1. Leadership Accountability Demonstration Project (LADP) Cohort 2 – Kickoff Webinar – Option I1 (intensive) April 24 th, 2014 © The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System

2. Goals for this project Develop deeper appreciation of the link between leadership and patient safety Select an area of focus for strengthening your efforts Implement the Model of Accountability with support from AI & VHA Learn, share, and sustain

3. Agenda 3 Introduction to the program The model, the evidence, and the plan The first steps Choosing a harm area and geographic area(s) Preparing for the site visit Learning from other teams Action items and discussion

4. Leadership Accountability Demonstration Project (LADP) Introduction to the model, evidence, and plan

5. Your cohort team: 2014 option 2 (intensive) Holy Redeemer hospital and Medical Center - Meadowbrook, PA INTEGRIS Canadian Valley – Yukon, OK INTEGRIS Health Edmond – Edmond, OK INTEGRIS Lakeside Women’s – Oklahoma City, OK INTEGRIS Southwest Medical Center – Oklahoma City, OK Jefferson Regional Medical Center – Pittsburgh, PA Swedish Covenant Hospital – Chicago, IL Southeastern Ohio Regional Medical Center - Cambridge, OH

7. Leadership at the highest levels matters Keroack et al., 2007; Academic Medicine

8. Leadership at the local level matters …the odds ratio for mortality increased by 1.24 for the hospital. For every 10% decrease in perceptions of management items… Huang et al., 2010

9. Evidence-based leadership for patient safety 1. Frankel A, et al., 2008, 2. Thomas EJ, et al., 2005, 3. Pronovost P et al., 2005, 4. Verschoor KN et al., 2007, 5. Keroack MA, et al., 2007 Executive walk rounds [1, 2] Executive leader ‘adopt a unit’ [3] Safety briefings [4] Patient safety strategic plan [5] Hands-on leadership style [5]

10. What are we working towards? Shared leadership accountability for patient safety and quality improvement A mutual sense of responsibility, contribution, and control related to organizational quality and safety improvement efforts Shared among both formal and informal leaders from different levels and areas of the organization.

11. Grounded in Leadership Model of Accountability

12. Assessing your Chain of Accountability

13. How we will work together Site visit conversation Identify opportunities to optimize leadership and accountability Monthly cohort calls Model of Accountability content Introduction of tools Collaborate, share experiences and troubleshoot with fellow cohort members Action planning Monthly coaching (one on one) Site specific consulting and support Build capacity 2 members per site trained in the AI Online Patient Safety Certificate Monthly feedback loops Share progress and innovations across organizations Accountability Model + Tools Site Visit Conversation Cohort wide calls Individual calls Data and Feedback Adaptive leadership

14. Timeline AprilMayJuneJulyAugSeptOctNovDec Cohort Calls Kickoff Call Site Visit Preparation Call Patient Safety Certificate Program Call Tool call 1: Learning tracer tool Business case tool Horizontal Learning Call 1 Tool call 2: Strategic prioritiza tion Safety comp Horizontal Learning Call 2 Tool call 3: Decision making tool Horizontal Learning Call 3 Site Visits and Coaching Calls Site Visit Conversations Monthly Individual Coaching Calls SurveysHSOPS & PSOA

15. PSOA Domain: Key Aspects of Safety (KAS) 15 1.Leadership (L1) Demonstrate patient safety as a top leadership priority (L2) Promote a non-punitive culture for sharing information and lessons learned 2.Strategic Planning (SP1)Routinely conduct an organization-wide assessment of the risk of error and adverse events in care delivery processes (SP2) The organization actively evaluates the competitive/collaborative environment and identifies partners with whom to learn and share best practices in clinical care: 3.Measurement, Analysis and Knowledge Management (MAKM) Analyze adverse events and identify themes across events

16. PSOA Domain: Key Aspects of Safety (KAS) - Cont. 16 4. Workforce Focus (WF1) Establish rewards and recognition for reporting errors and safety driven decision-making (WF2) Foster effective teamwork regardless of a team member’s position of authority 5.Operations Focus Implement care delivery process improvements that avoid reliance on memory and vigilance 6.Customer Involvement Engage patients and families in care delivery workflow process design and feedback 7.Results

17. Patient Safety Organization Assessment (PSOA) Cohort 1 Pre-Post Comparison

18. PSOA Cohort Pre-Post Comparison

19. The first steps Choosing harms and geographic area(s) Planning for the site visit

20. What harm should we focus on? For this project’s time frame, readmissions is not feasible.

21. What unit should we focus on? Where’s our biggest chance of success? Where’s our biggest challenge? What would make the most compelling success story (internally and externally)? What would position us best for spread?

22. Preparing for the site visit conversation Systematic way to gather ground truth Non-judgmental Confidential Collaborative Conversational Triangulates perceptions and knowledge Senior Leaders Clinical/Specialty Leaders Unit Leaders Conversation + Observation + Reflection

23. Site Visit Conversation Template

24. Preparing for Site Visit Conversation Plan to attend site visit prep call in May Consider sharing (or collecting new responses) Patient safety organization assessment (PSOA) Hospital Survey on Patient Safety (HSOPS) Survey measure of safety culture Can send to participating unit and 1 non-participating unit Can share existing data if your organization recently took the HSOPS

25. HSOPS and PSOA administration guidance Who should fill them out: Everyone from the participating unit Everyone from a non-participating unit How to fill it out If you already have the data, we have a way to upload it If you don’t have it, we will email survey links to you, you can fill it out online When to fill it out Before the site visit and after the last coaching call To evaluate your progress, we are offering the opportunity to administer these surveys at two points in time: Before site visit and +6months (Nov-Dec 2014) Report If you collect new HSOPS data we will share reports for each unit We will summarize results and share with you after the project

26. Next Steps 1.Gain focus. Develop internal consensus on your focus area (harm and unit) for this project. 2.Build your internal team. Select and invite your team to be part of this work. Point a contact person. 3.Schedule your site visit. Contact Alice (Xin-Xuan) Che: xche1@jhmi.eduxche1@jhmi.edu 4.Prepare for pre-visit survey administration.

27. Open discussion Please introduce yourself or your team Has your team talked about or decided on which of the targeted HEN harm areas that they would like to work on? If so, which one? If not are there a few that you might be considering?

28. Discussion Any questions or concerns? Contact: Alice: xche1@jhmi.edu Michelle: MLEWIS@vha.com