Session 93AB Creating and Sustaining a Culture of Innovation to Achieve Zero Events of Preventable Harm

Transcription

1 Prepared for the Foundation of the American College of Healthcare Executives Session 93AB Creating and Sustaining a Culture of Innovation to Achieve Zero Events of Preventable Harm Presented by: Brent Ibata, JD, PhD, FACHE Audrey Douglas-Cooke

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3 Creating and Sustaining a Culture of Innovation to Achieve Zero Events of Preventable Harm 93A & 93B Wednesday, March 29, 2017 Disclosure of Relevant Financial Relationships The following faculty of this continuing education activity has no relevant financial relationships with commercial interests to disclose: Brent Ibata, JD, PhD, FACHE Audrey Douglas-Cooke, RN 2 1

4 Presenters Brent Ibata, PhD JD MPH FACHE Audrey Douglas Cooke, RN MS 3 Learning Objectives Understand the value of rapid cycle innovation in the design, development and execution of quality performance improvement initiatives. Demonstrate how to create and sustain a culture of creative inquiry that achieves a high reliability organizational culture. 4 2

5 Agenda Evolution of Healthcare Innovation Fundamentals of High Reliability Organizations Rapid Cycle Innovation (Design Thinking) Our Journey to Zero 5 Sentara Healthcare Mission: We improve health everyday. Values: People, Quality, Patient Safety, Service & Integrity Vision: To be the healthcare choice of the communities we serve. 6 3

6 Sentara Healthcare 12 acute care hospitals 800-multi specialty physician group Virginia & Northeast North Carolina $5.5B net revenue Optima Health Plan serving 450,000 members Sentara College of Health Sciences Sentara Quality Care Network 7 Sentara Heart Hospital 114 beds PCI Center Advanced catheter based therapy Arrhythmia Center Advanced Imaging Cardiac Rehab Complex Cardiac Surgery Structural Heart Transplant, Artificial Heart, VAD Research/Learning center 8 4

7 Evolution of the Hospital 9 Evolution of Reimbursement FFS HMO VBP 10 5

8 Evolution of Patient Safety 11 Hospitals of the Future Highly reliable healthcare organizations share common core characteristics: Encourage and support continuous change Invest in staff self-efficacy & development Transparent patient safety accountability Patient centric focus 12 6

9 Hospitals of the Past Healthcare organizations that struggle with improving quality outcomes share common core characteristics: Deference to the status quo Limited staff development dollars Blame-game accountability Provider centric focus 13 Stages of Change: The data are wrong; The data are correct but it s not a problem; The data are correct and it s a problem, but it s not my problem; The data are correct and I own the responsibility to fix the problem. 14 7

10 To Err is Human Institute of Medicine (1999) At least 44,000 Americans die each year as a result of a medical error (may be as high as 98,000). Total cost between $17 and $29 billion (lost income, lost productivity, disability and healthcare costs). 15 To Err is Human Recommendations (1999) Establish a national focus to create leadership, research, tools and protocols to enhance knowledge of patient safety. Identify and learn from errors through mandatory reporting. Raise standards and expectations for improvements in patient safety through oversight organizations, purchasers, and professional groups. Create safety systems through the implementation of safe practices at the patient level. 16 8

11 Crossing the Quality Chasm Six Aims for Improvement (2001) Safe Effective Patient-Centered Timely Efficient Equitable 17 Serious Safety Events (Never Events) Retained foreign objects Wrong patient Wrong side Wrong procedure Falls Suicides Dialysis-related events Procedural/post-procedural events Delay in treatment Criminal events Perinatal death/injury Medication errors Fire-related events Source: Becker s Hospital Review ( ) 18 9

12 Cultures of Innovation Built environment Permission to fail Innovation space Culture that encourages and supports change Source: Brown, Tim. Change by Design 19 Anyone can create innovative solutions to reduce events of preventable harm Source: Saint Exupery, A. The Little Prince and Disney 20 10

13 Evolution of Improvisational Design Thinking Source: d.school; IDEO; The Second City 21 Agency for Healthcare Research & Quality Becoming a High Reliability Organization Sensitivity to Operations (Situational Awareness) Reluctance to Simplify (Multiple Failure RCA/ACA) (Healthy) Preoccupation with Failure (Situationally Appropriate) Deference to Expertise Resilience (Members of the Team) 22 11

