to High Reliability - Tennessee Center for Performance ... · The ability to sustain high...
Transcript of to High Reliability - Tennessee Center for Performance ... · The ability to sustain high...
Pattie Skriba
VP - Business Excellence
to High Reliability
February 2018
RELIABILITY
The ability to sustain high performance during complexity, uncertainty, and the unexpected.
2
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
HIGH RELIABILITY
The Business Dictionary
Being Counted On for Repeated Excellence
3
What Does Baldrige Say About High Reliability?
Leadership
Strategy
Customers Operations
Workforce
RESULTS
Measurement, Analysis, Knowledge Management
Integration
4
Key Cultural Attributes of High Reliable OrganizationsAligned with Baldrige Core Values & Concepts
1. Preoccupation with failure
2. Sensitivity to operations
3. Reluctance to simplify
4. Commitment to resilience
5. Deference to expertise
▪ Managing risk
▪ Systems perspective
▪ Management by fact
▪ Organizational learning & agility
▪ Valuing people
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)
5
AND
An organization can’t achieve repeatable excellence
without integrating processes deeply into the culture
Category 7: Results
6
✓ High performance levels
✓ SUSTAINED, beneficial trends
✓ Top performing comparisons
✓ Measures what’s important
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
9
High Reliability Doesn’t ‘Just Happen’
Creating a Culture of Performance Improvement
10
GSAM’s Ongoing Journey to High Reliability
Clinical &
Service
Excellence
Process-
Honoring
Culture
(Baldrige)
Broader
Deployment
of
PI Approach
Zero Harm by 2020
Value (LEAN)
Science of
Safety
2004 2006 2011 2013 2015High
Reliability
Units
Organizational
Transformation
Begins
Evidence-
Based
Management
Practices
2017
Engaging
Patients &
Families
Cycles of Improvement
“Moving from Good to Great”
DNV and ISO
ISO 2015
Adoption of A3
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
1
Understand
Stakeholder Requirements
Accountability
for Results
PatientCommunity
Suppliers
Partners
Physicians
Volunteers
Associates
Families
Mission
Values
Philosophy
Integrity
Passion
Caring
Perform to PlanDevelop, Reward
& Recognize
Learn, Improve
& Innovate
Set Direction
Establish Goals
Organize,
Plan & Align
#1 Anchor High Performance in the Vision & Direction of the Organization
To provide an exceptional patient experience, marked by superior
health outcomes, and value
14
0 Harm by 2020
#2 Systematically Enroll the Workforce in the VisionThe heart of change is the emotions. (Kotter)
15
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
Why Improve? Why Change?
16
“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
Associate Engagement
Patient Satisfaction
Physician Engagement
GrowthFunding
Our Future
Health /Safety
Outcomes
A Balanced Commitment to Excellence
17
Strategy Executive Team – Hospital Goals
Director Goals
Manager Goals
Frontline Goals
Supervisor Goals
#3 Intentional Cascading of Goals: A Context for Improvement
✓ Senior leaders own the goal setting process
✓ Target: minimally 75th%ile
✓ Stretch: top decile performance
✓ Goal achievement tied to performance
review which ties to raises $$
✓ Staff ‘see’ their impact
#4 Transparency:
Platform to Improve
18
61 Days Since the Last Serious
Safety Event
19
#5 Rigorous Use of Data at All Levels of the OrganizationAnalysis and Use of QUALITATIVE DATA
0%
5%
10%
15%
20%
25%
30%
Time w/Doc:Rushed, Short,
None
Courtesy of Doc Hospitalist,Partner:
Who? Why?
