George Mason University PE Building Renovation & Expansion Fairfax, Virginia
Converting Resistance to Buy-in: Virginia Mason Health ... · Melissa Lin, MS, CPHQ, LSSBB Virginia...
Transcript of Converting Resistance to Buy-in: Virginia Mason Health ... · Melissa Lin, MS, CPHQ, LSSBB Virginia...
Webinar SeriesSepsis: Across the Continuum of Care
Converting Resistance to Buy-in: Virginia Mason Health
System Sepsis Power Hour
Speaker:Melissa Lin, MS, CPHQ, LSSBBVirginia Mason Institute
Sepsis Alliance gratefully acknowledges the support provided for the Sepsis: Across the Continuum of Care webinar series by bioMérieux
SEPSIS ALLIANCE MISSIONTo save lives and reduce suffering by raising awareness of sepsis as a medical emergency
Sepsis Alliance | Sepsis.org
© 2017 Virginia Mason Institute
Converting Resistance into Buy-in: Sepsis Power Hour at
Virginia Mason Health System
Melissa Lin, MS, CPHQ, LSSBB
© 2017 Virginia Mason Institute
Learning Objectives
• Identify how technical change vs. adaptive change impacts your workplace
• Explain the urgency around mortality due to sepsis at Virginia Mason Health System that led executive leadership to evaluate and improve sepsis protocol.
• Describe how 2 Key Elements of Success converted staff/clinical resistance to staff empowerment, engagement, and just-in-time care delivery to septic patients
• Discuss the importance of communication and accountability through cross-functional team management to ensure quality care delivery and sustainability of the new Sepsis Power Hour protocol at Virginia Mason Health System
4
© 2017 Virginia Mason Institute
Levels of Resistance
Level 1: I don’t get itInformation – facts, figures, ideas
Level 2: I don’t like itEmotional reaction to the change
Level 3: I don’t like youTrust and confidence
5Source: Maurer, Rick. “Beyond the Wall of Resistance.” Bard Press, 2010.
© 2017 Virginia Mason Institute
Distress and Adaptive Work
6
Ronald A. Heifetz
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
© 2017 Virginia Mason Institute
1. Get on the balcony2. Regulate distress3. Give the work back4. Protect all voices
Leading Adaptive Change
7
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line. Harvard Business School Press. 2002; 108.
© 2017 Virginia Mason Institute
How do you see the correct current state?
Get on the Balcony
8
© 2017 Virginia Mason Institute
Urgency and Sepsis• There are more than 18 million cases of sepsis worldwide each
year, and it kills more than 258,000 Americans annually. 1,2
• Sepsis is the primary cause of death from infection. 2
Patients diagnosed with sepsis are estimated to have a mortality rate of 28 to 50 percent.3
• Patients with initially less severe sepsis make up the majority of sepsis deaths. In one study, septic shock was not present in 68 percent of patients who died from sepsis.4 Improving standardized care for patients with less severe sepsis could drive future reductions in hospital mortality.
9
1 Slade, Elizabeth, Pritpal S Tamber, and Jean-Louis Vincent. "The Surviving Sepsis Campaign: Raising Awareness To Reduce Mortality." Critical Care 7.1 (2003): 1. Web. 10 July 2017.
2 Adapting To The CMS Sepsis Bundle | Healthleaders Media". Healthleadersmedia.com. N.p., 2017. Web.
3 Angus, Derek C. et al. "Epidemiology Of Severe Sepsis In The United States: Analysis Of Incidence, Outcome, And Associated Costs Of Care". Critical Care Medicine 29.7 (2001): 1303-1310. Web.
4 Liu V, Escobar GJ, Greene JD, et al. Hospital Deaths in Patients With Sepsis From 2 Independent Cohorts. JAMA. 2014;312(1):90. doi:10.1001/jama.2014.5804.
© 2017 Virginia Mason Institute
Sepsis Urgency at Virginia Mason Health System
• Sepsis was the major cause of mortality in our institution with 2276 deaths from 2008-2014.