14 Foundation of Sentara HRO Culture We improve health everyday. HRO 23 Sentara Commitments I commit to: Always keep you safe Always treat you with dignity, respect & compassion. Always listen & respond to you. Always keep you informed & involved. Always work together as a team to provide you quality healthcare

15 Sentara Behavior Based Expectations I commit to always keep you safe: Pay attention to detail Communicate clearly Have a questioning attitude Hand off effectively Never leave my wingman 25 Collaborative Grant Program Rapid Cycle Innovation Training Grant in Healthcare Delivery Science and Health Services Research $20,000 multi-institution grant: 501(c)(3) hospital Medical school Liberal arts college 26 13

16 Grant Timeline Dec13 Jan14 Feb14 Mar14 Apr14 May14 Jun14 Develop Training Program X X Cohort #1 X X X X Cohort #2 X X X X Cohort #3 X X X X Revise Training Program R R R R R Present Innovation Projects #1 #2 #3 Plan Sustainability X Develop Training Program (Plan) Cohort #1 (Do-Study-Act) Cohort #2 (Plan-Do-Study-Act) Cohort #3 (Plan-Do-Study) Final Presentation(s) Act Plan Study Do 27 Planning Stanford d.school Florida Hospital Innovation Lab Mayo Clinic Center for Innovation TeamSTEPPS Master Trainer at Duke Plan Act Do Study 28 14

17 Innovation Cycles Plan Act Do Study Source: d.school and IDEO 29 Empathy (human-centered design) Empathy is the ability to be aware of, understand, and be sensitive to another person s feelings and thoughts without having had the same experience. Empathetic design is a process that involves interviews, observations, and iterative rapid cycle prototyping. Empathy is key to design thinking. Source: IDEO. Empathy on the Edge 30 15

18 Examples of IDEO Healthcare Innovations Change by Design Youth obesity with the U.S. Centers for Disease Control and Prevention Transforming care at the bedside for Institute of Healthcare Improvement and Robert Wood Johnson Foundation The emergency room experience at DePaul Health Center for SSM Health Care Improved patient-provider service for Mayo Clinic Nurse knowledge exchange for Kaiser Permanente Source: Brown, Tim. Change by Design 31 IDEO Brainstorming Rules: Defer Judgment Encourage Wild ideas Build on the Idea of Others Stay Focused on the Topic One Conversation at a Time Be Visual Go for Quantity 32 16

19 Yes, and (Improv Rules) 1. Defer Judgment (don t block) 2. Encourage wild ideas (fail fast, fail cheap) 3. Build on the Idea of Others (yes, and ) 4. Stay Focused on the Topic (don t deny) 5. One Conversation at a Time (give and take) 6. Be Visual (show, don t tell) 7. Go for Quantity (change, change, change!) 33 Rapid Cycle Innovation Boot Camp 34 17

20 FINAL Agenda Day # Icebreakers 0930 Marshmallow Exercise 1000 d.school Wallet Exercise 1100 How might we design the ideal office visit? 1200 LUNCH 1230 Post-It brainstorm Q s HRO Culture 1330 Empathy Hunt Debrief 35 FINAL Agenda Day # Icebreakers 0830 HRO TeamSTEPPS 0930 Post-It brainstorm dig deeper 1000 Empathy Hunt # Debrief 1200 LUNCH 1230 Fail fast, fail cheap Build prototype(s) 1300 Test Prototype(s) Debrief 36 18

21 Basic HRO Materials (pop-up workshops) Marshmallow ($25) Spaghetti, roll-of string, tape, tape measure. Wallet & prototyping ($3,000) Prototyping cart (cardboard, crayons, Play Doh, etc.) Brainstorming Z-Rack Whiteboard ($500) Z-Rack Post-Its (Priceless) Source: d.school.stanford.edu

22 How might we communicate HRO to front-line staff? 39 AHRQ TeamSTEPPS 40 20

23 41 EVMS Sentara Center for Simulation & Immersive Learning 42 21

24 Rapid Cycle Innovation Projects Wayfinding Physician Report Card Inventory Management 12-Lead EKG AMI LOS Rapid Response Audit Bed Flow Med Communication Seamless Discharge Falls OR Safety HRO Bulletin Board HRO Flip Book HRO 8 ½ x 11 Poster HRO Badge Card HRO TeamSTEPPS - Leader HRO TeamSTEPPS - Monitor HRO TeamSTEPPS Comm HRO TeamSTEPPS - Support 43 The Marshmallow Challenge Source: Wujec, Tom (2010). The Marshmallow Challenge

