Transcript Ohio Hospital Association & Joint Commission Resources

Indiana Association for Healthcare Quality
InAHQ Annual Conference
Marten House Hotel in Indianapolis
May 5-6, 2011
“A Clear Path to Success: Leadership Engagement
… Plus”
Thomas J. Schleter
Parkview Health
Fort Wayne, Indiana
260-373-3292
[email protected]
Opening
I would like to tell you about a successful Leadership engagement moment.
The Human Resources Vice-President and HR Specialist happened to be conducting
staff satisfaction interviews of operating room staff in a conference room just adjacent
to the operating rooms.
The same time that the interviews were being conducted, some of the operating room
staff had been working on a pretty bad trauma.
As luck would have it, the HR interview session ended just after the trauma case
ended ...
Opening
 I’ll
tell you what, from that day on:
Leadership was Engaged!
– To this day, they still talk about the experience. The HR
Specialist, now HR Manager, recently said, “It is an experience I
will never forget.”
– The ultimate success of the day was that Leadership not only saw
some fundamental standards of practice, but came into an
awareness of their connection to patient care that they didn’t have
before.
– The process of staffing, licensure, competencies, the whole HR
“reason for being” came under a new level of clarity, a deeper
understanding of their indirect but critically important role as
patient, staff, and hospital advocates.
Goals
A Clear Path To Success: Leadership Engagement +
Do you want to engage
Leadership?
Use stories.
Use creative presentations.
Get them to think about quality in a
different way.
Get them involved.
Goals
A Clear Path To Success: Leadership Engagement +
GOALS
My goals for you this morning
Goals
My goals for you this morning:
1.
2.
3.
4.
Motivate your Continuous Readiness thinking.
Share examples of methods, tools, and innovations.
Discuss concepts of Quality.
Examine Leadership Engagement.
Goals
A Clear Path To Success: Leadership Engagement +
How will we achieve these goals? It’s the “Plus”
The VALIDITY of Leadership depends on the relationship
between Structure, Process, and Outcome.
The VALUE of your Organization depends, ultimately, on the
relationship between Leadership and Satisfaction.
This is where Leadership needs to be. Your job is to help them find their way.
Structure, Process, and Outcome … plus Satisfaction.
Goals
AVEDIS DONABEDIAN, “Evaluating the Quality of Medical Care” (1966)
Leadership … Plus
1. STRUCTURE of a Clear Path

Assessment, Information, Finance, Quality,
Measurement, and Management.
2. PROCESS of a Clear Path

Innovations, Concepts, Coordination, Application.
Goals
AVEDIS DONABEDIAN, “Evaluating the Quality of Medical Care” (1966)
Donabedian + 1
3. OUTCOME of a Clear Path

Leadership Sessions, Leadership Quotes.
4. SATISFACTION of a Clear Path

Fire Pyramid

Joe
Background
A Clear Path To Success: Leadership Engagement +
BACKGROUND
Parkview Health, Fort Wayne, Indiana
Background
Introduction
A Clear Path To Success: Leadership Engagement +
INTRODUCTION
Let’s examine the title of this address
Introduction
 Breakout
Session title:
“A Clear Path to Success:
Leadership Engagement … Plus”
– But as I have reflected upon the title, I turned it
into a rhetorical question and asked myself,
“Is there ever a “Clear Path” to success?
– And if there was, what does that look like?
Introduction

We know that there are “Clear Paths” to success; it’s
when things have a defined starting point and ending
point.
– Building a car, constructing a bridge, school curriculums
(which outlines objectives; you are then tested on your knowledge),
getting to work everyday.
– Even the Joint Commission offers guidelines about what
path to follow in order to achieve success.

But now the path becomes murky because of the
human and system variables in healthcare, with one
particularly important “Continuous Readiness” or
“Clear Path to Success” variable called …
Leadership
Introduction

I think that, too often, (and you may agree or
disagree with me) that the idea of Continuous
Readiness is applauded at a communication level …

… but finds a more difficult road when Leadership is
asked to champion the integration of readiness into
the daily activities of the hospital’s practice.

