect how patients receive care, how hospitals are funded, and how leading organizations are

• perating.

Acute & Transitional Care

CCU & C5, B6, B7 & B8, ISU / Rehab, CCIP

Episodic Care

Mental Health, Emergency & Urgent Care, Outpatient Clinics

Planned Care

Maternal Child & Surgical

Care Support DI, Pharmacy, Lab, Infection Control & Medical Device Reprocessing

Finance & Supply Support

AP/AR & General Finance, Contracts, Home O2, Purchasing, Stores, Bio-Med, Environmental Services and Nutrition Services

Knowledge & Information Support

Decision Support and IT Patient Registration & Information, Flow, HIM & HIS Facilities and Maintenance

People Development

HR, Payroll, Volunteers Occ Health & Safety, Float Pool, & Scheduling

Quality, Risk & Professional Affairs

Strategy Deployment (Phase 1) Community Engagement & Partnerships (Phase 1)

Acute & Transitional Care Episodic & Outpatient Care Planned Care Care Support DI, Pharmacy, Lab, Infection Control & Medical Device Reprocessing

Finance & Supply Support

Knowledge & Information Support People Development Quality, Risk & Professional Affairs

DI Lab, IP&C, MDR Pharmacy DI IP&C, MDR Lab Pharmacy

CCU & C5 B6, B7 & B8

C5 CCU B6 B7 B8

RN, RPN, PSW, SW, DCP, OT/ PT, Unit Clerk, SLP, Dietician, RT, Pharmacist Maternal Child Surgical B3 & B4 Pre-op, DS, PACU OR B5 RN, RPN, PSW, SW, DCP, OT/ PT, Unit Clerk, SLP, Dietician, RT, Pharmacist

Mental Health ER & Willett

Mental Health ER

RN, RPN, PSW, SW, DCP, OT/ PT, Unit Clerk, SLP, Dietician, RT, Pharmacist Supplies

ESA

Facilities & Maint.

• Occ. Health,

People Professional Practice

Community Engagement & Partnerships (Phase 1) Strategy Deployment (Phase 1)

– Studied the change – Able to express how I feel – Clear change is necessary – Comfort steps taken to create lasting, sustainable change – Clear on the vision – I know what I might lose – How frequently should we meet – “Jim would like your feedback, questions”

Value Streams Transition surveys

Followed each group meeting Focused questions based on “transitions”

• Leader readiness to operate in

new VS

• Supports needed for success
• Extent VS seen as assisting

strategic directions

• What do we need to do, change

to realize opportunities

• Best of past to carry forward
• Most important message you

took away from Jim’s RIMs Survey 1 Survey 2

Survey 1 Summary

• People know why we are making changes & why

necessary

• Opportunity to build right structure
• Need to deal with sense of loss
• Need to be clearer about future state/vision
• Need to be mindful of the details
• Morale & workplace issues
• Skepticism
• List of questions

Recommended next steps

Transition Survey #2 - Results

• How ready are leaders to operate in the new value stream organization?

– 45% not at all/a little – 55% - somewhat/very

• What supports must be in place for leaders to be successful?

1. Clear role descriptions (92%) 2. Group Leadership discussions (76%) 3. Coaching between VSL and MVSL (76%) 4. Leadership development (62%) 5. Standardized work (60%)

The Win-Win-Win

• It is actually possible
• The theory and principles are tried and tested

in many industries

• This all depends on people being willing to rise

to this challenge – and convince their colleagues

• BCHS has a history of innovation and

pioneering

General insights ... To date

• Build the platform to change by listening,

seeking, learning

• Find balance between signalling early & often

and pulling off the band-aid

• Some fear change and anticipation of change

means loss of “good people” – but “good people” will want to work in the new way!

People are very open- minded about new things…

As long as they’re exactly like the old ones!

In a time of drastic change it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists. Eric Hoffer

I ain’t what I ought to be and I ain’t what I’m going to be But I ain’t what I was!

jhornell@bchsys.org