25 Sentara Heart Culture of Innovation Sentara Heart Operations Committee Admin, Physicians, Nurses, other(s) Sentara Heart Joint Operations Committee Sentara Cardiovascular Specialists Sentara Cardiovascular Research Institute Cardiac Grand Rounds Cardiac Journal Club 45 High Reliability Organization Standardization across the institution Reduce variability & decrease medical errors Improve health everyday 46 23

26 Nursing Quality Indicators Quality improvement since implementing HRO 47 Customer Service 48 24

27 Zero Wrong Events in OR, Imaging, Vascular, & Cath Labs 49 Prolonged Ventilation Extubation < 6 hours 29.5% 50 25

28 Prolonged Ventilation Extubation > 24 hours 14.98% STS goal = < 12% 10% 51 CSICU Length of Stay (LOS) 52 26

29 Post-Op Afib 53 Post-Op Renal Failure 54 27

30 The Marshmallow Challenge Source: Wujec, Tom (2010). The Marshmallow Challenge !? 56 28

31 57 Presenter Biography & Contact Info Brent Ibata, PhD JD MPH FACHE Research Compliance Officer for Sentara Healthcare Dr. Ibata has over twenty-five years of progressive healthcare leadership experience starting as an ER tech on the West Side of Chicago, moving through a decade at an academic teaching hospital in St. Louis, followed by three years as a director of a multidisciplinary clinic. Dr. Ibata is a Mensan and TeamSTEPPS Master Trainer who has spent most of his career building and sustaining environments that inspire and reward innovation and quality. The seeds for his career in healthcare innovation were planted in Chicago as a graduate of Lane Technical High School and The Second City Training Center. Dr. Ibata has a PhD with an emphasis in health services research, a JD with a certificate in health law, and a Master in Public Health. He is the author of numerous journal articles in addition to dozens of presentations at regional, national, and international conferences related to innovation in healthcare. baibata@sentara.com Phone: (757)

32 Presenter Biography & Contact Info Audrey Douglas-Cooke Vice President of Patient Care Services, Sentara Heart Hospital Audrey has worked in the health care profession for the past 30 years amassing a wealth of experience ranging from Oncology to Surgery to her current role as Vice President of Sentara Heart Hospital. In her current role, she oversees the fiscal & human resource management of a dedicated Heart Hospital which provides a comprehensive array of cardiac services which include but are not limited to heart transplantation & MCS, a robust Structural Heart Program & a comprehensive Arrhythmia program that utilizes 4 EP Labs & one Hybrid OR. As a STEMI Regional Center, the hospital is proud to provide several quaternary services as evidenced by a consistent growth in market share. She oversees an annual expense budget of $166M with a gross revenue of $1.1B. Her education includes: Bachelor s Degree in Nursing & a Minor in Psychology from Georgetown University Master s Degree in Hospital Administration from Central Michigan University abdcooke@sentara.com 59 Bibliography/References 1. Brown, T. (2009). Change by design. Harper Business. 2. Cleveland Clinic. A Lesson in Empathy. Available at: 3. dschool.stanford.edu 4. Hines S, Luna, K, Lofthus J, et al. (2008). Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. AHRQ Publication No Agency for Healthcare Research & Quality. 5. Ibata, B. (2009). Public Health Law & the Built Environment in American Public Schools: Detailed History with Policy Analysis. VDM Publishing. 6. Institute of Medicine (US) (2001). Crossing the quality chasm: a new health system for the 21st century. National Academy Press. 7. Institute of Medicine (US) (2000). To Err is Human: Building a safer health system. Institute of Medicine. National Academy Press. 8. Kelley, T. (2007). The art of innovation: Lessons in creativity from IDEO, America's leading design firm. Crown Business. 9. Kelley, T., & Kelley, D. (2013). Creative confidence: Unleashing the creative potential within us all. Crown Business. 10. Lanser May, E. (2013). The Power of Zero: Steps Toward High Reliability Healthcare. Healthcare Executive. 11. Wujec, Tom (2010). The Marshmallow Challenge. Ted Talk. Available at: