Transcript No one asked me to work on improvement

WHA Improvement Forum
For June

“Tapping Front-line Knowledge”
 
Presented by Stephanie Sobczak and Jill Hanson
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Today’s Webinar
 The front line staff perspective
 Levels of Involvement
Agenda  Strategies for Feedback
 “Real Time” Improvement
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Engaging Front-line Staff
“I was told I
have to go
to meetings
on my off
time”
“No one asked me
to work on
improvement”
“I’ve been involved
in the past, but I
got stuck doing
most of the work”
Why?
• Improved outcomes can only occur with
improved processes – “the work” of the staff.
• Staff already know where the waste and
inefficiencies are in their processes.
• Care giving staff are the eyes and ears of the
hospital.
• “Culture eats strategy for lunch”!
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How?
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Setting the Stage for Engagement
Emphasize Teamwork
Emphasize High Reliability
Emphasize Participation
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Teamwork
Success is only possible when everyone knows
what is expected, and what is important.
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Teamwork
Do your front line staff know that teamwork is
greatly valued in your organization?
Is it obvious?
Is it recognized?
Is it praised?
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High Reliability
The key is standardized approaches.
For the work: Use of checklists and written work
instructions and systematic methods of
communication (such as SBAR)
For the improvement: P-D-S-A
or other improvement approach
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Our Hospital
Where we do some of the
right things
for some our patients
some of the time.
“Engage the Engaged”
How do we know who is engaged?
You could ask directly, “Who wants to help?”
OR
Listen carefully to casual conversations:
Who loves working with the older folks? Or babies?
Or is a stickler for handwashing?
Who reads journals and publications and talks about it?
Who is going back to school?
Who starts their sentences with “You know, we should…”
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Levels of Involvement
Early
Fence
Adopters
Sitters
• Actively seek
their
knowledge
• Find ways to
lead
• Brief
interactions
• Low level
commitment
• Tap into
interests
Disengaged
• Ask for
support
• Keep mining
the “why”
• Reach out
occasionally
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Wise Words
A new way of doing something only
sticks when it can be easily
integrated during the work day
Work on improvement
during the work day
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Lose the “Meeting Mindset”
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Think This Through….
• What decisions need to be made in a committee
or council.
• What can be done in informal feedback huddles
– Okay to make decisions on small test of change
outside the meeting.
– Discuss results of small test and adapt quickly.
• Ensure transparency through a notebook or
whiteboard to document progress or concerns.
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Benefits of Fewer Meetings
1. Avoids the need to schedule space.
2. Allows people to meet as it is convenient for
them, so participation is more likely to
happen.
3. Reduces “calendar conflict” problem - the #1
reason for slowing down progress.
4. Changed processes, new tools, etc. are going
to work because they are really designed right
in the middle of “the work”.
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Staff Engagement through
Small Tests of Change
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1) Identify: Who
has to change
their process?
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5) Track tests and
gather data as
you go forward
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4) Teach testers
their role: Trial,
give feedback,
suggest
improvements
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2) Do they
know the
rationale for the
change?
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3) Find volunteer
testers and clarify
expectations
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Designing Tests and Trials
A. Begin with the smallest unit of change possible
“Rule of 1’s”
B. Plan for easy and efficient collection of
feedback from your testers - huddles
C. Spread by a few staff at a time
D. Work out the bugs along the way
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Page 3-3 in the Improvement Workbook
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Example in Workbook – Section 3
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Case Example
The Implementation Challenge
A care transitions workgroup of staff from a
hospital and two local long-term care centers
have developed a new transfer form:
How will they ensure that staff at both facilities
actually use the form?
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What, Who, When - Overview
Identify the parameters of the trial period
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What, When, Who - Detail
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Making Progress
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Insert hand written example
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Don’t Give Up
• Use pencil on this form and post-it for all to see.
• Even if testing goes well, keep going until
you reach your target number of participants.
• If testing doesn’t go well – back up a step and
try again.
So much better than assuming staff are going to change
– then being disappointed when they don’t’.
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Multiple Small Tests of Change
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Test and Trial Examples
Patient Demonstrates Understanding of Discharge Instructions
• Test medication teaching tools
HCAHPS – Patient Satisfaction with Discharge Instructions
• Test large-font discharge instructions
Patient Received a Follow-up Phone Call within 3 days
• Test new phone call script
Patient is Discharged with a Follow-up App’t scheduled
• Test calling a designated primary care nurse to schedule hospital
follow-up appointments.
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Small tests of change are a
guaranteed way to engage staff in
improvement
and
Have better buy-in and sustained
results
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Next Month:
Data driven Improvement Priorities
July 25
Noon
 From data to information
 “Data mining” your process measures
 Data driven decision making
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References
• Improvement Workbook Section 3
• The Improvement Guide: A Practical
Approach to Enhancing Organizational
Performance, Langley, Moen, & Nolan
• WHA Quality Center Tools and Templates
http://www.whaqualitycenter.org/Partnersfor
Patients/PfPTools.aspx
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Thank You!
Questions
Please complete 3 question survey when closing
webinar window.
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