Welcome to
Transforming Healthcare Leadership
and Patient and Family Engagement
For resource downloads go to:
www.safetyleaders.org
© 2013 TMIT
1
Welcome
Charles Denham, MD
Chairman, TMIT
Co-chairman, NQF Safe Practices Consensus Committee
Chairman, Leapfrog Safe Practices Program
TMIT High Performer Webinar
September 19, 2013
© 2013 TMIT
2
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© 2013 TMIT
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© 2013 TMIT
44
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go to: http://twitter.com/TMIT1
or use #safetyleaders
Also, go to:
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and related sites
© 2013 TMIT
5
TMIT Mission
Accelerate performance solutions that
save lives, save money, and build value
in the communities we serve and
ventures we undertake.
© 2013 TMIT
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Disclosure Statement
The following panelists certify:
that unless otherwise noted below, each presenter provided full disclosure
information, does not intend to discuss an unapproved/investigative use of a
commercial product/device, and has no significant financial relationship(s) to
disclose. If unapproved uses of products are discussed, presenters are expected to
disclose this to participants.
Michael Maccoby: Employed by The Maccoby Group; Associate Fellow, Saïd Business School, Oxford University
Regina Holliday: Patient rights arts advocate
MaryAnne Sterling: Employed by Connected Health Resources; Sterling Health IT Consulting
Doug Wilson: Employed by Next Solutions, Inc.
Dan Ford: Employed by Furst Group; CAPS (Consumers Advancing Patient Safety) member; World Health
Organization/Pan American Health Organization (WHO/PAHO) champion; TMIT Patient Advocate Team Member
Becky Martins: Founder, Voice4Patients.com; TMIT Patient Advocate Team Member
Jennifer Dingman: Founder, Persons United Limiting Substandards and Errors in Healthcare (PULSE), Colorado
Division; Co-founder, PULSE American Division; TMIT Patient Advocate Team Member
Stephen J. Swensen: Employed by Mayo Clinic College of Medicine
Charles Denham: Chairman, TMIT; TMIT education grantee of CareFusion and AORN with co-production by
Discovery Channel for Chasing Zero documentary and Toolbox including models; education grantee of GE with coproduction by Discovery Channel for Surfing the Healthcare Tsunami documentary and Toolbox including models.
HCC is a contractor or former contractor for GE, CareFusion, and Siemens. HCC and TMIT are collaborators and
contractors with Senior Care Centers.
Chasing Zero® is a registered trademark of CareFusion
© 2013 TMIT
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Disclosure Statement
TMIT certifies that:
• No funder or educational grantor had any influence or any
direct contact with researchers, analysts, or hospital
leaders contracted with TMIT involved in generation of
models, impact calculators, or consensus panels.
• Confidentiality of collaborators, patient data, and population
data has been and will be strictly maintained.
© 2013 TMIT
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Speakers
Charles Denham
Michael Maccoby
Regina Holliday
MaryAnne Sterling
Reaction Panel
Doug Wilson
© 2013 TMIT
Dan Ford
Becky Martins
9
Jennifer Dingman Steve Swensen
Voice of the Patient and Family
Regina Holliday
Patient Rights Arts Advocate
TMIT High Performer Webinar
September 19, 2013
© 2013 TMIT
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© 2013 TMIT
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Safe Practice Overview and Sharps
Charles Denham, MD
Chairman, TMIT
Co-chairman, NQF Safe Practices Consensus Committee
Chairman, Leapfrog Safe Practices Program
TMIT High Performer Webinar
September 19, 2013
© 2013 TMIT
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Culture
© 2013 TMIT
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Sharps Injuries – Magnitude of the Problem
•
•
•
•
•
•
•
•
•
•
384,000 sharps injuries per year in the United States
Operating Room one of the highest risk environments – Instruments and
Blood Exposure
38% of all surgical procedures are on patients w/bloodborne pathogens
Needle Safety and Prevention Act (2000) resulted in a decrease of injuries
from 24.1 to 16.5 per 100 beds (non-surgical sharps injuries)
This drop of 31.6% attributed mainly to safety devices
Conversely, surgical setting injury rate increased
(6.5%) or 6.8 per 100 procedures from 2000 to 2006
Cost can be as high as $4,838 per exposure with
significant indirect costs; litigation, rehire, moral impact..
59% of medical students experience needlesticks
83% of surgical residents experience needlesticks;
51% of residents do not report them…
There are risks to patients – if worker is the one infected (132 cases of
patients infected by a caregiver are reported)
Source: Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings
versus nonsurgical settings after passage of national needlestick legislation. AORN J 2011 Mar;93(3):322-30.
