Fostering engagement and innovation

through leadership accountability

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June 16, 2015

Presentation Outline

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1. Ideas Matter

2. Rouge Valley Health System’s Approach to Idea Generation

• About Rouge Valley

• Getting Started

• Our Approach

• Leadership Accountability

• Recognition

• Results

3. Other Key Engagement Initiatives

4. Lessons Learned

Ideas Matter

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The Benefits of Staff Ideas

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• High Performing Idea Systems have been found to show several important benefits:

o Create a culture of daily improvement

o Address improvement opportunities that are difficult for managers to see

o Enhance staff engagement and increase morale

o Promote rapid organizational learning

o Close the gap between staff and leaders

• Baptist Health Care: 14,000 staff ideas lead to $5.5M in cost savings

• Key features of effective idea systems include:

o Ideas are integrated into everyday work

o The emphasis is on small ideas

o Front-line performance metrics focus ideas on what is important

o Both managers and workers are accountable for their roles in the idea process

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Workers become more engaged when they see their ideas being used. And

managers, seeing the impact of employees’ ideas, give employees more authority—

which leads to more and better ideas.

…frontline workers have better knowledge of the particularities of products, services,

and processes than managers do. They’re better positioned to spot problems and

opportunities.

Pushing decision making down to the front lines for as many ideas as possible leads

to better decisions, faster implementation, and lower processing costs; it also frees

up managers’ time.

Getting the Best Employee Ideas

Harvard Management Update

FEBRUARY 28, 2008

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“…studies across many industries have linked employee

engagement to higher performance. This linkage holds true

even within health care. For example, in 2012, the National

Health Service in the United Kingdom conducted a survey of

280,000 health care employees, which demonstrated that

employee engagement scores correlated with lower patient

mortality, higher patient satisfaction, lower staff absenteeism,

lower staff turnover, and even lower infection rates. Yet the

idea of “engagement” remains a relatively new and

understudied concept for management.”

Quality and Safety as the Spark for

Employee Engagement

Davood Abdollahian, MD, Paul Nagy, PhD

2014

Rouge Valley’s Approach to

Idea Generation

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Rouge Valley Centenary (RVC) Rouge Valley Ajax and Pickering (RVAP)

About Rouge Valley

2013-2014 Stats 2700 staff

300 active MDs

Program RVAP RVC RVHS

Outpatient Clinic (ACU) 90,722 158,544 249,266

Emergency 63,791 66,212 130,003

MRI Scans 7,037 8,930 15,967

Surgical Outpatients 5,168 9,491 14,659

Surgical Inpatients 1,592 3,167 4,759

Cardiac Catheterizations N/A 4,784 4,784

Births 1,471 2,163 3,634

Our Staff

9

2734

1509

709

391

73

52

2994

1587

839

406

92

70

Total

Regular Full-Time

Regular Part-Time

Casual

Temporary Full-Time

Temporary Part-Time

Total 2014-15 Total 2009-10

: - -

Four Pillars of Our Quality Framework

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STANDARD All of the following are in place:

• Process Control Boards

• Performance Trending

Boards

• 6S

• A3

• Rounding

• Kaizen Participation

• Leader Training

ADVANCED All of the following are in place:

• Sustainment of Standard

level

• Kamishibai

• Safety Calendar (could be

part of kamishibai system)

• Idea Board with problem-

solving huddles

• Department leads and

sustains its own kaizen

events (at least 2 per yr)

ROLE MODEL All of the following are in place:

• Sustainment of Standard and

Advanced levels

• Internal knowledge sharing (joint kaizen with another dept;

facilitator for another dept’s Lean

event; lead an in-service; internal

article or poster presentation)

• External knowledge sharing (e.g. joint kaizen event with

external partners; conference

presentation; published article)

• Use of one or more higher-

level Lean tools (e.g. Kanban,

Andon, SMED/changeover, etc.)

2010/11

2011/12

2012/13

90%

100%

10%

100%

0%

10% 40%

67% 33%

The STAR Framework Corporately Defined Expectations for Lean Deployment and Sustainment

Reported on corporate balanced scorecard

Getting Started What to measure

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Ideas Implemented

Pros Cons

Linked to improvement

Leaders have an incentive to act on staff

ideas

Leaders have an incentive to empower

staff to take ownership for idea

implementation in order to get as many

ideas implemented as possible

Gaming is more difficult

Staff that bring forward ideas that are not

implemented (for whatever reason) may be

discouraged

Ideas for large scale change may drain

resources making it difficult to implement

smaller ideas

Big ideas and small ideas are counted

equally

May contribute to quick implementation

without adequate planning and risk

assessment

Ideas Generated

Pros Cons

Recognizes staff engagement in

bringing forward ideas regardless of

the feasibility or merit of the idea

Encourages risk taking and builds

trust in the team (there are no silly

ideas)

