Engaging frontline staff in changing clinical pract ice

Boards are human too!Dr Cathy Balding

2016.

What’s engaging boards got to do with engaging staf f in clinical practice?

EVERYTHING.

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Research on Effective Quality Systems:(Balding and Leggat, La Trobe University, 2016)

Leadership and Strategy• Everyone wants to provide ‘good care’, but only a few sites had a concrete and shared definition of good

care, and not all of these used the definition at point of care. Staff wanted consistency in this message.

• Board and executive have aspirations for the quality of care they want to provide, but the vision weakens the further it travels

• The further you get from the top, the less understanding there is about what the quality system is aiming to achieve, so the focus becomes ‘doing quality’:

• Audits

• P&P

• meeting standards

• collecting data etc.

• Clinician leaders and managers feel they lead good quality care by providing guidelines and encouraging and modelling good practice – often in spite of the quality system

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RESEARCH on Quality Systems: Outcomes(Balding and Leggat, La Trobe University, 2016)

Most health services don’t really know if the care is improving or not, except in areas covered by national standards where regular results were reported

Both managers and staff found it difficult to cite other evidence for improvement in quality of care over past 6 months, apart from access and process improvement

Lots of data but a general lack of ‘intelligence’.

“We have had some wins, but we are not sure why.”

“We have a sense of improvement.”

“In the absence of evidence to the contrary…”

“No one says there is anything wrong – our patients would tell us.”

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Without a clear message from the top of the organis ation…

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Improvement:Improving existing care and services, reducing

risk

Maintenance:Monitoring, ensuring

standards and policies are met

WHY???

LEAD ing IMPROVEMENT…

Leaders set direction. You’ve got to lead somewhere.

So first – you’ve got to define your somewhere.

Then work out how to get there… and

take people with you.

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SHARED PURPOSE

Providing safe, high quality care every day is

our ‘somewhere’…but getting there is harder than

winning three consecutive premierships!

And impossible unless…

• We help boards define what they’re trying to achieve with clinicians and consumers.

• Make it a strategic and business priority .

• Align the whole service around achieving it.

• Provide people with the intelligence they need to e ffectively pursue it.

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CRYSTAL CLEAR SHARED PURPOSE Messages about purpose must be clear and consistent :

not faddy, fancy or jargony!

Imagine if JFK had said in 1962:

‘Our mission is to become the international leader in the space industry through maximum team-centred innovat ion and strategically targeted aerospace initiatives.’

Fortunately - he didn’t!

“By the end of this decade we will land a man on the moon… and return him safely to the earth.’

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Strategic Quality System (RISE) Model: Great People supported by Great Systems

to achieve a Great Purpose with Consumers

EmpathicSkilledFocusedInformedAccountable

Quality Governance SYSTEM PILLARS (Board and Executive)

� Planning, Leadership and Culture

� Partnering with Consumers

� Positive People and Practice

� Pursuing High Performance

PEOPLE(at each level of the organisation)

SkilledSupportedAccountableInformedFocusedEmpathicResilient

PURPOSEA consumer

experience that is:ResponsiveIntegrated

SafeEffective

Every person, Every time

Balding, C (2016) Create a Great Quality System in Six Months.www.cathybalding.com

PURPOSE: Royal Children’s Hospital:Great Care

PersonalCare and services are responsive, respectful and

sensitive to create the best possible experience for each

individual

Connected& Right

Care provided is right for each person,

coordinated and based on the best available

evidence and knowledge.

SafeCare and services are designed and delivered to

minimise risk of harm

PURPOSE: Kyneton District Health Best Care Quality Goals

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UNITING AgeWell (aged care Vic and Tas)

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PURPOSE

What creates safe, high quality care?

Accreditation doesn’t create quality care

Audits don’t create quality care

Measures don’t create quality care

P&P don’t create quality care

Incident reports don’t create quality care…

PEOPLE create quality care.And boards are people too.

