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to High Reliability Pattie Skriba VP - Business Excellence February 2018 RELIABILITY 1.Giving the same result on successive trials 2.The ability to be trusted or relied upon for accuracy, performance, etc. 3.The ability to consistently

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Pattie Skriba VP - Business Excellence

to High Reliability

February 2018

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RELIABILITY

The ability to sustain high performance during complexity, uncertainty, and the unexpected.

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1.Giving the same result on successive trials 2.The ability to be trusted or relied upon for accuracy, performance, etc. 3.The ability to consistently perform as intended

  • r required on demand and without

degradation or failure

HIGH RELIABILITY

The Business Dictionary

Being Counted On for Repeated Excellence

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What Does Baldrige Say About High Reliability?

Leadership Strategy Customers Operations Workforce RESULTS

Measurement, Analysis, Knowledge Management Integration

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Key Cultural Attributes of High Reliable Organizations

Aligned with Baldrige Core Values & Concepts

  • 1. Preoccupation with failure
  • 2. Sensitivity to operations
  • 3. Reluctance to simplify
  • 4. Commitment to resilience
  • 5. Deference to expertise

▪ Managing risk ▪ Systems perspective ▪ Management by fact ▪ Organizational learning & agility ▪ Valuing people

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What Does Baldrige Say About High Reliability?

HOW Do You

  • Create an environment for long term success, achievement
  • f your mission (Category 1)
  • Ensure achievement of strategic objectives (Category 2)
  • Sustain the key outcomes of your action plans (Category 2)
  • Retain patients/customers (Category 3)
  • Retain new hires (Category 5)
  • Reduce variability and ensure processes meet customer

requirements (Category 6)

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AND

An organization can’t achieve repeatable excellence without integrating processes deeply into the culture

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Category 7: Results

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✓ High performance levels ✓ SUSTAINED, beneficial trends ✓ Top performing comparisons ✓ Measures what’s important

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High Reliability: A Non-Negotiable

▪ Publically Reported Health Outcomes: ‘0 Defects’

  • Required. 99% = the new ‘fail’

▪ Aviation: Do you want the processes your pilot uses to be reliable? ▪ Employee Retention: What does it cost your organization when your hiring/retention processes aren’t reliable? ▪ Customer Retention: What’s the cost of losing ONE customer to your business? ▪ Product or Service: Are you happy with your cell phone service reliability? ▪ Education: 62% of high school seniors read at or below grade level; 74% below grade level in math (2014) ▪ Hospital Errors: 3rd Leading Cause of Death in U.S

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Betty’s Story

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High Reliability Doesn’t ‘Just Happen’

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Creating a Cultu ture of Performance Improvement

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GSAM’s Ongoing Journey to High Reliability

Clinical & Service Excellence Process- Honoring Culture (Baldrige) Broader Deployment

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PI Approach Zero Harm by 2020 Value (LEAN) Science of Safety

2004 2006 2011 2013 2015

High Reliability Units Organizational Transformation Begins Evidence- Based Management Practices

2017

Engaging Patients & Families

Cycles of Improvement

“Moving from Good to Great”

DNV and ISO ISO 2015 Adoption of A3

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Culture Creation Begins with Leadership

  • Old Chinese proverb:

“If we don’t change our direction, we’re liable to end up where we’re headed.”

  • Transformational Leaders can change the

direction of an organization

  • Our success depends on Leadership’s ability

to create cultures of high performance and reliability

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The GSAM Leadership System

1 Understand Stakeholder Requirements Accountability for Results

Patient

Community Suppliers Partners Physicians Volunteers Associates Families Mission Values Philosophy Integrity Passion Caring

Perform to Plan Develop, Reward & Recognize Learn, Improve & Innovate Set Direction Establish Goals Organize, Plan & Align

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#1 Anchor High Performance in the Vision & Direction of the Organization

To provide an exceptional patient experience, marked by superior health outcomes, and value

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0 Harm by 2020

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#2 Systematically Enroll the Workforce in the Vision The heart of change is the emotions. (Kotter)

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Apathy: Neither for nor against. No interest or energy. Non-Compliance: Does not see the benefits and will not do what’s expected. Undermines through resistance and inaction. Grudging Compliance: Does not see the benefits; does not want to lose her job. Formal Compliance: See the benefits. Does what’s expected, no more. Genuine Compliance: Does everything expected; Follows the ‘letter of the law.’ Ownership & Commitment: Wants it. Owns it. Passionate. Will make it

  • happen. Will do whatever it takes. Inspires and enrolls others through actions

& words. “

Context Is Decisive

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Why Improve? Why Change?

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“One of the most under-appreciated roles of the effective leader is the creation of context for their team or

  • rganization.”