Acknowledges that there might be

barriers to implementation outside of

the team’s control (e.g. funding,

resources, competing priorities)

Gaming is relatively easy

Not necessarily linked to

improvement

Good ideas and not so good ideas are

counted equally; may not encourage

critical thinking around idea

generation

Does not incent leaders to act on staff

ideas (not acting on ideas will be

viewed as disrespectful of staff who

took the time to submit ideas)

Getting Started Target Setting

• There is wide variation in target setting practices

across organizations.

• In general, the advice is to be conservative with

target setting in early years and build over time

once the capacity of the organization to

implement changes increases. Targets are not

meant to be punitive and should consider the

organization's capacity to implement change

ideas as under resourcing places kaizen initiatives

at risk.

• Some of the questions that emerge are: – Should the target be the raw number of ideas or the number

of ideas per employee?

– How are employees defined and counted?

• FTEs vs. headcount? (the FTE approach gives higher

weight to FT employees, those who spend the most

time at the organization)

• Which staff groups are included – FT, PT, casual?

• Our review found that, for the most part, targets

are based on the number of suggestions per

employee.

• Manufacturing organizations use

a target of 3 suggestions per

employee per year, although

some feedback indicates that this

ranges from 2 - 50 suggestions

• St. Mary’s General Hospital

(Kitchener) set a target of 1000

suggestions per year

• St. Francis Health set a target of

1 suggestion per full time

employee in the first year

• Utah North Region of

Intermountain Healthcare did not

set targets for the first few years

of their programs. Over time, a

modest goal of 1 suggestion per

employee was identified

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Idea Boards at RVHS

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RVC Birthing Centre RVC Pharmacy

Layout of the Idea Board Im

pa

ct

Difficulty

Possible

Implement Challenge

Kibosh

New Improvement Ideas

PICK Chart

In Progress Work & Ideas

Almost Implemented Ideas

Ju

st

Do

Its

P

DS

As

Week 1 Week 2 Week 3 Week 4 Week 5

Implemented Ideas

Celebrations

Stephanie passed her AQ Exam!

Zero department pressure ulcers!

Idea Board Standard Work

Layout of the Idea Board Im

pa

ct

Difficulty

Possible

Implement Challenge

Kibosh

New Improvement Ideas

PICK Chart

In Progress Work & Ideas

Almost Implemented Ideas

Ju

st

Do

Its

P

DS

As

Week 1 Week 2 Week 3 Week 4 Week 5

Implemented Ideas

Celebrations

Start with work in progress:

a) Just Do Its – any barriers

to moving forward?

b) PDSAs – if the status

indicator is green,

acknowledge the work

and move on; if the status

is red, ask about barriers.

Move completed work to the

“Improvement Ideas

Implemented” section

Review and record any new

improvement opportunities:

-e.g., opportunities identified

on stat sheet

-Ask staff what barriers they

are encountering in their day

• Use the PICK chart to get feedback from staff

about whether working on this will have high or

low impact and whether it is easy or hard to do

• If an opportunity falls into Kibosh, circle back

with the originator but do not place on the

PICK chart

• All patient or employee safety or quality issues

are immediately moved to be worked on

• If opportunity is related to existing PDSA,

driver, or other work in progress, move the

Improvement Opportunity form to that PDSA

to be incorporated

• As capacity becomes available, problems can

be moved from PICK chart to work in progress

• Assign resources to new work in progress with

owner(s), & mentor / coach

• Review the implemented ideas and if any

opportunities in sustaining them

• Discuss any celebrations on the unit.

• Monthly (+/- daily) tracking on a run chart

or simple bar chart

• Improvement Tickets and PDSAs get

moved over to this area once completed

Idea Board and Huddle Training

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Step 1: Classroom Training

• Review of objectives and standard work

• Overview of coaching role

• Participants practice leading huddles

Step 2: Gemba Coaching

• Experienced coach provides real time feedback

• Develop managers’ skills to coach staff

• Transition coaching support to operational leaders

Weekly Idea

Board Huddle

Rouge Valley Accountability Structures

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RVHS Quality

Improvement Plan (QIP)

Board SMT PETE

RVHS Corporate

Scorecard RVHS Leader’s

Personal Business

Commitments

Quarterly Reviews on Progress to Target

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Number of Departments with STAR

Requirements in Place by VP: Quarter 4

Ow

ner / V

P

Dep

artm

en

t Co

un

t

6S

Pro

cess C

on

trol B

oard

Perfo

rman

ce T

ren

din

g

Bo

ard

Kam

ish

ibai

Safe

ty C

ale

nd

ar

Idea B

oard

/ Perfo

rman

ce

Hu

dd

les

A3

Dep

artm

en

t Co

mp

lete

d

the E

ven

t / Pro

ject

Req

uire

men

t?

