Leadership Accountability Demonstration Project

1. Leadership Accountability Demonstration Project September 22, 2014 LITE Cohort Call #2: Strategic Prioritization and Learning Tracer Tools

2. Agenda • How do we gain focus and reconcile competing priorities? • The Strategic Prioritization Tool • How do we capitalize on the innovative capacity of our workforce? • The Informal Learning Tracer Tool • Discussion

3. LADP Project Roadmap—Lite Group • June –August 2014 • Project kickoff • August 2014 • Cohort tool webinar • Try out the Aligning Goals Across the Organization tool • Try out the Defining Safety Competencies tool • Horizontal Learning Call • September 2014 • Cohort horizontal learning webinar • Cohort tool webinar • Try out the Strategic Risk Assessment and Prioritization Tool • Try out the Learning Tracer Tool • Horizontal Learning Call • October 2014 • Cohort horizontal learning webinar • November 2014 • Cohort tool webinar • Try out the Collaborative Tactical Decision Making Method • Interactive business case presentation • December 2014 • Cohort horizontal learning webinar

4. Armstrong Institute for Patient Safety and Quality Strategic Prioritization Tool

5. What is our aim? Leading with Intent • How do we set goals and priorities? • many measures have financial, reputational, and regulatory risks • How do we balance external priorities with internal priorities?

6. How do we currently assess risk as an organization? How many of you use a systematic process to prioritize organization quality and patient safety goals and priorities? If YES, Is the process well known throughout the organization? Might a systematic approach to guide the process be useful?

7. Creating High Value Healthcare

8. Competing Improvement Goals and Priorities Clinical Outcomes Patient/Family Reported Outcomes Staff Reported Outcomes Financial Goals/Measures of Efficiency

9. Armstrong Institute for Patient Safety and Quality Phase I: Clarify External Reporting Risks and Prioritize Action Areas Tool guided process to evaluate External patient safety related risks and opportunities for improvement across several domains Use results to help prioritize areas for improvements. Reputational Risk Feasibility Patient Harm Financial Risk Regulatory Risk

10. Strategic Risk Assessment and Prioritization

11. Armstrong Institute for Patient Safety and Quality Risk assessment table

12. A Case Example from Johns Hopkins Hospital • Aim: Exceed 96% compliance with nine key process measures. • PCI <= 90 minutes (AMI); Discharge instructions; Blood culture in ED prior to initial antibiotic; Cardiac surgery glucose control; Beta-blocker if pre, then post; Urinary catheter removal; Home management plan; Pneumococcal vaccination; Influenza vaccination

13. Approach stemming from strategic goals

14. Performance gains

15. Armstrong Institute for Patient Safety and Quality Learning tracer tool

16. Armstrong Institute for Patient Safety and Quality Several influential reports on patient safety have highlighted the importance of developing effective, efficient systems for learning to reduce preventable patient safety incidents Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices

17. Armstrong Institute for Patient Safety and Quality Closing the Loop

18. Armstrong Institute for Patient Safety and Quality Types of Learning in Hospital Setting • Formal Learning • Typically provided by an education or training institution, structured (in terms of learning objectives, learning time or learning support) and leading to certification • Intentional or deliberate from the learner’s perspective (Cedefop 2001) • Informal Learning • Resulting from daily life activities related to work, family or leisure. It is not structured (in terms of learning objectives, learning time or learning support) and typically does not lead to certification • May be intentional but in most cases it is not-intentional (or "incidental"/random) (Cedefop 2001)

19. Armstrong Institute for Patient Safety and Quality Types of Learning in Hospital Setting Cont’d

20. Armstrong Institute for Patient Safety and Quality Although huge amount of resources are spent on formal learning, it accounts for only 20% of learning that occurs The remaining 80% occurs through informal learning (1) Competency enhancement Informal Learning as a tool for learning and knowledge sharing

21. Armstrong Institute for Patient Safety and Quality 4 Key Steps for Building Capacity • Define relevant patient safety and quality related competencies for each link in your chain of accountability • What are we expecting each team member in our chain of accountability to know, do, and have awareness of or appreciation for in order to optimize patient safety and quality in our organization? • Help team members develop, retain, and continuously grow these competencies • How does (or should) our organization support team members (formally and informally) in building and retaining patient safety and quality related knowledge, skills, and attitudes?

22. Armstrong Institute for Patient Safety and Quality 4 Key Steps for Building Capacity-Con’t- • Reflect on how team members are held accountable for demonstrating the patient safety and quality competencies identified • How does our organization evaluate or reinforce patient safety and quality related knowledge, skills, and attitudes? • Ensure local lessons learned, great little ideas that help, and near misses are shared throughout our organization and leveraged as opportunities for continuous learning • How are we capitalizing on internal opportunities for learning, including sharing creative and innovative ideas or solutions?

23. Armstrong Institute for Patient Safety and Quality Learning from Defects Incidents or situations that caused or could potentially put pt. at risk for harm Defect = any clinical or operational event or situation that you would not want to have happen again. Near misses (or great catches) Operational inefficiencies or processes that are not currently optimal Surfacing defects is only useful if… Lessons learned from investigating the defect, and changes made in response to the defect are shared both vertically and horizontally throughout the organization using reflective learning processes

24. Armstrong Institute for Patient Safety and Quality Recommendations for Improving Knowledge Sharing Through Informal Learning Make time and space for learning Scanning for changes in the environment Attention to learning process and attention to goals Inductive mindset and reflective skills Climate of collaboration and trust

25. Armstrong Institute for Patient Safety and Quality Examples of strategic, but informal, learning structures or processes Developing internal experts Actively encouraging and rewarding sharing of concerns, creative ideas, and workarounds Mentoring, coaching, peer reviews, job shadowing M&M conference, incident reporting, chart reporting, prospective risk analysis Mobile device, online messenger systems, and social networks

26. Informal Learning Tracer Tool: Step 1 Armstrong Institute for Patient Safety and Quality Use the space below to draw a picture of what you personally think happens after a defect (an event, near miss, or other situation that you would not want to have happen again) occurs in your organization: Materials: Paper copies of this Tracer Tool, markers/colorful pens Instructions: • Use some of the time at one of your Leadership Accountability Demonstration Project team meetings (or other gathering) to have all meeting participants complete the exercise below individually. You may also ask participants to complete this page (page 7 only) on their own before coming to the meeting. • As a group, compare what you have drawn. Use this as an opportunity to compare any differences and align the team’s mental model (i.e., get on the same page) about what the ideal process should be.

27. Informal Learning Tracer Tool: Step 2

28. Armstrong Institute for Patient Safety and Quality Discussion

29. Next Steps • Continue progress on ‘Aligning goals across the organization’ • What is your implementation plan? • What’s new? What links are present, but need re-invigoration? • We will return to this tool throughout the project. • Try the ‘Learning Tracer Tool’