Presentation on theme: "Conflict of Interest Declaration"— Presentation transcript:
1 Conflict of Interest Declaration We declare that we have no conflict of interest linked to the work presented.
2 High-Impact Leadership 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; Available on
3 New Mental Models “Volume” “Value” Patient Satisfaction Increase Top Line RevenueComplex All-Purpose Hospitals and FacilitiesQuality Departments and Experts“Value”Persons as Partners in their CareContinuously Decrease Per Unit CostCare Organized by Business ModelQuality in Daily Work-Everyone
4 High-Impact Leadership Behaviors 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; Available on
8 Why is Change So Hard?Culture Lack of Shared Vision Misaligned Expectations No Urgency Ineffective Leadership
9 Compact Expectations members of an organization have that are: Unstated yet understoodReciprocalThe giveThe getMutually beneficialSet up & reinforced by society and the organization9
10 Clash of “Promise” and Imperatives Traditional “Promise”Legacy ExpectationsImperativesImprove safety/qualityImplement EHRCreate service experienceBe patient-focusedImprove accessImprove efficiencyRecruit/retain quality staffAutonomyProtectionEntitlement10
11 Vision Is Context for Compact Societal needsLocal marketCompetitionOrganization’s strengthsPhysicians give:What the organization needs to achieve the visionOrganization gives:What helps physicians meet commitmentWhat is meaningful to physiciansSTRATEGIC VISION
12 Virginia Mason Medical Center Physician Compact Organization’s ResponsibilitiesFoster ExcellenceRecruit and retain superior physicians and staffSupport career development and professional satisfactionAcknowledge contributions to patient care and the organizationCreate opportunities to participate in or support research Listen and CommunicateShare information regarding strategic intent, organizational priorities and business decisionsOffer opportunities for constructive dialogueProvide regular, written evaluation and feedbackEducateSupport and facilitate teaching, GME and CMEProvide information and tools necessary to improve practice RewardProvide clear compensation with internal and market consistency, aligned with organizational goalsCreate an environment that supports teams and individualsLeadManage and lead organization with integrity and accountability Physician’s ResponsibilitiesFocus on PatientsPractice state of the art, quality medicineEncourage patient involvement in care and treatment decisionsAchieve and maintain optimal patient accessInsist on seamless serviceCollaborate on Care DeliveryInclude staff, physicians, and management on teamTreat all members with respectDemonstrate the highest levels of ethical and professional conductBehave in a manner consistent with group goalsParticipate in or support teachingListen and CommunicateCommunicate clinical information in clear, timely mannerRequest information, resources needed to provide care consistent with VM goalsProvide and accept feedbackTake OwnershipImplement VM-accepted clinical standards of careParticipate in and support group decisionsFocus on the economic aspects of our practiceChangeEmbrace innovation and continuous improvementParticipate in necessary organizational change
13 The VMMC Quality Equation Q = A × (O + S)WQ: Quality A: Appropriateness O: Outcomes S: Service W: Waste
15 World-Class Management Daily Management:Leaders Have Two JobsRun your businessImprove your businessDaily ManagementSo what is Daily Management? It is what leaders are doing everyday and how they act every day to meet customer demand and identify and solve problems with their team.Know at a glance status of daily workCompleting planned workUnderstand status of upstream and downstream processesVariance from standard work and causesWhat action to take when variance occurs (countermeasures)Engage the staff to take action
16 The FIVE Principle Elements of Daily Management (Standard Work for Leaders) Visual ControlsCreate linked visual systems that drive actionDaily Accountability ProcessEstablish rounding process at all levelsLeader Standard WorkLeaders routinely complete key activities necessary to run and improve their businessDisciplineLeaders consistently verify the health of processes and systemsRoot Cause AnalysisAsking “why” and using data and analysis to attack problemsThisOr ThisAs we looked at these metrics, and went back to our Toyota training and readings to see what we were missing, we realized that we had tacked the tools and methods from Toyota onto our existing management methods. Emphasis on plural as we had as many methods as we had managers. No wonder our managers were telling us that they were too busy to do their improvement work. We hadn’t fundamentally changed how we were running our organization. And we certainly weren’t all doing our work as leaders in a standardized way.What we learned when we went back to our training is that we had neglected to understand the importance of having all of the components of what Toyota calls a “world class management system” in place in order to allow us to create an environment where we could both make the improvements and sustain them.
17 Leaders’ Role in Signal Generation “Leaders are signal generators who reduce uncertainty and ambiguity about what is important and how to act.”Charles O’Reilly IIIThisOr ThisAs we looked at these metrics, and went back to our Toyota training and readings to see what we were missing, we realized that we had tacked the tools and methods from Toyota onto our existing management methods. Emphasis on plural as we had as many methods as we had managers. No wonder our managers were telling us that they were too busy to do their improvement work. We hadn’t fundamentally changed how we were running our organization. And we certainly weren’t all doing our work as leaders in a standardized way.What we learned when we went back to our training is that we had neglected to understand the importance of having all of the components of what Toyota calls a “world class management system” in place in order to allow us to create an environment where we could both make the improvements and sustain them.
18 “Distress” and Adaptive Work DisequilibriumLimit of toleranceAdaptive challengeProductive range of distressThreshold of learningTimeHeifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, 2002, p 108
19 VMPS Standard Work for Leaders CEOBoardCOOBoardVPBoardADBoardDirectorBoardSupervisor BoardFront LineBoard
25 Ongoing Challenges - Culture Patient FirstBelief in Zero DefectsProfessional Autonomy“Buy In”“People are Not Cars”Pace of ChangeVictimizationLeadership ConstancyRigor, Alignment, ExecutionDrive for Results
29 Cincinnati Children’s (Fiscal 2013) Registered beds 598 Operating revenue $1.9 billion Employees 13,852; 97 nationalities Research grants $158 million Locations 16 Patients from 50 states; 53 countries Department of Pediatrics for the University of Cincinnati College of Medicine
31 Tressel Fragile System Transparency 5TresselFragile System15 years of intense work improving quality and safety34% decrease in hospital-wide mortality43% decrease in ICU mortalityTransparencyWith familiesWith employeesWith other institutionsWith the outside worldWe need to be able to talk about these things
32 Requirements to Create a Culture of Quality and Safety 6Requirements to Create a Culture of Quality and SafetyVision: Take time to develop it thoughtfully Plans: Focus on what needs to be done, not on trailing results, like financial results Consistent message: Consistent behavior, even when there is increased risk Management process that delivers sustainable outcomes
33 Our Vision: To be the leader in improving child health 7Our Vision: To be the leader in improving child healthIf we can deliver outstanding results in some areas, why not all?What results are we delivering?How are we measuring them?
35 Business Units: Participants 9Business Units: ParticipantsPhysician, nursing and business leadersShared objectivesSingle budgetAccess to senior leadership teamPredictable, recurring meetings
36 Business Units: Template Reports 10Business Units: Template ReportsFinancialActivity over time expressed in numbersHolistic view as a framework for changeNon-financialHow will we be safer, more accessible, patient-centered, innovative?Focused attention on transformation
37 Other Tools Real time data Strategic planning Transparency 11Other ToolsReal time dataStrategic planningTransparencyHigh-reliability systemsLearning from other high-risk industries
38 12Final ThoughtsEach part of the organization must perform well for the whole organization to perform to potentialOrganizational structure reflects prioritiesMechanisms must be hard-wired, predictable and must foster agilityInstitutionalize boundaryless thinking, risk taking, transparency, small tests of changeInstitution needs a shared, compelling vision and high aspirations
39 Creating a Culture of Excellence Michael J. DowlingPresident & Chief Executive OfficerNorth Shore-LIJ Health SystemParis, FranceApril 2014
41 The System Today Partnerships Clinical Enterprise Educational EnterpriseResearch EnterpriseInsurance Enterprise “CareConnect”Community Health EnterpriseInpatient facilitiesAmbulatory / outpatientLong Term / Home CareHospiceJoint venturesGME / CMEMedical School / ElmezziCLIDiscoveriesPublicationsClinical trialsRiskCapitation – Bundled paymentsProduct offeringsJoint product offeringsEmployer productsPopulation healthCommunity benefitAccess and education programsVeterans’ programsChildren’s programsPartnerships
42 An Integrated SystemLargest provider of health care in NY State – one of the largest employersMajor academic teaching centerMajor commitment to research – The Feinstein InstituteSingle governance – not just a collection of distinct, individual entitiesAdministratively and clinically integrated; Service Line approach to care deliverySingle system-wide management – clinical and administrativeDensely populated; competitive and diverse environmentProvides full continuum of carePossesses insurance license and capabilities to take risk and sell products
