Leadership for Safety: Getting the Board on Board Essential Hospitals Engagement Network August 22, 2013

2 OUR NEW NAME We’ve rebranded! The National Association of Public Hospitals and Health Systems is now America’s Essential Hospitals. Although we’ve changed our name, our mission is the same: to champion hospitals and health systems that provide the highest quality of service to all by achieving the best health outcomes for every patient, especially those in greatest need. The new name underscores our members’ continuing public commitment and the essential nature of our work to care for the most vulnerable and provide vital community services, such as trauma care and disaster response. This is an exciting time for us and our members, as we lean forward into new care models, opportunities and challenges of reform, and quality and safety innovations that often take root in our member systems. Our new website address:

3 CHAT FEATURE Please use the Chat Box on the webinar screen to type your question or comment at any time. NOW: Use the Chat Box to sign in. Enter your organization and names of all people in the room.

Leadership for Safety Web Workshop August 22, 2013 James L. Reinertsen, M.D

Action Planning Checklist Leadership Behaviors and ToolsActions Planned Take personal ownership of safety in your organization Eliminate the denominator: How many patients did we harm last year? Be transparent: wall displays, open discussion of serious safety events… Start every meeting with a patient story Frame safety aims in reference to the theoretical ideal Do “reality rounding” on key safety practices Executive visits to safety teams Daily safety huddle Make hard decisions that change the culture—on both values and technical performance!

Assignment 1: Start with a Story What: –Start every leadership meeting with a story about a patient who was harmed (or a near miss). –Your own organization, recent, serious, scripted, no medical details, emphasize the impact on patient and family –If possible, chosen to illustrate data to be reviewed later in the meeting How: –Three minutes, plus questions for clarification –No amateur-hour armchair problem solving! Who: –Senior executive, does not need to be CNO or CMO! –If you want to add 100x impact, ask patient or family member

Let’s hear your field reports 1.What meeting did you start with a patient harm story? Who was in the room? 2.What story did you choose? 3.How did you tell it? How long did it take? 4.What went well? 5.What didn’t go so well? 6.Did you get into any long digressions and discussions? Why? 7.What was the overall impact on the meeting? 8.What was your main learning from the experience? 9.Would you do it again? Make it a regular part of your leadership practices?

“We started our meeting today with a story about a recent needless death in our hospital. And we’re going to keep on telling one, every meeting, until there isn’t a story to tell.” Board Chair of a Colorado Hospital

Assignment 2: Eliminate the Denominator Modify your displays of safety data so that it’s clear how many people were harmed. Examples : Number of patients who became infected Number of patients who developed pressure ulcers Number of patients who fell and were injured Total number of patients harmed

Example from Harbor UCLA… 35% overall decrease in Harm (statistically significant at p = 0.002%) Harm Scores 2012 with Comparative Data from 2011

Let’s hear how it’s going in the field Which safety reports did you modify? Who did you show them to? Board? Quality Committee? Medical Staff leadership? Executive team? What was the reaction to “eliminating the denominator?” –Shock at the number of people harmed? –Did anyone say “Why didn’t we know about this before?” –Did this display method change the conversation in any way? How, exactly?

Next: Web Workshop –September 19, 2013, noon EST Assignment: –Transparency! Display your harm data someplace it’s never been seen before—e.g. hallways of care units, on hospital website, at medical staff annual meeting…. –Come to the workshop and tell us what it was like to “go naked in public!”

13 SAVE THE DATE Leadership for Safety: Yes, it’s Personal A Workshop for CEOs, Board Members and C-Suite Leaders October 7, :30 am – 4:30 pm PST San Mateo Marriott | San Mateo, Calif. Deadline to register: Sept. 13, 2013 More information: Safety-Yes-Its-Personal-A-Workshop-for-CEOs-Board-Members-and-C- Suite-Leadershttp://tc.nphhi.org/Archive/EHEN-Events/Leadership-for- Safety-Yes-Its-Personal-A-Workshop-for-CEOs-Board-Members-and-C- Suite-Leaders

14 THANK YOU FOR ATTENDING Next Leadership webinar: September 12 pm EST Evaluation: Feedback survey can be accessed in the chat box. Essential Hospitals Engagement Network website: