High Reliability Organizing (HRO) and the Patient Experience

Transcription

1 High Reliability Organizing (HRO) and the Patient Experience High Reliability Training Sisters of Charity Leavenworth Health System 25 May Healthcare Performance Improvement, LLC. ALL RIGHTS RESERVED. This material is a proprietary document of Healthcare Performance Improvement LLC. Reproducing, copying, publishing, distributing, presenting, or creating derivative work products based on this material without written permission from Healthcare Performance Improvement is prohibited.

2 This activity is jointly-provided by SynAptiv and the Colorado Hospital Association Conflict of Interest Disclosure Statement I have no financial interest or other relationships with the industry relative to the topics being discussed. 2

3 Patients Suffering Harmed Poor outcomes Care without compassion and connection Care givers and providers Injured Not respected for their contribution Not engaged in meaningful work Slide 5 Slide 6 3

4 Reliability Culture - Genius of the AND Safety Focus + performed as intended consistently over time = No Harm Evidence-Based Process Bundles + performed as intended consistently over time = Clinical Excellence Patient Centered + Financial Focus + performed as intended consistently over time RELIABILITY CULTURE Failure Prevention performed as intended consistently over time = Satisfaction = Margin Slide 7 Main Line Serious Safety Events January 200 September 205 Slide 8 4

5 Overall Hospital Mortality 58% decrease over 5 Quality Years Slide 9 Main Line PX, HCAHPS Top Box Slide 0 5

6 Kina ole (flawlessness) Doing the right thing in the right way, at the right time, in the right place, to the right person, for the right reason, with the right feeling, the first time. Fiscal Year 202 Playbook, Queen s Medical Center, Honolulu, HI Slide Complementary Strategies Codes Outside the ICU Surgical Site Infections Central Line Infections Hand Hygiene Culture and on, and on, and on 2006 Healthcare Performance Improvement, LLC. ALL RIGHTS RESERVED. Slide 2 6

7 Process Bundle People Bundle 4 for VAP Prevention. Elevation of the head of the bed to between 30 and 45 degrees 2. Daily sedation vacation and daily assessment of readiness to extubate 3. Peptic ulcer disease (PUD) prophylaxis 4. Deep venous thrombosis (DVT) prophylaxis (unless contraindicated) Read More: Community Health Network Reduces Deadly Infections Through Culture of Reliability, American Society for Quality (June 2008) Slide 3 Patient as Team Member Why do we have one culture for us and one culture for them? Cure Team Power Distance minimizing behaviors (tone) Thinking behaviors (tool) Thinking in team behaviors (tools) Hourly rounding (structure) Bedside reporting (structure) AIDET (tool + tone) Communication boards (structure) Discharge phone calls (process) Care Team High reliability innovator, W. Edwards Deming, dramatically broadened the definition of "customer" to include both internal and external customers. Each person or step in a process was to be treated as a "customer" and to be supplied with exactly what was needed, at the exact time needed. Include patient and family as members of the Collegial Interactive Team (CIT). Unify all behaviors into a single high-reliability bundle, and treat everyone like a customer (i.e. tone plus tools). Slide 4 7

8 Clinical Quality + Perceptual Quality Cared For + Cared About Expected + Not Expected That results in the WOW! Slide 5 Clinical Quality Technical Aspects of Care Was blood drawn correctly? Was the X-ray clear? Was the clinical pathway followed? Did the registrar enter all my insurance information correctly? Did the doctor practice evidence-based medicine? Perceptual Quality Service Aspects of Care Did it hurt? Was the table too cold and hard? How long was the wait? Was I greeted with a smile and told what happens next? Was the doctor compassionate? Slide 6 8

9 Client Example Taxonomy of Service Failures in Healthcare Communication (SC) Environmental (SE) Personal Needs (SP) Response Time (SRT) Care/Outcome (SO) Respect (SR) 5 SC Not kept informed of condition Excessive noise SE SP Lack of response to concerns /complaints Significant wait time SRT Pain not managed SO Lack of concern for SR privacy/dignity not honored SC2 Inadequate information about treatment/meds Room is dirty SE2 SP2 Lack of concern for comfort SRT2 Delayed test/treatment SO2 Hospital acquired condition 6 SR2 Staff did not show empathy 2 5 SC3 Negative or inappropriate comments by staff SC4 Rudeness of staff SC5 Rudeness of physician SE3 Room décor shabby or dated SE4 Room temperature SE5 Broken equipment 6 SP3 Lack of concern for inconvenience SP4 Lost or misplaced belongings 5 SRT3 Lack of prompt response to requests ) SRT4 Lengthy admission or discharge SRT5 Response to call bell 3 SO3 Poor clinical outcome SO4 Medical/medication error SO5 Patient not protected SR3 Not involved in decisions re: treatment SR4 Patient rights violated SR5 Spiritual needs not met SC6 No access to an interpreter SE6 Wrong meal; food temperature 4 Inadequate care SO6 No communication SC7 between staff, teamwork SC8 Staff did not smile or SE7 Difficult way finding SE8 Inadequate or Source: 73 Complaints SO7 Premature discharge greet inconvenient parking 2 SC9 Staff did not listen to me Service Failures by Event Type 23% rudeness, inappropriate comments by staff, physicians 8% inadequate care 4% inadequate information about treatment/meds Slide 7 Slide 8 9

