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Continuous Process Improvement I
Unit-Based Leadership Team Kick-off Retreat
1
Welcome + Introductions
2
Maria Novelero Director, Continuous Process Improvement UCSF Health
Name
Title
Unit or Department
3
Goals for the Day
• Align UBLTs on program objectives
• Provide the business case and evidence for deploying UBLTs
• Appreciate different individual leadership styles and practical tactics to lead others through change
• Develop an operating rhythm and compact that enables UBLTs to deliver innovations and improvements
4
Agenda
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8:15-8:45 Breakfast
8:45-9:00 Welcome + Quick Introductions
9:00–9:20 UCSF Health Leadership
9:20-9:35 CPI UBLT Program Overview
9:35-9:45 The Power of Unit-based Leadership
9:45-10:00 The UCSF Health Operating System
10:00-10:10 Relax, Restore, Re-caffeinate
10:10-10:30 Building a Baseline
10:30-11:10 Building Lasting Partnerships
11:10-12:15 Building Capacity to Lead Improvement
12:15-12:30 Creating a Culture of CPI
12:30-2:00 Lunch at Your Leisure
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Our Partners
Kim Petty Sr. Managing Director
Gidon Margolin Senior Manager
UBLT Implementation Schedule
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Session 1: Unit-based Leadership Kick-off Retreat
Session 2: Change Management Techniques
Session 3: Driving Sustainability, Boosting Engagement and Hardwiring Outcomes
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Quick UBLT Ice Breaker (5 mins)
What is your favorite hobby?
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Opening Remarks
Mark Laret Chief Executive Officer UCSF Health
Josh Adler, MD Chief Medical Officer UCSF Health
Sheila Antrum, RN Chief Nursing Officer UCSF Health
Ken Jones Chief Operating Officer UCSF Health
CPI + UBLT Program Overview
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Ralph Gonzales, MD, MSPH Chief Innovation Officer UCSF Health
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CPI is a Key Strategic Priority UCSF Health System Strategic Plan 2014-2019
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Vision: Advancing the UCSF Health System The UCSF Health System will provide innovative, high-quality, cost-
competitive clinical services, and deliver an unparalleled patient experience across the entire care continuum.
Strategic Priorities: 1. Developing world class
destination programs
2. Establishing a high-value system of care (ACO)
3. Creating a culture of continuous process improvement (CPI)
Continuous Process Improvement (CPI)
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CPI = Iterative
CPI is the daily practice of achieving incremental changes in our processes to improve the quality, safety, efficiency, and value of our services.
CPI = Transformative
CPI depends on an environment that supports a “learning” health care system that relies upon real-time data coupled with front-line empowerment and insights.
CPI = Efficient
CPI requires on an operating rhythm that seeks to reduce waste and drive capacity for excellence.
QUALITY TRAINING
PROCESS IMPROVE-
MENT DATA
Quality Cost
Experience
Best Place to Receive Care
Best Place to Work + Learn
Job Satisfaction Mission Alignment
Voice CPI
HUB
STRATEGY
UCSF Health System Leadership
Providers/Trainees/Staff
SOLUTIONS
UN
IT-B
ASE
D
LEA
DER
SHIP
TEA
MS
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UBLT Integration of CPI Partners
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CPI HUB
Service Excellence/
LIVING PRIDE
Performance Excellence/
LEAN
Quality + Safety
Information Technology
Decision Support
APeX Clinical Systems
You!
Learning and Development
The Power of Unit-based Leadership
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Gidon Margolin Experience Innovation Network
The Power of Unit-Based Leadership
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Key Unit /Practice Partners
Medical Director
Nurse /Practice Manager
Improvement Specialist
Relationship-Based Culture
What are Unit Based Leadership Teams (UBLTs)?
‒ A leadership model that places a high value on establishing goals and achieving results through teamwork and collaboration
‒ Empowerment of local leaders to lead and sustain transformational change
‒ Defining and aligning shared priorities and accountability
‒ Promoting front line engagement to build capacity to lead improvement
‒ Leveraging available resources to accelerate improvement
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Unit-based Leadership Aligns the Organization
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Strategic Direction
Communication
Support
Engagement
Alignment
Trust
Front Line Engagement – Continuous Improvement – Communication
UCSF Health
Executive Leadership
UBLTs
Value of Unit-Based Leadership Model
• Forms a foundation for multidisciplinary collaboration
• Aligns initiatives between nursing and medicine
• Boosts physician/nursing leadership engagement in tactical and strategic initiatives
• Ensures that frontline voice informs local and strategic decision making
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Communication Coordination Teamwork Relationship
Case Study: UPenn Unit Based Clinical Leadership
Goal: Enhance interdisciplinary collaboration, Improve coordination of care and improve quality by reducing bloodstream infections (BSI).
