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3/6/2017
1
Leading Quality Improvement
Essentials for ManagersLesson 4: Coach Your Team
March 7, 2017
These presenters have
nothing to disclose
Janet Porter, PhDDave Munch, MDKathy Duncan, RN
Today’s Host2
Rebecca Goldberg, Project Coordinator, Institute for
Healthcare Improvement (IHI), coordinates multiple
projects focused on increasing value in health care by
improving quality and reducing costs. Currently,
Rebecca’s primary responsibility is coordinating and
hosting IHI’s Expeditions, monthly virtual support
programs focused on specific topic areas. Rebecca is a
recent graduate of Georgetown University in
Washington, D.C., where she obtained her Bachelor of
Science degree in human science with a minor in public
health.
3/6/2017
2
Phone Connection (Preferred)3
To join by phone:
1) Click on the “Participants”
and “Chat” icon in the top,
right hand side of your
screen to open the
necessary panels
2) Click the button on
the right hand side of the
screen.
3) A pop-up box will appear
with the option “I will call
in.” Click that option.
4) Please dial the phone
number, the event
number and your attendee
ID to connect correctly .
WebEx Quick Reference
• Please use chat to
“All Participants”
for questions
• For technology
issues only, please
chat to “Host”
4
Enter Text
Select Chat recipient
Raise your hand
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5
Chat
5
Name and the Organization you represent
Example: Sam Jones, Midwest Health
Please send your message to All Participants
LQI Structure
9 Lessons in the program
– Each lesson is composed of:
1. Preparation work on the Learning Management System (videos,
articles, case studies, and an assignment)
2. A coaching call for that Lesson (WebEx call with faculty)
– Lesson preparation work opens two weeks before the lesson’s
coaching call (Lesson 5 pre-work will open after this call)
– While you complete your preparation activities, please feel free
to email the listserv, [email protected], or the Lesson faculty
with questions
6
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Lead Faculty7
David Munch, MD, Senior Vice President and Chief Clinical
Officer, Healthcare Performance Partners, leads the
organization’s clinical and Lean Healthcare engagements. He
previously served as Chief Clinical and Quality Officer at
Exempla Lutheran Medical Center, where he led their Lean
Production applications for more than five years, resulting in
substantial improvements in both clinical and non-clinical
processes. Dr. Munch has been a frequent speaker on
leadership effectiveness and Lean transformation for a number
of health care organizations, including The University of
Rochester Medical Center, Yale-New Haven Health System,
Tulane University Medical Center, Pittsburgh Regional Health
Initiative, Institute for Clinical Systems Improvement, and the
Voluntary Hospital Association. He served on the Agency for
Healthcare Research and Quality's High Reliability Advisory
Group, and he has an extensive background in hospital
operations, health plan governance, physician organization
governance, and clinical practice in Internal Medicine.
Supporting Faculty8
Kathy D. Duncan, RN, faculty, Institute for Healthcare
Improvement (IHI), directs IHI Expeditions and manages IHI's
work in rural settings. Previously, she provided spread expertise to
Project JOINTS, co-led the 5 Million Lives Campaign National
Field Team, and was faculty for the Improving Outcomes for High
Risk and Critically Ill Patients Innovation Community. She also
served as the content lead for the Campaign's Prevention of
Pressure Ulcers and Deployment of Rapid Response Teams
areas. She is a member of the Scientific Advisory Board for the
AHA NRCPR, NQF's Coordination of Care Advisory Panel, and
NDNQI's Pressure Ulcer Advisory Committee. Prior to joining IHI,
Ms. Duncan led initiatives to decrease ICU mortality and morbidity
as the director of critical care for a large community hospital.
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LQI Objectives
At the end of the program, participants will be able to:
Describe the skills, tools, and resources needed by
a middle manager to lead quality improvement
efforts in their local settings
Demonstrate how to link department-level
improvement activities to the organization’s goals
and overall strategic plan
List at least three ways middle managers can be
successful in partnering with front-line staff in quality
improvement activities
9
LQI Lessons
Lesson 1 – Know Yourself, Janet Porter
Lesson 2 – Managing Time and Attention, Dave Munch
Lesson 3 – Practice Improvement Essentials, Kathy Duncan
Lesson 4 – Coach Your Team, Dave Munch
Lesson 5 – Patient Engagement, Janet Porter
Lesson 6 – Problem Solving in a Culture of Safety, Dave Munch
Lesson 7 – Managing Systems and Connections, Dave Munch
Lesson 8 – Empower Teams to Engage in Improvement, Janet
Porter
Lesson 9 – Identify and Spread Successful Improvement, Kathy
Duncan
10
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Agenda
Welcome & Introductions
Debrief Action Period Assignment
– Dan Harroff Case Study Questions
Coaching Your Team
Closing
11
Action Period Assignment
Provide your responses to the Dan Harroff Case
Questions and be prepared to discuss during our
session.
12
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The Dan Harroff Case13
The Dan Harroff Case
What recommendation would you give to Dan on how to
approach Dr. Newton with his goals to get the doctor’s
buy-in and support?
How should Dan approach coaching his previous peers
to transition their long-held management styles from
directive to more collaborative?
How might Dan engage the staff in the development of a
business plan for off-site services?
How should Dan build a case that working with QI on a
value stream could be worthwhile?
