Leadership Accountability Demonstration Project

LITE Cohort Call #2: Strategic Prioritization and Learning Tracer Tools

September 22, 2014

Agenda

• How do we gain focus and reconcile competing priorities?– The Strategic Prioritization Tool

• How do we capitalize on the innovative capacity of our workforce?– The Informal Learning Tracer Tool

• Discussion

LADP Project Roadmap—Lite Group June –August 2014

• Project kickoff

August 2014• Cohort tool webinar

Try out the Aligning Goals Across the Organization tool

Try out the Defining Safety Competencies tool

• Horizontal Learning Call

September 2014• Cohort horizontal learning webinar• Cohort tool webinar

Try out the Strategic Risk Assessment and Prioritization Tool

Try out the Learning Tracer Tool

• Horizontal Learning Call

October 2014• Cohort horizontal learning webinar

November 2014• Cohort tool webinar

• Try out the Collaborative Tactical Decision Making Method

• Interactive business case presentation

December 2014• Cohort horizontal learning webinar

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Strategic Prioritization Tool

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What is our aim?

Leading with Intent– How do we set goals and priorities?

– many measures have financial, reputational, and regulatory risks

– How do we balance external priorities with internal priorities?

How many of you use a systematic process to prioritize organization quality and patient safety goals and priorities?

15%

85%

If YES, Is the process well known throughout the organization?

YES N

O

68%

32%

YES N

O

0%

100%

Might a systematic approach to guide the process be useful?

How do we currently assess risk as an organization?

Creating High Value Healthcare

Competing Improvement Goals and Priorities

Clinical OutcomesPatient/Family Reported OutcomesStaff Reported OutcomesFinancial Goals/Measures of Efficiency

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Phase I: Clarify External Reporting Risks and Prioritize Action Areas

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Tool guided process to evaluate

External patient safety related risks and opportunities for improvement across several domains

Use results to help prioritize areas for improvements.

Feasibility

Financial Risk

Reputational Risk

Regulatory Risk

Patient Harm

Strategic Risk Assessment and Prioritization

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Risk assessment table

 TYPE OF RISK LEVEL OF RISK

Low Medium High      

Patient Risk/Harm Measure indicates potential for low patient harm and/or has limited to no evidence

Measure indicates potential for moderate patient harm and/or has ample evidence

Measure indicates potential for severe patient harm and/or has strong and compelling evidence

Financial Risk(includes penalty, rewards, and opportunity cost)

Not a pay for performance/reporting initiative with < $ XK at stake*

Pay for performance/reporting initiative with ≥ XK and < $XXK at stake* 

Pay for performance/reporting initiative with ≥ $XXK at stake*

Reputational Risk Not publicly reported or evaluated by any external agency

Reported or evaluated by external agencies but not shared publicly

Publicly reported or evaluated by one or more regulatory and external agencies (Leapfrog, Consumers Union, Healthgrades etc.)  

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A Case Example from Johns Hopkins Hospital

• Aim: Exceed 96% compliance with nine key process measures.– PCI <= 90 minutes (AMI); Discharge instructions; Blood culture in ED prior to

initial antibiotic; Cardiac surgery glucose control; Beta-blocker if pre, then post; Urinary catheter removal; Home management plan; Pneumococcal vaccination; Influenza vaccination

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Approach stemming from strategic goals

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Performance gains

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Learning tracer tool

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Several influential reports on patient safety have highlighted the importance of developing effective, efficient systems for learning to reduce preventable patient safety incidents

Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices

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Closing the Loop

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Types of Learning in Hospital Setting

Formal Learning– Typically provided by an education or training institution,

structured (in terms of learning objectives, learning time or learning support) and leading to certification

– Intentional or deliberate from the learner’s perspective (Cedefop 2001)

Informal Learning– Resulting from daily life activities related to work, family or

leisure. It is not structured (in terms of learning objectives, learning time or learning support) and typically does not lead to certification