Much of the Leadership/Quality disruption has it’s
roots founded in the basement understanding of
what quality is, what it isn’t, and it’s relationship to
business fundamentals.
Keep Your Eye on the Ball
STRUCTURE
1.
2.
3.
4.
5.
Assessment
Information
Finance / Quality
Measurement
Management
Assessment
A Clear Path To Success: Leadership Engagement +
ASSESSMENT
– Why can it be a difficult road when Leadership
is asked to champion the integration of
readiness into the daily activities of the
hospital’s practice?
Assessment
First, I’d like to quote from JC’s Sentinel Event
Alert #43, “Leadership Committed to Safety.”
(This is going to sting a bit)
“In 2006, when a sentinel event occurred
in a health care organization, inadequate
or ineffective leadership was a contributing
factor in 50 percent of the sentinel events.”
Assessment

Half of leadership was not engaged?! This is
incredibly significant.
– Why?? Two-thirds of all Sentinel Event victims
died – and we did it.

Jeff Selberg, CEO of Exempla Healthcare,
says, “My first priority is to understand how
we improve our clinical environment to reduce
the possibility of doing harm.” This Leader is
engaged. He gets it.
Now, back to assessing our audience …
Assessment

The Board draws the hospital’s roadmap.

Hospital leadership is responsible for following the roadmap, which is
ultimately expressed in hospital operations.

Hospital operations is shared by many different groups and many
different people all of which provide information to Leadership so they
can make decisions in the best interest of the hospital’s Mission,
Vision, Goals, and Values.

Boards are comprised of Medical Staff, Hospital Staff, and most
generally, community leaders.

Community leaders are likely to have accountability in some type of
Business or Finance. Ultimately, you can also make the argument that
Medical Staff and high-level Hospital Staff have a stake in Business or
Finance, too.
Information
A Clear Path To Success: Leadership Engagement +
INFORMATION
– We have now assessed our Boards and
Leadership.
– So, what types of information makes the most
sense to them?
Information

Business and Finance information!
That’s their comfort level, that’s their
experience level. Business and Finance
numbers are tracked and measured
constantly, every second of every day.

And it’s true: You have to know what those
numbers mean for the viability of the
business. The numbers are tangible; the
numbers represent real things.
Information

We can therefore conclude that
Leadership is influenced
… by what is real.

However, this is where Continuous
Readiness runs into serious problems.

We don’t have anything at the level of
reality that Business and Finance can bring
to the table.
Finance vs. Quality
A Clear Path To Success: Leadership Engagement +
Finance vs.
Quality
Let’s illustrate this “Level of Reality”
Finance vs. Quality

Take a look at some change (a penny, a quarter) and find
the date. How old is it? 1 year old? 15? 30? More?

Notice the texture of the coins, the hardness, the shape, the
color, even the odor. You earn it regularly and having it allows
you to exchange it for things in your life that you find important
or valuable. It’s tangible, isn’t it? It’s real. It even has a logo:
The dollar sign!
 Finance
is real and it has a face.
That’s why it’s easy to relate to.
Finance vs. Quality

Now let’s take a look at Quality, in which being continually
ready plays a very large role. Let’s put Quality to the same
test:
– So, how long does Quality last? 1 year? 15? 30? More?
(We WANT it to!)
– Does Quality have a texture, a hardness, a shape, color, or odor?
Can you earn Quality regularly and exchange it for things in your
life that you find important or valuable?
– You can’t say, “Oops, I dropped my Quality” and go pick it up.
You can’t reach into your pocket and say, “Here, you can have
some of my Quality.”
 Quality
isn’t real in the same sense
as Finance.
Finance vs. Quality

Quality doesn’t have a logo, Quality doesn’t
have a face.