The people have to have data that speaks to them, t o inform their decisions and actions for creating quality care. 14

What should we report to boards and clinicians to e nable them to lead high quality care?

WRONG QUESTION

What do boards and clinicians want and need to know to lead high quality care?

BETTER QUESTION

How can we know if we’re achieving high quality car e for every consumer, every time?

BEST QUESTION

Information to support care leadership

So instead of ‘what data do we need?’ The question becomes:

‘what do we need to know to see if we’re making pro gress towards each goal?’:for both boards and clinical staff.

RESPONSIVE INTEGRATED

SAFE EFFECTIVE

FOR EACH GOAL: INFORMATION required:

What are the risks and how are we managing them?

Hot spot scanning and risk register; incident reporting and analysis, audit, complaints

Are we doing the right things to get the best results from a clinician and consumer perspective?

Audit, direct observation, staff and client surveys, incidents, complaints

Are we getting the best possible outcomes?

Outcomes monitoring for high risk/cost/activity conditions,external comparative data, audits of care plan implementation, benchmarking, lessons from M&M meetings

Where are the strengths and how are we learning from them?

Spotting consistently high performing services in each of the above – learning and spreading - data and stories

Craft the messages to develop a shared comprehension of the quality of care

�Information drives understanding –

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but feelings drive action.

Tip: Whoever it is…Start Where They Are

You have the curse of knowledge…

E.g.: We noticed in the first half of this year tha t in the XXX resident population constipation rose from 50% residents to 75% residen ts. Firstly staff pointed it out and then we collected some data which showed the si ze of the problem.

The quality manager and an EN conducted a three day observation audit on caring for people with constipation and found that staff are spending 60/60 per day, on average, attending to residents with constipation-related issues; up from 30/60 one year ago.

We looked at the at the research on constipation, and saw that in Europe the average % of residents with constipation in residential aged care is 40% , and in some facilities in Sweden they have reduced it to zero. New research from the US says that constipation affects residents in a number of ways, including tiredness.

We want to reduce the % of residents with constipation to 40% in the next three months and 10% by the end of the year.

Getting the message across: the facts

Getting the message across, the human face(implications for staff)

If we don’t do something, by the end of the year we will spend at least 120 hours over the next 6 months attending to residents with constipation-related issues - basically that’s 3 weeks of extra work that we have to fit into our already heavy workload.

This means that some residents will miss out on some of their activities as staff won’t have as much time to devote to non-clinical resident support.

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As part of our regular scanning for resident participation in exercise, we identified that Alice Aitken hadn’t attended her exercise class, something she told us she very much enjoyed, for two weeks, because she was feeling too tired. We assessed her and found that she had developed mild constipation. She recovered well with a change in diet and got back to her exercise class within a week.

Getting the message across: the human face(a resident story)

…to this!

Alice went from this…

Getting the message across – with an I get it ‘Oh!’ (analogy)

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The survey showed that only 30% of employees have a clear idea of their specific role in preventing pressure injuries.

This is like having 7 kids on a soccer team who have no idea what they’re supposed to be doing and don’t know which end their goal is.

OR… You can give people more and more facts about climate change…or make it a little closer to home… (quality and quantity of coffee beans may be a casualty of global warming…)

Getting the message across with an Oh! of recognition (comparison with something familiar)

37 grams of saturated fat in a medium size box of movie popcorn cooked in coconut oil.

That’s like having bacon and eggs for breakfast, a Big Mac and fries for lunch and steak and chips for dinner!

ONCE YOU’RE CRYSTAL CLEAR ABOUT WHERE YOU’RE GOING, AND KNOW WHERE YOU’RE

STARTING…

GO AFTER those goals… as if lives depend on it…

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Remember…one man in a thousand is a leader of men…

Visit www.cathybalding.com for free resources and training, and

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– the other 999 follow women! (Groucho Marx)

THANK YOU!