YT

D: N

um

ber o

f Ideas

Gen

era

ted

YT

D: N

um

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f Ideas

Imp

lem

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Crite

ria

Campos 3 3 3 3 3 3 3 3 3 55 48 3 0 0 0 0 0 0 0 0

Topaloglou 3 1 3 3 3 3 3 3 3 27 18 1 0 0 0 0 0 0 0 2

Brazeau 2 2 2 2 2 2 2 2 2 26 26 2 0 0 0 0 0 0 0 0

Gooding 6 6 6 6 6 6 6 6 4 242 56 4 0 0 0 0 0 0 0 2

Gowrie 6 6 6 4 4 5 6 2 4 131 56 2 0 0 0 0 0 3 1 0

James 20 18 20 19 19 20 19 16 17 888 662 13 0 0 0 0 1 0 2 4

Williams 18 18 18 18 18 18 17 18 17 301 224 18 0 0 0 0 0 0 0 0

McCutcheon 27 27 27 27 27 27 27 27 27 803 470 27 0 0 0 0 0 0 0 0

Dr. Mohan 1 1 1 1 0 0 1 1 0 18 8 0 0 0 0 0 0 1 0 0

Total 86 82 86 83 82 84 84 78 77 2491 1568 70 0 0 0 0 1 4 3 8

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Cumulative Number of Ideas Generated

(By Portfolio)

Note: New presentation of metric for 2014/15. Annual Target also broken down into quarterly targets for ‘Number of Ideas Implemented’

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Cumulative Number of Ideas Implemented

(By Portfolio)

Recognition

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Application for Idea Submission Deadline: Monday, March 23, 2015

IMPROVEMENT OPPORTUNITY Key Contact Name: Key Contact Phone:

Department: Date Idea implemented:

Describe the Idea

Is this idea: Fully implemented? If so, when was it implemented. In progress? Expected date of full implementation. Please provide a description of where this idea can be observed in action:

What are the actual/expected benefits from this idea: Describe the benefits from implementation of this idea – was there significant change to a process? Are there less steps in the process? What other changes have been observed? If applicable, please provide detailed before/after drawings of action plan with this application.

Please check off and describe any or all wastes that were impacted by this improvement: Transportation: was there less walking/moving for a person or object as a result of this improvement?

Defect/rework: Motion: was there a reduction in searching for supplies? Patients? Paperwork? Excess processing: Waiting: was there less waiting for information? Supplies?

Overproduction: Inventory: was inventory reduced because of this improvement?

Please circle any/all the corporate dimensions that your idea impacts Access Service Team Fiscal

Please describe how this improvement has enhanced patient or customer service:

How does this idea make RVHS better for our staff?

Do you see potential opportunities for this idea to be spread across other areas? If so, please explain briefly how/where this might happen: In this space, please provide pictures or diagrams that help describe the improvement idea

New ideas are a vital part of our continuous improvement culture at Rouge Valley. Our team of staff, physicians, midwives and volunteers come up with many ideas that help us provide a better patient experience. The patient experience/team engagement (PETE) quality committee is sponsoring an idea celebration on Tuesday, March, 31, 2015 at both RVC and RVAP from 12:00 to 1:00 pm. At this event, we will present an award for the top two ideas at each site as selected by the PETE committee. One grand prize per site will be awarded for the best implemented improvement idea. A second award will be given for one idea from each site that has been generated, but not yet fully implemented. The winners will be selected using the following criteria:

1. Originality of idea

2. Transferable (how easily can this idea be adopted by other departments)

3. Lean thinking (contribution to waste reduction, visual management, respect for people,

etc.)

4. Positive impact on patients (on access to care and service excellence), via team engagement,

and fiscal responsibility

5. a) Implementation has been completed (grand prize); b) Idea is generated, but not yet fully implemented (runners up).

Submissions may include ideas that have come forward from staff, volunteers, physicians, or midwives that have been implemented, or are in the process of being implemented, between April 1, 2014 and March 20, 2015. Applications must be submitted no later than Monday, March 23, and must be validated by the manager of the unit, or another staff member (charge staff, healthy workplace champion, etc.) who can confirm idea generation and implementation. Applications are available from the HR department at both sites, or

Access Application: On the Intranet under the Employee Centre Home Page Forward completed forms to: crsamuel@rougevalley.ca

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SHARE YOUR IDEAS!!

