IHI High-Impact Leadership2016 IHI National Form

Workshop Sessions D13, E13

December 7, 2016

These presenters have nothing to

disclose

Michael Pugh, MPHStephen Swensen, MD

Why do we need new ideas about leadership?

“Every system is perfectly designed to produce the

results it gets.”

As leaders, you are responsible for the results of those systems

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Paul Batalden, MD

IHI Triple AIM:

Success is Leadership Dependent

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Per Capita

Cost

Experience

of Care

Population

Health

A useful definition…

Leadership is a process of social influence, which

maximizes the efforts of others, towards the

achievement of a goal.

Kev in Kruse Forbes.com What is Leadership April 9, 2013

Kevin Kruse

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Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.

High-Impact Leadership:

Improve Care, Improve the Health of Populations, and Reduce Costs

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Mental Models

How leaders think is critically important

– Beliefs, theories and assumptions provide a “lens” through which leaders view and filter challenges and define the universe of potential solutions and actions

Fill in the Blank:

Patient experience would be significantly

improved if we ______________________.Think of two management actions you might take based on how you answered

the question.

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New Mental Models

Reshape Improvement Efforts

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Patient Satisfaction driven by being nice

Improvement projects are in addition to the daily work

Manage to my budget/funding

Common Mental Models

Patient satisfaction driven by engagement of patients and families

Improvement is part of daily work of everyone

Seek to continuously reduce per unit operating costs

New Mental Models

New Mental ModelsReshape Board and Governance Process

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Good doctors mean good quality

Patient harm is rare and largely unpreventable or malpractice

The medical staff is responsible for quality

Common Board Mental Models

Safe and reliable systems + good doctors drive quality results

Patient harm is preventable and unacceptable

The Board is responsible for all organizational outcomes including clinical

New Board Mental Models

Transitioning from Volume-based to Value-based

Systems Requires New Mental Models

Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of

Populations, and Reduce Costs. Cambridge, MA: Institute f or Healthcare Improv ement; 2013. Av ailable on www.ihi.org.

Mental Models: QA, QC and QI

Quality Assurance• Inspection-looking for the

“Bad Apples”

• Retrospective Review

• Risk Management—Root Cause Analysis

Quality Control• Monitor Key Process

Indicators (KPI’s) against targets

• Take Action when not meeting targets

• Regulatory approach Quality Improvement• Process and system

improvement

• Reduce Variation

• Align outputs to customer needs

• Continuous & part of daily work

• Science of Improvement

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The Big Mental Model ShiftChanging the Way We Think About Patients and Families

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What’s the Matter?

What matters to you?

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Builds on the construct of Will, Ideas and Execution

Provides a guide to the key areas where leadership needs to focus efforts to drive improvement and innovation

Useful for organizational assessment and gap analysis

Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of

Populations, and Reduce Costs. Cambridge, MA: Institute f or Healthcare Improv ement; 2013. Av ailable on www.ihi.org.

IHI High-Impact Leadership Framework

High-Impact Leadership BehaviorsWhat Leaders Do to Make a Difference

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Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.

Leadership Dimensions

Shanafelt, Menaker, Buskirk, Gorringe, Swensen. 12 Leadership Dimensions. Mayo Clinic Proceedings. April 2015: 90(4); 432-440

(P<0.001

)

(P<0.001

)

Mayo Clinic Diffusion ModelLeadershipCulture

Sponsoring Body

Value Creation Team

Best Practice

StandardizedMayo CareProcessModel D

iffu

sio

nT

eam

Best PracticeOwner

Order sets

Rules/Alerts

Patienteducation

Staffeducation

Workflowchanges

Operational Work Unit

Implementation

EMR/Deptsystems

BrochuresPAG, GPS

Ask MayoExpert

Outcomemeasures

IT Liason and Infrastructure Support

Dilling , Swensen… Mayo Clinic Model of Diffusion. Jt Comm J Qual Patient Saf. 2013;39:167.

Doyle, (2013). British Medical Journal, 3(1). Hsu, I, et al. (2012) Patient Education

Counseling. 88(3). Cosley, Journal Experimental Social Psychology 46.5 (2010) 816-

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Pain

Anxiety

BP

LOS

Readmissions

Wound healing

Kindness

Barsade, O’Neill. What’s Love Got to Do with It? A Longitudinal Study of the Culture of Companionate Love. Administrative Science Quarterly. May 29, 2014

Satisfaction

Engagement

Commitment

Productivity

Exhaustion

Burnout

Companionate Love

Empathy

Systems Issues

Huddleston. Learning From Every Death. J Patient Safety March 2014

Who are the Core Leaders?

Everyone “in the middle” responsible for managing and leading divisions,

departments, functions, programs, and/or clinical teams

– Managers

– VP’s

– Supervisors

– Clinical Leads

– Division Leaders

– Clinical Team Leaders

– Program Managers

– Physician Leaders

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What do they need to

know?

How do we develop

their leadership skills?

MDP and DM 2016

MDP & DM 2016

High-Impact Leadership Behaviors and Management

Focus Shaped by Distance from the Patient

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• Vision & Strategy

• Shape Culture

• Allocate Resources

• Track Progress

Senior Leadership

• Deploy Resources

• Manage structure

• Align efforts

• Translate Priorities

Area or Service Leadership

• Provide care

• Manage daily work

• Lead care teams

• Solve Problems

• Improve care

• Keep patients safe

Clinical and Team Leaders and

Managers

Furtherfrom the Patient

Closer to the Patient

MDP 2016

MDP & DM 2016

You can manage things, but you have to lead people

Leadership Skills

•Strategic Thinking•Will Building

•Team Building•Communicating

•Prioritizing•Accountability

•Role Modeling•Engaging

Management Skills

•Allocating•Budgeting

• Improving•Staffing

•Measuring•Hiring & Supervising

•Ordering (Clinical)•Planning

Leadership Management

MDP 2016

MDP & DM 2016

High-Impact Core Leadership Competencies

Manage the Work

Build Team

Capability

Improve the Work

Shape Team

Culture

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Management

Skills

Leadership

Skills

MDP and DM 2016

MDP & DM 2016

Manage the Work

Manage time and resources

Create standard work and process, including your own

Measure: financial, quality, customer,

key process

Surface and solve problems in real time

Engage across departmental/team

boundaries

Improve the Work

Prioritize and align to strategy and aims

Understand current state, cause and target conditions

Learn and use improvement tools

and methods

Reduce variation and waste

Get results and sustain them

Build Team Capability

Develop competency through coaching

Use the whole team

Communicate effectively

Establish respect and accountability

Shape Team Culture

Share vision and build will

Promote transparency

Model the way

Encourage mindfulness

Keep the person at the center

A Blueprint for High-Impact Core Leader

Development

MDP and DM 2016

Management

Skills

Leadership

Skills

MDP & DM 2016

Contact Information

Michael Pugh, MPH

– (719) 671-2668

– michael@mdpassociates.com

Steve Swensen, MD

– (507) 284-6186

– swensen.stephen@mayo.edu

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