It isn’t tangible and you can’t relate to it in real
terms, that’s why it’s so difficult to
measure and manage and that’s why it’s
so hard to get Leadership to make it a
priority on the action list.
Finance vs. Quality

You might put up the argument, “What do you
mean by, “Quality isn’t real or tangible?”
– We measure practice, we have data, we have
graphs, we take action, and the outcomes tell us
how we did …

These outcomes (the measurement of practice)
represent the Quality of our Services.
Or do they?
Wuzzle
(“Wuzzles” by Tom Underwood)
Q
U
A
L
I
T
+Y
Measurement
A Clear Path To Success: Leadership Engagement +
MEASUREMENT
– Finance vs. Quality / Tangible vs. Intangible
Measurement of Quality: The great unknown!
Measurement
Let’s go beyond tradition …
 Let me make an outrageous, scandalous,
and shocking proposal to you:

We absolutely cannot measure
(underlined and in quotation marks)
“Quality”
Measurement
The first reason:
 We, within the collective world-wide
group of healthcare representatives,
have never agreed upon the actual
definition of “Quality!”
Measurement


The healthcare definition of Quality is so fragmented
and so nebulous that all the way down to the facility
level – all the way down to the level of each individual
within the facility – has varying opinions of what
actually constitutes “Quality.”
We even have different types of Quality associations
and think-tanks that publish all kinds of standards
that, from their point-of-view, constitute Quality
outcomes.
It reminds me of an old card game,
see if you know this one …
Measurement
Measurement

So, how do we know what to do with Quality?
– What does Leadership need to know?
– And why is Quality so hard to define?

Leadership needs to know that Quality is a
behavior; Quality is not a “thing.”
– Quality behavior is a piece of the puzzle, part of a process, it
is not an “ends” (… Finance vs. Quality).
– Automotive industry: Quality is “built-in.” Quality is within …
it is a part … of the whole.

Quality is hard to define and difficult to
measure because Quality is a behavior.
Measurement

It is easy to define a thing but try defining a
behavior.

You can describe a behavior, a qualitative
assessment of what someone is doing, but a
behavioral definition is dependent upon …
oh, about a billion variables.

Quality, or rather a Quality behavior, is
essentially a “means” to a destination; the
behavior is a piece of the puzzle or a part of a
process, it is not an “ends.” … Finance vs. Quality.
Measurement
The second reason:
– and this is the underlying, root-cause …
We can only measure
the echo of Quality.
The echo of Quality... The echo of Quality...
The echo of Quality...
Measurement
We can’t define Quality because it doesn’t last for
days or months or years like a penny does;
Quality is fleeting.
 It lasts for only the split second it is delivered and
then it’s gone.
 We document what we think we did … then go
back and look at the evidence.
 Then we throw cost into the mix and say, “Yes,
here is our Quality!” We even try to figure what
our Quality outcomes look like over time.

Wuzzle
(“Wuzzles” by Tom Underwood)
QUALITY
Management
A Clear Path To Success: Leadership Engagement +
MANAGEMENT
– Leadership needs to know that Quality is a
behavior and we can only measure its echo …
– Quality is also very hard to manage.
Let’s examine the management of Quality.
Management
Quality
Care
Management
Quality
Care
Management
Quality is so hard to manage
because Quality cannot be
separated from care.
– Quality occurs only at the time that it’s
delivered.
– If staff does not perform well at the precise
moment that Quality is determined …
Management
… than the impact will show that you have
not achieved regulatory compliance, or the
best patient outcomes, the highest patient
satisfaction, the lowest cost, all over time.
… you will not be “Continually Ready” for
your next patient let alone your next
survey.
Management
I
think Jim Collins, the author of “Good
to Great and the Social Sectors,”
has it right.
 He
talks about, “Performance, Impact, and
Endurance,” or put in another way,
Performance and Impact
over Time
Management

So, all the things you do
– (your performance)

plus all of your consequences
– (impact)

Over a period of time.
Quality is your Performance
(your instances of behavior)
Satisfaction is your Impact
(with goals of “excellence”)
Repeated as often as possible.
Management
 But
Leadership needs to hear it!
– Performance and it’s relationship to behavior.
– Satisfaction and it’s relationship to
Excellence.
– All over Time!
(P * I) / t
This is the engagement message!
Management