10 Likelihood to Recommend % Very Good 6//206 A Client Example Increased HCAHPS Scores in 8 of the 9 HCAHPS Domains (December 200 to May 20) December 200 May 20 HCAHPS Domains Top Box Percentile Top Box Percentile Rate hospital 0 0 6% 22 nd 67.4% 49 th Recommend Hospital 65% 29 th 82.2% 89 th Communication w/nurses 75% 42 nd 80.0% 75 th Response of Hospital Staff 66% 67 th 67.7% 74 th Communication w/ Doctors 77% 28 th 8.5% 64 th Hospital Environment 63% 44 th 7.0% 82 nd Cleanliness of Hospital Env. 49% 84 th 86.4% 95 th Quietness of Hospital Env. 58% 4 th 55.6% 5 st Pain Management 68% 39 th 78.0% 93 rd Communication about Med 59% 39 th 57.7% 33 rd Discharge Information 80% 29 th 80.9% 38 th Focus Areas: Dashboards and Drill Down Tools; Staff and Physician Education; Nurse Leader Rounding; Hourly Rounding; Bedside Reporting; Secret Shopper Program; Pain Posters; Discharge Paperwork Slide 9 Impact of Effective Service Recovery Likelihood to Recommend by Response to Concerns and Complaints 00% 90% 80% 70% 60% 50% 40% 30% 20% 0% 0% 93% 44% 8% 9% 0% Very Poor Poor Fair Good Very Good Response to Concerns/Complaints Made During Your Stay Source: Press Ganey Slide 20 0

11 Non-Technical Skills Non-technical skills describe how people interact with technology, environment, and other people. These skills are similar across a wide range of job functions. These skills include attention, information processing, and cognition. Generic non-technical skills: Situational awareness Attention Communication repeat backs call outs phonetic & numeric clarification clarifying questions inquiry, advocacy, assertion Critical thinking Protocol use Decision-making Flin, O Connor, and Crichton Safety at the Sharp End Slide 2 Power Distance Large Distance Relations are autocratic and paternalistic Power acknowledged based on formal, hierarchical positions Small Distance Relations are consultative and democratic Relate as equals regardless of formal positions The perceived distance not necessarily the real difference as seen by the subordinate Reference: Hofestede, Geert. Culture s Consequences, 200 (2 nd edition). Slide 22

12 Collegial Interactive Teams (CIT) = Tone + Tools Setting the tone You had me from Hello - Greetings include first names - Cordiality, openness - Eye contact and body language Team goals - Use we and us vs. I and you - What s best for the patient Invite a Questioning Attitude - Leaders set the tone for the flow of information - If any member of the team sees anything that is unsafe, I expect you to speak up... Slide 23 Safety Patient identification Double checks Quality CAUTI bundle Skin Care bundle Fall assess/prevention Pain assess next dose Service Excellence Bedside report Hourly rounding Communication boards Discharge phone calls Slide 24 2

13 Getting Started. Recast safety first leadership as high reliability leadership 2. Modify the transformation team(s) 3. Study strengths, weaknesses, and opportunity 4. Culture (re)design for leadership and staff/medical staff 5. Align behavior, structure, and process/protocol: a. Include behaviors in behavior bundles b. Develop specific bundles for structure, process, and protocol 6. Educate/train leaders, medical staff, and staff a. Shrink the Change to minimize disruption b. Use culture in a box to maximize learning effectiveness Slide 25 Evidence-based leadership for Safety (high reliability) requires less change. Lead the safety journey Message safe, effective, patient-centered Expand purpose and scope Expand purpose and scope Use as opportunity to adjust leader behaviors Slide 26 3

14 Staff/medical staff behaviors require some additions Recast purpose for safe, effective, patient-centered Add the Tones Add some Tools (AIDET) Use as opportunity to adjust staff behaviors Slide 27 Leader Tool: Communicate Voice of Patient Our commitment to a positive safety, high quality experience The Voice of the Patient The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. HCAHPS surveys are designed to produce data about patients' perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers. Public reporting of the survey results creates new incentives for hospitals to improve quality of care. Public reporting serves to enhance accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment. Slide 28 4

15 Leader Tool: Unit Top 2 Alignment in improving the patient experience Voice of the Patient Kudos: We got this one right!. Nurses always communicate well 75 th percentile Focus Questions:. Patients always receive help quickly 70 th percentile 2. Patients pain was always controlled 68 th percentile Recommendations: Continue hourly rounding Use the patient communication board to document pain levels and time next dose medication due 3% 2% 7% % 0% Overall Facility Rating % % 73% 9-0's The HCAHPS survey asks discharged patients 27 questions about their recent hospital stay, including core questions about critical aspects of patients' hospital experiences. 5 of the survey questions are more highly correlated with HCAHPS "recommend such as staff do everything to help with pain. The Unit Top 2 list communicates the prioritization of the area of focus so that all caregivers will know what questions the unit is focusing on improving. The two focus questions are posted monthly on the Voice of the Patient communication board. Slide 29 Innovators Sentara Five Promises with Promise : Always keep you safe (with 5 behaviors) Lee Memorial Safety Culture first then expanded to Safety + Service on HRO platform CHRISTUS Spohn Safety + Service on HRO platform as first intervention Queen s Medical Center Tones & tools of the CIT to reduce power distance Cancer Treatment Centers of America Service Culture first then expanded to Safety + Service on HRO platform Group Health Cooperative Safety + Service on HRO platform using Tones, Tools, and Power Tools Slide 30 5

16 Lessons-Learned. Patient Experience satisfaction 2. Tones & tools shrink the change for staff 3. Blue printing further shrinks change (for nursing) 4. Train in simulation learning is doing with feedback 5. High reliability is good leadership not necessarily good marketing (to patients and staff) 6. Leader structure still makes all work Slide 3 The HPI Team Craig Clapper PE, CQM/OE Partner & Chief Knowledge Officer Healthcare Performance Improvement 504 Corporate Woods Drive, Suite 80 Virginia Beach, VA Tel: (757) Slide 32 6