– May be intentional but in most cases it is not-intentional (or "incidental"/random) (Cedefop 2001)

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Types of Learning in Hospital Setting Cont’d

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• Although huge amount of resources are spent on formal learning, it accounts for only 20% of learning that occurs

• The remaining 80% occurs through informal learning (1)

• Competency enhancement

Informal Learning as a tool for learning and knowledge sharing

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4 Key Steps for Building Capacity

1. Define relevant patient safety and quality related competencies for each link in your chain of accountability

– What are we expecting each team member in our chain of accountability to know, do, and have awareness of or appreciation for in order to optimize patient safety and quality in our organization?

2. Help team members develop, retain, and continuously grow these competencies

– How does (or should) our organization support team members (formally and informally) in building and retaining patient safety and quality related knowledge, skills, and attitudes?

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4 Key Steps for Building Capacity-Con’t-

3. Reflect on how team members are held accountable for demonstrating the patient safety and quality competencies identified

– How does our organization evaluate or reinforce patient safety and quality related knowledge, skills, and attitudes?

4. Ensure local lessons learned, great little ideas that help, and near misses are shared throughout our organization and leveraged as opportunities for continuous learning

– How are we capitalizing on internal opportunities for learning, including sharing creative and innovative ideas or solutions?

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Learning from Defects

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Defect = any clinical or operational event or situation that you would not want to have happen again.

Surfacing defects is only useful if…Lessons learned from investigating the defect, and changes made in response to the defect are shared both vertically and horizontally throughout the organization using reflective learning processes

Incidents or situations that caused or could potentially put pt. at risk for harm

Near misses (or great catches)

Operational inefficiencies or processes that are not currently optimal

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Recommendations for Improving Knowledge Sharing Through Informal Learning

Make time and space for learningScanning for changes in the environmentAttention to learning process and attention to goalsInductive mindset and reflective skillsClimate of collaboration and trust

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Examples of strategic, but informal, learning structures or processes

Developing internal expertsActively encouraging and rewarding sharing of concerns, creative ideas, and workaroundsMentoring, coaching, peer reviews, job shadowingM&M conference, incident reporting, chart reporting, prospective risk analysisMobile device, online messenger systems, and social networks

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Informal Learning Tracer Tool: Step 1Materials: Paper copies of this Tracer Tool, markers/colorful pensInstructions:1. Use some of the time at one of your Leadership Accountability Demonstration Project team meetings (or other gathering) to have all

meeting participants complete the exercise below individually. You may also ask participants to complete this page (page 7 only) on their own before coming to the meeting.

2. As a group, compare what you have drawn. Use this as an opportunity to compare any differences and align the team’s mental model (i.e., get on the same page) about what the ideal process should be.

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Use the space below to draw a picture of what you personally think happens after a defect (an event, near miss, or other situation that you would not want to have happen again) occurs in your organization:

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Informal Learning Tracer Tool: Step 2

Link in the Chain Think about the most recent defect that occurred in your work area (e.g., the most recent fall, SSI, CLABSI, near miss, operation inefficiency, or workaround)…

Did you hear about this defect? (Yes/No)

How did you hear about or learn about it?

Did you pass on what you heard or learned to anyone else? (Y/N)

Did learning about this defect influence or change your personal practice or daily work in any way? (Y/N)

What do you think happened after this defect occurred?

What do you think we could learn from this as a unit or as an organization?

Have we change/enhanced anything based on what we learned from this that you are aware of?

Patient & Family

Frontline Staff& Physicians in participating unit(s)

Frontline Staff& Physicians in other unit(s)

Unit Leaders of participating unit(s)

Unit Leaders in other unit(s)

Department Heads

CEO Direct Reports

CEO

Board Members

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Discussion

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Next Steps

Continue progress on ‘Aligning goals across the organization’

– What is your implementation plan?• What’s new? What links are present, but need

re-invigoration?

– We will return to this tool throughout the project.

Try the ‘Learning Tracer Tool’