Last Word On Power, Tracy Goss

The ACTION of Leadership Is Communication

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Associate Engagement Patient Satisfaction Physician Engagement Growth Funding Our Future Health / Safety Outcomes

A Balanced Commitment to Excellence

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Strategy Executive Team – Hospital Goals Director Goals Manager Goals Frontline Goals Supervisor Goals

#3 Intentional Cascading of Goals: A Context for Improvement

✓ Senior leaders own the goal setting process ✓ Target: minimally 75th%ile ✓ Stretch: top decile performance ✓ Goal achievement tied to performance review which ties to raises $$ ✓ Staff ‘see’ their impact

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#4 Transparency: Platform to Improve

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61 Days

Since the Last Serious Safety Event

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#5 Rigorous Use of Data at All Levels of the Organization

Analysis and Use of QUALITATIVE DATA

0% 5% 10% 15% 20% 25% 30% Time w/Doc: Rushed, Short, None Courtesy of Doc Hospitalist, Partner: Who? Why? Doc Communication Discharge Delays

% of Complaints

Top 5 Physician-related Complaints Discharge Calls & Surveys:

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Supplies in the Critical Care Unit

Nurse Satisfaction 2.77 on 5.0 scale

52% of labeling on cabinets/drawers is not accurate

24 20 16 12 8 4 # of times a RN had to leave pt room to search (each dot is 1 shift) Dotplot of Day Shift Observations

Means 3 nurses logged having to leave room 8 times during their shift

Data You Can Only Get by Observing & Talking With People Who Do the Work

#5 Rigorous Use of Data at All Levels of the Organization

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Visual Management: Identifies Process Defects and Allows for Correction

#5 Rigorous Use of Data at All Levels of the Organization

Surgical Registration: Days Out

Monthly Performance Daily Performance Defects Actions to Improve

Surgical Pre-Certs: Days Out

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Fully Deploy and Integrate a Performance Improvement and Sustainment System

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Box 1: Problem Statement Box 4 Root Cause Analysis Box 7: Plan to Implement Box 2: Current State Box 5: Possible Solutions Box 8: Confirmed State Box 3: Target State Box 6: Test Possible Solutions Box 9: Learnings

PLAN PLAN PLAN PLAN PLAN DO DO STUDY ACT

GSAM’s Performance Improvement Approach: PDSA-A3

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Achieving Excellence Is HA

HARD RD

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Sustaining Excellence Is HARDER

DER

“Excellent organizations consistently do what mediocre organizations do occasionally.”

  • - K & N Management
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Tools That Enable Sustainment & High Reliability

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Observe & Coach Calendar Visual Management ISO Process Audits Standard Work OFI Board

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GSAM’s PI System: Deployment

Transformation & Innovation

Learn, Do, Coach, Mentor 24 month deployment

Value Streams

RIE RIE RIE RIE

Leadership Development

A3 A3 Thin hinkin king Vis isual ual Mana anagem gement ent Leading in Leading in a a Lean Lean Envir ironment

  • nment

High Reliability Unit Training

Intr ntro to

  • to A3

A3 Thin hinkin king

Daily Improvement

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Start the Shift Huddle: Managing for Daily Improvement

WINS…. What Yesterday Was Like?… What We Need to Do Today to Have a ‘Good’ Day Today?

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20 40 60

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16

Unit 43 HRU Improvements

Improvements Goal

2016: 220+ Improvements

Engaging the Frontline in Safety & Improvement

Opportunity for Improvement

Name: Date: Issue: Impact for patients and our unit: How often does it happen? Possible root causes:

WHY IS IT HAPPENING?

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Respiratory Standard Work: Avoiding BIPAP Disconnect

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Keeping Patients Safe: Culture and Process Improvement

✓ Vision: “0 Harm by 2020” ✓ Leadership owned ✓ Leadership High Reliability training: 18 months ✓ HRUs: engaging the frontline in safety ✓ Defined Be Safe Behaviors; audits ✓ Stories ✓ Rigorous use of our PI approach

00 11 0000000 11 00 2 00 1 3 111 2 1 3 1 22 1 1 22 1 3 1 2 1 111111 00 11 2 1 1 000 1 2 1 1 00 1 00 0.25

Baseline 1.25

0.52

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8

1 2 3 4 5 6 7 8

Serious Safety Event Rate Count of Serious Safety Events

Advocate Good Samaritan Serious Safety Event Rate (SSER)

Rolling 12-month rate per 10,000 APD January 2012 through December 2017 58.4% Decrease in Serious Safety Events Longest Stretch With No Death or Permanent Harm: 15 months

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Box 1: Problem Statement

2011 Baseline 1.44

Vent Index

Too many patients unnecessarily on ventilators causing distress to patients, complications, deaths and avoidable costs

✓ Cascaded goal ✓ A3 – Root Causes ID ✓ Standard Work ✓ Visual Management ✓ Rigorous use of data ✓ Leadership ‘pull’ – Lane Review ✓ Observe, Coach Bottom Quartile Nationally

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1.44 1.19 1.06 1.02 1.20 0.96 0.87 0.83 0.93 0.88 0.81 0.82 0.81 0.73

0.65 0.75 0.85 0.95 1.05 1.15 1.25 1.35 1.45

2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q4 2014 Q4 2015 Q4 2016 Q1 2017 Q2 2017

VENT RATIO (OBSERVED/EXPECTED)

2011 – 2016

Source: APACHE

GSAM Vent Day Index

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Sustained Top Decile Performance

GOOD

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Hand Hygiene

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2Q2015 3Q2015 4Q2015 1Q2016 2Q2016 3Q2016 4Q2016 1Q2017 4Q2017

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“Try Harder” + Posters 1st Pass A3

Good % Compliance

Target: 90% “True” Secret Shoppers 89.3% 95% 48% 56% ✓ 2nd pass A3: group, data ✓ ID true root causes ✓ Standard Work ✓ Teach Standard Work ✓ Observe, Coach, & “Thank You” ✓ Leadership ‘pull’ – Daily Report out 80% Continue: Observing & Coaching & Reporting Out 3rd pass A3

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Closing Thought

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Th Thank Y ank You

  • u

Pattie Skriba, VP – Business Excellence Pattie.skriba@advocatehealth.com 630-275-1495