Leadership With Accountability (Avoiding Financial Penalties) Ana M. Hands, M.D. Vice President International Health & Transplant Services

The Definitions Leadership: The development of vision, strategies and alignment of relevant people behind those strategies and empowerment of individuals to make vision happen despite obstacles Accountability: The obligation of an individual or organization to account for its activities, accept responsibility for them, and to disclose the results in a transparent manner Leadership can be hard to define and it means different things to different people. In the transformational leadership model, leaders set direction and help themselves and others to do the right thing to move forward. To do this they create an inspiring vision, and then motivate and inspire others to reach that vision.

The Basics What separates the good, the bad, and the ugly are attributes such as vision, culture, communications, goals, integrity, knowledge, training, and accountability, to name a few important qualities

Top Issues Facing Healthcare Governmental Mandates Patient Safety and Quality Patient Satisfaction Physician-Hospital Relations Technology Personnel Shortages Creating an Accountable Care Organization Financial challenges

Top Issues Facing Healthcare Will Cost Money!!! Governmental Mandates Patient Safety and Quality Patient Satisfaction Physician-Hospital Relations Technology Personnel Shortages Creating an Accountable Care Organization Financial challenges

Patient Safety

The Headlines

Patient Safety Issues Inpatient suicides medication errors, wrong site surgery, restraint injuries, elopement, falls, retained foreign objects, delay in diagnosis, Infant abduction communication errors/ Misdiagnosis transfusion errors, surgical site infection, Heparin /Warfarin complications, critical lab results, skin tears infections like MRSA and VRE,

Patient Safety Having a non-punitive environment would encourage reporting of errors and near misses Both the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) require a non-punitive environment A person who is reckless or does something intentional to harm a patient should be terminated from employment

Safety Culture The concept of safety culture started in areas outside of healthcare such as the airline industry The studies look at high reliability organizations Thee are organizations that were complex and hazardous yet they were able to minimize adverse events These organizations maintained a commitment to safety at every level The hospital must have organizational commitment to establish a culture of safety

Safety Culture Hospitals need to be proactive to prevent harm from occurring instead of being reactive and doing something once a patient is harmed Patient safety needs to be viewed as a strategic priority The entire hospital needs to be focused on patient safety if a culture of safety is to be established A safe culture is evidenced by employees who are guided by the organizational commitment and where safety standards are upheld on a personal and team level

Safety of Culture There needs to be visibility among senior leaders to front line staff How many hospitals leaders do patient safety rounds or walkabouts? Strategic planning of patient safety is important There needs to be greater education of physicians about safety efforts Many physicians did not report adverse events See Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center. Pronovost PJ, Weast B, Holzmueller CG, et al. Qual Saf Health Care. 2003;12:405-410.

Safety Initiatives Hospital in the study had a patient safety committee This committee created a safety mission statement Developed a non-punitive error reporting policy Created information sheet of safety tips for patients and families Educated staff on the science of safety and how to disclose errors Developed a safety intranet site to share stories on patient safety Implemented senior safety walk abouts

1000 480 Negligence Injuries Filling Claims All Injuries All Negligent Injuries 480 However, this is still an over estimation because this assumes that all claims involve a negligent injury 176 Files a Claim 37% of Negligent Injuries Results in a Claim

Deaths Due To Medical Errors

Strategies That Can Make A Difference

What Makes A Leader ? Expertise Execution Emotional Intelligence Leadership Traits Leadership can be hard to define and it means different things to different people. In the transformational leadership model, leaders set direction and help themselves and others to do the right thing to move forward. To do this they create an inspiring vision, and then motivate and inspire others to reach that vision. Vision Innovation

Habits Of Highly Effective Leaders Watch The Money Monitor Quality and Performance Spend Time Planning Participate and Have Productive Meetings Spend Time on Staff Development and Retention Support Data Management Efforts Build Networks and Relationships

Becoming an Effective Leader Define and clarify roles, goals and expectations Don’t accept denial, blaming, excuses and scapegoating When things don’t go right, beware the “victim mindset.” Don’t let department heads and team or project leaders off the hook Take initiative to figure out where the barriers to success lie Set milestones and metrics Find balance between process and results

Critical Success Factors Shared vision – leadership and organizational transformation Accountability for learning and performance outcomes Information for evaluation, continuous feedback and benchmarking Commitment of resources, time, and energy

Leadership Structures and Systems Leadership structures and systems must be established to ensure that there is organization-wide awareness of patient safety performance gaps, Direct accountability of leaders for those gaps, Adequate investment in performance improvement abilities, Actions must be taken to ensure safe care of every patient served.

Leadership Structures and Systems Do you have a patient safety program? Is there education on patient safety and patient safety plan? Just culture where frontline staff are comfortable disclosing errors but still maintains accountability Is there a patient safety officer? Who coordinates patient safety education? With direct and regular communication with board and senior leaders? Senior leaders and department directors are accountable to close performance gaps

Leadership Structures and Systems Is there an interdisciplinary patient safety committee? Do leaders support the committee? Board and leaders help set patient safety goals Oversee RCA and feedback to frontline workers Provides training in teamwork techniques Direct organization-wide leadership accountability Board briefed in results of culture survey and activities to identify and mitigate risks Every board meeting should include patient safety issues

A Successful Organization The difference between a successful organization and one that is not can usually be attributed to leadership. The individual capabilities of the people in any organizations are the same, whether in a military unit, business, volunteer organization, or anything else.

“ Coming together is a beginning; keeping together is a progress; working together is success “ -Henry Ford