Leadership will begin to believe in the
Continuous Readiness message, and if they
believe in it than it will drive their behavior …
–
–
–
–

to take action and demand new processes,
to achieve excellent outcomes,
to ultimately satisfy not only the patients,
but medical staff, hospital staff, and the community
at-large.
Your Mission, Vision, Goals, and especially the
Value of your organization, will be maximized.
Goals
AVEDIS DONABEDIAN, “Evaluating the Quality of Medical Care” (1966)
Leadership … Plus
1. STRUCTURE

Assessment: Organization relationships.

Information: Business & Finance & Quality.

Finance: Tangible. Through experience.

Quality: Intangible. Through behavior.

Measurement: Quality is integrated within practice.

Management: Performance, Impact, Time.
PROCESSS
6.
7.
8.
9.
Innovations
Concepts
Coordination
Application
Innovations
A Clear Path To Success: Leadership Engagement +
INNOVATIONS
(tools)
Connection. Interest.
Attention. Belief.
Innovations

Innovations connect people in new or imaginative
ways. They spark interest. They focus attention. They
encourage belief.
– What kind of organization would you become if Leadership
mandated innovation at every single level of your organization?
And hey, if you haven’t tried it, innovation can be really fun!

Each of the following 4 examples has been successful in
engaging Leadership ...
The Chart Talker ©
The Area Talker
(“Mirror Mate” by Our Pet’s Company)
The “110” Dashboard
Interactive FMEA
Concepts
A Clear Path To Success: Leadership Engagement +
CONCEPTS
(education)
– Let’s dive into some CONCEPTS (or education) that
you can use toward engaging Leadership.
– EACH ONE OF THESE CONCEPTS IS DESIGNED
TO INFLUENCE LEADERS INTO ACTION.
The concept of … PAYING ATTENTION.
Look-Alike Medications
The concept of … PRIORITIES.
The 3-Rules
(based on, “I, Robot”)
The concept of … COMMUNICATION.
“What’s Coming Up”
 Leadership engagement example, from Sue
Ehinger, EVP/COO, Parkview Hospital, in her weekly
“What’s Coming Up” email message commented
upon Health Care Reform and our hospital response:
1.
2.
3.
4.
5.
Board and CEO commitment drives change.
Strategic planning matters.
Quality should be a core Business strategy.
Measurement must become a mania for us.
Rapid-cycle improvement is a must.
The concept of … DANGER.
Sentinel Events: Retention 7th Place (5%)
“Unintended Retention of a Foreign Body”
The concept of … VALUE, TIME, SATISFAC.
The Brain and Belief Integration
Coordination
A Clear Path To Success: Leadership Engagement +
COORDINATION
(sharing)
You must put the rubber on the road.
Being “ready” means involving everyone in the gathering of
data, expressing the data in effective ways, and improving
upon sub-standard practice.
Top-10 Screens
Accreditation Readiness Score (ARS)
Top Compliance > Level-2 > S3 > RFI > Mandatory
Accreditation Readiness Score (ARS)
Accreditation Readiness Score (ARS)
Quality Teams
MOS Dashboard
MOS Dashboard - Report
MOS Dashboard - Graphs
MOS Dashboard - Action
MOS Dashboard – FMEA
Application
A Clear Path To Success: Leadership Engagement +
APPLICATION
(external use)
A large part of engaging Leadership is showing
them what happens to our readiness information
outside of the walls.
Legibility and IOM Report
Public Reporting
Exposes Your Outcomes
“Big” Performance Healthcare Measurement is Here to Stay
Sentinel Event Alerts
Preparation – Reality - Responsibility
Goals
AVEDIS DONABEDIAN, “Evaluating the Quality of Medical Care” (1966)
Leadership … Plus
2. PROCESS

Innovations: Tools to excite and motivate.

Concepts: Education for influence.

