Presentation on theme: "Utah Association of Local Health Departments"— Presentation transcript:
1Utah Association of Local Health Departments Train-the-TrainerWorkshopOctober 19 and 20, 2011
2Workshop OverviewWelcome RemarksIntroductionsWhy are we here?Expectations
3Innovative Solutions. Measurable Results. …PHF Mission:We improve the public’s health by strengthening the quality and performance of public health practiceInnovative Solutions. Measurable Results.3
4Brainstorming 5 minutes individually, write down: What issues have arisen around implementing or setting up a QI training session?Volunteer ideas as scribe writesBuild on listed ideasAdd new thoughts as they occurDebrief to whole groupGrace
6The purpose of coaching QI Teams is to: Build a partnership between the coach, team leader, and team membersHelp the team move to a higher level of achievementHelp the team overcome obstaclesHelp the team navigate a politically sensitive situationProvide training or problem solving assistance
7Coaching QI TeamsBuilding a partnership between the coach, team leader, and team members is effective when there are:Agreed upon ground rulesClear expectationsSpecific time framesEstablished goals and measures of success
8Some Issues That Could Arise: Coach groups into teamsClarify objectives and goalsDissolve hidden agendasMove to commitment & accountabilityMove from hoping to actingGenerate efficiencyModel success of other high performing teamsShare values & vision of the organizationOvercome frustration & failureKeep them goingGive recognition
10Coaching QI TeamsThe goal is to build a culture of commitment and accountability
11What is Coaching? Establish trust Build rapport and open communication Clarify key roles and responsibilitiesEstablish goals and an effective personal development planCreate and implement a mentoring agreement
12Coaching Exercise, #1Break into teams of five eachList out the elements you would want in a coachIdentify the top three elements you would consider most important for a successful coaching intervention.Debrief
13First Rule of CoachingStart where your client “is” and not where you think he should be or where you are.
14Second Rule of Coaching Confirm readiness:Is the client receptive to coaching?Do they want to be coached?Have they requested coaching or been told to get it?What do they expect to get from coaching?
15Third Rule of CoachingSet Expectations:Establish goalsIntent is to help, not run the teamBuild trust – who do you have to report your results to – make it clearEstablish when and where coaching will take place
16Fourth Rule of Coaching Observe The Team:Identify destructive behaviorsDocument specific incidencesDocument their strengths and weaknessesUnderstand what they think is blocking or hindering their progress
17Fifth Rule of Coaching Develop an Improvement Plan: Describe observed team behaviors and the impacts; both good and badReview causes that lead to bad outcomes for the teamSet realistic change expectationsBuild the plan around their strengthsDescribe specific corrective actions to overcome weaknessesIndicate any training that may be required and how they can obtain it.
18Sixth Rule of CoachingConfidentiality:What you observe, recommend, or help the team with stays in “Vegas”If you must report your finding to some one higher in the organization let the team know at the outset
19Seventh Rule of Coaching Follow-Up:Set a time to follow-up with the team to see if progress has been madeAsk them to send you brief updates on a regular basis – what is and is not working
20Coaching Exercise #2Choose a partner for this exercise. You will practice coaching techniques.Look at the three most important elements for a successful coaching intervention each of you chose during exercise 1.Choose one element to practice with your partner. You can each choose a different element.Continued…
21Coaching Exercise #2The first “coachee” sets up the situation in which the “coach” will provide support. The coach LISTENS to the “coachee” to understand their coaching need.The coach then explores different approaches (DO NOT TELL) to that scenario with the “coachee.”Take no longer than 5 minutes for the exchange.Take two minutes for the “coachee” to express observations of the helpfulness of the coaching.Swap roles and repeat with the second partner.
25Problem Solving vs. Decision Making Whenever teams encounter a problem, we are involved in decision making.We are involved in decision making even when there is NOT a problem.Quality Improvement is about process, not only the outcome of our processes (W. Edwards Deming)
26Improvement versus Redesign for QI Analysis is for more than just solving problems. Dr. Juran’s Trilogy of Quality Planning, Quality Control, and Quality Improvement encourages us to design processes from the beginning to be effective and efficient. It is less costly to plan quality into a product or service before implementing (Act) than after valuable resources are expended in piloting or complete rollout has occurred. This chart identifies both a problem solving situation and an opportunity to redesign a process that is within control limits. Teams can use the QI tools for both of these situations.
27The Basic Feedback Loop Decision making is a result of effective analysis. This simple feedback loop shows the comparison of the current state performance of a process (1), with the future state desired process outcomes (3), through a sensor, or metrics tool (2). The analysis of the comparison drives the actuator or decision function (4) for action or maintenance of the current process (5). The PDCA and SDCA cycles described in our earlier QI training in September are the vehicle Public Health Departments have adopted initially to drive the continuous improvement of our organizations.
28Align Quality Improvement Measures ActDoCheck/StudyPlanThree steps for generating data for analysis and decision making:Assessing: Identifying, defining, prioritizing – PlanAnalyzing: Examining and investigating – Do and CheckAnswering: Finding solutions - ActPerformance Measurement Systems are created to maintain and improve the output and outcomes of our PH processes. As we map each core process with the HD, one of the critical steps is establishing measures that clearly align the process with the key priorities of the Health Department. Remember the training we participated in last month. Fully a third of those two days was dedicated to measures, data gathering and analysis.
29In Reality; There Are Two Qualities A product or service – Attribute QualityWhat you deliver to the clientA management tool – Method QualityWhat do you do internally to deliver the product or service to the client?How does the service you provide support the critical goals of your Department?The PDCA cycle and the 7 basic Quality tools not only help us meet our commitments to our clients and stakeholders (effectiveness). They also help us be more efficient with the resources we have available to us to do our jobs. We participate in improvement team activities for both internal and external customers. The three areas of measures we discussed in our initial quality training – process, capacity, and outcomes – are applicable to our internal processes and also the client facing processes that our communities see.We all work in Quality. We all work to improve the department. Quality isn’t about titles or departments, It’s about methods and their impact on individuals, our communities and how well we use our resources.
31Analyzing Goals and Measures of Success Activity preparation:What organizational goals do you have in common with others in this session?Focus on the most operational goals possible for this activityGroup in teams of 4 or 5 who have at least 3 common goals.Decision Making and Analysis is a vehicle for identifying and supporting the critical goals of the organization; whether they are internal or external. QI means constantly monitoring the effectiveness and efficiency of our processes so we can create and sustain organizational excellence.
32What and HowHow You Do ItWrongRightRight ThingsRTWRTR%%What You DoWrong ThingsWTWWTR%%
33RTR Analysis and Decision Making 15 Minutes: Using the RTR matrix handout, identify:Which of the identified goals are the right or wrong priorities based on your most critical stakeholder needs?Which actions taken to meet the identified goals are either the right or wrong ones to successfully meet those goals?Share your RTR observations
35Listening and Communicating A good coach is an outstanding listener and effective communicator
36Listening and Communications Communications is a two-way processSpeaker has to accurately convey their thoughts to the listenerThe listener must make sure they understand the messageThis seems simple enough
37Listening and Communications When the message understood by the listener matches the message intended by the speaker we have successful communicationsWhenever we communicate there are two basic factors at work:IdeasFeelings
38Listening and Communications Ideas – thought process which contains the concept we are attempting to communicateFeelings – emotions associated with the concepts we are communicating
39Listening and Communications An Idea-feeling relationship is in balance most of the timeDuring stressful situations the feel factor will take over and distort the messageStressful situations require an emphasis on effective listening
40Listening and Communications IdeasIdeasFeelingsFeelingsNormalStressful
41Class ExerciseBreak into teams of two each and sit back to backOne person faces the screen; the other makes sure you cannot see the screenThe person facing the screen must instruct the person sitting behind them to draw the figure to be shownYou have 3 minutesQuick debrief – what happened and why
43Class Exercise Now turn and face each other One person faces the screen; the other makes sure you cannot see the screenThe person facing the screen must instruct the person sitting in front of them to draw the figure to be shownYou have 3 minutesQuick debrief – what happened and why
48Cues of Communications: Verbal:What we say and our choice of wordsBig versus little wordsno slangSpeak from our experience which may not be your listener’s experience - disconnect
49Cues of Communications: Vocal – how we say it – tone, pitch, volume, inflectionVolume – too soft suggests uncertaintyPitch – high pitch suggests excitement or nervousnessTone – may suggest skepticism or disagreementInflection – upward pitch at the end of a sentence may make a statement sound like a question
50Listening and Communication Research indicates that:50% of our communications comes from body language43% from tone of voice7% from the actual words we speak
52Every Body’s Talking A way to read emotions not put into words Nonverbal speak loudly – sometimes louder than wordsWatch your intended message recipient or audience for these cluesWashington Post, Section F 1, June 24, 2008
54Listening and Communications Three types of listening:Passive listeningAcknowledgement responseActive listening
55Three types of listening Passive listening:Listener may or may not be paying attentionNo response to spoken words – silenceLimited or no body movementVoice can whine
56Three types of listening Acknowledgement response:Listener hears and understandsResponse acknowledges messageDirect eye contactBody movement – gestures of acknowledgement
57Three types of listening Active Listening:Listener uses feedbackListener tries to gain additional informationEye contactPositive body gestures
58Active ListeningKnow the purposePay attentionInterpretEvaluateRespond
59Remember The busy employee spends 50% of their time listening to people and still does not remember half of what is saidWe forget 1/3 to 1/2 of what we hear within one to eight hoursWe forget an additional 25% in the next 48 hoursWe forget more in the first eight hours than in the next six months
60We ignore, forget, distort, and/or misunderstand 75% of what we hear RememberWe ignore, forget, distort, and/or misunderstand 75% of what we hear
61Listening Is A SkillFind areas of interest – worth of the message – match your experiencesJudge the content not the deliveryHold your fire – listen to the content, not the hot button words – do not jump in right away – over stimulatedListen for ideas or facts that are interestingBe flexible and open minded
62Listening Is A Skill Work at listening – be prepared physically Resist distractionsExercise your mindKeep your mind open – do not go to the deaf spotCapitalize on thought speed
63Communications Model M S C N R Message Channel Source Noise Receiver Feedback
64SummaryWe need to make sure we keep our listener(s) fully engaged or they will drift offUse visuals, exercises, handouts, etc. to fill in the voids that words cannot possible do
65Research indicates that we can: Speak at 100 words per minute SummaryResearch indicates that we can:Speak at 100 words per minuteHear at 200 words per minuteThink at 600 words per minute
68Being an Effective Team QI Team Building The following material is from the text “Growing Teams” by G. Fetteroll, G. Hoffherr, and J. Moran, Goal/QPC, 1993
6916 Guidelines For Teams To Work Effectively Establish goals and objectives all team members acceptLet each team define its own standards of performanceAllow members to disagree in a constructive way to resolve problemsReview past actions when making plans for the futureMake decisions by consensusRemain cohesive and maintain a sense of unityStrive for synergyDevelop a comfortable working atmosphereUse physical space that is conducive to the team process
7016 Guidelines For Teams To Work Effectively Listen to each other and provide useful feedbackUse constructive criticism to facilitate group interactionAllow members to express their ideas fully and franklyRecognize individuals for the contribution they make within the teamAssist members when it ensures successful completion of team goalsHighly value creative approaches to problemsIncorporate flexibility in the team’s thoughts and action
71Roles and Responsibilities Sponsor:Set improvement project goalSelect the team leaderParticipate with the team leader to select team membersRemove barriersEmpowerMonitorReview progressHelp implement final improvement
72Roles and Responsibilities Facilitator:Keep the team on trackTrain if neededAssist the team leaderHelp overcome negative behaviorsImpartial observer – give the team constructive feedback
73Roles and Responsibilities Team Leader:Conducts the meetingsPrepares agendasParticipates actively in the team meetingsRepresents the team to managementFollows up on action items between meetingsSecures needed resources for the team
74Roles and Responsibilities Team Members:Give your undivided attentionTake responsibility for comprehendingListen to understand rather than to refuteControl your emotionsListen for the main ideas, not the detailsPut your mind to work
75Teaming“I not only use all the brains that I have, but all that I can borrow.”Woodrow Wilson
93Topics We Will Cover What is Responsibility Charting When do you use Responsibility ChartingKey DefinitionsThe Four-Step Process for Responsibility ChartingTips for Analyzing a Responsibility Chart
94ObjectivesDescribe the need for and benefits of having clearly defined roles and responsibilities within teamsAnalyze and develop an effective RACI chart
95So What is RACI Charting? A systematic and participative technique to:Identify all functions (activities, tasks, and decisions) that have to be accomplished for effective operationClarify roles and individual levels of participation in relation to each functionDevelop best methods for individuals to fill these rolesRACI charts are used in many situations to clarify roles and responsibilities. For example:After an event when the flow of work has been changed and the tasks have been modified or operations simplified.Gathering current state data on an operation to show where there are overlaps of responsibilities.Creating a future state for an operation or department with the new roles and responsibilities clearly stated.HR departments can use the output of a new RACI chart to define the job responsibilities of positions.
96Increased productivity through well defined accountability Therefore, with clear roles and responsibilities we should expect to see...Increased productivity through well defined accountabilityIncreased capacity by eliminating overlaps and redundanciesLess confusion/misunderstandings by encouraging teamworkStreamlined work process by eliminating unnecessary interfaces and assigning ‘accountability’ where it belongsImproved team effectiveness by allowing disciplines to cooperate and share responsibilitySome of the benefits of RACI charts.
97Unclear roles and responsibilities result in comments like these… “My team leader always overrules my recommendations whenever he/she wants”“The approval process for even the simplest item takes so long today”“It seems every department has someone putting together a spreadsheet on the same data”“Things are always slipping through the cracks”“I have the responsibility, but not the authority, to get the job done”We know none of these problems occur in our organization?!Clear roles and responsibilities can be identifiedthrough RACI charting
98RESPONSIBLE: Do The Job. Execute. R: ResponsibleA: AccountableC: ConsultI: InformThese are the individuals who actually complete the task or activity and are responsible for action and/or implementation.Responsibility is often shared, with each individual’s degree of responsibility determined by the individual with the “A”.More than one person can be responsible for doing a job or task.The “A” can also have an “R”
99ACCOUNTABLE: Make the decision. Take ultimate ownership. R: ResponsibleA: AccountableC: ConsultI: InformThis is the individual who carries the “yes” or “no” authority and has full veto power for an activity.It is important to clarify the levels of accountability and to distinguish between management accountability and operational accountability.Only one “A” can be assigned to a task or activity and authority must accompany accountability.The person with the “A” is the “go to” person if something is wrong, or, if going right, to recognize the efforts of the individual and the team they supervise.The “A” person is “where the buck stops” (quoting former President Harry Truman).Q: How many A’s should each task have?A: Every task must have one and only one ‘A’.
100CONSULT: Communication before. In the loop. R: ResponsibleA: AccountableC: ConsultI: InformThese are the individuals who must be consulted prior to a final decision or action.“Consult” implies two-way communication.The “C” person does not do the work, but must be consulted before it is implemented. This implies ownership of the activities and some measure of accountability although not formally.Only use a ‘C’ when the individual must be consulted. If consulting is optional, omit the ‘C’.
101INFORM: Need to know. Do not change the decision. R: ResponsibleA: AccountableC: ConsultI: InformThese are the individuals who need to be informed after a decision or action is taken because they, in turn, may take action or make a decision based on the output.“Inform” is FYI and implies only one-way communication.These are the people we “cc:” on our s.Try to reduce the number to a minimum of only those who actually need to know.Q? How much time do you spend every day deleting s without even reading them?Q? Do you know individuals who “group cc:” to a fault?When we construct a RACI chart we need to be aware of the overuse of the “I”
102The output RACI Matrix can initially look quite complex Roles of ParticipantsDecisionsorActivitiesBut it really isn’t. The following slides tell the story.RACI’s provide lots of information in a very simple format
103RACI Chart for Validating Open Position See for the Grading sub process next pageR = Responsible (execute)A = Accountable (Yes or No)C = Consulted beforeI = Informed After
104RACI Chart for the grading/regrading R = Responsible (execute)A = Accountable (Yes or No)C = Consulted beforeI = Informed After
105Determine the activities Prepare a list of functional roles The 4–Step ProcessDetermine the activitiesPrepare a list of functional rolesDevelop the RACI chartGet feedback and buy-in (validate)Activities along the “Y” axis from top to bottom; Roles on the top in the “X” orientation, usually with the highest ranking person to the left, moving “down” the org chart to the right.Don’t use people’s names on the chart – people move from job to job.Use the position or title.
106Guidelines for developing a RACI Chart (to-be) Remember new ‘culture’ philosophy when defining roles and responsibilities:Eliminate “checkers checking checkers”Encourage teamwork100% accuracy is not always requiredPlace ‘accountability’ (A) and ‘responsibility’ (R) at the lowest feasible levelThere can be only one accountability per activityAuthority must accompany accountabilityMinimize the number of ‘consults’ (C) and ‘informs’ (I)All roles and responsibilities must be documented and communicated (use team charter)First fill in the Rs – who does the work.Then fill in the As – those with the ultimate authority.Remember only one A per task.A position can have both the A and the RTry to place the A at the lowest reasonable level to minimize excessive sign-offs and levels of approval. It may mean we have to create templates and guidelines with limits of authority to insure small decisions can be made without too many approval levels.
107Obtain Feedback and “Buy–In” The RACI chart is shown to people that represent the functional roles on the chartThese individuals are asked for their input, and the RACI chart is revised as appropriateThe RACI chart may be validated in conjunction with the other products generated by the QI teamsThis is the validation process – our sanity check before implementing the changes.
108Common Errors‘RACI’ everything (instead of thinking about what is value-added)Do not take into account that people are trying to justify their jobsDo not eliminate the "coordinators & consolidators"Do not use enough ‘action’ verbs in constructing the “Activities” listDo not understand it will changeDo not consider "interface" issuesLearn about it in training and think they can do it without practiceRACI everything – sometimes it is simple enough to avoid doing a RACI – only use it if it adds value to the process, not just to do it.
109Let’s see what we know True False 1. If you have an "R“ (to someone else's "A") it becomes your "A“ in most cases.2. If you have the "A" that means you have no constraints or limits in your decisions…for that task.3. To ensure good communication in an organization, we should encourage many "consults" and "informs" on a task.4. It is quite common to see the VP in an area have the "Accountability" for a task, and an Operator to have the "R," so we should be okay with that.5. The structure of RACI allows even the most recent of Core / Process team members to successfully complete it.6. RACI is interesting as an exercise, but it doesn't help to eliminate the "non value-added" work/functions.7. When in doubt, give the "A" to the highest ranking individual in the room.FalseFalse – still have to work within the constraints of the business – not a free for all.False – not many – enough to cover the necessary bases. Too much red tapeFalse – Just because the VP is in the line up for a series of tasks, doesn’t mean he/she will always have the aFalse – needs training and practice! Easy to describe more difficult to implementFalse -False – Strive to push the Accountability as low into the organization as possible
113Before the first team meeting, the Team Leader should: Review the team charter and direction with the Team Sponsor*Clarify rolesDraft a planIdentify pertinent existing dataSet meeting logisticsDraft an agenda* Some organizations and Sponsors develop the team charter before the team comes together. Others see value in having team members define their own charter for greater empowerment.
114Create and Maintain a Team Charter A Team Charter provides the initial focus for a quality improvement project.This is an example of a simple team charter. This document should be drafted as one of the first activities when a team is created.The Team Charter is a living document and should be reviewed and modified to reflect the progress of the team through the different phases of the project.
115Goals for the first few meetings: Build relationships:Get to know each otherLearn to work as a teamWork out decision making issuesSet ground rulesUnderstand the project:Review the charterDevelop a work planIdentify stakeholdersLearn new tools and skills:The scientific approach (PDCA)Team behavioral skillsBasic quality tools
116The Team Meeting Cycle Conduct the Meeting Design the MeetingDevelop the agendaDesign the formatConduct the MeetingAgenda reviewDiscuss itemsID follow-up actionsEvaluate the meetingCarry out between meeting assignmentsCollect information needed to design the next meeting
123Follow the Communication Plan in your Team Charter Internal team communications according to ground rules (informal)Tollgate reviews with Sponsor, process owner and Senior Management (formal)Involvement of key stakeholders (formal and informal)Effective project management tools: (formal)Project deadlines, action items and trackerGantt chartMeeting minutes
124What is a Tollgate Review A Tollgate Review, as the name indicates, is like a checkpoint in an improvement project where the various team members meet with the Team Sponsor to determine whether the work has been performed as indicated in the project plan and whether the objectives planned have been achieved.
125Tollgate Review ToolsThe diagram below indicates how a tollgate review is carried out at the end of each stage. When the goals have not been met, activities within the stage need to be re-visited. For example, Check Sheets, Project Deliverables Document and List of Milestones.PlanTollgate ReviewDoCheckActStandardizeRead more:
126Tollgate PreparationTo ensure successful tollgate review outcome, it is important to conduct pre-review groundwork. This may involve the following:Ensuring all required attendees are informed of the review.Blocking time in everyone’s work-day for the duration of the review.Preparing a suitable presentation consisting of check sheets, milestone lists, etc. for review.Creating a structured agenda for the presentation.Read more:
128Gantt Charts A Gantt chart is a matrix diagram The vertical axis lists all the tasks to be performed for a projectEach row contains a single task identificationThe horizontal axis is headed by columns indicating estimated task duration in hours, days, weeks, months, etc., skill level needed to perform the task, and the name of the person assigned to the task, followed by one column for each period in the project's duration.128
131Gantt Chart Henry L. Gantt – WWI Franklin Arsenal 1910Progress ChartWork planned and accomplished are shown in the same spaceEmphasizes work movement through timeDeals with plans and progressHelps identify and eliminate obstaclesThe Gantt Chart – William Clark, The Ronald Press Co, NY 1922131
132Use Of Gantt Charts Establish order of tasks: Sequential and ParallelIdentify resources requirementsTiming of resource needsIdentify the critical pathMonitor the project “On-Time” ScheduleAlerts where remedial action is required
133Traffic Light Gantt Chart Task: City of XYZ HD29-Feb7-Mar14-Mar21-Mar28-MarFinalize assessment analysisXGain consensus on prioritiesIdentify comm. with elected off.Plan PHF consultant visitSet agenda and travel scheduleCity HD/PHF PI meetingOn ScheduleWatchLate or at RiskUse Excel to build itHelps make projections on potential progresshighlights potential problemsVery Visual133
134Communication Activity Time allotted: 20 minutesIn your QI teams, identify:Team SponsorProcess OwnerKey StakeholdersCore team membersDraft a timeline for communicating team progress with each of the above individuals.Identify the communication subject and choose either formal or informal format.Be prepared to share your thoughts with others.
137Audience AnalysisDefinition: Study that describes the nature of the worker or students.Who are they?What do they already know?Are they confident?Have they volunteered to participate?How many are in the target population?Are they local or remote?What kinds of technology support are available to them?Are their managers interested in this topic?Are their managers supportive of their career growth?
138Analyzing the training needs Definition: Study to design and develop instructional and informational programs and materials.After the performance analysis has determined that training or informational materials are indeed appropriateNeeds assessments involve:Subject matter studyAudience analysisDetermination of prerequisite skills and attitudesError and work product examinationResolution of disagreements among expertsDefinition of the details that drive training approaches
139Activity: Describe your audience Time allotted: 15 minutesAssume that you have been asked to facilitate an improvement project in your own local HDAnswer as best you can the questions on the audience analysis slide using your HD colleagues as the “target population.”How would you estimate the skill and attitude level of your LHD colleagues in QI tools and techniques? Entry, Working Knowledge, Advanced?Be prepared to share your assumptions with the class.
142Building the agenda and materials exercise Time allotted: 40 minutesUsing all the materials and activity output from the last session and this session:Draft an agenda for training your Health Department on QI tools and techniques.List the materials you will use to introduce and reinforce the lessons you share with the students.Be prepared to share your agenda items and material suggestions with your class mates.
148Organizational Wisdom on Improvement and Change Understand the history behind the current culture.Don’t tamper with systems, improve them.Be prepared to listen and observe.Involve everyone affected by the change in making it.