1. Culture Change: Regional, Local, Global Tania R. Lyon, PhD St. Clair Hospital Pittsburgh PA December 2014

2. The Pittsburgh Story Paul O’Neill

3. The Pittsburgh Story Karen Feinstein

5. Pittsburgh Lessons  Data transparency is not sufficient  Competitive markets matter  Top leadership matters  Pockets can thrive  All in good time…PRHI 2.0

6. Lean means…  Creating more value for customers with fewer resources  “An organization’s cultural commitment to applying the scientific method to designing, performing, and continuously improving the work delivered by teams of people, leading to measurably better value for patients and other stakeholders.”

7. A Community Hospital

8.  How deep, how wide?  Training, Operations & Culture

9. Training Classes Classes Internal Certification Program Internal Certification ProgramOperations The Starter Miracle Strategic InitiativesCulture Channels for frontline involvement Leader Standard Work Winning hearts and minds

10. Which group is hardest to convert/persuade?  Senior Management  Middle Management  Frontline Staff  Physicians

11. Training Classes Classes Internal Certification Program Internal Certification ProgramOperations The Starter Miracle Strategic InitiativesCulture Channels for frontline involvement Leader Standard Work Winning hearts and minds Show me the outcomes Change behavior to change thinking

12. Original ED: updated & renovated (no changes to basic floor plan) New addition

15. Training Classes Classes Internal Certification Program Internal Certification ProgramOperations The Starter Miracle Strategic InitiativesCulture Channels for frontline involvement Leader Standard Work Winning hearts and minds Show me the outcomes Change behavior to change thinking

17. A Community Hospital  How deep, how wide?  Training, Operations & Culture  Winning hearts and minds  Integration with Quality & Safety Depts

18. How we used to look on paper Chief Operating Officer Chief Quality Officer QualitySafety Director of PI

19. How we look now on paper Chief Operating Officer QualitySafety Director of PI

20. How we are starting to operate functionally Quality SafetyPI

21. A Community Hospital  Lessons Learned  Personalities and culture matters  Personal commitment from senior team matters  Leader standard work matters (a Management Operating System)  Physicians need to be partners, not customers; special challenge at the community hospital level

22. A Global Perspective

23. Yes, it is worse quantitatively…

24. …but not qualitatively

25. Lessons Learned  Systems are systems  A resource rich system can still be poorly designed  BUT – larger system cultures heavily influence micro-system cultures; top leadership is a major lever

26. Teneriefe Airline Disaster Canary Islands, 1977

27. Captain Sully lands plane safely on the Hudson River, 2009