2/18/2016. Amy Mervak Hospice Care of Southwest Michigan. "Spiral Learning" with Kata. By Amy Mervak

Transcription

1 Amy Mervak Hospice Care of Southwest Michigan "Spiral Learning" with Kata By Amy Mervak 1

2 TAKE AWAY: As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy* grows. * The perception of one's ability to reach a goal 2

3 Spiral Learning Strategic priorities must be focused & formally expressed. The STRATEGY Learning Spiral Improvement efforts cannot be separate from management. Storyboards are most effective when linked to strategic priorities. Reframe missteps as experimentation Intentional practice = Intentional learning The PROCESS Learning Spiral Good processes produce important outcomes We take care of people who are dying, and their families. Spiritual Physical Emotional 3

4 January 2015 Hospice Aides Primary RNs Clinical Staff Resource/ IRPT RNs After-Hours RN Team Nurse Manager (1) 16 Director of Client Care 26 Director Hospice Aides RNs with Client Caseloads Resource/Irregular Part-Time RNs After-Hours RNs December 2015 Homecare 1 Homecare 2 Homecare 3 Clinical Staff After-Hours RN Team RN Managers (3) 13 Manager 12 Manager 12 Manager Director of Client Care 9 Director Hospice Aides RNs with Client Caseloads Resource/Irregular Part-Time RNs After-Hours RNs 4

5 Unclear Territory Negative media coverage Operating loss Staffing challenges Regulatory requirements Cost Auditor scrutiny Competition The STRATEGY Learning Spiral Strategic priorities must be focused & formally expressed. Improvement efforts cannot be separate from management. Storyboards are most effective when linked to strategic priorities. 5

6 Our Improvement History Success with Projects using the IHI s Model for Improvement Variability in sustainment of gains Improvement efforts cannot be separate from management. Continual Projects does not equal Continual Improvement! Down is better Early Storyboards 75% of my To-Do List items will be addressed by the end of the work day. 60 min/day are devoted to projects (tasks that can be delayed by day-today work/firefighting). 6

7 Strategic priorities must be focused & formally expressed. Storyboards don t relate to the organization s priorities. Organization s priorities are not sufficiently expressed. Too many priorities (# in the 40s) and not well-defined. 40 priorities = No priorities Storyboards are most effective when linked to strategic priorities. 2 Challenges Alignment Storyboards Priorities Advance Group Weekly Leadership Meetings As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy grows. 7

8 The STRATEGY Learning Spiral Strategic priorities must be focused & formally expressed. Improvement efforts cannot be separate from management. Storyboards are most effective when linked to strategic priorities. The PROCESS Learning Spiral Reframe missteps as experimentation Intentional practice = Intentional learning Good processes produce important outcomes 8

9 Reframe missteps as experimentation By 11/24, create a 1 st draft / worst map of a revised protocol that reflects what we have learned to date. That it will be rough AND informative AND be a step toward 11/30 due date. Map completed! That this is doable That a visual map is helpful That this needs to be formalized. That we need broad agreement on it. 9

10 Assumption: alone ensures understanding & execution Our Pattern Change idea Guideline Expectation Delay Evaluation (Frustration) Assumption: is a part of ensuring understanding & execution Our Latest Approach Change idea Guideline Expectation Intentional practice = Intentional learning Staff meeting discussion Immediate evaluation Adjust / Follow up 10

11 Good processes produce important outcomes Good processes produce important outcomes 11

12 Good processes produce important outcomes The PROCESS Learning Spiral Intentional practice = Intentional learning Reframe missteps as experimentation Good processes produce important outcomes 12

13 Our "Learning Edge" 5 Steps of Process Analysis PROCESS STRATEGY Bonus: Don t skip the process analysis steps Virtual Storyboard 13

14 Visual Management Toyota Kata Process Analysis Steps 1. What is the task unit? How much time do we have to complete it? HCSWM Example Having the conversation re: current statin. Discontinuing it or documenting reason why it will remain active in 2 weeks. 2. What are the typical patterns of work? (Draw it) How is the process currently operating (process measures) See process map * 0 clients on statins (payer=hcswm) * All clients have supportive documentation (payer=client) 3. Do we have any machine constraints? (Data) Phone call time with pharmacy 4. How many people are necessary if the process were stable? 5. How is the process performing over time (Outcome measures) Appropriate RN caseloads Good=10 Excellent=13 Meet 2016 budget for non-formulary medication cost - $2.00 per patient day Reduce pill burden and side effects of unnecessary medications by DCing statins TAKE AWAY: As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy grows. Strategic priorities must be focused & formally expressed. STRATEGY Learning Spiral Improvement efforts cannot be separate from management. Storyboards are most effective when linked to strategic priorities. Reframe missteps as experimentation Intentional process = Intentional learning PROCESS Learning Spiral Good processes produce important outcomes 14