45 Behavioral Expectations: Core Competency Model Individual ContributorTeam LeaderOperational/Strategic LeaderCompetency #1Execution: Displays technical and functional expertise. Takes ownership of work, structures job tasks and maintains appropriate pace in handling multiple deadlines to achieve excellence by:Behavioral DemonstrationCompleting assigned tasks accurately and within established timeframes and budget, and adopting a resourceful and results-driven approach.Ensuring team performance in achieving excellence through organizing resources, adjusting for complexities, measuring results, and planning for improvements.Creating a culture of excellence and accountability through motivation of talent, translation of strategy into reality, exercising sound judgment, and aligning communication, people, processes and resources.Competency #2Organizational Awareness: Understands how to overcome obstacles and ably works through the realities of a large healthcare organization. Applies best approaches to achieve business goals by:Collaborating with peers, managers and internal/external customers to solve problems in formal and informal settings and within the guidelines of key policies and practices.Displaying superior understanding of group behavior and organizational politics, culture and operations, and exhibiting strong decision-making skills that align to key business priorities and objectives.Understanding the competition, creating solid cross-functional partnerships, and successfully navigating the organization’s culture to obtain the buy-in necessary to drive critical business outcomes.
46 Individual Contributor Operational/Strategic Leader Team LeaderOperational/Strategic LeaderCompetency #3Enable Change: Willingly adapts to shifting business needs and seeks opportunities to champion new processes and ideas. Anticipates and responds to change to improve work outcomes by:Behavioral DemonstrationSeeking and acting on feedback to identify improvement opportunities, displaying enthusiasm for expanding one’s knowledge and scope, and thinking differently to find new solutions.Regularly offering feedback, analyzing successes and failures to identify improvement opportunities, and planning for and creating avenues to implement process enhancements within the team.Creating a climate that embraces new and different solutions, removing barriers that limit change, maintaining a global line of sight, and gaining commitment and partnership from others to execute change plans.Competency #4Developing Self: Takes consistent action to increase knowledge and skills. Embraces challenging assignments and seeks learning opportunities to enhance performance by:Exercising self-accountability for becoming a subject matter expert within one’s own job role, seeking performance-related feedback, and identifying learning opportunities to explore with one’s manager.
47 Behavioral Expectations: Core Leadership Competency Model Team LeaderOperational/Strategic LeaderLeadership Competency #1Managerial Courage: Acts with conviction to make the right decisions for the right reasons. Exercises sound judgment and takes action to preserve the integrity of the organization by:Behavioral DemonstrationAdhering to a strict ethical and moral code in all business decisions and dealings with people, delivering critical messages honestly and effectively, displaying the ability to make difficult decisions in a timely manner, rewarding those who display desirable behaviors, and holding direct reports accountable for poor performance. Also ensures direct reports are compliant with mandatory trainings, educational processes and system initiatives.Empowering and standing behind direct reports and others to make ethical decisions, removing political barriers that may limit or prevent positive change, and implementing practices to ensure that employees in assigned area(s) are held accountable for their behavior and performance at all levels. Additionally ensures all employees in area(s) of responsibility comply with mandatory training, educational requirements and system initiatives.Leadership Competency #2Motivating and Inspiring Others: Leverages and embraces diversity and shares wins and successes. Motivates and energizes others to achieve high-level results by:Celebrating the efforts and achievements of individuals and teams, creating a feeling of belonging within the team, conveying confidence in the ability of others to make valuable contributions, and ensuring that team members have the skills, support and resources necessary to produce the desired results. Also ensures direct reports are rewarded/recognized for good performance, and that, when appropriate, consequences are delivered to drive the right behaviors.Creating opportunities to promote team successes at department and system levels, managing with an “open door” policy, ensuring assigned area(s) understand how each contributes to the larger goals of the organization, and continuously taking inventory to ensure assigned area(s) are equipped with the resources necessary to achieve superior results. Additionally empowers leaders in area(s) of responsibility to reward employees for good performance and to deliver consequences, as appropriate, to drive the right behaviors.