14
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Conclusions
Dan shared and explained data which supported his
approach, and gave Dr. Newton the information he
needed to endorse Dan
Dan engaged the Supervisors in an informal
brainstorming session and delegated the chairing of the
collaborative group, supporting their decisions
Dan created a steering committee to oversee the
business plan
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Interconnected Responsibilities
•Do the Standard Work
•Surface Problems
•Solve those that they can
• Improve the Standard Work
Staff
•Observe, Measure, Analyze, Action
•Coach the Front Line
•Support and Lead the Improvements
Management•Align to Strategy
•Develop the System and Structures for Support
•Coaching in the Work
•Steward the Changes
Executive
16
Performance Improvement, Decision Support, HR, I.T. Facilities
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Coaching
“Coaching in its truest
sense is giving the
responsibility to the learner
to help them come up with
their own answers.”
– Vince Lombardi
Coaching: The Development of People
CoachingPresence
Aim
Timely
Active Inquiry
Action & Follow-up
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The Five Elements to Coaching
Presence: Know yourself, know your people, be in the work– Observe directly to know specifically what people are doing
Objective - Every coach has a playbook– Build your Playbook: Strategic to tactical including the basics
– If there are too many: develop rotating weekly (or monthly) schedule
– Be specific about the coachee’s role: GRRATE
– Goals, Roles, Responsibilities, Accountabilities, Timeframe, Empowerment
Timeliness: Immediate intervention is the most effective– John Shook - “Know normal from abnormal, and know it right
now.”
The Five Elements to Coaching
Interaction: Active Inquiry
– It is not about the right answer, it is about The Right Question
– To Understand where they are and why they are there
– To listen for stuck points, blind spots and build other alternatives
– To stimulate learning, create new insights and come to agreement
The Action: Advancing Performance and Development
– What is your role in supporting and empowering the coachee:
address barriers, etc.
– Reflect & Discuss Follow up
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Approach determined by level of knowledge and situation
Instruction
Socratic Method
None Intermediate Advance
Coaching
Commanding
Routine Urgent Emergent
Level of Knowledge
Situation
Dysfunctional
Upward
Delegation
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The Most Important Characteristic of Coaching
Use Active Listening– Verbal and Nonverbal– Coaching is 80% listening, 20% talking
Types of Questions:
Diagnostic Questions
– Open, exploring the thinking of the coachee
Suggestive Questions
– Making a suggestion through a question
– There is danger here, be careful
Process oriented questions
– How are we doing? Am I being helpful? Do you understand
what we are trying to do in this conversation?
Personal revelations and admissions
Edgar Schein
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Powerful Questions
Why,
How,
What?
Who, When,
Where?
Which, Yes/No
More Powerful
Less Powerful
My Favorite Powerful Questions
What did you observe?
What possibilities exist that we haven’t thought of yet?
How would that work?
What would it take to,…?
Why is that the case?
What would that look like?
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The Power of Coaching
JCAHO Transforming Care
UnderstandingThe Problem
ManagerCoachTraining
ManagerCoaching
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Rat
e of
Com
pli
ance
Weekly Hand Hygiene Rates
October 2008-December 2010
P UCL Average LCL
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Outcome Measures
Does all this washing make a difference?
HAI Prevalence Correlated with Hand Hygiene Compliance
0.00
0.50
1.00
1.50
2.00
2.50
3.00
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08
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HA
I P
revale
nce
0
20
40
60
80
100
120
Han
d H
yg
ien
e C
om
pli
an
ce
HAI Prevelance per 1,000 pt days Hand hygiene percent compliance
Problem Solving QuestionsThe Heart of Coaching: Thomas G. Crane
Global– How are things going?
– What are your goals?
– What are you trying to accomplish?
Problem Identification– What results have you achieved
so far?
– Where are you stuck?
– What kinds of problems are you encountering?
Options and Solutions– What solutions have you
attempted?
– What do you see as your options?
– Do you want input from me?
Planning– What is your “go forward” plan?– How can you apply what you’ve
learned to your job?– Who else would benefit from
knowing this?
Support– What can I do to better support
you?– Whose support do you need?– Would it be helpful to talk again?
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Going Forward
Identify one of your key projects or activities and
delegate it to someone else. Use the opportunity as a
chance to develop your staff.
31
References and other reading
Humble Inquiry: The gentle art of asking instead of telling:– Edgar H. Schein. Berrett-Koehler Publishers 2013
The Heart of Coaching: Thomas G. Crane– Second addition, July 2002, FTA Press
The Art of Powerful Question, Catalyzing Insight Innovation and Action:
– Eric E. Gogt, Juanita Brown and Davis Isaacs. Whole Systems Associates: www.theworldcafe.com
Learning to Lead at Toyota: Steven J. Spear– Reprint R0405E: www.hbr.org
The Blind Spot Parts I and II: – Blog article by David Munch, www.leanhealthcareexchange.com
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Questions?
Please chat in or, if you are connected by
phone, raise your hand to be unmuted!
33
LQI Communications
All sessions are recorded
– Recording and materials sent in post-call email and uploaded to
your MyIHI account
Pre-work materials are located in LMS
Listserv address for session communications:
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Lesson 5
Janet Porter, MBA, PhDConsultant
Stroudwater Associates
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Tuesday, March 21, 1 PM ET
Partner with Patients and Families
Thank You!36
Rebecca Goldberg
Please let us know if you have any questions or
feedback following today’s LQI Coaching Call.