Insert name of presentation on Master Slide Leadership and Safety Climate March 18, 2008 Presenter: Sue Gullo, RN,MS

Improving Leadership For Quality 1.Establish executive accountability. 2.Address culture at all levels. 3.Demonstrate visible leadership behavior. 4.Use patient stories and input. 5.Establish aims and monitor system level improvement. 6.Orientate Board agendas. 7.Address Board level learning and education. Leadership and Safety Climate

Questions to ask at every level of the organization How good is our care? Is our care getting better? Leadership and Safety Climate

Setting Aims- Executive Level Set a specific aim to reduce harm this year  Make an explicit, public commitment to measurable quality improvement 

Getting Data and Hearing Stories- Executive Level Select and review progress toward safer care as the first agenda item at every board meeting. Ground the work in transparency, and putting a “human face” on harm data. Engage with patients and families. Tools: chart audit; case study of a specific case Leadership and Safety Climate

USA Campaign Blog Entry Greeted by VP for Performance Improvement Dan Varnum and Tom Evans of the Iowa Healthcare Collaborative, we heard more about Mercy’s story of improvement. Dan identified Mercy’s greatest transformation as their development of a culture of safety. By changing the attitudes of leaders and team members, they found they were able to work cooperatively to achieve sustainable results. To help to align their work and maintain a uniform focus, they now perform multidisciplinary rounds, arrange doctors and nurses into pods in the emergency department to facilitate improved communication flow, and practice daily goal setting in the ICU. From board reports to quality measurements and statistics, Mercy is also working to make their practice increasingly transparent. While they have found success in engaging teams of providers, what was also astonishing about Mercy was their focus on the patient and family. In a newly renovated facility, Mercy has designed their patient rooms to accommodate family members by including couches, desks, and internet connectivity. After observing an eye-opening catheterization procedure, the patient’s family was brought in immediately. Mercy doesn’t believe in restricted patient visiting hours and it’s this commitment to the patient that really impressed us. What surprised me most, though, happened on our ride back to the airport. Clinical Safety Coordinator Monica Gordon described how she felt that Mercy still had so far to go. This hospital – which had achieved so many great clinical outcomes and created a community seemed to be at the top. However, this desire to constantly strive for better was a display of the true engagement of Mercy’s staff in the improvement process. Campaign or no Campaign, they intend to continue their work in quality improvement. There’s no better campaign statement than that. Leadership and Safety Climate

5Million Lives Entry The organization regularly and transparently reviews its performance data. Honest, frequent assessment of data by everyone in the organization, including front-line staff (and, often, the public), allows high-achieving facilities to stay agile, focusing energies on their most acute problems and building joint accountability for progress. Leadership and Safety Climate

5 Million Lives Entry The organization invests in human capital and continuous learning, building capacity at all levels. Hospitals we visited invested significant resources in developing staff to better execute safety and quality initiatives at all levels of the organization, systematically exchanging new evidence and new approaches to managing change. In particular, supporting and developing middle managers led to strong unit-level results that tied to the larger safety and quality agenda of the organization. Leadership and Safety Climate

What It Takes to Win  Will  Ideas  Execution

Winning Execution Strategies Pick a patient segment upon which to test Work with those who want to work with you Small tests of change, small tests of change, small tests of change Learn as you go: develop process for review and improvement Encourage customization

Engage Leadership and Governance The Goal: Boards in all hospitals will spend at least 25% of their meeting time on quality and safety issues Full Board will have a conversation with at least one patient (or family member of a patient) who sustained serious harm at their institution within the last year

What Does the Evidence Tell Us? Outcomes are better in hospitals where: ─The Board spends >25% of its time on quality and safety ─The Board receives a formal quality measurement report ─There is a high level of interaction between the Board and medical staff on quality strategy ─Senior executive compensation is based in part on quality and safety performance ─The CEO is identified as the person with the greatest impact on QI, especially when so identified by the QI Executive Vaughn T, Koepke M, Kroch et. al. J of Patient Safety 2:2-9

Six Things That Boards Can Do  Set a specific aim to reduce harm this year and make an explicit, public commitment to measurable quality improvement (e.g., reduction in unnecessary mortality or harm)  Select and review progress towards safer care as the first agenda item at every Board meeting Get data on harms and hear stories; put a “human face” on data  Establish and monitor a small number of organization-wide “role up” measures that are updated continually and are transparent to the entire organization and its customers

Six Things That Boards Can Do  Commit to establish and maintain an environment that is respectful, fair, and just for all who experience pain and loss from avoidable harm Patients, their families, and staff at the sharp end of error  Develop the capability of the Board Learn how the “best in the world” Boards work with executive and MD leaders to reduce harm Set an expectation for similar levels of education/training for all staff  Oversee the effective execution of a plan to achieve the Board’s aims to reduce harm, including executive team accountability for clear quality improvement targets

In Summary It is within your power to make a difference one patient at a time. It is your choice. Never believe that a few caring people can't change the world. For, indeed, that's all who ever have. Margaret Mead Leadership and Safety Climate