© 2013 TMIT
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Sharps Injuries – Causes
• Common devices causing injury
•
•
•
Suture needles 43.4%
Scalpels 17.1%
Syringes 12.1%
• Worker Injuries:
•
•
•
•
15.6% Surgeons
17% Residents
30% OR nurses
37.1% Sx Technicians
• Surgeons and residents are most likely
to be injured during use of device
• Nurses and techs are most likely to be
injured when passing the device
Source: Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings
versus nonsurgical settings after passage of national needlestick legislation. AORN J 2011 Mar;93(3):322-30.
© 2013 TMIT
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Sharps Injuries – Socio-technical Barriers
•
Low adoption of safety-engineered devices in OR
setting
•
•
•
•
•
•
•
•
•
Double gloving: Challenging for surgeons but benefit clearly
documented
Hands-free passing shows 35-59% effectiveness
but low adoption (workflow change)
Usability of safety-engineered devices – e.g., scalpels
Awareness – low promotion of devices to OR by manufacturers
Leadership and Teamwork
•
•
•
•
Adoption of blunt suture needles – less than 5% in US
Habituation period (getting used to new devices)
Increase in pressure needed
Change of technique
Most injured member NOT the original user of device –
Surgeons reported 15.6% injuries vs. 84.4% of Sx team
Lack of awareness of link between device choice and safety
Low motivation to change workflow and devices
Lack of enforcement and compliance monitoring
of reporting sticks and use of safety devices
Source: Interview with Dr. Janine Jagger – Engineered Sharps Injury Prevention
Double Gloving: Myth Versus Fact – http://www.infectioncontroltoday.com/articles/2011/04/double-gloving-myth-versus-fact.aspx
© 2013 TMIT
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Sharps Injuries – Potential Solutions
•
Raise awareness through educational
programs – teach residents
•
Evaluation of surgical procedures as
sharpless (up to 20% might qualify)
•
Involve End User in design of safetyengineered devices a barrier – e.g., surgeons
and scalpels
•
Educate Leadership – Clinical and
Administrative on business case of sharps
prevention program (ROI model and Impact
Calculator): AORN has developed programs.
Double gloving plus other solutions could
reduce 15%-20% of injuries with vigilance.
Source: Makary MA, Pronovost PJ, Weiss ES, et al. Sharpless surgery: a prospective study of the feasibility of performing
operations using non-sharp techniques in an urban, university-based surgical practice. World J Surg 2006 Jul;30(7):1224-9.
© 2013 TMIT
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Transforming Health Care Leadership:
A Systems Guide to Improve Patient Care,
Decrease Costs, and Improve Population Health
Michael Maccoby, PhD
President, The Maccoby Group
TMIT High Performer Webinar
September 19, 2013
© 2013 TMIT
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Transforming Health Care
Leadership:
A Systems Guide to Improve
Patient Care, Decrease Costs,
and Improve Population Health
Dr. Michael Maccoby
Clifford L. Norman
C. Jane Norman
The Maccoby Group
4825 Linnean Avenue, NW
Washington, DC 20008
www.maccoby.com
Austin API, Inc.
4604 Castle Pines Cove
Georgetown, TX 78628
www.apiweb.org
Profound Knowledge
Products, Inc.
4604 Castle Pines Cove
Georgetown, TX 78628
www.pkpinc.com
19
Why Transform Health Care
Organizations?
To Achieve the Triple Aim
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013); Ch. 3, p. 37
20
Triple Aim
• Improve Patient Care
• Decrease Costs
• Improve Population Health
21
How Do Health Care Organizations
Have to Change?
Create a Learning Organization
with Leadership at All Levels
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013); Ch. 3, p. 37
22
From Bureaucracy
to a Learning Organization
From Silos
To an Interdependent System
Need
President
Grant
Planning
Suppliers
Design &
Redesign of
Processes &
Products
Plan to
Improve
Market
Research
Measurement
& Feedback
Meade
VP
Marketing
Butler
VP
Distribution
and Service
Haupt
VP
Research &
Development
Services
Halleck
Sheridan
Region 1
Buford
VP
Region 2
Grierson
VP
Administration
and Support
Porter
Region 3
Handcock
Purpose of the
Organization
Customers
A
B
C
D
E
F
G
Production of Product or Service
Support Processes
23
Distribution
Defining Attributes of a Health Care
Learning Organization
 A social system where all the parts interact to
achieve the purpose of serving patients
 Learning from practice is widely shared and used
for innovation and improvement
 Learning is used to inform the community, aid in
the prevention of illness, and improve
population health
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013); Ch. 2, p. 21
24
Transformation Requires Leadership,
Not More Management
Management is based on Task Accomplishment
Management can be delegated
Leadership is based on Relationships
Leadership Can NOT be Delegated (i.e., Relationships
can not be delegated)
• A Learning Organization Leverages Leadership from
ALL Roles (not just Managers)
• Both leadership and management are necessary for
the success of organizations
•
•
•
•
25
What Do We Have to Do to Transform
Health Care Organizations?