Coordination: Sharing results effectively.

Application: External use of data and performance.
OUTCOME
10. Leadership Sessions
11. Leadership Quotes
Leadership Session
A Clear Path To Success: Leadership Engagement +
LEADERSHIP
SESSIONS
Show-off to surveyors! The final exam!
– The Leadership Session is intended for you to show-off to
surveyors that every level of Leadership is engaged and that you
can talk about your hospital with accuracy, confidence, and pride.
Leadership Session

Leadership must believe in YOU.
– If they believe in your conviction, trust in
your passion, they will become engaged.
–
–
–
–
–
JC Perspectives
JC Survey Activities Guide
JC Strategic Surveillance System (S3)
JC Targeted Solutions Tool (TST)
JC Home / Library / Publications
* Give Leadership usable information.
– Organize and lead a mock Leadership
Session …
Leadership Session - Structure

Organization Participants
– Suggested participants include senior leaders who have responsibility
and accountability for design, planning, and implementation of
organization processes.
– Leaders typically include but are not limited to members of the governing
body/trustee, CEO, and leaders of the medical staff and clinical staff.

Logistical Needs
– The suggested duration of this session is approximately 60 minutes.

Objective
– Surveyors will explore leadership’s responsibility for creating and
maintaining your organization’s systems, infrastructure, and key
processes which contribute to the quality and safety of care, treatment,
or services.
Leadership Session - Overview




During this session, surveyors explore system level issues. The surveyors use
Priority Focus Areas (PFA) and findings from the survey to discuss the potential impact
on your organization from the perspective of organizational systems.
The surveyor also facilitates discussion with leaders to understand their roles
related to performance of your organization-wide processes and functions.
Surveyors do not limit discussion to survey findings; they explore key
characteristics of the PFA.
Organization leaders should provide surveyors with their view and
perspective about an area or topic being discussed. Discussion topics include:
–
–
–
–
–
–
–
–
–
The planning process used
How data is used once it is collected
The approach used to change processes and work flow
How information about newly implemented processes is communicated throughout your
organization
How leaders envision the performance of the PFA or function under discussion
Leadership support and direction, including planning and resource allocation
The degree to which the implementation is comprehensive and organization-wide
The relationship of the PFA or function to patient/resident/individual served safety and quality
How the effectiveness of the performance of the PFA or function is evaluated
Leadership Session – Questions
--------------------------------------------------------------------------------------------------- Inquired if organization received a pre-survey prior to surveyors
arriving.
– This is a new procedure to assess HCO’s expectations prior to survey.
Inquired if there were any observations this week that surprised anyone.
 Inquired as to what were HCO’s greatest opportunities.
 Inquired as to how effectiveness of communication is assessed.
 Inquired as to how HCO transitioned from “shared governance” to
“shared decision making.”
 Inquired as to how culture is communicated.
 Inquired about organizational planning and how the community is
included.
 Inquired as to how the community communicated a need for services.
 Inquired as to the largest challenge with the medical staff.
 Inquired as to what drives employee retention.
---------------------------------------------------------------------------------------------------
Leadership Session – Questions
--------------------------------------------------------------------------------------------------- How do you accomplish the things you have accomplished here?
 We have seen some things that others haven’t been able to accomplish so
how have you done it?
 How did you plan all this within the hospital?
 What are your pillars here?
 How do you plan in your budget the small issues vs. the big money items?
 How do the non-money generating necessary items get the resources they
need?
 How does your medical staff advocate for those items?
 How do you communicate to the medical staff and others to buy into quality
and safe care?
 How do you make sure your medical staff can voice their “push back” or
concerns?
 You are a community hospital. How does the organization ensure care for
indigent patients and work with the community to ensure they are receiving
the appropriate care and follow-up care?
----------------------------------------------------------------------------------------------------
Leadership Session – Questions
---------------------------------------------------------------------------------------------------We would like to hear how you handle certain things:
How do you perceive the years ahead for your HCO?
 How are you going to meet the needs of the community – physician
recruitment, etc., based on the current financial environment?
 What draws people here?
 How do you plan, from a strategic perspective, for patient care and services?
 How does the board look at what the community needs strategically?
 Are you considering any community needs other than with the critical care
areas?
 As you expand your services, how are you going to keep up your nursing
staff? Your therapy staff?
 As you are responsible for everything here, how do you insure things are
getting done and your mid-level managers get it done to meet your
standards?
 What part of your culture is driven by faith?
 How does that culture play a role in your organization?
---------------------------------------------------------------------------------------------------
Quotes
A Clear Path To Success: Leadership Engagement +
QUOTES
From Senior Leadership
One of the ultimate acts of engaged
Leadership is public display.
“Going on record” to express their commitment to
Leadership and the success of the business.
“A Clear Path to Success: Leadership Engagement”
- What does this mean to you?

