1. WHA Improvement Forum For September    “Managing the Improvement Portfolio”   Tom Kaster & Travis Dollak 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. 1

2. 2 Today’s Webinar Agenda  Method’s for sustaining great outcomes  Monitoring multiple projects  Taking action when its needed

3. Institutionalize Accountability *Reference August Improvement Forum Managing Multiple Projects – Start with Roles 3 BoardQuality Council Improvement Manager Team Leaders Team Members Unit Managers Other Frontline Staff Quality and/or Practice councils: Review the outcomes Make decisions on what are the priorities Communicate the priorities house wide Marshall the resources to do the work Refrain from “doing the work” Hold clinical areas accountable for their outcomes.

4. Key Responsibilities 4 GroupTasks Quality Council-Regular review of outcome data (dashboard) -Analyze the big picture and key improvement needs -Allocate resources Improvement Manager-Coach teams and frontline staff on improvement methodology -Provide data support -Assign Team Leads -Aid in improvement team selection, structure and objective development Team Leaders-Organize team functions -Direct small tests of change -Analyze outcome and process measures -Liaison between team and Improvement manager -Aid in spread Team Members-Conduct small tests of change -Provide real time feedback -Capture process measures -Advocate for process improvements

5. Unintended consequences If the roles become “murky”…. Quality is tasked with reporting and doing Clinical areas are too far removed from their measureable outcomes Everything is a priority Eyes are taken “off the ball” – something is missed Capacity to be agile and adapt to change ( i.e. new evidence, rules and regs ) is limited. 5

6. Tools to Prevent “Murky” Roles, Responsibilities, and Competing Priorities 6 Project Plan Sustainability Plan (WHA Improvement Workbook) Spread Matrix (WHA Improvement Workbook) Gantt Chart Creates structure and timeframes Prevents units from being overwhelmed Aids in accountability Builds consensus on what needs to be done

7. 7 Sustainability Defined Spread – Successful changes in one area are adopted (and improved!) in other areas. Sustainability – Improvements made will continue and high performance is retained over time, with little regression.

8. Sustainability Defined 8 1.Results are better than when started 2.Variation is reduced

9. 9 Methods for Sustaining 1)Front line staff was involved from the beginning 2)Review performance trends with your team- track data and watch for changes 3)Teach the team to watch for drift and take action 4)Coach them to not overreact to the “blips”, but to understand what they are. 5)Plan for how to achieve the AIM (again, if needed). 6)Maintain roles and accountability.

10. Reviewing Performance Trends – More than the Dashboard Static red, yellow, green boxes don’t help you predict Unable to see trends/shifts Lack ability to provide context *May be appropriate for senior leaders, but not the sole tool to help front line staff improve. *Senior leaders should also see data over time to avoid obsessing on a single data point. 10

11. A Better Choice – Keep Up a Regular Review of Your Run Charts 11

12. Now Keep on Top of That for A Dozen Projects 12 Measuring Outcome Data Alone Won’t Solve This Challenge

13. Would you? 13 OutcomesProcessesProactive Prevention

14. Would you? 14 Outcomes ProcessesProactive Prevention

15. Would you? 15 Outcomes Processes Proactive Prevention Insuring drift does not happen by auditing KEY processes Keeping an Eye On Your Outcomes Regular Audits of Hourly Rounding

16. Bottom Line? 16 Outcomes ProcessesProactive Prevention If you wait for the outcome measure to drift… 1.You have lost your improvement momentum 2.The staff has already regressed to past behavior 3.Your training and education efforts were for not 4.Your are back at square one

17. Bottom Line? 17 OutcomesProcessesProactive Prevention If you institutionalize the auditing of key processes… 1.You can catch slips before the momentum is lost 2.You are able to help staff get past the awkward change period and hardwire the new processes 3.You are on top of unforeseen changes 4.You validate your investment

18. The Sustainability Plan 18

19. Calendaring the Auditing of Key Processes 19 Quarterly: Jan/Apr/ July/Oct Hourly Rounding Prevalence Falls Project Team Regroup Nurse Manager Initiate Quarterly: Feb/May/A ug/Nov VTE: Protocol Prevalence Unit Managers regroup Unit Managers

20. The Spread Matrix 20

21. When and How to Take Action WHEN Process measures are drifting (trend or shift) A bad outcome occurs Teams aren't meeting Turnover in teams Team needs coaching on QI concepts Feedback/help for team Accountability is not clear 21 HOW Don’t take over the project Ask questions Coach on the improvement methodology Do offer up resources Reference roles and responsibilities Recognize other projects/priorities Encourage data driven decisions

22. What Is Different In This Approach? More transparent data and accountability Tools that provide structure (not just lip service) Greater emphasis on continued measurement Helps avoid the ‘project mentality’ Focus on tracking improvement for sustaining success 22

23. Next Month: October 24 23 Review Survey Results

24. References 24 http://www.whaqualitycenter.org/PartnersforPatients/PFPWave2Materials/PfPImprovementWorkbook/PfPImpWkbkSection6. aspx On the Quality Center

25. How do you keep your eye on the ball? 25 Discussion time: Would anyone share what strategies their hospital uses to sustain high performance? Please be sure your phone lines are muted to keep background noise to a minimum. You can select *6 to MUTE and *7 to un MUTE

26. Announcements Partners for Patients – Improvement Leader Fellowship (ILF): Helps staff boost their QI knowledge to better execute their HEN projects as well as future improvement work your organization may take on. Session 4 is October 16, two-hour webinar. These sessions will blend QI knowledge along with the content of the 10 HEN topics. Low-risk/low-investment to expose staff to this material without having to arrange travel, staff coverage, etc. Each session will provide CEU credits. Questions/More Information – Contact Travis Dollak (tdollak@wha.org) or Tom Kaster (tkaster@wha.org)tdollak@wha.orgtkaster@wha.org 26

27. Thank You! Questions Please complete 3 question survey when closing webinar window. 27