The Complimentary Toolbox for Practice Improvement

Disclosures Nothing to disclose

Welcome & Introductions Who are we? Who is in the room? What are you interested in hearing about today?

Objectives: Apply matrix principles to conversations about practice change Explain how relational coordination is essential to improving task integration Demonstrate how lean tools reduce waste, increase value, and support practice change Increase awareness of unconscious bias and the impact it has on relational systems.

Matrix Model of Communication Matrix Leadership Institute Boulder, Colorado Amina Knowlan http://matrixleadership.org/

Video Slide

Yarn Activity Break into 2 groups, form circles Pick a person in your circle, name them, ask a curious question while tossing yarn to them Receiver may answer (or not), then pick another person in circle and repeat process Continue until everyone is included

Relationships = Connections

Activity Debrief Representation of communication patterns Building “Ground of Health” Investment in building strong connections Safety net Connections  

Barriers to Strong Matrix Lots of barriers realistically Awareness What do you bring to the table? What experiences do others bring? Choose your response, don’t react Own it! Make deliberate decisions

What is Unconscious Bias?

Unconscious Bias Activity Warmth and Competence Exercise On a sheet of paper give each of the following pictures of 6 famous people a score for 1) warmth and 2) competence. Rate them using a 1 (lowest) to 5 (highest ) scoring scale.

Warmth and Competence Exercise 1 2 3 4 5 6  

Unconscious Bias Pause….. What are some biases we may encounter in our own healthcare environment? Pause….. Recognize that everyone has biases Recognize our own biases Resources - IAT

Summary/Debrief Remember what it looks and feels like to pause: Stop and listen Acknowledge your own reaction Actively Listen Seek to understand other possible interpretations Engage in an empowering and affirming manner Collaborate Make it Happen

Relational Coordination Communicating and relating for the purpose to accomplish a job together as a team.

Relational Coordination Survey Validated tool to ground the relational issues more concretely to the work or task at hand. 7 Dimensions of an effective team: Frequent Communication Timely Communication Accurate Communication Problem Solving Shared Goals Shared Knowledge of one another’s roles Mutual Respect http://rcrc.brandeis.edu/

Family Practice Average 3.62 RC Dimension Family Practice Average Frequent Communication 4.11 Timely 3.71 Accurate 3.72 Problem-Solving 3.18 Shared Goals 3.76 Shared Knowledge 3.29 Mutual Respect 3.57 Relational Coordination 3.62 3.5-4.00 is Moderate <3.5 is Weak > 4.0 is Strong

9 Months later… RC Dimension Family Practice Average Frequent Communication 4.11 Timely 3.71 Accurate 3.72 Problem-Solving 3.18 Shared Goals 3.76 Shared Knowledge 3.29 Mutual Respect 3.57 Relational Coordination 3.62 9 Months later… 3.5-4.00 is Moderate <3.5 is Weak > 4.0 is Strong RC Dimension Family Practice Average Frequent Communication 4.22 Timely 3.89 Accurate Problem-Solving 3.73 Shared Goals 3.98 Shared Knowledge 3.53 Mutual Respect 3.97 Relational Coordination Between Workgroups Mean Min Max Relational Coordination 3.89 3.39 4.19 Frequent Communication 4.22 3.40 4.80 Timely Communication 3.89 3.40 4.20 Accurate Communication 3.89 3.30 4.20 Problem-Solving Communication 3.73 3.50 4.10 Shared Goals 3.98 3.50 4.33 Shared Knowledge 3.53 2.90 4.00 Mutual Respect 3.97 3.70 4.20

LEAN Thinking “LEAN” –eliminate waste, increase value. NOT a quick fix, problem solving through continuous improvement- a culture

Lean Strategies to Achieve “Flow” Standard Work Process Mapping Problem Solving using A3s Daily Management System Huddles Daily Metrics

Lean Activity One Piece Flow versus Batching We need 2 groups of 5 people. Facing back to back. Timer for each group.

Indirect Work throughout the day Urgent Flow Station Inbox Phone Note Document Visit CPO Test result Non-Urgent Flow Station Inbox

Complimentary Toolbox Summary Matrix Model of Communication Strengthen the network of relationships Relational Coordination Communicating and Relating for the purpose of a task Unconscious Bias Recognize bias and implement strategies Lean Culture of Continuous Improvement

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