WHA Improvement ForumFor September

“Managing the Improvement Portfolio”

Tom Kaster & Travis Dollak

Courtesy Reminders: •Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) •Please do not take calls and place the phone on HOLD during the presentation. 1

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Today’s Webinar

Agenda

Method’s for sustaining great outcomes

Monitoring multiple projects

Taking action when its needed

• Institutionalize Accountability *Reference August Improvement Forum

Managing Multiple Projects – Start with Roles

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Quality and/or Practice councils:• Review the outcomes• Make decisions on what are the priorities• Communicate the priorities house wide• Marshall the resources to do the work

Refrain from “doing the work”

• Hold clinical areas accountable for their outcomes.

Key Responsibilities

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Group Tasks

Quality Council -Regular review of outcome data (dashboard)-Analyze the big picture and key improvement needs-Allocate resources

Improvement Manager -Coach teams and frontline staff on improvement methodology-Provide data support-Assign Team Leads-Aid in improvement team selection, structure and objective development

Team Leaders -Organize team functions-Direct small tests of change-Analyze outcome and process measures-Liaison between team and Improvement manager-Aid in spread

Team Members -Conduct small tests of change-Provide real time feedback-Capture process measures-Advocate for process improvements

Unintended consequences If the roles become “murky”….• Quality is tasked with reporting and doing• Clinical areas are too far removed from their

measureable outcomes• Everything is a priority• Eyes are taken “off the ball” – something is missed• Capacity to be agile and adapt to change (i.e. new

evidence, rules and regs) is limited.

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Tools to Prevent “Murky” Roles, Responsibilities, and Competing Priorities

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•Creates structure and timeframes•Prevents units from being overwhelmed

•Aids in accountability•Builds consensus on what needs to be done

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Sustainability Defined

Spread – Successful changes in one area are adopted (and improved!) in other areas.

Sustainability – Improvements made will continue and high performance is retained over time, with little regression.

Sustainability Defined

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1. Results are better than when started2. Variation is reduced

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Methods for Sustaining

1) Front line staff was involved from the beginning2) Review performance trends with your team- track

data and watch for changes3) Teach the team to watch for drift and take action4) Coach them to not overreact to the “blips”, but to

understand what they are.5) Plan for how to achieve the AIM (again, if needed).6) Maintain roles and accountability.

Reviewing Performance Trends – More than the Dashboard

• Static red, yellow, green boxes don’t help you predict

• Unable to see trends/shifts• Lack ability to provide context*May be appropriate for senior leaders, but not the sole tool to

help front line staff improve. *Senior leaders should also see data over time to avoid

obsessing on a single data point.

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A Better Choice – Keep Up a Regular Review of Your Run Charts

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Now Keep on Top of That for A Dozen Projects

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Measuring Outcome Data Alone Won’t Solve This Challenge

Would you?

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Outcomes ProcessesProactive Prevention

Would you?

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Outcomes ProcessesProactive Prevention

Would you?

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Outcomes ProcessesProactive Prevention

Insuring drift does not happen by auditing KEY processes

Keeping an Eye On Your Outcomes

Regular Audits of Hourly Rounding

Bottom Line?

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Outcomes ProcessesProactive Prevention

If you wait for the outcome measure to drift…

1.You have lost your improvement momentum2.The staff has already regressed to past behavior3.Your training and education efforts were for not4.Your are back at square one

Bottom Line?

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Outcomes ProcessesProactive Prevention

If you institutionalize the auditing of key processes…

1.You can catch slips before the momentum is lost 2.You are able to help staff get past the awkward change period and hardwire the new processes3.You are on top of unforeseen changes 4.You validate your investment

The Sustainability Plan

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Calendaring the Auditing of Key Processes

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Quarterly: Jan/Apr/ July/Oct

Hourly Rounding Prevalence

Falls Project Team Regroup

Nurse Manager Initiate

Quarterly:Feb/May/Aug/Nov

VTE: Protocol Prevalence

Unit Managers regroup

Unit Managers

The Spread Matrix

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When and How to Take ActionWHEN

• Process measures are drifting (trend or shift)

• A bad outcome occurs• Teams aren't meeting• Turnover in teams• Team needs coaching on QI

concepts • Feedback/help for team• Accountability is not clear

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HOW• Don’t take over the project• Ask questions• Coach on the improvement

methodology• Do offer up resources• Reference roles and

responsibilities• Recognize other

projects/priorities• Encourage data driven decisions

What Is Different In This Approach?• More transparent data and accountability• Tools that provide structure (not just lip service)• Greater emphasis on continued measurement• Helps avoid the ‘project mentality’• Focus on tracking improvement for sustaining

success

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Next Month: October 24

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Review Survey Results

References

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http://www.whaqualitycenter.org/PartnersforPatients/PFPWave2Materials/PfPImprovementWorkbook/PfPImpWkbkSection6.aspx

On the Quality Center

How do you keep your eye on the ball?

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Discussion time:Would anyone share what strategies their

hospital uses to sustain high performance?

Please be sure your phone lines are muted to keep background noise to a minimum. You can select *6 to MUTE and *7 to un MUTE

AnnouncementsPartners for Patients – Improvement Leader Fellowship (ILF):• Helps staff boost their QI knowledge to better execute their HEN projects

as well as future improvement work your organization may take on. • Session 4 is October 16, two-hour webinar. These sessions will blend QI

knowledge along with the content of the 10 HEN topics.• Low-risk/low-investment to expose staff to this material without having to

arrange travel, staff coverage, etc. • Each session will provide CEU credits.

Questions/More Information – Contact Travis Dollak (tdollak@wha.org) or Tom Kaster (tkaster@wha.org)

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Thank You!Questions

Please complete 3 question survey when closing webinar window.

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