1. InAHQ Annual Conference April 2012 Natalie Webb BS, RN, CPHQ Director Performance Improvement

2.  Describe Qualitative approach and compare/contrast to Quantitative approach  Describe observe for understanding and patient inquiry  List the 4 categories used in the “observe for understanding” technique  Give examples of tools used in observe for understanding and patient inquiry

3. Clinicians Compliance

4. Empower Insiders

5. 5 Model for Change Contextualist Model User ResearchAnalysisPrototypingImplementation Empowerment ProblemAnalysisAction PlanImplementationClinicians Compliance Traditionalist Model

6. Quantitative  Tradition-what, how often  Problem is pre-defined  Research evidence  Surveys, questionnaires Ideal Models Compare & contrast to ideal model Qualitative  Context-how, why  Problem not pre- defined  Dynamic situation & environment  Issue lies hidden in actual situation, not pre-defined  Go directly to insiders who live and work in the situation and environment

7. Contextual Journey  INSIDE OUT  Observe then define  Observation for understanding  Patient inquiry  Solutions are uncovered, guided by insiders, those directly involved Traditional Journey  OUTSIDE IN  Define then observe  Observation for compliance  Solutions are pre- defined, guided by outsiders, those indirectly involved

8. ◦ “I used to observe for compliance, now I observe to understand why things are done the way they are and to find solutions”. ◦ “ I now use both traditional/quantitative and qualitative approaches”

9.  P = People  E = Environment  A = Artifacts  R = Relationships 9

10.  People ◦ Observe Primary Users ◦ Hidden users  Environment ◦ Space ◦ Sounds ◦ Smells ◦ Lighting ◦ Mood of the area  Actions/Artifacts ◦ Procedures ◦ Gestures ◦ Objects ◦ Tools  Relationships ◦ Interactions ◦ Exchanges ◦ Body Language

11. Not looking for compliance No preconceptions Observing to understand the context staff work in Ask open ended questions Encourage sharing of thoughts To learn what might be barriers to implementing an approach that is touted as leading practice Observe for Understanding

12.  Who will collect  Record the Details  Maintain a Natural Setting  Suspend Judgment  Look for the unanticipated  Pay attention to interactions 12

13.  Fly-on-the-wall ◦ Remain Unobtrusive ◦ Do something else while looking and listening ◦ Don’t want people to know you are observing  Shadowing ◦ Let them know your goals ◦ Not looking for compliance ◦ Observing to understand the context they work in ◦ Ask open ended questions ◦ Encourage them to share their thoughts

14.  Descriptive  Situational  Contrast  Watch Outs ◦ Yes/No ◦ Why ◦ Multiple Choice

15. Patient/Family Inquiry Listen carefully and allow for spontaneity Ask questions by picking up on works or phrases they use. Echo their words in your follow up questions Use questions to learn more  What else  Who else  How  Tell me more about that  Walk me through your thoughts when  What might I see or hear when  Identify patient stories (both best and worst scenarios) that serve as inspiration for staff to implement and sustain

16.  Share observations  Cluster observations  Patterns will start to emerge  Identify Gaps  Further interviews

17.  Prototyping -Redesign your clinical practice based on findings from your user research  Leaders, Managers, Front line staff  Facilitates ongoing Conversation  Visual Depiction of process and your culture  Uncover hidden influences and relationships

20.  Systematic approaches to problem solving  Improved reliability and reduce variability  Process mapping  Accountability  Training staff on tools

21.  Leadership involvement  Staff feel safe to share  Develops defenses and contingency plans  Proactive and reactive

22. This VHA Inc. information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly prohibited. Any violation of this prohibition may be subject to penalties and full recourse under law. Copyright 2011 VHA Inc. All rights reserved. v1 Natalie Webb, Director, Performance Improvement, nwebb@vha.com or phone: 317.818.8015nwebb@vha.com