3/22/2016

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Joy

Orlando

March 2016

Derek Feeley, CEOTrissa Torres, SVP

17th Annual Summit on Improving Patient Care in the Office Practice and the Community

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Quality Improvement

(when we had 5 smiley faces)

https://vimeo.com/102914044

Why Now?

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The Burning Platform

60% respondents of MD survey are considering leaving practice

70% knew at least one MD who left practice due to poor morale

37% of newly licensed RNs are thinking of leaving their job

13% vacancy rate for RNs

Impact not limited to clinicians

Lucian Leape Institute. 2013. Through the eyes of the workforce: creating joy, meaning and safer health

care. Boston, MA: National Patient Safety Foundation.

Problem Worsening

Mayo Clinic Proceedings, Dec 2015

In 2014 physician survey:

• 54% of physicians report burnout, an increase of 10% from 2011

• Satisfaction with work life balance declined from 48% to 41%

• Little change in trends in working US adults, resulting in increasing disparity

http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/fulltext

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Impact on Business Outcomes

Other industries have demonstrated a relationship between employees engagement and:

Customer satisfaction

Productivity

Profit

Employee turnover

Accidents

Harter JK, Schmidt FL, Hayes TL. Business-unit-level relationship between employee satisfaction, employee engagement and business outcomes: a meta-analysis. J Appl Psychol 2002; 87:268-279

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Burnout Affects Patients

A variety of studies have shown association of provider burnout with:

Lower levels of empathy

Less patient satisfaction

Reduced adherence to treatment plans

Overuse of resources

More mistakes

Bodenheimer, T., Sinsky, C. From the Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine, Inc, 2015

“Workplace safety is

inextricably linked to

patient safety. Unless

caregivers are given the

protection, respect, and

support they need, they are

more likely to make errors,

fail to follow safe practices,

and not work well in

teams.”

L. Leape

Welcome to IHI

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Definition

Joy in Work…intellectual, behavioral, and emotional commitment to meaningful and satisfying work

IHI Framework to Promote Joy in Work is a validated approach with roles for the organization, leaders,

individuals, and all three together

Joy

Gratitude

Hope

Awareness of abundance

Deep satisfaction from serving others

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The path from burnout to joy?

Joy is more than absence of burnout…

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Comprehensible, Manageable and Meaningful

Deming and Joy

“Management’s overall aim should be to create a system in which everybody may take joy in his work.”

– Dr. W. Edwards Deming

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Why would it be any different at work?

2. Understand unique impediments to joy locally

(Physical and psychological safety need to be

assured before camaraderie, choice, equity, meaning)

3. Create an organizational commitment to share

responsibility at all levels (work unit, leader,

individual)

4. Use validated approaches to improve joy

(Resiliency, 3 Leadership Behaviors, Participative

Management, QI)

1. Ask “What Matters to you”

Steps Leading to Joy in work resulting in:↑ Patient experience

↑ Organizational performance↓ Staff burnout

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2. Understand unique impediments to joy locally

(Physical and psychological safety need to be

assured before camaraderie, choice, equity, meaning)

3. Create an organizational commitment to share

responsibility at all levels (work unit, leader,

individual)

4. Use validated approaches to improve joy

(Resiliency, 3 Leadership Behaviors, Participative

Management, QI)

1. Ask “What Matters to you”

Steps Leading to Joy in work resulting in:↑ Patient experience

↑ Organizational performance↓ Staff burnout

What Matters to You?

Imperial College Healthcare, Paediatric Department

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Physical safety

Psychological safety

Equity

Camaraderie

Choice

Meaning

2. Understand unique impediments to joy locally

Impediments to Joy

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23

Era 3 for Medicine and Health Care

Era 1 was the ascendancy of

the profession. It’s values: the

profession of medicine is

noble; it has special

knowledge, inaccessible to

laity; it is beneficent; and it will

self-regulate.

- Donald Berwick

Donald M. Berwick, MD, MPP. Era 3 for Medicine and Health Care. JAMA. Published

online March 03, 2016. doi:10.1001/jama.2016.1509

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No slide here – I will just talk

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Race, Ethnicity, and Medical Student

Well-being in the United States

Race, Ethnicity, and Medical Student Well-being in the United State. Arch Intern Med. 2007;167(19):2103-2109. doi:10.1001/archinte.167.19.2103

NHS England Staff Satisfaction Survey

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Staff Experience and Safety & Quality

Good staff management, climate of trust and respect = higher quality

care

The greater the proportion of staff from a black or minority ethnic (BME)

background who report experiencing discrimination at work in the

previous 12 months, the lower the levels of patient satisfaction.

The number of both BME and white staff who are praised by

management after raising a concern is 3% BME 7.2% for white staff.

24% of BME staff compared to 13% of white staff did not raise a

concern for fear of victimization.

West M and J Dawson. NHS Staff management and health service quality.

Coghill, Y. Race Equality in the NHS. Jan 2016 presentation.

Constancy of purpose

Consistency of values

Shared leadership

3. Create an organizational commitment to share

responsibility at all levels (work unit, leader,

individual)

Commitment to Share Responsibility

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Don Berwick31

“The source of energy at

work is not in control, it is

in connection to purpose.”

