High Impact Leadership –Safety First Understanding The System, its Influence on Patient Safety and The Leadership Framework to Manage it Successfully David Munch M.D. IHI Faculty Chief Clinical Officer Healthcare Performance Partners

The Cycle of Excellence Design Deploy Sustain -True North -Scientific Method -Training -Feedback (Requires Metrics) -Coaching -Establish Standard Work -Management Systems -Problem Solving -Situational Awareness -Maintain Standard Work Leadership & Improvement Team Management & Operations

˜ Understanding Complex Systems

Dr. W. Edwards Deming: System of Profound Knowledge Appreciation for a System Understanding Variation Theory of Knowledge Psychology “The various segments of the system of profound knowledge cannot be separated. They interact with each other.”

Appreciation for a System A system is an interdependent group of items, people and processes with a common aim. All work is done through processes Every system is perfectly designed to achieve exactly the results it gets. If each part of a system, considered separately is made to operate as efficiently as possible, then the system as a whole will not operate as effectively as possible People are a key part of systems in organizations: they want to do a good job and take pride in their work.

Leading Functional and Front Line Teams Manage the Work Improve the Work Shape Team Culture Leading and Managing Excellence in a System Get Results and Sustain Them Manage Time & Resources Create Standard Work & Process: Including your own Measure: Financial, Quality, Customer, Key Process Surface and Solve Problems in Real Time Engage Across Boundaries Prioritize and Align to Strategy and Aims Understand Current State, Cause and Target Condition Learn and use improvement tools to Redesign Process Reduce Variation and Waste Build Team Capability Promote Transparency Create Vision & Build Will Model the Way—High-Impact Behaviors Put the Person at the Center Develop Competency through Coaching Manage Delegation: Use the Entire Team Communicate Effectively Establish Respect and Accountability

Where is the Abnormality?

Seeing Your Problems Now, where is the abnormality?

You cannot see the abnormal until you have defined the normal

Questions to ponder How do you distinguish between a variation and a defect? What defines a problem? If you have no standards, you have no problems. If you have no problems, you have a big problem.

Mitigation includes knowing normal from abnormal right now and responding immediately. Responding to Problems Time Harm or Damage Determining Cause High Low Defect: E.g.. Adverse Event Probability

Engage Across Boundaries: The Hospital system Governance Therapies Leadership Supply Chain Transition Evaluation Management HR: Recruiting & Training Care Design Entry Staff Information Systems Financial Systems Drivers The Patient Support

Engage Across Boundaries The Health System Governance Outpatient Leadership Supply Chain Inpatient Home- Family Management HR Recruiting & Training Care Design Community The Care Team Information Systems Financial Systems Drivers The Patient Support Care Team PhysicianPharmacist Nurse & Adv. Pract. Social Worker Care Manager & Navigator

Leading Functional and Front Line Teams Manage the Work Improve the Work Shape Team Culture Leading and Managing Excellence in a System Get Results and Sustain Them Manage Time & Resources Create Standard Work & Process: Including your own Measure: Financial, Quality, Customer, Key Process Surface and Solve Problems in Real Time Engage Across Boundaries Prioritize and Align to Strategy and Aims Understand Current State, Cause and Target Condition Learn and use improvement tools to Redesign Process Reduce Variation and Waste Build Team Capability Promote Transparency Create Vision & Build Will Model the Way—High-Impact Behaviors Put the Person at the Center Develop Competency through Coaching Manage Delegation: Use the Entire Team Communicate Effectively Establish Respect and Accountability

Aim Statement: Increase the percentage of neurologically intact, non-traumatic, out-of-hospital Ventricular Fibrillation (VF) cardiac arrest (OHCA) adult patient survivals by 10% by June 30, 2013 by: Increasing the number of OHCA patients who receive dispatcher assisted CPR to 50% of cases Increasing bystander/layperson CPR to 50% of witnessed arrests Implementing team-based resuscitation for on 80% of OCHA patients with resuscitations attempted. High quality CPR with minimum interruptions is performed for 85% of all OHCA cases.

Combine with A3 Thinking What is the problem we actually have (not perceive)? What are the causes of the problem? – Why is the defect occurring? – How do the parts relate to the whole? – How does the system influence the problem? What are we going to do to fix the problem? – Repeated cycles of A3 thinking – Note: Are we fixing the problem or putting a Band-Aid on it? How will we know our changes are effective? What systems and structures will be establish to support and sustain?

Leading Functional and Front Line Teams Manage the Work Improve the Work Shape Team Culture Leading and Managing Excellence in a System Get Results and Sustain Them Manage Time & Resources Create Standard Work & Process: Including your own Measure: Financial, Quality, Customer, Key Process Surface and Solve Problems in Real Time Engage Across Boundaries Prioritize and Align to Strategy and Aims Understand Current State, Cause and Target Condition Learn and use improvement tools to Redesign Process Reduce Variation and Waste Build Team Capability Promote Transparency Create Vision & Build Will Model the Way—High-Impact Behaviors Put the Person at the Center Develop Competency through Coaching Manage Delegation: Use the Entire Team Communicate Effectively Establish Respect and Accountability

“Coaching in its truest sense is giving the responsibility to the learner to help them come up with their own answers.” – Vince Lombardi Coaching

Coaching: The Development of People Coaching PresenceAimTimely Active Inquiry Action & Follow-up

20 The Power of Coaching JCAHO Transforming Care Understanding The Problem Manager Coach Training Manager Coaching

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Outcome Measures Does all this washing make a difference?

Leading Functional and Front Line Teams Manage the Work Improve the Work Shape Team Culture Leading and Managing Excellence in a System Get Results and Sustain Them Manage Time & Resources Create Standard Work & Process: Including your own Measure: Financial, Quality, Customer, Key Process Surface and Solve Problems in Real Time Engage Across Boundaries Prioritize and Align to Strategy and Aims Understand Current State, Cause and Target Condition Learn and use improvement tools to Redesign Process Reduce Variation and Waste Build Team Capability Promote Transparency Create Vision & Build Will Model the Way—High-Impact Behaviors Put the Person at the Center Develop Competency through Coaching Manage Delegation: Use the Entire Team Communicate Effectively Establish Respect and Accountability

The Managers Most Important Job Your job is to create the conditions for a learning environment, having sufficient empathy with your people to understand where they are in their learning process and learn what interventions you can offer that will help them grow and excel. Don’t Lecture. Ask, Listen, Explore, Experiment Dr. Paul Levy: President and CEO Beth Israel Deaconess Medical Center

Finding Joy in Work