Mike Packnett
President and CEO, Parkview Health
– “I believe that success, as defined by our Mission, Vision, and
Values, in addition to our "Diamond of Success" (Safety & Quality,
Service Excellence, HR & Finance, and Growth), is based upon
productive leadership.
– Leaders who are engaged develop the capacity to create change
so as to bring about a higher value of service to our community.
– My personal goal is to continually develop engaged leaders
because I believe that the greater the leadership engagement,
the clearer the path is to success.”
“A Clear Path to Success: Leadership Engagement”
- What does this mean to you?

Betty Brown
Chief Quality and Patient Safety Officer
Parkview Health
NAHQ President-Elect
– "Key to a healthcare organization's success are leaders who
understand and inspire those who care for the patients with
clarity of purpose, expected behaviors, and appropriate
consequences.
– This can not be underestimated."
“A Clear Path to Success: Leadership Engagement”
- What does this mean to you?

Sue Ehinger: EVP/COO, Parkview Hospital / North /
Behavioral / Home Health
– “During tough times, a leader doesn't lose sight of the vision.
– A leader triples communication efforts, focuses upon what is most
important, engages high performers and acts on low performers, gets
rid of the waste, and leads with courage.”

Julie Fleck: COO, Parkview Ortho Hospital
– “Leadership Engagement is the foundation assuring the highest quality
of safety, clinical competence, and service excellence.
– Engaged leaders work to remove obstacles clinicians encounter while
delivering patient care and assessing compliance to standards.
– Finally, engaged leaders lead by example. They support, and then
inspire, their team members to attain the highest level of quality care
for patients.”
“A Clear Path to Success: Leadership Engagement”
- What does this mean to you?

Dave Hunter: COO, Parkview Noble Hospital
– “My expectation is that my Leadership team turns the accreditation
regulations into action oriented, living and breathing processes.”

Rob Meyers: COO, Parkview LaGrange Hospital
– "As leaders, it's important to clearly demonstrate to our co-workers
what is important to us and our organization. At PLH, Quality &
Accreditation are one of the very top items on that list.“

Dan Garman: SVP/Operations and Government
Relations, Parkview Hospital
– "Leaders round within departments and regularly interact with coworkers. This gives the opportunity to hear the voice of the customer
and to provide support and encouragement to our staff.”
“A Clear Path to Success: Leadership Engagement”
- What does this mean to you?

Judy Boerger: CNE Parkview Health, SVP/CNO
Parkview Hospital / North / Behavioral / Home Health
– "The challenge for nursing lies in our ability to increase the line-of-sight
between leadership and individual bedside nurses.
– In my role as Chief Nursing Executive, my active participation and
reinforcement of nurses' intrinsic sense of individual accountability for
quality outcomes is essential.“

Bridget Johnson: CNO, Parkview Whitley Hospital,
IONE (IN Organization of Nursing Executives) President
– “Leading others is about the art of influence, but it also all about having
quality in every aspect of our measures of success.
– Quality is about removing variance, and removing variance is about
having clearly defined and followed processes, and having clearly
defined and followed processes is about having engaged coworkers,
and having engaged coworkers is about having engaged leaders who
facilitate the processes by setting clear goals.”
“A Clear Path to Success: Leadership Engagement”
- What does this mean to you?

