1. © Copyright, Joint Commission Resources Organizational Capacity for Change and Patient Safety Deborah M. Nadzam, PhD, FAAN - Joint Commission Resources Lorrie Jones-Hartley, MSN, CRRN-A - Durham Regional Hospital

2. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Presentation Objectives –Briefly describe Patient Safety Connections service –Provide background information about Organizational Capacity for Change –Describe application of OCC survey –Discuss findings and use of OCC at one organization

3. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Patient Safety Connections Goal: To significantly increase the organization’s ability to take effective actions on safety risks and produce sustainable improvement in safety. Collaborative assessment: Project Team including JCR consultants and client organization leaders

4. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Collaborative Assessment Strategies Clinical patient tracers Shadowing clinicians and staff Adverse event reporting assessment Review of P.I. projects Group interviews Observations of practice Conversations with frontline staff Online surveys: AHRQ and OCC

5. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Organizational Capacity for Change –William Q. Judge –E.V. Williams Chair of Strategic Leadership and Professor of Strategic Management Old Dominion University, Norfolk VA –“OCC is a broad and dynamic organizational capability that allows the enterprise to adapt old capabilities to new threats and opportunities, as well as create new capabilities.” (Judge, 2005)

6. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Organization Capacity for Change Compares 8 dimensions across 3 groups Executives, managers, frontline staff 8 dimensions = 4 dualities Leadership must balance between dualities

7. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources 8 Dimensions:4 Dualities Trusting staff:Trustworthy Leadership Capable Champions:Involved Middle Management Systems Thinking:Systems Communications Accountable Culture: Innovative Culture

8. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Trusting Workers Trustworthy Leaders Frontline workers are open to change, know how change will help them, and trust leaders to carry out change efforts. Leadership presents a clear vision, inspires confidence, and upholds organizational values while encouraging change.

9. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Capable Champions Involved Middle Management Change efforts are led by champions with Interpersonal skills, leadership support, and the will and ability to challenge the status quo. Middle managers effectively connect front line staff with leadership, balance the need for change with the need to complete current work.

10. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Systems Thinking Systems Communications Change champions focus on causes rather than symptoms, the importance of aligning incentives, and the need to change systems. People get the information they need in a timely way, across units and from customers.

11. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Accountable Culture Innovative Culture People meet deadlines; they have clear Roles and responsibilities, and experience Reasonable consequences for their actions. The organization attracts and retains Creative people and support innovative changes.

12. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources

13. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources What do these differences mean? Research shows that a rating below the first quartile by any group, even when the overall score is in the first quartile, is related to limited change capability. The value of report is to: challenge managers to look more closely into areas where there are differences in perception, even though their own perception is that there are no concerns, and focus improvement efforts on the organizational capabilities related to executing change initiatives. For example, Durham may expand its review of frontline staff’s opinion related to systems communication.

14. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Durham Regional Hospital’s Opportunities for Change

15. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Organizational Capacity for Change o 24 respondents  8 in the top group  12 in the middle group (including physicians)  4 in the frontline group

16. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Trusting Workers Trustworthy Leaders oOverall score for trusting workers 1st quartile  Executives and frontline staff scored them in the1st quartile  Middle manager them in the 2nd quartile. oOverall Score trustworthy leaders 2nd quartile.  Executives scored them in the1st quartile,  Both other groups scored them in 2nd quartile. oThis represents an opportunity for further assessment and a plan for developing a trusting relationship

17. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Capable Champions Involved Middle Management oAll staff rate involvement of middle management in the first quartile  Correlates with AHRQ findings related to supervisors do not sacrifice patient safety oFront line staff rate capable champions in the second quartile. oImproving the effectiveness of department champions would increase overall improvement capability.

18. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Systems Thinking Systems Communications oSystems thinking (focus on causes rather than symptoms, change systems)  Senior staff and middle managers rate1st quartile  Front line staff 2nd quartile  Correlates with AHRQ in that staff feel mistakes are held against them and working in crisis mode oSystems communication is rated overall in the 2nd quartile  All groups rated 2 nd quartile  Correlates with AHRQ findings around communication oDeveloping effective, systematic communication mechanisms, and monitoring and improving their effectiveness is an opportunity for development oCommunications survey, developing report from SRS system, revamped walk rounds

19. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Accountable Culture Innovative Culture oAll staff rate Durham in the first quartile for accountable culture, while front line staff rate innovative culture in the second quartile.  Just Culture oThis suggests that front line staff perceive the work environment as having a stronger emphasis on accountability than on supporting initiative, innovation, or improvement at the front line.  Magnet journey, developing Patient Safety Champion Program

20. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Current Strengths - A sample oThe Board and Executive Team are driving patient safety oCommunication from Senior Leaders oSeveral safe practices have been implemented oMedication Management

21. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources More Strengths oStrong peer-to-peer support at the front line oAttention to employee morale and professional growth oThe success of the Surgical Care Improvement Project

22. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Themes of Concern oAlignment of the medical staff with the organization’s commitment to quality and patient safety initiatives.  New CMO, Revise Physician Peer Review, Compensate Physicians for Committee involvement oStaff engagement throughout the organization in patient safety activities  Magnet, Patient Safety Champions, Walk Rounds oVariation in clinical practice across the organization and in implementation of national patient safety goals.  Magnet, Stroke Program

23. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Themes of Concern (continued) oInterdisciplinary communication re: clinical issues  Flash Rounds, Transport Communication Sheet oPerformance improvement and sustainability  Redesigned PI committee, Six Sigma Oversight oCommunication channels for frontline staff to express concerns about quality and patient safety  Revamp SRS system, revise Walk Rounds oReporting and analysis of patient safety concerns, adverse events and near misses.  Revamp SRS system with reporting capabilities

24. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Next Steps oDisseminate the results of the patient safety assessment and improvements underway oPrioritize focused areas posing greatest risks to patients oDevelop specific strategies and timelines with the involvement of staff, physicians, executive leadership team, and Board oAct!

25. Durham Regional Hospital – Patient Safety Connections- April 2007 © Copyright, Joint Commission Resources Questions & Comments