Approach: Physician and Nurse Leaders are paired at the unit level with an Improvement Specialist who brings data and project management skills.
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2007 2008 2009
The job:
• Weekly Operating meeting
• Interdisciplinary Rounding
• Orienting house staff
• Two Improvement Projects
• 5 Teams focused on reducing BSI
13 Pilot Teams
34 Official Teams, + 12 “Operating As”
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Results
13 patient units with UBCL avg. 100 fewer BSIs in FY 08 vs. FY 07
Unit Clinical Leadership Model: A Successful Partnership between Front-Line
Penn Systems: Taking Quality to the Next Level Our Winning Strategies
Assessing the Financial Impact of a Unit Based Clinical Leadership Model at a
University Hospital:
Case Study: UCSF Sepsis Program
Goal: To improve the timely implementation of evidence-based sepsis interventions (the sepsis bundle) in order to achieve a reduction in sepsis mortality.
Surveillance
Leveraged the existing electronic health record to
incorporate continuous sepsis surveillance in the Emergency Room and all inpatient
adult units.
Alerts
This data triggers Sepsis Best Practice Alerts (BPA) to warn
clinicians of the possibility of sepsis
from its earliest onset and guide
them to implement sepsis care from
order sets.
Response
Through interaction with the alerts,
nurses and providers can activate a Code Sepsis. The team responds to the
patient’s bedside immediately and
assists to implement the sepsis bundle
and to triage patients who need a higher
level of care.
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Results
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‒ ED achieved Sepsis bundle compliance of 93%
‒ 12.6 % sepsis mortality rate in FY 2014, an all-time low at UCSF
A great patient
experience starts
with a great
provider and
staff experience.
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Care Team Engagement is Low
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Source: The Advisory Board April 2014,
The National Prescription for Nurse Engagement
Key Drivers of Engagement
1. Growth
2. Teamwork
3. Individual Contribution
4. Basic Needs
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Experience Impacts Financial Performance
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5%+ in customer loyalty results in a 25-85%+ in profits
Employee &
Provider
Experience
Patient &
Family
Experience
Profitability
and Outcomes
+ =
Source: Adapted from The Service Profit Chain – How Leading Companies Link Profit and Growth To Loyalty, Satisfaction and Value, James L. Heskett, Thomas Jones,
Gary Loveman, W. Earl Sasser, and Leonard Schlesinge Copyright 1997
Engagement and Outcomes
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In Summary
‒ UBLTs Build Capacity within UCSF to Lead Improvement + Innovation
‒ Front-line team member engagement is critical to overall success
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Pa
ge
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The UCSF Health Operating System
The Toyota Way 2001
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Aimed at refocusing staff on the underlying philosophy
The Toyota Way 2001
Challenge Kaizen Genchi
genbutsu Respect Teamwork
Co
ntin
uo
us
im
pro
vem
en
t
Resp
ect
fo
r p
eo
ple
© 2014 by Rona Consulting Group
All rights reserved - licensed to UCSF by Rona Consulting.
Leadership and Culture
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Current
state
Future
state
How do we
improve?
A B
Practice tools
Principals
PDCA
Management
thinking and
routines
Cultural
transformation
© 2014 by Rona Consulting Group All rights reserved - licensed to UCSF by Rona Consulting.
The Lean Management System
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Frontline:
Clinicians
and staff
Process owners
UBLT;
Unit Partners
• Action
• Schedule
• Vision
• Strategies
• Tactics
• Resources
Strategic
plan
REVIEW
Sponsors:
CPI Partners;
HS Leadership
© 2014 by Rona Consulting Group All rights reserved - licensed to UCSF by Rona Consulting.
Layers of Kata
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Front
Line
P
D
C
A
P
D
C
A D D A A
P
P
C
C
D A
P
Strategy kata
CPI Partner or HS
Leadership kata
UBLT kata
UBLT or Unit
Partner kata
© 2014 by Rona Consulting Group All rights reserved - licensed to UCSF by Rona Consulting.
Daily
Weekly
Weekly-
Monthly
Monthly-
Quarterly
The regular practice of maneuvers that become automatic and reflexive, free thinking and allow creativity to occur
The Daily Huddle & Performance Board
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DAILY PERFORMANCE BOARD
Management thinking and the target condition…
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© 2014 by Rona Consulting Group
All rights reserved - licensed to UCSF by Rona Consulting.