Eliminate Counterproductive
Management Myths by Employing
Strategic Intelligence and Profound
Knowledge
26
What Management Myths
Must be Eliminated?
12 myths are addressed
We will focus on 6 myths today
27
Myths We Will Highlight
1. Leaders are Born, not Made
2. The Best Results are Gained by Managing By
the Numbers
3. People Need to be Held More Accountable
4. Incentives Will Get People to Change
5. To Improve Quality, It Costs More
6. To Motivate People, We Just Need to Pay
Attention to Them and Be Caring Bosses
28
Myth #1:
Leaders are Born, not Made
• Leaders: People Who Have Followers
• Three Types of Leaders
• Not all Leaders are
Managers
• Not all Managers
Are Leaders
29
Myth #2
The Best Results are Gained by
Managing By the Numbers
Understanding Variation
Using Different Improvement
Strategies Based on Common Cause
or Special Causes
30
Using Measures for Judgment Versus Learning
Transforming
Healthcare
Leadership
– A Systems
to Improve
Decrease
& Improve
Population
Transforming
Healthcare
Leadership
– A Systems
GuideGuide
to Improve
Care,Care,
Reduce
Costs &Costs
Improve
Population
Health.
Maccoby,
Norman,
Norman,
Margolies
(2013)
Health,
Maccoby,
Norman,
Norman,
Margolies
(2013);
Ch. 7 31
What Can We Predict for the Target of 7.5
Unplanned Returns to the ED?
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs
& Improve Population Health, Maccoby, Norman, Norman, Margolies (2013); Ch. 7, p. 119
32
What Can We Predict for the Target
of <2 Infections/1000 Patients?
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs
& Improve Population Health, Maccoby, Norman, Norman, Margolies (2013); Ch. 7, p. 119
33
Mistake One vs. Mistake Two
•
MISTAKE 1: React to an outcome as if it came from a special cause, when
actually it came from common causes of variation.
•
MISTAKE 2: Treat an outcome as if it came from common causes of variation,
when actually it came from a special cause.
ACTUAL SITUATION OF SYSTEM
ACTION
NO CHANGE
CHANGE
Take action on individual
outcome; Treat as a
special cause variation.
-$
Mistake 1
+$
Correct Decision
(A)
Treat outcome as part of
system; work on changing
the system-Treat as
common cause variation
+$
Correct Decision
(B)
-$
Mistake 2
34
Myth #3:
People Need to be Held More
Accountable
Attribution error
System thinking
35
Attribution Error
• Attribution theory describes the tendency for
observers to underestimate situational (the system)
influences and overestimate individual motives and
personality traits as the cause of behavior.
Need
Suppliers
A
B
C
D
E
F
G
Design &
Redesign of
Processes &
Products
Plan to
Improve
Market
Research
Purpose of the
Organization
Measurement
& Feedback
Customers
Production of Product or Service
Distribution
Support Processes
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013); Ch. 6, p. 100.
36
Who or What Is to Blame?
“A fault in the interpretation of
observations, seen
everywhere, is to suppose that
every event (defect, mistake,
accident) is attributable to
someone (usually the one
nearest at hand), or is related
to some special event. The fact
is most troubles with service
and production lie in the
system.”
–W. Edwards Deming
37
Health Care as an Interconnected System
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs
& Improve Population Health, Maccoby, Norman, Norman, Margolies (2013); Ch. 10
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Reduce Costs & Improve Population Health. Maccoby, Norman, Margolies (2013)
Myth #4:
Incentives Will Get
People to Change
Types of Incentives depend on
the type of work
5 Rs
39
Incentives Depend on the Type of Work
Transactional Work
Knowledge Work
• Rewards and Negative
Consequences
Generally Increase
Productivity and
Motivation
• Rewards and Negative
Consequences
Generally DECREASE
Productivity and
Motivation
40
How does this thinking relate to
Pay for Performance … Paying
doctors to see more patients?
41
What Motivates?