Denise Lemmon: Past Board Quality Chair, Parkview
Noble Hospital
– “I've been involved with the first formal initiatives in response to IOM's and Dr.
Berwick's concerns about healthcare quality. It's been very gratifying to
attend national conferences on safety and quality initiatives to reach
performance measures and discover that the Parkview organization has,
most often, already established a regimen to accomplish identified targets.
– Over the last 10 years, "quality" as priority # 1 has gone from an assignment
to an expectation of Parkview Health's culture.
– This successfully established culture of quality is a direct result of the ground
floor involvement of ALL Parkview stakeholders. The strategy from the
beginning has been to train and engage everyone in pursuit of excellence.
– So, board members and management heard and directed what physicians
heard and directed what front line providers heard and directed what
housekeeping staff heard and directed. No one has been exempt. Excellent
safety and quality has transitioned from goals and objectives to expectation!!
– The system-wide results have been realized by instructing and gaining buy-in
from health care leaders who could then manage the implementation every
step of the way.”
Outcomes
AVEDIS DONABEDIAN, “Evaluating the Quality of Medical Care” (1966)
Leadership … Plus
3. OUTCOMES

Leadership Sessions: Are all Leaders engaged?

Leadership Quotes: Going on the record.
SATISFACTION
12. Fire Pyramid
13. Joe
Leadership Session
A Clear Path To Success: Leadership Engagement +
SATISFACTION
– We’ve examined STRUCTURES and
PROCESSES and OUTCOMES in building
Leadership engagement.
– Finally, let’s review SATISFACTION in
building Leadership Engagement.
The Fire Pyramid
Joe
Real-world Fire Pyramid example.




March, 2011.
Altered Mental Status, Multi-Embolic Stroke, EF of 20.
ICU: Climbing over the rails, being aggressive, agitated.
Established “The Rules” (Pyramid foundation).
– Rule #1: Keep Joe safe. Rule #2: Make Tom happy.

By his discharge, we had kept Joe safe.
– Now that was satisfying, not only on a personal level,
but on an organization level.
– I’m hoping that Joe was satisfied too.
Goals
AVEDIS DONABEDIAN, “Evaluating the Quality of Medical Care” (1966)
Leadership … Plus
4. SATISFACTION of a Clear Path

Fire Pyramid – A new way to influence.

Joe – Fire Pyramid application.
Conclusion
A Clear Path To Success: Leadership Engagement +
CONCLUSION
Conclusion
My goals for you this morning:
1.
2.
3.
4.
Motivate your Continuous Readiness thinking.
Share examples of methods, tools, and innovations.
Discuss concepts of Quality.
Examine Leadership Engagement.
Goals
A Clear Path To Success: Leadership Engagement +
Leadership depends on the relationships
between Structure, Process, and Outcome.
Value depends, ultimately, on the relationship
between Leadership and Satisfaction
(both internally and externally).
Goals
A Clear Path To Success: Leadership Engagement +
Use stories.
Present creatively.
Get Leadership to think about quality in a
non-traditional or different way.
Get Leadership involved. Make it real.
Conclusion
A Clear Path To Success:
Leadership Engagement +
But, if you’ve given it your all …
and still find that, too often, the idea of
Continuous Readiness is communicated by
Leadership, but not integrated into the daily
activities of your hospital’s practice …
Leadership is Not Engaged
 Low
Safety
 Low Quality
 Low Readiness
Leadership is Engaged
 High
Safety
 High Quality
 High Readiness
The Face of Quality
I know earlier that I told you that
Quality does not have a face.
But it does
The Face of Quality
- Just look in the mirror
Emerson
“Finish everyday and be done with it.
You have done what you could,
some blunders and absurdities crept in;
forget them as soon as you can.
Tomorrow is a new day.
You shall begin it serenely and with too
high a spirit to be encumbered with
your old nonsense.”
Thank you!