1. VUMC Quality Pillar Goal: Pioneer Program Michael Cull, PhD, MSN Director, Education and Dissemination Office of Quality and Patient Safety

2. Roadmap Quality Pillar Organizational Culture Culture Change and Organizational Learning Pioneer Programs

3. FY2012 GOAL FY2011 Baseline FY2012 Threshold FY2012 Target FY2012 Reach Reduce O/E Mortality 0.73 (409 lives) 0.71 (440 lives) 0.69 (470 lives) Reduce Healthcare Acquired Infections 1.01 (recalibrated) 0.91 (- 57 infections) 0.86 (- 86 infections) 0.76 (- 145 infections) Reduce Adverse Events 1.42 (recalibrated to FY12 convention) 1.281.201.13 Achieve Top Performance in Clinical Programs 88% 90%95% Improve System Reliability 106 – 78 – 910 – 12 FY2012 Goals

4. FY2012 GOAL FY2011 Baseline (Projected) FY2012 Threshold FY2012 Target FY2012 Reach Reduce Readmissions in AMI, HF, Pneumonia populations New Refine and Verify Baseline Develop or Adopt Predictive Models and Target Improvement Efforts Reduce Readmissions by 10% for each clinical condition Advance a Culture of Patient Safety, Improvement, and Reliability New Enlist and Prepare Three Pioneer Programs Initiate Two Projects per Program from Menu Increase Safety Climate Survey Response Rate to 65% in targeted programs (faculty, management, staff, residents, fellows, inclusive) FY2012 Goals Continued

5. FY2012 GOAL FY2011 Baseline (Projected) FY2012 Threshold FY2012 Target FY2012 Reach Reduce Readmissions in AMI, HF, Pneumonia populations New Refine and Verify Baseline Develop or Adopt Predictive Models and Target Improvement Efforts Reduce Readmissions by 10% for each clinical condition Advance a Culture of Patient Safety, Improvement, and Reliability New Enlist and Prepare Three Pioneer Programs Initiate Two Projects per Program from Menu Increase Safety Climate Survey Response Rate to 65% in targeted programs (faculty, management, staff, residents, fellows, inclusive) FY2012 Goals Continued

6. FY2012 GOAL FY2011 Baseline (Projected) FY2012 Threshold FY2012 Target FY2012 Reach Reduce Readmissions in AMI, HF, Pneumonia populations New Refine and Verify Baseline Develop or Adopt Predictive Models and Target Improvement Efforts Reduce Readmissions by 10% for each clinical condition Advance a Culture of Patient Safety, Improvement, and Reliability New Enlist and Prepare Three Pioneer Programs Initiate Two Projects per Program from Menu Increase Safety Climate Survey Response Rate to 65% in targeted programs (faculty, management, staff, residents, fellows, inclusive) FY2012 Goals Continued CULTURE

7. Step 1: Sit down Step 2: Hold on for 8 seconds

8. Landing a passenger jet on the Hudson

9. A successful landing

10. QPS Mission Continuously inspire improvement for the health and safety of patients, families, faculty and staff; Advance a culture of habitual excellence and high reliability; and Champion discovery, innovation, and transformation in healthcare to high reliability and bring excellence to full-scale.

11. Organizational Culture What is organizational culture? Should it be changed? Can it be changed? If so, what strategies are available?

13. Culture “A pattern of shared basic assumptions that was learned by a group as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way you perceive, think, and feel in relation to those problems“ Edgar Schein

14. Why Change Culture? Culture supports - or creates barriers for -systems' efforts to innovate and learn. 1 Cultures that emphasize affiliation, teamwork, and coordination implement and sustain more CQI initiatives. 2 By contrast, cultures that emphasize formal structure, regulations and reporting relationships. 3

15. What is Vanderbilt’s Culture?

16. Subcultures Dominant Culture Enhancing Cultures Orthogonal Cultures Counter Cultures

17. Subcultures Dominant Culture Enhancing Cultures Orthogonal Cultures Counter Cultures

18. Types of change Revolutionary Sub-groups, targeted Incremental

19. Types of change Revolutionary Sub-groups, targeted Incremental

20. Types of change Revolutionary Sub-groups, targeted Incremental

21. How will we advance the Culture? Artifacts – Values – Assumptions - Beliefs

22. How will we advance the Culture? Artifacts – Values – Assumptions - Beliefs

23. CULTURE change vs SYSTEM change “Changing the system, will change what people do. Changing what people do, will NOT change the system.” Peter Scholtes

24. What will change look like? …people in the organization identifying with new role model heroes… telling different stories to one another… spending their time differently on a day-to-day basis… asking different questions and carrying out different work rituals. 4

25. What is the Pioneer Program? An intensive, yearlong program designed to support service line level improvement goals and advance a culture of patient safety, quality, and reliability at VUMC.

26. Vehicles for change Application and Selection Sept Training Cohorts Oct Projects designed and implemented Nov - Jan Progress reports May Graduation Jun

27. Resistance to Planned Culture Change 5 Lack of Ownership Complexity External Influences Lack of Appropriate Leadership Cultural diversity Dysfunctional consequences

28. Ownership and Cultural Diversity Internal RFP process Collaborative learning Interdisciplinary involvement Application and Selection Sept Training Cohorts Oct Projects designed and implemented Nov - Jan Progress reports May Graduation Jun

29. Pioneer Program

31. Complexity, External Influences and Dysfunctional Outcomes Collaborative learning Design and Scoping, goal alignment QPS expertise Application and Selection Sept Training Cohorts Oct Projects designed and implemented Nov - Jan Progress reports May Graduation Jun

32. Pioneer Program

33. Leadership and Dysfunctional Outcomes Stated strategic goal Required Leadership involvement Formal report-outs and celebration Application and Selection Sept Training Cohorts Oct Projects designed and implemented Nov - Jan Progress reports May Graduation Jun

34. What did we expect? What is the mission, make-up, and organizational structure of your program? What are some examples of successes and challenges with improvement projects? How will program leadership contribute to the Pioneer year? What do you hope to accomplish and how will this advance VUMC’s goal of creating a culture of safety, quality, and reliability?

35. Evaluation Criteria Organizational readiness / maturity Commitment to the process Energy for change Alignment with VUMC quality and patient safety goals Leadership engagement

36. Selection 10 Person selection committee 22 full proposals submitted for review 17.95 Average Score 22.75 High Score

37. Pioneer Year Design Kick-off with Lucian Leape, MD Comprehensive curriculum that encompasses both internal and external subject matter experts Modified IHI Learning Collaborative model Customized sessions with onsite technical assistance for project design, scope, implementation, and evaluation

38. Learning Sessions Safety Culture Julie Morath, RN, MS Leadership an promoting professional accountability Gerald Hickson, MD Ranja Ramanujam, PhD Tim Vogus, PhD Teamwork and Improvement Science Allan Frankel, MD Reliability and Safety Science Tim Vogus, PhD Allan Frankel, MD

39. Between Sessions Plan Bi-weekly collaborative calls: Updates Discussion of barriers Interactive educational component with SME Independent between-session team meetings Ad-hoc training and consultations using supported coaching

40. Wraparound model of support QPS Support External Consultant Coach Pioneer Program

41. Threshold – Target - Reach Programs Enroll and prepare 3 Pioneer Program Projects Implement 1- 2 improvement projects Survey 65% response rate on AHRQ Safety Climate Survey

42. Questions?