Not to solve but to develop people who become problem solvers
Proposed Annual UBLT Work Plan
Respect for People
• Staff Impact Plans
• Provider and Housestaff Engagement Plans
Continuous Improvement
• 2 system goals… learn best approaches from each other
• 2 unit goals… at least one should be related to quality
• The goals should be measurable with a clear baseline and target measure.
Regular Celebration and Recognition
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Working Together to Achieve CPI
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Relax, Restore, Re-caffeinate
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Welcome Back - Agenda
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10:10-10:30 Building a Baseline
10:30-11:10 Building Lasting Partnerships
11:10-12:15 Building Capacity to Lead Improvement
12:15-12:30 Creating a Culture of CPI
12:30-2:00 Lunch at Your Leisure
Name
Title
Unit or Department
What was the last movie you watched?
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Building a Baseline
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A great patient
experience starts
with a great
provider and
staff experience.
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Provider Experience Survey
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Diane Sliwka, MD Medical Director of Patient and Provider Experience UCSF Health
The Mother Test
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Employee Experience Mirrors Patient Experience
48 Source: Ascension Health
50%
55%
60%
65%
70%
75%
80%
85%
90%
-40.0% -30.0% -20.0% -10.0% 0.0% 10.0% 20.0% 30.0% 40.0%
Correlation: .539
Pati
en
t N
PS
Associate NPS Source: Ascension Health
At UCSF, more engaged workgroups outperformed less engaged workgroups in each HCAHPS domain
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Note: UCSF Medical Center HCAHPS Analysis
78%
86% 85%
76%
70%
76%
81% 78%
68%
62%
40%
50%
60%
70%
80%
90%
100%
Overall Rating Doctors Nurses Pain Management Responsive- ness
Top Half of Workgroups Bottom Half of Workgroups
What is NPS?
50
10 9 8 7 6 5 4 3 2 1 0
Not at all likely
Neutral Extremely Likely
Detractors Passives Promoters
% Promoters (9s and 10s)
% Detractors (0 through 6)
Net Promoter
Score = -
Calculating NPS
How likely are you to recommend a colleague or friend?
The Pulse Survey 2014 MD Pulse Survey Results
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% promoters % detractors
-
NPS
= 22% 33% -11
Last Updated: October 14 2014
619
N
6.9
Avg
% promoters % detractors
-
NPS
= 44% 18% 26 619
N
7.9
Avg
Place to Work
Come for Care
Emerging Themes
• Teamwork + Culture
• Communication
• Leadership Support
• Efficiency + Standardization
• Pay + Incentives
• Staffing & Support
• Facilities / Physical Plant
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Communication
“We need more standardized forms of communication, it is very challenging to know what changes are coming and how best to prepare for them. We need to be more transparent in ways that physicians can understand how decisions are made, some things are based on who has the most clout and not who might be most impacted.”
Acknowledgement “The providers are rarely, if ever acknowledged. They are asked to reach into their free time to support staff at their various functions, give talks to them, they are cut out of any incentives that staff receive.”
Teamwork / Culture
I think that the if there were more opportunities for small events that are unit/floor/or service centric, there would be improved interprofessional collaboration.
Practice Management/
Support Staff
“Provide adequate practice management to ensure that practice administration is appropriate, coordinated, and staff are properly trained; prevent administrative under-staffing (when it is not unavoidable) so that providers can focus on patient care and not on administrative issues that are supposed to be handled by administrative staff who are overwhelmed/under-responsive/etc.”
What would you do to improve UCSF as a place to come for work?
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Access + Coordination
“Outpatient clinics continue to be a problem. Long wait times, often unhelpful staff, poor coordination of care, etc. This needs to be a major priority. The current efforts to improve are a start but I fear are not enough to truly change the culture and practice of ambulatory care.”
Communication “Improve communication. Focus on patients' experience not on doctor or staff convenience. Improve privacy during conversations between doctors and patients and families especially in and around operating room.”
Efficiency “Improve efficiency. Patients often experience long wait times due to clinic inefficiency. Too few exam rooms is currently our greatest source of inefficiency, followed by staff to check in & room patients.”
Physical Plant “Cleaner facility. More professional appearance of staff members. More professional, polite behavior of staff members. More chairs in patient rooms.”
What would you do to improve UCSF as a place to come for care?