48 Operational/Strategic Leader Team LeaderOperational/Strategic LeaderLeadership Competency #3Strategic Agility: Seeks opportunity to gain/share expertise with other areas to create innovative strategies. Exercises both narrow and broad perspective to ensure business success by:Behavioral DemonstrationDemonstrating complete understanding of department’s workflow, operations and necessary skill sets, leveraging the talents of the team to brainstorm and anticipate future consequences and solutions, and partnering with other areas to share knowledge and influence strategy development outside of normal defined scope.Ensuring operations of assigned area(s) align with the larger organizational goals, establishing formal and informal processes for high performers to become involved in cross-organizational improvement efforts, and leveraging connections with other organizational leaders to develop and execute breakthrough strategies that impact organizational operations on multiple levels.Leadership Competency #4Developing Others: Continuously seeks opportunity to develop the capabilities of others. Provides challenging stretch assignments and tasks to enhance departmental performance by:Holding frequent performance and development discussions with direct reports, providing diverse opportunities for team participation in projects outside of normal defined scope, and shaping team roles to leverage skills, build capabilities and foster team collaboration.Developing high performers through mentorship and coaching, creating opportunities for joint problem-solving and cross-functional learning through shared projects, and embracing feedback for one’s own improvement.
49 Behavioral Expectations: Core Values Individual ContributorTeam LeaderOperational/Strategic LeaderCore Value #1Customer Experience: Addresses the needs of customers to exceed expectations by:Behavioral DemonstrationBuilding relationships with customers while understanding and reacting to their concerns and expectations daily.Maintaining relationships with customers and developing practices to ensure customer satisfaction within assigned area.Expanding departmental relationships with customers and identifying opportunities to increase customer satisfaction through cross-department collaboration.Core Value #2Integrity: Acts honestly and ethically to promote excellence at all levels by:Respecting others at all times, serving as a role model, and adhering to privacy and confidentiality practices.Leading by example, protecting confidentiality, and ensuring all team members are empowered to make decisions in the best interests of the organization.Acting as a leader of leaders to ensure assigned area(s) are held accountable for acting in the best interests of the organization at all times.Core Value #3Excellence: Promotes quality in work performance to achieve business outcomes by:Producing results of the highest standards while demonstrating passion for the job, function, department and organization.Ensuring the team collaboratively produces results of the highest standards and fostering a work environment that recognizes and celebrates successes.Ensuring assigned area(s) produce results of the highest standards and identifying/executing opportunities to bring quality to the next level.
50 Individual Contributor Operational/Strategic Leader Team LeaderOperational/Strategic LeaderCore Value #4Teamwork: Inspires others to work together to achieve organizational goals by:Behavioral DemonstrationHelping others to succeed and collaborating to identify and solve problems with the whole team.Helping direct reports and others succeed through team-building, mentoring, coaching and fostering an environment of workforce engagement.Helping those in assigned area(s) to succeed through mentoring and creating practices and processes that reinforce teamwork and engagement at every level.Core Value #5Caring: Demonstrates empathy toward others to promote an environment of trust by:Treating everyone with compassion and sincerity regardless of background, appearance or orientation.Fostering two-way dialogue with customers and direct reports to explore concerns and ideas, and creating a work atmosphere where each employee feels valued.Establishing practices to ensure a workplace and customer environment where all individuals feel confident that their concerns and ideas will be heard and addressed.Core Value #6Innovation: Generates creative solutions to positively impact business goals by:Displaying openness to and suggesting new ideas, challenging the status quo, and respecting the creative influence of others.Encouraging the formation of new ideas and promoting an environment where impactful suggestions are recognized and considered for implementation.Establishing a work environment that welcomes new ideas and assisting assigned area(s) with implementation of ideas through use of leadership and influence.
