1. © 2009 On the CUSP: STOP BSI Senior Leadership of Quality and Safety Initiatives in Health Care

2. © 2009 Learning Objectives To understand the differences between technical and adaptive work To understand the role of senior leaders in addressing both types of work in QI efforts To share tactics used successfully by senior leaders to support QI

3. © 2009Goals To work to eliminate central line associated blood stream infections (CLABSI); state mean < 1/10000 catheter days, median 0 To improve safety culture by 50% To learn from one defect per month

4. © 2009 Safety Score Card Keystone ICU Safety Dashboard CUSP is intervention to improve these* 20042006 How often did we harm (BSI) (median) 2.8/10000 How often do we do what we should 66%95% How often did we learn from mistakes* 100s Have we created a safe culture % Needs improvement in Safety climate* 84%43% Teamwork climate* 82%42%

5. © 2009 Technical Work Addresses problems for which the definition is clear, the potential solutions are reasonably clear, and usually require little or minimal learning Responsibility for implementing a solution is reasonably clear between leaders and followers.

6. © 2009 Leadership Without Easy Answers (Heifetz, 1994) Leadership is “activity to mobilize adaptive work” (p. 27).

7. © 2009 Adaptive Work Addresses problems that require a change in attitudes, beliefs, and behaviors Involves shared responsibility for change: leaders share responsibility with organizational staff and key stakeholders.

8. © 2009 Most Common Leadership Error Treating an adaptive problem as technical

9. © 2009 The Work of Adaptive Change Determining the direction – what must change Determining the methods - how to change

10. © 2009 Pronovost: Health Services Research 2006 SeniorTeam Staff leaders Engage adaptive How does this make the world a better place? Educate technical What do we need to know? Execute adaptive What do we need to do? How can we do it with my resources and culture? Evaluate technical How do we know we improved safety? Leading Change

11. © 2009 Leading Change: “On the CUSP: Stop BSI” Is everyone clear on the goals, timelines, and mission? Is the necessary structure in place – people, roles, authority and responsibility? Are decision making, problem solving and conflict management processes clear? Are material resources in place – space, equipment, people, budgets? Are financial tracking mechanisms in place (CMS P4P implications)

12. © 2009 Action Items for Senior Leaders 1.Make certain an executive is assigned to each ICU and meets regularly as a member of the project team. – let the staff know senior leaders are invested and will work as hard as they do to make it a success. 2.Set clear project goals and expectations for the leaders and staff in critical care units. – Provide opportunities for project teams to meet with senior leaders and the board to discuss the project 3.Provide the necessary resources – time to work on the Project, funds for travel, training, equipment, supplies, etc.

13. © 2009 Action Items for Senior Leaders 3. Support transparent communication – BSI rates – Process barriers and successes – Tell your own Josie Story; publically discuss a patient who suffered preventable harm at your organization 4. Expect resistance and be prepared to address it effectively 5. Celebrate wins and provide encouragement, support, attention, and resources if there are set backs.