—
Intrinsic Motivation
+
(Reasons, Responsibilities, Relationships, Recognition)
+
Compliant
Motivated
Demotivated
(Not Engaged)
Frustrated
Extrinsic
Motivation
(Rewards)
—
42
How Can We Motivate Those Whose Work
Requires Thinking & Knowledge?
1. Reasons: the purpose of our work
2. Responsibilities: our roles and work
3. Relationships: within the system and with
collaborators and customers
4. Recognition: for significant contributions
5. Rewards
– Intrinsic
– Extrinsic
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013); Ch. 5, p. 62
43
Myth # 5:
To Improve Quality, It Costs More
Inspection vs. Improvement
Model for Improvement
System Map Integration
44
Inspecting In Quality Versus
Improvement of the System
45
Theory of Knowledge
Model For Improvement
• Three Questions
– What are we trying to
accomplish?
– How will we know that
a change is an
improvement?
– What changes can we
make that will result in
improvement?
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013) Ch. 9 p. 179
46
System Map Integration
47
Myth #6:
To Motivate People, We Just Need to Pay
Attention to Them and Be Caring Bosses
Creating a Leadership Philosophy
which creates Engagement &
Collaboration
48
Developing a Leadership Philosophy:
Four Questions
1. What is the purpose of this organization?
2. What ethical and moral reasoning
determines the key decisions we make?
3. What practical values do we need to practice
to achieve the purpose?
4. How do we define goals and results so they
are consistent with our purpose and values?
Transforming
Healthcare
Leadership
– A Systems
Guide Guide
to Improve
Care, Reduce
Costs Costs & Improve Population
Transforming
Healthcare
Leadership
– A Systems
to Improve
Care, Decrease
& Improve
Population
Maccoby,
Norman,
Norman,
(2013); Ch. 4
Health.
Maccoby,Health,
Norman,
Norman,
Margolies
(2013);Margolies
Ch. 4 p. 46
49
Summary
Purpose
1.
2.
3.
4.
5.
Practical Values
Vision
Ethical & Moral
Reasoning
Reasons
Responsibilities
Relationships
Rewards
Recognition
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013)
50
Summary
Purpose
1.
2.
3.
4.
5.
Practical Values
Vision
Ethical & Moral
Reasoning
Reasons
Responsibilities
Relationships
Rewards
Recognition
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013)
51
Summary
Purpose
1.
2.
3.
4.
5.
Practical Values
Vision
Ethical & Moral
Reasoning
Reasons
Responsibilities
Relationships
Rewards
Recognition
Need
Suppliers
A
B
C
D
E
F
G
Design &
Redesign of
Processes &
Products
Plan to
Improve
Market
Research
Purpose of the
Organization
Measurement
& Feedback
Customers
Production of Product or Service Distribution
Support Processes
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013)
52
Summary
Purpose
1.
2.
3.
4.
5.
Practical Values
Vision
Ethical & Moral
Reasoning
Reasons
Responsibilities
Relationships
Rewards
Recognition
Need
Suppliers
A
B
C
D
E
F
G
Design &
Redesign of
Processes &
Products
Plan to
Improve
Market
Research
Purpose of the
Organization
Measurement
& Feedback
Customers
Production of Product or Service Distribution
Support Processes
Structure
Processes
Policies
Procedures
Perception
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013)
53
Strategic Intelligence
Strategy:
"the art or skill of careful
planning toward an
advantage or desired end“
Strategic Intelligence:
Gaining these strategic
skills
Transforming Healthcare Leadership – A Systems Guide to Improve Care, Decrease Costs & Improve Population
Health. Maccoby, Norman, Norman, Margolies (2013)
54
Summary
• Health Care Leaders Need to Challenge Old Ways of
Thinking (myths)
• Transformation Requires Leveraging Learning
Throughout the Organization
• Managers should be leaders, and in fact, most can be
developed for leadership roles
• Understanding variation allows leaders to make better
decisions and develop useful strategies for
improvement
• To motivate people we need to understand the type of
work they do, ensure alignment to the organization’s
Philosophy, and utilize the 5 Rs of Motivation
55
56
© 2013 TMIT
56
Patient and Family Engagement:
Using SpeakerLink® to Match Speakers and Seekers
Regina Holliday
Patient Rights Arts Advocate
TMIT High Performer Webinar
September 19, 2013
© 2013 TMIT
57
Patient and Family Engagement:
Using SpeakerLink to Match Speakers and Seekers
A presentation by
Regina Holliday
58
Disclosure Slide
I have presented or painted before these venues and companies:
2.0
59
How do those who speak from the patient view help Seekers?
We connect the silos of thought and practice.