Constancy of Purpose

• A human face behind

every statistic

• Foundation of Trust

• Stay true and don’t

walk past

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Serious Safety Event Rate

Wellstar Health System January 2008- February 2010

0.00

0.20

0.40

0.60

0.80

1.00

1.20

Jan-

08

Feb-

08

Mar-

08

Apr-

08

May-

08

Jun-

08

Jul-

08

Aug-

08

Sep-

08

Oct-

08

Nov-

08

Dec-

08

Jan-

09

Feb-

09

Mar-

09

Apr-

09

May-

09

Jun-

09

Jul-

09

Aug-

09

Sep-

09

Oct-

09

Nov-

09

Dec-

09

Jan-

10

Feb-

10

Ev

en

t R

ate

0

1

2

3

4

5

6

7

8

9

10

Nu

mb

er

of

Ev

en

ts

SSE's

SSE RateRolling 12 month Serious Safety Events expressed per 10,000 adjusted patient days

February adjusted patient days based on previous 12 months average

SSER February 2010: 0.35 Average Days between events:

18 days (Rolling 12 month)

11 days (CY 08)

18 days (CY 07)

37 days (CY 06)

55% Reduction SSER

111 days since last event

Medical Staff Leaders required mandatory Safety training for all 1700

All 11,000 employees trained as well

Baby Girl V.

5/12/2008

Mother’s Delay in Tx

Ursula H.

2/12/2008

Fall

Helene C.

9/5/2008

Fall

Jimmy P.

7/07/2008

Fall

Robert S.

10/13/2008

Fall

Baby Boy S.

8/1/2008

Wrong Pt. Procedure

Wade W.

7/16/2008

Delay in Tx

John B.

9/06/2008

Delay in Dx

Florita H.

7/03/2008

Delay in Tx

Joann E.

9/23/2008

Wrong Site Surgery

Joseph R.

9/08/2008

Delay in Dx.

A different look at our baseline

Alvin G.

8/17/2008

Fall

Nicole S.

1/4/2008

Delay in Dx

Ms. L.

2/14/2008

Delay in Tx

Teodur C.

1/29/08, 2/12/2008

Delay in Tx

Tamika M

4/21/2008

Med Error

Nancy H.

6/18/2008

Med Error

Regina D.

12/9/2008

Wrong Site Surgery

Sandra M.

12/10/2008

Post Procedure Death

Mary D.

3/9/2008

Med Error

Margaret H.

2/6/2008

Med Error

Baby Boy G.

3/25/2008

Med Error

Lorena W.

11/10/2008

Post Procedure Death

Cynthia K.

11/10/2008

Delay in Tx

Dale W.

10/12/2008

Med Error

Eugene B.

10/27/2008, 10/28/2008

Med Error, Fall

Kathy W.

12/16/2008

Post Proced Loss of

Function

Robert B.

12/2/2008

Post Procedure Death

Chantal E.

6/26/2008

Inapprop Touching

Gary B.

6/13/2008

Fall

Lester J.

9/5/2008

Fall

Calvin P.

4/4/2008

Med Error

Gwendolyn P.

10/28/2008

Wrong Implant

Douglas T.

10/18/2008

Med Error

Mary C.

12/19/2008

Fall

Lance D.

10/30/2008

Delay in Tx

Priscilla W.

8/30/2008

Delay in Tx

Kyle W.

9/13/2008

Delay in Tx

Andrea M.

6/24/2008

Wrong Procedure

Karen G.

8/5/2008

Proced Cx/Delay in Tx

Nicole H.

8/12/2008

Post-proced Cx

Virginia L.

8/12/2008

Delay in Tx

Cynthia M.

10/27/2008

Med Error

Shirley H.

12/23/08

Post Proced Death

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Trust (Lencioni)

Don’t Walk Past

www.youtube.com/watch?v=QaqpoeVgr8U

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Empathy

Recommit to Quality Improvement

3 Good Things

4. Use validated approaches to improve joy

(Resiliency, 3 Good Things, Participative

Management, QI)

Approaches to Improve Joy

Empathy

The research shows that kindness-oriented care has a more statistically significant impact on outcomes than aspirin for reducing a heart attack.

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Four Aspects of Empathy

Perspective taking

Staying out of judgement

Recognizing emotion in others

Communication

Boss vs Leader (or humility is in)

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HP’s BeWell

Model

Six

Dimensions

that align

with our

overall goal

at the center

of the

diagram

Philosophy of our approach

• Leverage the expertise across our organization

• “The experts are among us”

• Meet colleagues where they’re at

• Involve and engage

• Be flexible and adaptable

• Align with our strategic plan

• Integrate with all cultural efforts

• Keep it visible

• Define and measure success

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Simple Quality Improvement

Overall, IHI is an excellent place to work.

0% 0% 0% 0 2% 2% 1% 1% 0% 0%6% 3% 2% 1% 1% 2% 2% 1% 1% 1%

12%9%

7%3% 3%

6% 5% 5% 3% 2%

52%

45% 51%

42%

53% 42%38%

33% 37%44%

29%

42% 40%

54%

41%48%

54%60% 58%

53%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

May September November January March May July September November January

Strongly Disagree Disagree Not Sure Agree Strongly agree

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I believe IHI is going in the right direction.

1% 1% 1% 0% 0% 0% 1% 0% 0% 0%

10%3% 1% 1% 1% 3% 3%

1% 0% 0%

36%

28%25%

8%18% 11% 9%

9.80% 12% 12%

40%

51%53%

55%

56%

54% 57%

50%

58%

46%

13% 17% 21%

36%

25%32% 29%

39%30%

41%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

May September November January March May July September November January

Strongly Disagree Disagree Not Sure Agree Strongly agree

3 Good Things

Seligman (adapted from www.midmichigan.org/3goodthings)

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Three Takeaways

1. This is not a project – needs to be

integral to our work.

2. The 3 C’s - Coherence, Consistency

and Connection (to purpose).

3. Just Start!

If in doubt……just start