Cake and Beverages will be served

Video Clip of Example of Ideas at RVHS

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https://www.youtube.com/watch?v=erDFLWNS6H4&list

=PLI15kvPeM6uKIoC9VajCR0rwx_ZzIbe72&index=1

Results

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Cumulative Number of Ideas Generated and

Implemented at RVHS

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2013-14 2014-15

86 departments across RVHS report idea generation and

implementation on a quarterly basis

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Number of Departments with

STAR Requirements in Place

RVHS Staff Engagement Scores

In 2014:

• our overall engagement score increased by 7.2 points over 2012, and

is 5.7 points above the 2012 OHA average.

• positive scores for every question were higher than our 2012 results,

and five of the six were higher than the 2012 OHA average.

• for the category “how would you rate RVHS as a place to work?” our

2014 rate was 0.6% higher than 2012, and 1.2 % higher than the 2012

OHA average.

The greatest difference between our 2014 rate and the 2012 OHA

average was in the category “this organization really inspires the very

best in me in the way of job performance.” This category also saw the

greatest increase (7.2%) from our 2012 rate.

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LMS Staff Feedback (Wave 1)

Note:

• A score of 6 or above indicates a positive response

• There were 56 respondents in the pre-LMS survey and 36 respondents in the post-LMS survey (See appendix for details)

4.4

5.1

4.5

5.0

5.1

7.7

4.7

5.7

6.2

5.7

6.9

7.3

6.8

6.8

7.1

8.2

7.0

8.0

8.0

7.1

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0

10. When changes are made in my unit/department, employees and physicians are involvedin the process

9. Visual displays of hospital performance data are regularly reviewed and used to driveimprovement

8. The organization facilitates regular knowledge/idea sharing forums acrossunits/departments that are related to hospital improvement

7. Employees and physicians understand how their area's performance metrics impact thewhole organization's performance

6. Employee and physician suggestions on how to improve department and/or hospitalperformance are actively solicited

5. Learning is an important part of our daily work

4. Senior Leaders are aware of front line issues and challenges (the way things really arearound here)

3. Department performance metrics are openly displayed and reviewed with front line staffon a regular basis

2. There are regular meetings on units/departments that focus on the review ofunit/department performance metrics and result in plans to improve processes

1. I understand what the department goals are for the next year

POST LMS Score PRE LMS Score

4.4

5.1

4.5

5.0

5.1

7.7

4.7

5.7

6.2

5.7

6.9

7.3

6.8

6.8

7.1

8.2

7.0

8.0

8.0

7.1

0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0

10. When changes are made in my unit/department, employees and physicians are involvedin the process

9. Visual displays of hospital performance data are regularly reviewed and used to driveimprovement

8. The organization facilitates regular knowledge/idea sharing forums acrossunits/departments that are related to hospital improvement

7. Employees and physicians understand how their area's performance metrics impact thewhole organization's performance

6. Employee and physician suggestions on how to improve department and/or hospitalperformance are actively solicited

5. Learning is an important part of our daily work

4. Senior Leaders are aware of front line issues and challenges (the way things really arearound here)

3. Department performance metrics are openly displayed and reviewed with front line staffon a regular basis

2. There are regular meetings on units/departments that focus on the review ofunit/department performance metrics and result in plans to improve processes

1. I understand what the department goals are for the next year

POST LMS Score PRE LMS Score

Other Key Engagement Initiatives

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S.T.A.R.T. with Heart SM Respond with H.E.A.R.T.® Coach with H.E.A.R.T.SM

A resource for compassionate

and caring communication

S.T.A.R.T. with HEARTSM Goals

• Increase awareness of impact

of every patient, visitor and

employee interaction, every

day, every time

• Understand the role of the

employee, physician, or

volunteer is greater than tasks

associated with his/her job

• Understand that employees

should feel empowered to

deliver world-class care

“Before I care

how much you

know, I want to

know how much

you care”

[RVHS Patient]

Lessons Learned

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Lessons Learned

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• It is not just about the number of ideas implemented!! The

idea board and huddle have several objectives:

– Staff participation in idea generation and implementation

– Promote continuous improvement as part of everyone’s job

– Team communication and prioritization of opportunities

– Managing the work in progress to accelerate implementation

– To create coaching opportunities to develop problem solving

capabilities in our staff and to teach leaders to delegate and share

responsibility

• Effective huddles require coaching and support. Leaders

require feedback and encouragement to develop this new

skill