Leadership Accountability Demonstration Project (LADP)

Cohort 2 – Kickoff Webinar – Option I1 (intensive)

April 24th, 2014

© The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System

Goals for this project

• Develop deeper appreciation of the link between leadership and patient safety

• Select an area of focus for strengthening your efforts

• Implement the Model of Accountability with support from AI & VHA

• Learn, share, and sustain

3

Agenda

• Introduction to the program• The model, the evidence, and the plan

• The first steps• Choosing a harm area and geographic area(s)• Preparing for the site visit

• Learning from other teams

• Action items and discussion

Leadership Accountability Demonstration Project (LADP)Introduction to the model, evidence, and plan

Your cohort team: 2014 option 2 (intensive)

• Holy Redeemer hospital and Medical Center - Meadowbrook, PA

• INTEGRIS Canadian Valley – Yukon, OK

• INTEGRIS Health Edmond – Edmond, OK

• INTEGRIS Lakeside Women’s – Oklahoma City, OK

• INTEGRIS Southwest Medical Center – Oklahoma City, OK

• Jefferson Regional Medical Center – Pittsburgh, PA

• Swedish Covenant Hospital – Chicago, IL

• Southeastern Ohio Regional Medical Center - Cambridge, OH

Leadership at the highest levels matters

Keroack et al., 2007; Academic Medicine

Leadership at the local level matters

…the odds ratio for mortality increased

by 1.24 for the hospital.

For every 10% decrease in

perceptions of management items…

Huang et al., 2010

Evidence-based leadership for patient safety

1. Frankel A, et al., 2008, 2. Thomas EJ, et al., 2005, 3. Pronovost P et al., 2005, 4. Verschoor KN et al., 2007, 5. Keroack MA, et al., 2007

• Executive walk rounds[1, 2]

• Executive leader ‘adopt a unit’[3]

• Safety briefings[4]

• Patient safety strategic plan[5]

• Hands-on leadership style[5]

What are we working towards?

• Shared leadership accountability for patient safety and quality improvement

• A mutual sense of responsibility, contribution, and control related to organizational quality and safety improvement efforts

• Shared among both formal and informal leaders from different levels and areas of the organization.

Grounded in Leadership Model of Accountability

How we will work together

• Site visit conversation• Identify opportunities to optimize leadership

and accountability

• Monthly cohort calls• Model of Accountability content• Introduction of tools• Collaborate, share experiences and

troubleshoot with fellow cohort members• Action planning

• Monthly coaching (one on one)• Site specific consulting and support

• Build capacity• 2 members per site trained in the AI Online

Patient Safety Certificate

• Monthly feedback loops• Share progress and innovations across

organizations

Accountability Model + Tools

Site Visit Conversation

Cohort wide calls Individual calls

Data and Feedback

Adaptive leadership

Timeline

April May June July Aug Sept Oct Nov Dec

Cohort Calls

Kickoff Call

Site Visit Preparation Call

Patient Safety Certificate Program Call

Tool call 1:• Learning

tracer tool • Business

case tool

Horizontal Learning Call 1

Tool call 2:• Strategic

prioritization

• Safety comp

Horizontal Learning Call 2

Tool call 3:• Decision

making tool

Horizontal Learning Call 3

Site Visits and Coaching Calls

Site Visit Conversations Monthly Individual Coaching Calls

Surveys HSOPS & PSOA HSOPS & PSOA

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PSOA Domain: Key Aspects of Safety (KAS)

1. Leadership• (L1) Demonstrate patient safety as a top leadership priority • (L2) Promote a non-punitive culture for sharing information and lessons

learned

2. Strategic Planning• (SP1)Routinely conduct an organization-wide assessment of the risk of error

and adverse events in care delivery processes • (SP2) The organization actively evaluates the competitive/collaborative

environment and identifies partners with whom to learn and share best practices in clinical care:

3. Measurement, Analysis and Knowledge Management• (MAKM) Analyze adverse events and identify themes across events

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PSOA Domain: Key Aspects of Safety (KAS) - Cont.

4. Workforce Focus• (WF1) Establish rewards and recognition for reporting errors and

safety driven decision-making • (WF2) Foster effective teamwork regardless of a team member’s

position of authority

5. Operations Focus • Implement care delivery process improvements that avoid reliance

on memory and vigilance

6. Customer Involvement• Engage patients and families in care delivery workflow process

design and feedback

7. Results

Patient Safety Organization Assessment (PSOA) Cohort 1 Pre-Post Comparison

L1 L2

Lead

ership SP

1SP

2

Strati

gic Plan

ning

MAKMW

F1W

F2

Workf

orce Fo

cus

Operations F

ocus

Customer

Involve

...2.50

3.00

3.50

4.00

4.50

5.00

4.09

4.04

4.06

3.60

3.00 3.

30

4.22

3.55

3.48

3.51 3.

93

3.72

4.31

4.00 4.

15

4.01

3.75 3.88 4.

17

3.97

3.95

3.96

3.97 4.06

Pre ten hospital average Post ten hospital average

PSOA Cohort Pre-Post Comparison

3.50

3.70

3.90

4.10

4.30

4.50

4.70

4.90

3.95

4.40

3.904.00

4.23

4.56

4.21

3.82

Pre ten hospital average Post ten hospital average

Based on a 4-point scale

The first steps

Choosing harms and geographic area(s)

Planning for the site visit

What harm should we focus on?

For this project’s time frame, readmissions is not feasible.

What unit should we focus on?

• Where’s our biggest chance of success?

• Where’s our biggest challenge?

• What would make the most compelling success story (internally and externally)?

• What would position us best for spread?

Preparing for the site visit conversation

• Systematic way to gather ground truth• Non-judgmental• Confidential• Collaborative• Conversational

• Triangulates perceptions and knowledge• Senior Leaders• Clinical/Specialty Leaders• Unit Leaders

• Conversation + Observation + Reflection

Site Visit Conversation Template

Preparing for Site Visit Conversation

• Plan to attend site visit prep call in May

• Consider sharing (or collecting new responses)• Patient safety organization assessment (PSOA)• Hospital Survey on Patient Safety (HSOPS)

• Survey measure of safety culture• Can send to participating unit and 1 non-participating unit • Can share existing data if your organization recently took the

HSOPS

HSOPS and PSOA administration guidance

• Who should fill them out:• Everyone from the participating unit• Everyone from a non-participating unit

• How to fill it out• If you already have the data, we have a way to upload it

• If you don’t have it, we will email survey links to you, you can fill it out online

• When to fill it out• Before the site visit and after the last coaching call

• To evaluate your progress, we are offering the opportunity to administer these surveys at two points in time: Before site visit and +6months (Nov-Dec 2014)

• Report• If you collect new HSOPS data we will share reports for each unit

• We will summarize results and share with you after the project

Next Steps

1. Gain focus.• Develop internal consensus on your focus area (harm

and unit) for this project.

2. Build your internal team.• Select and invite your team to be part of this work.• Point a contact person.

3. Schedule your site visit.• Contact Alice (Xin-Xuan) Che: xche1@jhmi.edu

4. Prepare for pre-visit survey administration.

Open discussion

Please introduce yourself or your team

Has your team talked about or decided on which of the targeted HEN harm areas that they would like to

work on?

If so, which one? If not are there a few that you might be considering?

Discussion

• Any questions or concerns?

• Contact:• Alice: xche1@jhmi.edu• Michelle: MLEWIS@vha.com