60
We provide new eyes and new ears to focus on old problems.
61
We live within
the
Big Picture.
62
How does SpeakerLink® help those who wish to speak?
It is much easier to fly when there is a safe place to land.
63
Let Patients Speak
We must encourage every committee,
conference, and hospital board
to actively recruit and include patients
in every aspect of the care process from
design to implementation to resolution.
Invite patients and you will include artists,
poets, and writers in creating health policy.
64
65
Lessons Learned from a (Reluctant) Speaker/Advocate:
A Family Caregiver Educating the Masses
MaryAnne Sterling, CEA
CEO, Sterling Health IT Consulting
TMIT High Performer Webinar
September 19, 2013
© 2013 TMIT
66
LESSONS LEARNED FROM A
(RELUCTANT) SPEAKER/ADVOCATE:
A FAMILY CAREGIVER
EDUCATING THE MASSES
TMIT
September 19, 2013
67
Agenda
• Background (the CliffsNotes version of my story)
• How and why I became a speaker
• My speaking purpose
• What I give to my audiences
• What I’ve learned from my audiences
• Personal best practices
• My toolbox
68
Background
(the CliffsNotes version of my story)
• Caregiver and healthcare system navigator for aging
parents for last 17 years
• 3-out-of-4 parents/in-laws have some form of dementia
• Father showed first signs in late-1970s
• Advocate for family caregivers
• Bringing family caregiver voice to several federal advisory
committees
• Alzheimer’s Association Ambassador (Senator Warner’s Office) for
the implementation of National Alzheimer’s Project Act (NAPA)
• Small business owner
• Spearheading innovative new projects to improve how patients and
family caregivers navigate the healthcare system
69
How and why I became a speaker
How
Why
• Began meeting with
• Personal mission to educate
legislators in 1997 to bring
awareness to AD and its
impact on family
caregivers
• Evolved to speaking at
healthcare conferences,
testifying at hearings, and
providing public comment
at Alzheimer’s Advisory
Council meetings
others on the challenges of
caregiving for aging parents
• Frustration at lack of
community support for AD
patients and their families
• Desire to share my
experiences and new ideas
on family
caregiver/healthcare system
collaboration
• Therapy …
70
My speaking purpose
• Educate
• Motivate
• Start the conversation …
Walking Gallery Jacket #78
71
What I give to
my audiences
Challenge them to think
outside the box …
• To show
things from
a different
perspective
• To apply in
their
community
New
information
New ideas
and tools
Pause
Action
items
• To think
about how
this applies
to them
• So they can
begin
making a
difference
72
What I’ve learned from my audiences
• Many can relate to my situation
• They are eager to hear different perspectives
• They want to learn from my experiences
• They want to share their stories too
• They don’t care if I’m not perfect
• They feed off of my energy
• They have great questions
73
Personal best practices
• Prepare!
• Know your audience/tailor your message
• Practice the delivery and don’t rely on a teleprompter
• Don’t assume anything
• Start by drawing your audience into the story
• Show them how your topic impacts them
• Healthcare is personal; your speech/talk/conversation should
•
•
•
•
be too
Use plain language
Don’t forget the visual learners
Give your audience action items
Always take the time to interact
• Take questions from your audience and answer them honestly
74
My toolbox
• My story
• My mission
• My Walking Gallery jacket
• And a great speech coach …
http://www.mhealthsummit.org/aboutsummit/super-sessions-corporatespotlights
75
Contact info
• E-mail:
[email protected]
• Twitter: @SterlingHIT
76
Are You Listening … Are You Really Listening?
http://www.safetyleaders.org/templates/pageTemplateRecentArticles.jsp
© 2013 TMIT
77
One Hundred Thousand Voices
for Safe and Appropriate Imaging of Children
Standard #1: Minor Head Trauma Imaging
Standard #2: Dual Phase Head and Chest CT Imaging
Standard #3: Pediatric CT Imaging Protocols
© 2013 TMIT
© 2006 HCC, Inc. CD000000-0000XX
78
Reaction Panel
Doug Wilson
© 2013 TMIT
Dan Ford
Becky Martins
79
Jennifer Dingman Steve Swensen
October 17, 2013 Webinar
Martin A. Makary, MD, MPH
Surgeon, Researcher
Johns Hopkins School of Medicine and School of Public Health
© 2013 TMIT
© 2006 HCC, Inc. CD000000-0000XX
80
Voice of the Patient and Family
Regina Holliday
Patient Rights Arts Advocate
TMIT High Performer Webinar
September 19, 2013
© 2013 TMIT
81