Culture, change and infusion quality: an organization science perspective Benjamin B. Dunford, Ph.D. What are some of the biggest changes you have seen with infusions over the past 30 years?

Infusion Task Reallocation One of the significant changes in the field has been what we call the reallocation of infusion tasks to different occupational levels. 30 years ago, infusions were primarily performed by physicians. Eventually as cost pressures and technology improved, these tasks were delegated to teams of skilled nurses, then to individual skilled nurses. Today, infusions are being done by lower level nurses, and there is speculation that they will one day be done at home (perhaps this is already being done).

Infusion Benchmarking Report N=1760 Hospitals and Clinics Benjamin Pratt Mary Alexander We have partnered with Mary Alexander and 5 nursing associations to conduct an empirical examination of how infusion task reallocation impacts outcomes like readmissions and infection rates. This work is not yet complete, but we have some initial results to share with you that provide a platform on which to discuss organizational change, and start a conversation about how REMEDI may be expanded to help you solve more of your problems.

Who Performs Insertions?

What % of your infusion teams have been disbanded or reduced in their place of work? 11.4% 37.9%

With Infusion Teams Without

With Infusion Teams Without Safety improvement refers to the amount of improvement which respondents perceive their organizations have made regarding safety in the last year. Safety comparison refers to respondents’ perceptions of safety characteristics in their places of work, compared with what they know about peer institutions in their industry. Finally, organization comparison is a scale that allows respondents to compare a number of their organizations’ practices (safety or otherwise) with those of peer/competing organizations. Differences noted between hospitals with and without an infusion team are statistically significant for the full group of respondents. For respondents from ANN, differences in safety improvement are not statistically significant. However, ANN respondents from organizations with infusion teams indicate that their organizations compare more favorably against peer institutions in organizational practices and safety than ANN respondents from organizations without infusion teams. The differences in safety comparison and organizational comparison scores between the two groups are statistically significant (p < .05), meaning that those differences are greater than we would expect on the basis of chance.

More than half of healthcare executives say that their organization is in need of help to both facilitate and respond to change. Https://hbr.org/2015/02/the-biggest-u-s-health-care-challenges-are-management-challenges Given the amount of pressures in the environment, it is no wonder that healthcare executives are looking for tools to both respond to and facilitate change.

Organization Development Unfreeze Change Refreeze Intervention Diagnosis The field of Org Development from the ORG sciences is devoted to understanding how to facilitate change for long lasting effectiveness. There are numerous models and tools that I wont describe today. This particular model is from Kurt Lewin, the father of OD, who developed his theories in the 1930s and 1940s. I use his field model as a point of departure for a discussion about how REMEDI could help you facilitate change in your organization. Unfreezing means that we try to eliminate barriers (restraining forces) to change and enhance driving forces). This entails accurate diagnosis and action planning. How good is your organization at diagnosig problems? What tools do you have for diagnosing problems with smart pumps? Source: Kurt Lewin (1939)

What diagnostic tools do you use? How precise are they?

Alerts By Drug or Fluid 2015 YTD

% Infusions with Guardrails by Profile

REMEDI helps identify where operational problems are Drugs Drug profiles Facilities But it does not tell you why problems occur or how to solve them

Would additional data and different methods be useful to improve your diagnosis and problem solving?

A Vision for REMEDI Expansion What information would you like to have that does not come from the pumps? What constraints do you experience with diagnosis? What barriers to problem solving do you experience? How can RCHE help?

Sample Culture Report

Appendix

Culture Drives Change

What drives success in lean transformation efforts to solve operational problems?

Manually coded 892 comments Assigned > 88% of comments to themes Data Analysis Soft Lean Learning Team Processes Trust Leadership Engagement General Management Workload Hard Lean Gemba Practices Value Stream Practices Other Lean P&T Culture Manually coded 892 comments Assigned > 88% of comments to themes

What drives operational success?