Provider Engagement Next Steps
1. Results Dissemination
• Chairs, Senior Leadership, UBLTs, all Medical Directors, All
2. Seek Provider Input Widely and Locally
• Town Halls/Focus Groups, Faculty Meetings, Learning from High Performers
3. Action Planning (Local and Organizational)
4. Improvement Goal Setting, F/U PULSE
5. Communication Plan Development
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Living PRIDE Training Events
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Living Pride Events # of Trainings # of Staff Completed
Annual Living PRIDE Institute (LPI) 3 200 per LPI
Living PRIDE Institute
• Clinical/Ancillary Support Services
• Ambulatory
3 192
Living PRIDE Department Training
• Nursing patient Relations Council Retreat
• Women’s Health Retreat
2 400
Ambulatory Customer Care Training 60 1,200
AIDET Simulation Labs 134 Labs in
46 hour-long sessions 404
AIDET Supersessions 25 513
AIDET SMILE for Physicians 2,600
Adult Nursing Hourly Rounding Validation 1,800
TOTAL 7,309
UBLT Best Practices for Provider Engagement
• Dissemination of Results/Local Priority Setting and Action Planning
• Process for “Rounding” on Providers and Regular Communication Back
• “Thank You” Notes
• Include Providers in Team Efforts/Team Building
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Gallup Engagement Overview
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Sausan Fahmy, Ed. D. Chief Learning Officer Learning & Organization Development
2013 2014
Q12 GrandMean 3.70 3.77 +
Overall Satisfaction 3.78 3.87 +
Opportunities to learn and grow 3.71 3.74 +
Progress in last six months 3.47 3.54 +
Best friend 3.34 3.46 +
Coworkers committed to quality 3.92 3.97 +
Mission/Purpose of company 3.94 4.00 +
My opinions count 3.37 3.46 +
Encourages development 3.54 3.63 +
Supervisor/Someone at work cares 3.80 3.88 +
Recognition last seven days 3.19 3.26 +
Do what I do best every day 3.91 3.95 +
Materials and equipment 3.86 3.92 +
I know what is expected of me at work 4.36 4.37 +
GROWTH
TEAMWORK
INDIVIDUAL CONTRIBUTION
BASIC NEEDS
UCSF Medical Center 2014 Engagement Survey Results
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Encouraging Peer Engagement
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Organization
41% …of top drivers of
engagement capital
Manager
23% …of top drivers of
engagement capital
Peers
36% …of top drivers of
engagement capital
• The average employee interacts with 42% of coworkers in their business unit or department on a regular basis.
• In a business unit of 50 employees, that means there are 21 individuals that could substantially influence an employee’s engagement.
Source: Corporate Executive Board
Three Ways to Increase Engagement
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Effective impact planning
Integrate engagement into everyday work life
Encourage and support peer engagement practices
Examples of Integrating Engagement into UBLT Actions
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1. Consistently connect team members’ work to patient care, safety and satisfaction
2. Round on staff and follow up (stop light report) quickly
3. Ask staff for improvement ideas or involve them in CPI projects
4. Recognize staff’s specific contributions to CPI
5. Review best engagement practices on Engagement Resource website and apply
6. UBLT discusses the unit’s impact plan and generates ideas for how all UBLT members can contribute
•Senior/Executive Training (Train the Leader)
•Manager Training (Two Levels)
•Staff Training Guide (Peer impact)
•Integration of engagement in development programs
Training
•Assessment, Consulting & Facilitation Low Rated
Department Support
•Consulting to Senior Leaders and Executives
•Monitor and report on action planning status
Organization Development
Support
•Gather and communicate engagement best practices Best Practices
LEARNING & Development Engagement Support and Resources
63 Resources available at: http://learning.ucsf.edu/engagement-resources
UCSF Learning and Organization Development Staff Engagement Survey Resources
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Building Lasting Partnerships
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Kim Petty, MBA, MBB Experience Innovation Network
Building Lasting Partnerships Weaving together disparate skill sets and unify efforts…
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Leveraging Your Strengths – About Strengths Based Leadership
• Gallup scientists have also been examining decades of data on the topic of leadership. They’ve studied:
‒ 1 million work teams
‒ 20,000 in-depth leadership interviews
‒ 10,000+ followers around the world
• A survey of 10,000 followers showed they followed their leaders because:
1. The most effective leaders are always investing in strengths.
2. The most effective leaders surround themselves with the right people and then maximize their team.
3. The most effective leaders understand their followers needs.
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What is a strength?
• Strength: is the ability to consistently provide near-perfect performance in a specific activity.
• Talents: Naturally recurring patterns of thought, feeling, or behavior that can be productively applied.
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Strength = Talent x (Knowledge + Skills)
The key to building a strength is to identify your dominant talents, then complement them by acquiring knowledge and
skills pertinent to the activity.
Applying Your Strengths
“People progress more rapidly in their areas of greatest talent than in their areas of weakness.”
“The real tragedy of life is not that each of us doesn’t have enough strengths, it’s that we fail to use the ones we have.”
Sample Questions to ask your team:
• What parts of your job give you the greatest satisfaction?
• How do you capitalize on your strengths in your current role?
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Source: Buckingham: NDYS
The Four Dimensions of Leadership Strength
1. Executing - are those whom you turn to time and again to implement a solution
2. Influencing - are those are innately good at influencing
3. Relationship Building - are the glue that holds a team together
4. Strategic Thinking - are constantly pulling a team and its members into the future
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Source: Strengths-Based Leadership
Strengths and Leadership Domains
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Executing Influencing Relationship
Building Strategic Thinking
Achiever
Arranger
Belief
Consistency
Deliberative
Discipline
Focus
Responsibility
Restorative
Activator
Command
Communication
Competition
Maximizer
Self-Assurance
Significance
Woo
Adaptability
Connectedness
Developer
Empathy
Harmony
Ideation
Includer
Individualization
Positivity
Relator
Analytical
Context
Futuristic
Ideation
Input
Intellection
Learner
Strategic
Source: Strengths Based Leadership
UBLT Strengths-based Leadership – Breakout Discussion
• Share your top strengths + themes (10 Mins)
• Potential Discussion Questions:
1. What strengths influence your style and interactions with your team members and patients?
2. How can you use these insights into each other’s strengths to become more effective as a UBLT?
• Group Discussion (5 Mins)
72
With your UBLTs:
Recap
• People progress more rapidly in their areas of greatest talent than in their areas of weakness.
• The are four basic dimensions of leadership strength: ‒ Executing
‒ Influencing
‒ Relationship Building
‒ Strategic Thinking
• World Class leaders do not have all 4, but complement their gaps with their team members.
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Building Capacity to Lead Improvement
Attributes of Successful UBLTs
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1 Mutual respect and recognition of each other's valuable knowledge and skills
2
Joint strategic agenda and accountability for performance goals, whereby disagreements occur privately, but in public the UBLT speaks with one voice
3 A clearly defined operating rhythm and communication process
4 Clear ownership and championing of key initiatives based on individual capabilities and strengths
Mutual Respect of Knowledge and Skills
76
Performance Improvement
Staff/Provider Engagement
Data-Driven Project
Management
Goals and Accountability
Collaborative Culture
1
A Joint Strategic Agenda and Goals
77
2
Goals
• Quality • Safety • Operations • Experience
Levers
• Infection Prevention
• Falls Prevention • Door to Doc • Communication • Teamwork / PI
Tactics
• Lean • Experience
Mapping • Leader Rounds • Relationship
Based Communication
Operating Rhythm and Communication Process
• Frequent Team Huddles
• Weekly meetings with key unit leaders + partners (established)
• Monthly UBLT meetings
78
Outcomes
Tactics
UBLTs
Strategy
3
Clear Ownership of Key Initiatives
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Initiative Owner Status Goal
Redesigned Stroke Protocol
Leadership Rounds
Falls Prevention
Multidisciplinary Rounding
…
4
Things to Consider - Common Pitfalls
1. Failure to truly build relationship and work collaboratively
2. Breakdown of communication, either in terms of amount or quality
3. Undermining the unit-based leader by communicating disagreement or blame
4. Failure to align the UBLT goals and projects with existing strategic priorities + projects
5. Inability to energize front line teams to own and accelerate improvement
80
In Your Data Packet…
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• Pulse Survey data
• Employee Engagement Data
• Patient Satisfaction (CAHPS)
• Impact plans
• Available Resources
Aligning to Deliver – UBLT Planning Breakout
82
Step Activity Duration
(Mins)
1
Individually: • Reference Breakout Guide • Review list of responsibilities • Determine your responsibilities
10
2
As a UBLT: • Complete the Responsibility Chart • Assign remaining responsibilities • Discuss how you will manage responsibilities • Complete Compact
15
3 Review Employee Engagement Impact Plan 10
4 Large Group Discussion 10
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Creating a Culture of Continuous Process Improvement
Next Steps + Support
84
Action Target Completion
Improvement Specialist Data Training 11/20
Meet with UBLT to debrief, review data and metrics and summarize current state.
12/1 - 17
Engage front line teams to: 1. Introduce CPI journey 2. Validate and prioritize improvement opportunities 3. Begin to define project scope (e.g., quality project, others…)
12/19
Submit Project Charter 1/15
85
Thank You!
