1. Wednesday 10 June 2015 Carrie Marr Executive Director Organisational Effectiveness WSLHD Mobilising People and Leading Sustainable Change

2. Integrating Finance & Quality FinancialWaste DemographicHarm Safety & QualityVariation Context

3. The “Triple Aim” Health of the Population Experience of Care Per Capita Cost 2

5. Voices of America’s Best: Strategies that Sustain Quality 3 Keys to Success: Engaged leadership –Ambitious goals, inspire change and benchmark against the best Established culture –Patient centred, teamwork is valued and staff empower each other Continuous improvement –Transparency and consistency in reporting, identifying vulnerabilities and testing improvement strategies to close the gaps (Health Grades 2014)

6. 6 Essential Capabilities to Creating High-Performing Organisations (KP) Leadership and the ability of leaders to identify the “vital few breakthrough opportunities” A systems approach Measurement capability at all levels The culture of a learning organisation (with an infrastructure to harvest best practices for sharing and learning to create potential for spreading practices with the greatest impact) Team engagement from the bottom up A strong internal capability to improve Bosignano, M & Kennedy, C (2012) Pursing the Triple Aim

7. Characteristics Created By Leading QI Organisations To Deliver Improved Outcomes Build Infrastructure & Capacity Quality improvement education programme Evidence based learning Leadership development Priorities maintained during crises Stability of general management and program management Supporting and enabling staff in their “day job” of improvement Adaptive internally and externally Technology & Innovation Real time measurement and information systems Alignment: Will and commitment Vision Strategy Culture Measurement Learning organisation Ref: Staines 2009

8. Hard wiring Excellence Continuous Learning Continuous improvement Creating Public Value Through Quality Innovative Coaching Accountability Engaged/Committed Safe and reliable Caring & Compassionate Resilient Collaborative “A Just Culture”

9. “focusing on information and data to provide assurance on improvement and quality to deliver better, safer care”. Board ET EMT Directorate / CHP Ward / Team Level Patient / Practitioner Level ASSURANCE Validated Data for 6 domains: Access, Efficiency, Infection & Prevention, Quality & Patient Experience, Patient Safety and Data Quality PERFORMANCE Validated and un-validated data across 6 domains: Clinical Excellence, Finance & Activity, Valuing Staff, Capacity & Activity Planning, Patient Experience and Patient Safety Improvement Performance Assurance Data and Measurement for improvement IMPROVEMENT Un-validated data provided in real time through Unified Patient Tracking, Clinical Portal and operational dashboard with metrics covering Patient Flow, Inpatient Activity, Out Patients, Waiting Times, Patient Safety, Infection Control, Clinical Outcomes

10. Creating the conditions for change… Create the conditions for change Is there an agreed aim known by everyone involved? Do we have the knowledge to prioritise our biggest QI impact and stop/start where appropriate? Is everyone clear about the means of securing improvement towards our aim – our tools and techniques? Are we able to measure and report progress on our aim in realtime? Do we know how to deploy our resources and expertise to accelerate change when required? Do we have a plan to test and spread new learning?

11. Experts 0.5% Senior Leaders & Boards (All) Change Agents (Middle Managers, project leads 10-15%) Everyone Staff Teams Continuum of PI Knowledge and Skills Deep Knowledge Many People Few People What Skills Do We Need? Source: Kaiser Permanente, 2008 Shared Knowledge A key operating assumption of building capacity is that different groups of people will have different levels of need for QI knowledge and skill – what will you need people to have? Our approach will be to make sure that each group receives the knowledge and skill sets they need when they need them and in the appropriate amounts.

12. Changing the old Making the future attractive Framework: Leadership for Improvement Will Ideas Execution Establish the Foundation Setting Direction: Mission, Vision, and Strategy PULL PUSH

13. We need to deliver on our statutory responsibilities as well as our ‘contract’ with Ministry But we also need to create capacity and capability within the District to realise the potential for reducing unwarranted variation, waste an harm. The simple truth is that it is these resources that will realise our ability to transform our services. The Leadership Challenge

15. carrie.marr@health.nsw.gov.au @carriemarr Thank You