51 Making the Workforce Your Competitive Advantage Leadership LoyaltyEnsuring leadership is accessible and loyal to our employeesRecognize ValueDisplay CaringWorkforceEngagement:Creating a multi-dimensional,trust-based relationshipwith the workforceRecognizing the value of the workforceCaring for all workforce members and their familiesProvide GrowthProviding opportunities for growth and developmentSolicit FeedbackSoliciting input from the workforce & involving employees in collaborative decision-makingRespect DiversityPromote inclusionTwo-Way CommunicationOffer ReinforcementPerformanceManagementClear communication channels between managers and employeesHow each employee’s work contributes to the organization’s goalsLinking vision, goals and values to individual performance
52 The Center for Learning & Innovation: Organizational Structure ORGANIZATIONAL DEVELOPMENTBEGINNINGSLEADERSHIP DEVELOPMENTCOACHINGWORKFORCE DEVELOPMENTCHANGE MANAGEMENT FACILITATIONCUSTOMIZED SESSIONSPATIENT SAFETY INSTITUTESIMULATION BASED EDUCATIONINTER-PROFESSIONAL TEAM EDUCATIONCLINICAL SKILLS EDUCATIONEDUCATIONAL RESEARCHPHYSICIAN LEADERSHIP INSTITUTEPHYSICIAN BEGINNINGSDEPARTMENT SPECIFIC EDUCATIONDEPARTMENT TEAM BUILDINGCLINICAL EDUCATION AT PATIENT SAFETY INSTITUTESCHOLAR PIPELINEADMINISTRATIVE FELLOWSHIPSMEDICAL SCHOLARS PIPELINE PROGRAMNEW YORKERS FOR CHILDREN PROGRAMINSTITUTE FOR HEALTH PROFESSIONSIS 59 PARTNERSHIPDOMESTIC AND INTERNATIONAL INTERNSHIPSEMERGENCY MEDICAL INSTITUTEPARAMEDICEMERGENCY MEDICAL TECHNICIANADVANCED EMTAEMT & EMT RECERTIFICATIONACLS/BLSCONTINUING MEDICAL EDUCATIONHOFSTRA NORTH SHORE LIJ SCHOOL OF MEDICINEEVALUATION AND ASSESSMENTCLINICAL SIMULATIONBIOSKILLS EDUCATION CENTERATTENDING AND RESIDENT PHYSICIAN PROGRAMSHYBRID SIMULATIONVENDOR SPONSORED PROGRAMSCLINICAL TRANSFORMATIONLEAN / SIX SIGMA PROGRAMPROGRAM / PROJECT MANAGEMENTEHR CONTENT DEVELOPMENTCLINICAL COLLABORATIVESINDUSTRIAL ENGINEERING
53 How Leadership is Built: Leadership Capabilities In order for education to make a business impact, it needs to focus on the four core elements of learning. The Business needs to design educational processes that help build capabilities that drive change with knowledge, actions, beliefs and networks.KnowledgeWhat do people need to know that is different?ActionsWhat do people need to do that is different?BeliefsWhat do people need to believe that is different?NetworksWhat networks need to be different?Self awarenessTeam leadership toolsStrategic thinkingInfluencing and network techniquesInnovation toolsLead high performing teamsDemonstrate increased self awareness of strengths and potential derailersDrive strategy development and market knowledgeLeadership’s impact on strategic results and valueEngagement and play to your strengthsDrive the industry, company and self forwardCollaborative medicineProgram participants and alumniSupport teams and resources
54 12 Principles of Leadership Be authentic, accountable and caringBe humble and recognize the power of teamEnergize your culture every dayPaint the pictureCreate systems behind the smilesBe positive and enthusiasticGrow talent including your ownCommunicate and engageFoster an environment of low fear and high trustCelebrate innovation and risk takingRecognize, recognize, recognizeEthics are everything
55 A Sample of Specific Strategies BeginningsSelection, recruitment, on-boardingSetting expectations earlyTalent development and managementCreating multiple opportunities for learning and growthIdentification of emerging leaders and high potentialsFocus on opportunities at all levels of the organization, not just the topSuccession planningCross-fertilize and promote transparency
56 Maximize the use of simulation Real life experiences that enhance teamwork, communication and skillEngagement and inputAllow free flow of ideas from all parts of the organizationRecognition and rewardFeedback – closing the loop
57 “Perfection is not attainable, but if we chase perfection we can catch excellence.”-Vince Lombardi