1. WHA Improvement Forum For June    “Tapping Front-line Knowledge”   Presented by Stephanie Sobczak and Jill Hanson Courtesy Reminders: Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) Please do not take calls and place the phone on HOLD during the presentation.

2. 2 Today’s Webinar Agenda  The front line staff perspective  Levels of Involvement  Strategies for Feedback  “Real Time” Improvement

3. Engaging Front-line Staff “No one asked me to work on improvement” “I’ve been involved in the past, but I got stuck doing most of the work” “I was told I have to go to meetings on my off time”

4. Why? Improved outcomes can only occur with improved processes – “the work” of the staff. Staff already know where the waste and inefficiencies are in their processes. Care giving staff are the eyes and ears of the hospital. “Culture eats strategy for lunch”! 4

5. 5 How?

6. Setting the Stage for Engagement Emphasize Teamwork Emphasize High Reliability Emphasize Participation 6

7. Teamwork 7 Success is only possible when everyone knows what is expected, and what is important.

8. Teamwork 8 Do your front line staff know that teamwork is greatly valued in your organization? Is it obvious? Is it recognized? Is it praised?

9. High Reliability 9 The key is standardized approaches. For the work: Use of checklists and written work instructions and systematic methods of communication (such as SBAR) For the improvement: P-D-S-A or other improvement approach

10. Our Hospital Where we do some of the right things for some our patients some of the time.

11. “Engage the Engaged” How do we know who is engaged? 11 Listen carefully to casual conversations: Who loves working with the older folks? Or babies? Or is a stickler for handwashing? You could ask directly, “Who wants to help?” Who reads journals and publications and talks about it? Who is going back to school? OR Who starts their sentences with “You know, we should…”

12. Levels of Involvement 12 Early Adopters Actively seek their knowledge Find ways to lead Fence Sitters Brief interactions Low level commitment Tap into interests Disengaged Ask for support Keep mining the “why” Reach out occasionally

13. Wise Words A new way of doing something only sticks when it can be easily integrated during the work day Work on improvement during the work day 13

14. 14 Lose the “Meeting Mindset”

15. 15

16. Think This Through…. What decisions need to be made in a committee or council. What can be done in informal feedback huddles – Okay to make decisions on small test of change outside the meeting. – Discuss results of small test and adapt quickly. Ensure transparency through a notebook or whiteboard to document progress or concerns. 16

17. Benefits of Fewer Meetings 17 1.Avoids the need to schedule space. 2.Allows people to meet as it is convenient for them, so participation is more likely to happen. 3.Reduces “calendar conflict” problem - the #1 reason for slowing down progress. 4.Changed processes, new tools, etc. are going to work because they are really designed right in the middle of “the work”.

18. Staff Engagement through Small Tests of Change 18

19. 1) Identify: Who has to change their process? 2) Do they know the rationale for the change? 3) Find volunteer testers and clarify expectations 4) Teach testers their role: Trial, give feedback, suggest improvements 5) Track tests and gather data as you go forward 19 1 2 3 4 5

20. Designing Tests and Trials A.Begin with the smallest unit of change possible “Rule of 1’s” B.Plan for easy and efficient collection of feedback from your testers - huddles C.Spread by a few staff at a time D.Work out the bugs along the way 20

21. 21 Page 3-3 in the Improvement Workbook

22. 22 Example in Workbook – Section 3

23. Case Example The Implementation Challenge A care transitions workgroup of staff from a hospital and two local long-term care centers have developed a new transfer form: How will they ensure that staff at both facilities actually use the form? 23

24. What, Who, When - Overview 24 Identify the parameters of the trial period

25. What, When, Who - Detail 25

26. Making Progress 26

27. Insert hand written example 27

28. Don’t Give Up Use pencil on this form and post-it for all to see. Even if testing goes well, keep going until you reach your target number of participants. If testing doesn’t go well – back up a step and try again. 28 So much better than assuming staff are going to change – then being disappointed when they don’t’.

29. Multiple Small Tests of Change 29

30. 30 Test and Trial Examples Patient Demonstrates Understanding of Discharge Instructions Test medication teaching tools HCAHPS – Patient Satisfaction with Discharge Instructions Test large-font discharge instructions Patient Received a Follow-up Phone Call within 3 days Test new phone call script Patient is Discharged with a Follow-up App’t scheduled Test calling a designated primary care nurse to schedule hospital follow-up appointments.

31. Small tests of change are a guaranteed way to engage staff in improvement and Have better buy-in and sustained results 31

32. Next Month: 32 Data driven Improvement Priorities July 25 Noon  From data to information  “Data mining” your process measures  Data driven decision making

33. References Improvement Workbook Section 3 The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, Langley, Moen, & Nolan WHA Quality Center Tools and Templates http://www.whaqualitycenter.org/Partnersfor Patients/PfPTools.aspx http://www.whaqualitycenter.org/Partnersfor Patients/PfPTools.aspx 33

34. Thank You! Questions Please complete 3 question survey when closing webinar window. 34