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Conflict of Interest Declaration

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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 Revenue Complex All-Purpose Hospitals and Facilities Quality Departments and Experts “Value” Persons as Partners in their Care Continuously Decrease Per Unit Cost Care Organized by Business Model Quality 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

5 High Impact Leadership

6 “If you are dreaming about it… you can do it.”
Sensei Chihiro Nakao


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 understood Reciprocal The give The get Mutually beneficial Set up & reinforced by society and the organization 9

10 Clash of “Promise” and Imperatives
Traditional “Promise” Legacy Expectations Imperatives Improve safety/quality Implement EHR Create service experience Be patient-focused Improve access Improve efficiency Recruit/retain quality staff Autonomy Protection Entitlement 10

11 Vision Is Context for Compact
Societal needs Local market Competition Organization’s strengths Physicians give: What the organization needs to achieve the vision Organization gives: What helps physicians meet commitment What is meaningful to physicians STRATEGIC VISION

12 Virginia Mason Medical Center Physician Compact
Organization’s Responsibilities Foster Excellence Recruit and retain superior physicians and staff Support career development and professional satisfaction Acknowledge contributions to patient care and the organization Create opportunities to participate in or support research  Listen and Communicate Share information regarding strategic intent, organizational priorities and business decisions Offer opportunities for constructive dialogue Provide regular, written evaluation and feedback Educate Support and facilitate teaching, GME and CME Provide information and tools necessary to improve practice  Reward Provide clear compensation with internal and market consistency, aligned with organizational goals Create an environment that supports teams and individuals Lead Manage and lead organization with integrity and accountability  Physician’s Responsibilities Focus on Patients Practice state of the art, quality medicine Encourage patient involvement in care and treatment decisions Achieve and maintain optimal patient access Insist on seamless service Collaborate on Care Delivery Include staff, physicians, and management on team Treat all members with respect Demonstrate the highest levels of ethical and professional conduct Behave in a manner consistent with group goals Participate in or support teaching Listen and Communicate Communicate clinical information in clear, timely manner Request information, resources needed to provide care consistent with VM goals Provide and accept feedback Take Ownership Implement VM-accepted clinical standards of care Participate in and support group decisions Focus on the economic aspects of our practice Change Embrace innovation and continuous improvement Participate in necessary organizational change

13 The VMMC Quality Equation
Q = A × (O + S) W Q: Quality A: Appropriateness O: Outcomes S: Service W: Waste

14 Our current management system?
© DC Comics

15 World-Class Management
Daily Management: Leaders Have Two Jobs Run your business Improve your business Daily Management So 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 work Completing planned work Understand status of upstream and downstream processes Variance from standard work and causes What 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 Controls Create linked visual systems that drive action Daily Accountability Process Establish rounding process at all levels Leader Standard Work Leaders routinely complete key activities necessary to run and improve their business Discipline Leaders consistently verify the health of processes and systems Root Cause Analysis Asking “why” and using data and analysis to attack problems This Or This As 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 III This Or This As 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
Disequilibrium Limit of tolerance Adaptive challenge Productive range of distress Threshold of learning Time Heifetz, Ronald A. and Marty Linsky. Leadership on the Line, Harvard Business School Press, 2002, p 108

19 VMPS Standard Work for Leaders
CEO Board COO Board VP Board AD Board Director Board Supervisor Board Front Line Board

20 Effective Sponsorship
Vision of success Set stretch goal Provide resources Remove barriers “Fail forward fast” Celebrate achievements

21 Genchi Genbutsu “It’s all lies” Go where the action is
Know your people and let them know you Vulnerability is ok Connect the dots

22 Managerial Courage It will be worth it Patients and staff depend on it
Leading change is hard work Skeptics can become champions

23 Flu Vaccination “Fitness for Duty”
Do we put patient first? Compelling science Staff resistance Staying the course Organizational Pride

24 VMMC Influenza Vaccination Rates

25 Ongoing Challenges - Culture
Patient First Belief in Zero Defects Professional Autonomy “Buy In” “People are Not Cars” Pace of Change Victimization Leadership Constancy Rigor, Alignment, Execution Drive for Results

26 Copyright © 2009 Virginia Mason Medical Center. All Rights Reserved.
“In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.” Eric Hoffer Copyright © 2009 Virginia Mason Medical Center. All Rights Reserved.

27 Creating a Culture of Quality and Safety
Making Excellence a Way of Life James M. Anderson President and CEO,

28 2

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

30 4 Video

31 Tressel Fragile System Transparency
5 Tressel Fragile System 15 years of intense work improving quality and safety 34% decrease in hospital-wide mortality 43% decrease in ICU mortality Transparency With families With employees With other institutions With the outside world We need to be able to talk about these things

32 Requirements to Create a Culture of Quality and Safety
6 Requirements to Create a Culture of Quality and Safety Vision: 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
7 Our Vision: To be the leader in improving child health If we can deliver outstanding results in some areas, why not all? What results are we delivering? How are we measuring them?

34 8 Creating a Culture

35 Business Units: Participants
9 Business Units: Participants Physician, nursing and business leaders Shared objectives Single budget Access to senior leadership team Predictable, recurring meetings

36 Business Units: Template Reports
10 Business Units: Template Reports Financial Activity over time expressed in numbers Holistic view as a framework for change Non-financial How will we be safer, more accessible, patient-centered, innovative? Focused attention on transformation

37 Other Tools Real time data Strategic planning Transparency
11 Other Tools Real time data Strategic planning Transparency High-reliability systems Learning from other high-risk industries

38 12 Final Thoughts Each part of the organization must perform well for the whole organization to perform to potential Organizational structure reflects priorities Mechanisms must be hard-wired, predictable and must foster agility Institutionalize boundaryless thinking, risk taking, transparency, small tests of change Institution needs a shared, compelling vision and high aspirations

39 Creating a Culture of Excellence
Michael J. Dowling President & Chief Executive Officer North Shore-LIJ Health System Paris, France April 2014

40 North Shore-LIJ Health System

41 The System Today Partnerships Clinical Enterprise
Educational Enterprise Research Enterprise Insurance Enterprise “CareConnect” Community Health Enterprise Inpatient facilities Ambulatory / outpatient Long Term / Home Care Hospice Joint ventures GME / CME Medical School / Elmezzi CLI Discoveries Publications Clinical trials Risk Capitation – Bundled payments Product offerings Joint product offerings Employer products Population health Community benefit Access and education programs Veterans’ programs Children’s programs Partnerships

42 An Integrated System Largest provider of health care in NY State – one of the largest employers Major academic teaching center Major commitment to research – The Feinstein Institute Single governance – not just a collection of distinct, individual entities Administratively and clinically integrated; Service Line approach to care delivery Single system-wide management – clinical and administrative Densely populated; competitive and diverse environment Provides full continuum of care Possesses insurance license and capabilities to take risk and sell products

43 We’re With You Every Step of the Way

44 North Shore-LIJ Culture Blueprint

45 Behavioral Expectations: Core Competency Model
Individual Contributor Team Leader Operational/Strategic Leader Competency #1 Execution: 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 Demonstration Completing 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 #2 Organizational 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 Leader Operational/Strategic Leader Competency #3 Enable 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 Demonstration Seeking 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 #4 Developing 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 Leader Operational/Strategic Leader Leadership Competency #1 Managerial 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 Demonstration Adhering 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 #2 Motivating 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 Leader Operational/Strategic Leader Leadership Competency #3 Strategic 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 Demonstration Demonstrating 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 #4 Developing 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 Contributor Team Leader Operational/Strategic Leader Core Value #1 Customer Experience: Addresses the needs of customers to exceed expectations by: Behavioral Demonstration Building 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 #2 Integrity: 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 #3 Excellence: 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 Leader Operational/Strategic Leader Core Value #4 Teamwork: Inspires others to work together to achieve organizational goals by: Behavioral Demonstration Helping 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 #5 Caring: 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 #6 Innovation: 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 Loyalty Ensuring leadership is accessible and loyal to our employees Recognize Value Display Caring Workforce Engagement: Creating a multi-dimensional, trust-based relationship with the workforce Recognizing the value of the workforce Caring for all workforce members and their families Provide Growth Providing opportunities for growth and development Solicit Feedback Soliciting input from the workforce & involving employees in collaborative decision-making Respect Diversity Promote inclusion Two-Way Communication Offer Reinforcement Performance Management Clear communication channels between managers and employees How each employee’s work contributes to the organization’s goals Linking vision, goals and values to individual performance

52 The Center for Learning & Innovation: Organizational Structure

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. Knowledge What do people need to know that is different? Actions What do people need to do that is different? Beliefs What do people need to believe that is different? Networks What networks need to be different? Self awareness Team leadership tools Strategic thinking Influencing and network techniques Innovation tools Lead high performing teams Demonstrate increased self awareness of strengths and potential derailers Drive strategy development and market knowledge Leadership’s impact on strategic results and value Engagement and play to your strengths Drive the industry, company and self forward Collaborative medicine Program participants and alumni Support teams and resources

54 12 Principles of Leadership
Be authentic, accountable and caring Be humble and recognize the power of team Energize your culture every day Paint the picture Create systems behind the smiles Be positive and enthusiastic Grow talent including your own Communicate and engage Foster an environment of low fear and high trust Celebrate innovation and risk taking Recognize, recognize, recognize Ethics are everything

55 A Sample of Specific Strategies
Beginnings Selection, recruitment, on-boarding Setting expectations early Talent development and management Creating multiple opportunities for learning and growth Identification of emerging leaders and high potentials Focus on opportunities at all levels of the organization, not just the top Succession planning Cross-fertilize and promote transparency

56 Maximize the use of simulation
Real life experiences that enhance teamwork, communication and skill Engagement and input Allow free flow of ideas from all parts of the organization Recognition and reward Feedback – closing the loop

57 “Perfection is not attainable, but if we
chase perfection we can catch excellence.” -Vince Lombardi

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