Improvement Forum    A webinar series for QI Managers, Nurse Leaders and others supporting healthcare improvement in Wisconsin’s hospitals    March 2012

Engaging Leaders, Aligning Strategy    Our Topic for March 2012    Stephanie Sobczak, QI Manager Wisconsin Hospital Association

Today’s Agenda 3 Objective : To highlight the important role hospital leadership plays in large improvement initiatives. Content Sharing – Why Aligning Quality with Strategy is Key – How to assess alignment? – What is Leadership “Engagement”? – Making the most of opportunities to engage Resources Discussion Questions

How do we know we can do better? Disclaimer information here… 4 Source: “AHRQ National Healthcare Quality Report, 2008,” Agency for Healthcare Research and Quality. Last accessed: September 13, 2010.Agency for Healthcare Research and Quality According to AHRQ, there was much more improvement in quality measures in the hospital setting. Overall quality improvement has been significant but can be accelerated.

Quality Initiatives & Strategy Aligned “Of central importance is how you achieve alignment and consistency….(which) are intended to provide a basis for setting and communicating priorities for ongoing improvement – part of the daily work of all departments and units.” 2012 Baldrige Health Care Criteria Sec. 2.2 Strategy Deployment 5

Better alignment over time Disclaimer information here… 6  Malcolm Baldrige Criteria Book, 2009 An analogy for continued refinement of improvement approaches

Better alignment over time Disclaimer information here… 7  Malcolm Baldrige Criteria Book, 2009

Better alignment over time Disclaimer information here… 8  Malcolm Baldrige Criteria Book, 2009 Achieving true alignment between business strategy and quality improvement aims will take some time. This is the path to continuous improvement and innovation.

Assessing Alignment Disclaimer information here… 9 Does the improvement topic align explicitly with your Strategic Plan for 2012? Have you achieved the best known level of performance and sustained over a 6 month period? Is there significant interest in working on this topic in 2012 or 2013? Is there a strong likelihood that measureable improvement will be demonstrated within 2 years? Key questions to evaluate alignment YN YY

What if there isn’t alignment Options: Is the strategic plan set for 2012? If No, talk to leadership about reviewing alignment and the process for QI being part of the strategic plan. If Yes, Keep in mind the cycle of planning for Disclaimer information here… 10

What if top performance isn’t there? Options: Even hospitals who have reached best performance levels may be challenged with sustaining them over time. It may be a good time to focus on variation and sustaining excellent performance, even if the common interventions have been addressed. Disclaimer information here… 11

What if interest isn’t there? Options: Process improvement takes everyone involved in the work to “buy-in” at some level. Without a core group dedicated to working on getting better, success will be difficult. Consider expanding the opportunity for participation to new staff, people who haven’t been asked, or others beyond “the same ten people”. Disclaimer information here… 12

What about measureable improvement? Options: Consider your hospital’s rate of improvement over the past 2-3 years. If it’s not better than 3% per year, it might be time to revisit the topic. If performance fluctuates a great deal, processes may need to be examined again. Disclaimer information here… 13

Engagement defined Hospital Leadership supports and encourages quality improvement efforts Managers ensure that the work for improvement efforts is shared by many All employees are encouraged to be involved in improvement efforts Widespread communication about improvement efforts occurs at least monthly Every project uses data so that actual improvement can be measured There are specific strategies used to ensure that the change “sticks” Successful improvement efforts are widely recognized in the hospital Internal champions of improvement efforts are identified and involved 14

Alignment Defined Slide text 15

16 Barriers to Engagement (lower score indicates greater barrier) SCORE (out of 5) 1. Too little time at work to participate on teams Compared to the rest of staff’s work, it isn’t a high priority Understanding of QI is uneven across the hospital Recommendations for new processes and procedures aren’t followed Teams have trouble following a consistent process to improve Managerial support for staff participation isn’t good Leadership support these for efforts are unclear 4.61 WHA Survey of QI Managers

Addressing Barriers Disclaimer information here… 17

Addressing Barriers Disclaimer information here… 18

Formal Opportunities Management Meetings Quality Council Meetings Medical Staff Meetings Board Meetings But don’t stop there…. 19

Just-in-time Opportunities Hallways, Elevators, Dining Room – use these opportunities to ask how it’s going, how are the data looking, any challenges? Seek out individuals to touch base with directly Thank people for their efforts, personally. (Particularly front-line staff) Disclaimer information here… 20 Look for ‘golden moments’

Support What leadership support of initiatives is: Is there true consensus among leaders about what “accountability” for improvement means in your hospital? Is there a clear pathway to communicate with leaders about barriers? Is this carried out in informal as well as formal channels? 21

Encouragment Slide text 22

Measurement Slide text 23

Rewards “Reward the results; expect the work.” Celebrate results proven by data Excessive celebration of “in process” work can send the wrong message 24

Slide heading Slide text 25

Summary: The unique role of leadership Establish the value system in the hospital Set strategic goals for the activities to be undertaken Align efforts to achieve these goals Provide resources for the creation, spread, and sustainability for effective systems Remove obstacles to good work and improvement Require adherence to know practices that will promote patient safety Leadership Guide to Patient Safety, IHI,

Resources 27 HRET Report: "Using Workforce Practices to Drive Quality Improve: A Guide for Hospitals” Botwinick L, Bisognano M, Haraden C. “Leadership Guide to Patient Safety.” IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; (Available on

Questions and Answers    What can we learn from each other?    Stephanie Sobczak, MS, MBA Manager QI, Wisconsin Hospital Association Next Month’s Topic: Stay tuned for the 2012 Calendar