• Sepsis was responsible for 47% of the total mortality cases over this 7 year time period.
• Sepsis survivors experience:– Longer lengths of stay with high utilization of precious
healthcare resources– Higher rates of readmission– Long term injury and effects of the disease which could
be life altering
10
© 2017 Virginia Mason Institute
– John Kotter
“People change what they do less because they are given analysis that shifts their thinking than because they are shown a
truth that influences their feelings.”
© 2017 Virginia Mason Institute
How do you know when to raise the heat?
Regulate Distress
12
© 2017 Virginia Mason Institute
Distress and Adaptive Work
13
Ronald A. Heifetz
Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, Boston, MA,2002, pg. 108.
© 2015 Virginia Mason Medical Center
Virginia Mason Strategic Plan
© 2017 Virginia Mason Institute
Setting an Aggressive Standard
15
< 1 hour
Researchers have found that each hour of delay in administering antibiotics results in an average decrease in survival of 7.6 percent. 1
1 Adapting To The CMS Sepsis Bundle | Healthleaders Media". Healthleadersmedia.com. N.p., 2017. Web.
2 Liu et al. Hospital Deaths in Patients With Sepsis From 2 Independent Cohort. JAMA July 2014
Additionally early sepsis was targeted because two-thirds of those who die do not have sepsis on arrival.2
© 2017 Virginia Mason Institute
Give the Work Back
16
© 2017 Virginia Mason Institute
Edgar Schein
“It can be argued that the only thing of real importance that leaders do is create and manage culture; that the unique talent of leaders is their ability to understand and
work with culture.”
© 2017 Virginia Mason Institute
The Virginia Mason Production System
Sense of Urgency
Visible and Committed Leadership
Aligned Expectations
OneManagement
System
Technical and Human Dimensions
of Change
Shared Vision
© 2017 Virginia Mason Institute
VMPS Methods and Tools
© 2017 Virginia Mason Institute
Early Sepsis Recognition and Treatment
20
© 2017 Virginia Mason Institute
Sepsis Power Hour
•Identify Sepsis
•Check Lactate
•Draw Blood Cultures
•Start Bolus
RN Work
•Confirm Sepsis
•Start Antibiotics
•Complete Bolus
MD Work•Prioritize Antibiotics
•Dose and Prepare
•Deliver
Pharmacy Work
21
< 60 minutes< 30 minutes
© 2017 Virginia Mason Institute
SNIP: Sepsis Nurse Initiated Protocol
22
© 2017 Virginia Mason Institute
Protect All Voices
23
© 2017 Virginia Mason Institute
Peter Drucker
“Culture eats strategy.”
© 2017 Virginia Mason Institute
Respectfully Promoting Change
25
People don’t change all at once.Time is important.
Rogers, Everett M. Diffusion of innovations (1st ed.) New York: Free Press of Glencoe, 1962.
Chasm
Innovators2.5%
Early Adopters13.5%
Early Majority34%
Late Majority34%
Laggards16%
© 2017 Virginia Mason Institute
Respectfully Promoting Change
26
© 2017 Virginia Mason Institute
2 Key Elements of Success
27
Empower your care team to take immediate action.
Rapidly bring services directly to the patient.
© 2017 Virginia Mason Institute
Communication and Accountability
28
Registered Nurse Nursing Assistant Phlebotomist
Provider Pharmacist Project Manager
© 2017 Virginia Mason Institute
Maintaining the Gains
• Engaged leaders
• Monthly data tracking
• Individual follow-up
• Revisiting the message
29
© 2017 Virginia Mason Institute
Project Manager Oversight
“Dr. Calderon,
Thank you for using the order set and ordering antibiotics STAT! The patient received antibiotics in 31 minutes, well under our 60 minute target.
Thanks again,Sepsis Guiding Team”
30
© 2017 Virginia Mason Institute
Provider Perspective
• “I was having a pretty chaotic night and the order set and process made things easier.”
