Driving to Results: Key Changes and Leadership Behaviors: Management Systems to Deploy & Sustain the Improvements David Munch M.D. IHI Faculty Chief Clinical Officer Healthcare Performance Partners

Why Effective Planning, Deployment and Review Process are Important 90% of companies fail to execute their strategies 85% of executive teams spend less than one hour per month discussing strategy 60% of organizations don’t link strategy to budget Only 25% of managers have their initiatives linked to company strategy Only 5% of employees understand the company’s strategy Kaplan & Norton: The Strategy Focused Organization, 2005 Harvard University Press

The Cycle of Excellence Plan Deploy Review -True North -Scientific Method -Training -Feedback (Requires Metrics) -Coaching -Establish Standard Work -Management Systems -Problem Solving -Situational Awareness -Maintain Standard Work Leadership & Improvement Team Management & Operations

Leading Functional and Front Line Teams Manage the Work Improve the Work Shape Team Culture Leading and Managing Excellence in a System Get Results and Sustain Them Manage Time & Resources Create Standard Work & Process: Including your own Measure: Financial, Quality, Customer, Key Process Surface and Solve Problems in Real Time Engage Across Boundaries Prioritize and Align to Strategy and Aims Understand Current State, Cause and Target Condition Learn and use improvement tools to Redesign Process Reduce Variation and Waste Build Team Capability Promote Transparency Create Vision & Build Will Model the Way—High-Impact Behaviors Put the Person at the Center Develop Competency through Coaching Manage Delegation: Use the Entire Team Communicate Effectively Establish Respect and Accountability

Executive Leadership “True North” Strategy Deployment Developing Manager Capability (Coaching) Provide the Systems & Structures Taking Away Barriers Hardwire with Standard Work Middle & Front Line Management Execute the work Drive Improvement Visual Management MFI & A3 Deployment Developing Team Members (Coaching) Hardwire with Standard Work (Manager) Front Line Staff Standard Work aligned to Strategy Surfacing & Solving Problems Participate in Improvement Continuous Improvement and Operational Excellence Improve Process & Performance while Developing People: “Learn by Doing” The System of Continuous Improvement Interlocking Operational Responsibilities Performance Improvement, Decision Support, HR, I.T. Facilities

Visual Management (The Scoreboard) Management System Overview The Work (Outcomes) The Process (Capable?) (Optimal?) The People (Empowered?) (Engaged?) (Accountable?) Leadership Standard Work (The Engine) Managing The Work? Managing The Process? Managing The People? MFI/A3 Deployment (The Approach) Empowerment With Accountability Respect For People Right Process = Right Results

Required of every Business Unit (Departments, Clinics, Services Lines) for improvement Balanced Scorecard (12 to 20 indicators) for organization Annual Improvement Plan aligned with Organization Wide Improvement Plan Management System (performance boards and area scorecard) – Manager working daily with staff using visual boards and A3 problem solving to improve, – Reviewed Weekly by Director, – Reviewed Monthly by Executive. – Continuous learning and improving on the part of everyone. Daily Huddle Format – Frontline“ready for the day, daily management” – Mid-Level“ready for the day, daily management, remove barriers frontline” – Director Level“ready for the day, daily management, remove barriers mid-level” – Senior Level“Pillar review for improvement, remove barriers director level”

Example: Pareto Chart Root Cause Analysis Action Plan Follow-up Countermeasur es Future State/Target Test/Cost/Bene fit Current Condition Background Issue Example A3 Root Cause Analysis Action Plan Follow-up Countermeasur es Future State/Target Test/Cost/Bene fit Current Condition Background Issue Example A3 Root Cause Analysis Action Plan Follow-up Countermeasur es Future State/Target Test/Cost/Bene fit Current Condition Background Issue Example A3 Root Cause Analysis Action Plan Follow-up Countermeasur es Future State/Target Test/Cost/Bene fit Current Condition Background Issue Example A3 Root Cause Analysis Action Plan Follow-up Countermeasur es Future State/Target Test/Cost/Bene fit Current Condition Background Issue Example A3 Patient Experience Financial Sustainability Quality/ Safety People and Partners Cost of Care Pareto Key Drivers of Performance Problem Solving Daily Management Process Metric History Performance Over Time Example: Run Chart x x x x Example: Daily data x x x x x x x x x x x x x x x x Performance Board: Tool for Situational Awareness

Visual and Daily Management

Design Elements for a System of Reliability & Patient Safety Prevention Mitigation Redesign Humans are Reliably Unreliable. You need to build the system around them to protect the patient. Design & Deploy Reliable Effective Process Identify and Respond to Defects Immediately Use Experience and Feedback to inform The next cycle of Improvement

Reflection Using the functional elements of plan-deploy-review, where are your biggest opportunities to strengthen your patient safety efforts? What can you do within the next 90 days to strengthen your system for patient safety?