DocCommunication
Discharge Delays
% o
f C
om
pla
ints
Top 5 Physician-related ComplaintsDischarge Calls & Surveys:
Supplies in the
Critical Care
Unit
Nurse Satisfaction 2.77 on 5.0 scale
52% of labeling on cabinets/drawers is not accurate
24201612840
# of times a RN had to leave pt room to search (each dot is 1 shift)
Dotplot of Day Shift Observations
Means 3 nurses logged
having to leave room 8
times during their shift
Data You Can Only Get by Observing & Talking With People Who Do the Work#5 Rigorous Use of Data at All Levels of the Organization
Visual Management: Identifies Process Defects and Allows for Correction#5 Rigorous Use of Data at All Levels of the Organization
Surgical Registration:
Days Out
Monthly
Performance
Daily
Performance
Defects
Actions
to
Improve
Surgical Pre-Certs:
Days Out
Fully Deploy and Integrate a Performance Improvement and Sustainment System
23
Box 1:Problem Statement
Box 4Root Cause Analysis
Box 7: Plan to Implement
Box 2:Current State
Box 5: Possible Solutions
Box 8: Confirmed State
Box 3:Target State
Box 6:Test Possible Solutions
Box 9:Learnings
PLAN
PLAN
PLAN
PLAN
PLAN
DO
DO
STUDY
ACT
GSAM’s Performance Improvement Approach: PDSA-A3
24
Achieving Excellence Is HARD
25
Sustaining Excellence Is HARDER
“Excellent organizations consistently do what mediocre organizations do occasionally.”
-- K & N Management
Tools That Enable Sustainment & High Reliability
26
Observe & Coach CalendarVisual Management
ISO Process Audits
Standard Work
OFI Board
GSAM’s PI System: DeploymentTr
ansf
orm
atio
n &
Inn
ova
tio
n
Learn, Do, Coach, Mentor
24 month deployment
Value Streams
RIE
RIE
RIE
RIE
Leadership Development
A3 Thinking
Visual
Management
Leading in a
Lean
Environment
High Reliability Unit Training
Intro to A3
Thinking
Daily Im
pro
vemen
t
28
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?
29
0
20
40
60
Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16
Unit 43 HRU Improvements
Improvements Goal
2016: 220+ Improvements
Engaging the Frontline in Safety & Improvement
Opportunity for ImprovementName: Date:
Issue:
Impact for patients and our unit:
How often does it happen?
Possible root causes:
WHY IS IT HAPPENING?
Respiratory Standard Work: Avoiding BIPAP Disconnect
30
31
Keeping Patients Safe: Culture and Process Improvement
✓ 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
00
11
0000000
11
00
2
00
1
3
0
111
0
2
1
0
3
1
22
1
0
1
22
1
0
3
0
1
2
1
0
111111
00
11
2
1
0
1
000
1
2
1
0
1
00
1
00
0.25
Baseline 1.25
0.52
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
0
1
2
3
4
5
6
7
8
Seri
ou
s S
afet
y Ev
ent
Rat
e
Co
un
t o
f Se
rio
us
Safe
ty E
ven
ts
Advocate Good Samaritan Serious Safety Event Rate (SSER)Rolling 12-month rate per 10,000 APDJanuary 2012 through December 2017
58.4% Decrease in Serious Safety Events
Longest Stretch With No Death or Permanent Harm: 15 months
Box 1:Problem
Statement
2011 Baseline 1.44
Vent Index
Too many patients unnecessarily on
ventilators causing distress to patients,
complications, deaths and avoidable
costs
✓ Cascaded goal
✓ A3 – Root Causes ID
✓ Standard Work
✓ Visual Management
✓ Rigorous use of data
✓ Leadership ‘pull’ – Lane Review
✓ Observe, Coach
Bottom Quartile Nationally
1.44
1.19
1.06
1.02
1.20
0.96
0.870.83
0.93
0.88
0.81 0.82 0.81
0.73
0.65
0.75
0.85
0.95
1.05
1.15
1.25
1.35
1.45
2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q4 2014 Q4 2015 Q4 2016 Q1 2017 Q2 2017
VEN
T R
ATI
O (
OB
SER
VED
/EX
PEC
TED
)
2011 – 2016
Source: APACHE
GSAM Vent Day Index
33
Sustained Top Decile Performance
GO
OD
Hand Hygiene
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2Q2015 3Q2015 4Q2015 1Q2016 2Q2016 3Q2016 4Q2016 1Q2017 4Q2017
35
“Try Harder”
+ Posters
1st Pass A3
Go
od
% C
om
pli
an
ce
Target: 90%
“True” Secret
Shoppers
89.3%
95%
48%
56%
✓ 2nd pass A3: group, data
✓ ID true root causes
✓ Standard Work
✓ Teach Standard Work
✓ Observe, Coach, & “Thank You”
✓ Leadership ‘pull’ – Daily Report out
80%
Continue: Observing
& Coaching &
Reporting Out
3rd pass A3
Closing Thought
36
37
Thank You
Pattie Skriba, VP – Business Excellence
630-275-1495