• “The system worked perfectly for this patient!”
31
© 2017 Virginia Mason Institute
Sepsis Power Hour at Virginia Mason
32https://youtu.be/p_peptJgp-4
© 2017 Virginia Mason Institute
Results at Virginia Mason Medical Center
33
Lead Time Reduction Sepsis Mortality Rates (2011 versus 2016)
© 2017 Virginia Mason Institute
Sepsis Power Hour Bundle
34
© 2017 Virginia Mason Institute35
The Sepsis Power Hour solution https://www.virginiamasoninstitute.org/sepsis-power-hour/
Learn about additional trainings and services www.VirginiaMasonInstitute.org
Email us [email protected]
To Learn More About our Sepsis Solution
© 2017 Virginia Mason Institute
Social MediaConnect with us
36
© 2017 Virginia Mason Institute
-Sensei Takumi Nakao
“Change work cannot only be about kaizen, it has to be about heart, too.”
© 2017 Virginia Mason Institute
Ask your questions via the question tool.Question and Answer Session
A lean journey is a learning journeyTM
© 2017 Virginia Mason Institute
SEPSIS AWARENESS MONTH
Sepsis Awareness Month™• Launched in 2011 by SA• State designations• Community events• Sepsis Superhero™ Challenge• Toolkits for healthcare providers
• Printable Posters and Infographics• Digital and Social Media tools• Ideas to get involved• Template messaging
www.SepsisAwarenessMonth.org
• Annual celebration of sepsis
leadership across the country
• September 12, 2019
• Marquee New York City
Webinar SeriesSepsis: Across the Continuum of Care
Register: www.sepsiswebinar.org
Unlocking the Potential of Artificial Intelligence in Sepsis CareAugust 7 at 2 pm ET
Sepsis Alliance gratefully acknowledges the support provided for the Sepsis: Across the Continuum of Care webinar series by bioMérieux and this webinar by Jvion
Speakers:
Michael H. Hooper, MD, MScVice President Medical AffairsSentara Norfolk General HospitalAssociate Professor of Medicine Eastern Virginia Medical School
Scott D. Stewart, BS, LSSBB, PMP, CSMClinical Process ImprovementSenior EngineerSentara Healthcare
GE Healthcare Sponsor Innovation Webinar
Register: www.sepsiswebinar.org
Can We Solve Sepsis Together with GE?Interactive Augmented Intelligence for Sepsis Medical CareAugust 22 at 2 pm ET
Sepsis Alliance gratefully acknowledges the support provided for this webinar by GE Healthcare
Speaker:
Jeff Hersh, MD, PhDChief Medical Officer GE Healthcare
Sepsis: Common, Lethal, and Unrecognized
Date: August 27 at 2 pm ET
Speaker: Angel O. Coz, MD, FCCPAssociate Professor of Medicine University of KentuckyPulmonary and Critical Care Specialist Lexington Veterans Affairs Medical Center
Register: www.sepsiscoordinatornetwork.org
Webinar SeriesSepsis: Across the Continuum of Care
Register: www.sepsiswebinar.org
The Blind Spot of Antibiotic Stewardship: Antibiotic Overuse at DischargeSeptember 24 at 2 pm ET
Sepsis Alliance gratefully acknowledges the support provided for this webinar by Thermo Fisher Scientific
Speaker:
Valerie Vaughn, MD MScAssistant Professor University of Michigan Medical School and Ann Arbor VA Healthcare System
Sepsis: Across the Continuum of CareWebinar series
The information in this webinar is intended for educational purposes only. The presentations and content are the opinions, experiences, views of the specific authors/presenters and are not statements of advice or opinion of Sepsis Alliance. The presentation has not been prepared, screened, approved, or endorsed by Sepsis Alliance.
Sepsis Alliance gratefully acknowledges the support
provided for the Sepsis: Across the Continuum of Care webinar series by bioMérieux