to High Reliability Pattie Skriba VP - Business Excellence - PowerPoint PPT Presentation

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 perform as intended or required on demand and without degradation or failure The Business Dictionary HIGH RELIABILITY The ability to sustain high performance during complexity, uncertainty, and the unexpected. Being Counted On for Repeated Excellence 2

What Does Baldrige Say About High Reliability? Workforce Strategy RESULTS Leadership Integration Operations Customers Measurement, Analysis, Knowledge Management 3

Key Cultural Attributes of High Reliable Organizations Aligned with Baldrige Core Values & Concepts 1. Preoccupation with failure ▪ Managing risk 2. Sensitivity to operations ▪ Systems perspective 3. Reluctance to simplify ▪ Management by fact 4. Commitment to resilience ▪ Organizational learning & agility 5. Deference to expertise ▪ Valuing people 4

What Does Baldrige Say About High Reliability? HOW Do You • Create an environment for long term success , achievement of 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) An organization can’t achieve repeatable excellence without integrating processes deeply into the culture AND 5

Category 7: Results ✓ High performance levels ✓ SUSTAINED, beneficial trends ✓ Top performing comparisons ✓ Measures what’s important 6

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 7

Betty’s Story

High Reliability Doesn’t ‘Just Happen’ 9

Creating a Cultu ture of Performance Improvement 10

GSAM’s Ongoing Journey to High Reliability “Moving from Good to Great” Organizational Transformation Begins 2015 2004 2006 2011 2013 2017 Value (LEAN) High Clinical & Process- Engaging Broader Reliability Service Honoring Adoption of A3 Patients & Deployment Units Excellence Culture Families Zero Harm by 2020 of (Baldrige) PI Approach Evidence- ISO 2015 Based Science of Management Safety Practices DNV and ISO Cycles of Improvement

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 12

The GSAM Leadership System Set Direction Establish Goals Understand Stakeholder Requirements Mission Values Philosophy Organize, 1 Learn, Improve Physicians Plan & Align & Innovate Patient Community Volunteers Associates Suppliers Families Partners Integrity Passion Caring Develop, Reward Accountability Perform to Plan & Recognize for Results

#1 Anchor High Performance in the Vision & Direction of the Organization To provide an exceptional patient experience, marked by superior health outcomes, and value 0 Harm by 2020 14

#2 Systematically Enroll the Workforce in the Vision The heart of change is the emotions . (Kotter) 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 “ 15

Why Improve? Why Change? “One of the most under -appreciated roles of the effective leader is the creation of context for their team or organization.” Last Word On Power , Tracy Goss The ACTION of Leadership Is Communication 16

#3 Intentional Cascading of Goals: A Context for Improvement A Balanced Commitment to Excellence Funding Associate Patient Physician Health / Growth Our Engagement Satisfaction Engagement Safety Future Outcomes Executive Team – Hospital Goals Strategy Director Goals ✓ Senior leaders own the goal setting process ✓ Target: minimally 75 th %ile Manager Goals ✓ Stretch: top decile performance Supervisor Goals ✓ Goal achievement tied to performance review which ties to raises $$ Frontline Goals ✓ Staff ‘see’ their impact 17

#4 Transparency: Platform to Improve 61 Days Since the Last Serious Safety Event 18

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#5 Rigorous Use of Data at All Levels of the Organization Analysis and Use of QUALITATIVE DATA Top 5 Physician-related Complaints Discharge Calls & Surveys: 30% 25% 20% % of Complaints 15% 10% 5% 0% Time w/Doc: Courtesy of Doc Hospitalist, Doc Discharge Delays Rushed, Short, Partner: Communication None Who? Why?

#5 Rigorous Use of Data at All Levels of the Organization Data You Can Only Get by Observing & Talking With People Who Do the Work Supplies in the Critical Care Unit 52% of labeling on cabinets/drawers is not accurate Dotplot of Day Shift Observations Means 3 nurses logged having to leave room 8 times during their shift 0 4 8 12 16 20 24 # of times a RN had to leave pt room to search (each dot is 1 shift) Nurse Satisfaction 2.77 on 5.0 scale

#5 Rigorous Use of Data at All Levels of the Organization Visual Management: Identifies Process Defects and Allows for Correction Surgical Registration: Surgical Pre-Certs: Days Out Days Out Monthly Performance Daily Performance Defects Actions to Improve

Fully Deploy and Integrate a Performance Improvement and Sustainment System 23

GSAM’s Performance Improvement Approach: PDSA-A3 PLAN PLAN DO Box 1: Box 4 Box 7: Problem Statement Root Cause Analysis Plan to Implement PLAN PLAN STUDY Box 2: Box 5: Box 8: Current State Possible Solutions Confirmed State PLAN DO ACT Box 3: Box 6: Box 9: Target State Test Possible Solutions Learnings 24

Achieving Excellence Is HA HARD RD Sustaining Excellence Is HARDER DER “Excellent organizations consistently do what mediocre organizations do occasionally.” -- K & N Management 25

Tools That Enable Sustainment & High Reliability Observe & Coach Calendar Visual Management Standard Work OFI Board ISO Process Audits 26

GSAM’s PI System: Deployment Learn, Do, Coach, Mentor 24 month deployment Transformation & Innovation Leadership High Reliability Value Streams Development Unit Training Daily Improvement Intr ntro to o to A3 A3 Thin hinkin king A3 Thin A3 hinkin king RIE RIE Vis isual ual Mana anagem gement ent RIE RIE Leading in Leading in a a Lean Lean Envir ironment onment

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? 28

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? Unit 43 HRU Improvements 60 Improvements Goal 40 20 2016: 220+ Improvements 0 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 29

Respiratory Standard Work: Avoiding BIPAP Disconnect 30

Keeping Patients Safe: Culture and Process Improvement Advocate Good Samaritan Serious Safety Event Rate (SSER) Rolling 12-month rate per 10,000 APD 8 January 2012 through December 2017 1.8 1.6 7 58.4% Decrease in Serious Safety Events 1.4 6 Baseline 1.25 Serious Safety Event Rate Count of Serious Safety Events 1.2 5 1 4 0.8 3 3 3 0.52 3 0.6 2 2 22 22 2 2 2 2 0.4 11 11 1 111 1 1 1 1 1 1 1 111111 11 1 1 1 1 1 1 0.25 1 0.2 00 0000000 00 00 0 0 0 0 0 0 0 00 0 000 0 00 00 0 0 Longest Stretch With No Death or Permanent Harm: 15 months ✓ 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 31