High Impact Leadership for Patients

High Impact

Leadership for

Patients …the Mayo Clinic Story

Stephen Swensen, MD, MMM, FACR

Director Leadership Development

Senior Fellow IHI

This presenter has nothing to disclose.

Design matters

Attention matters

Leaders matter

Design matters

No one is big enough to be independent of others.

They selected a superb site for the new State House close to the

summit of the south side of Beacon Hill, overlooking Boston

Common and the Back Bay.

The land had originally served as a cow pasture for the

Revolutionary patriot and governor John Hancock.

152

Every system is perfectly designed …to get the results it gets

Berry LL, Seltman KD: Management Lessons from Mayo Clinic: Inside One of the

World's Most Admired Service Organizations. 2008, New York: McGraw Hill Same pension and benefits for all 61k Socialism run by Republicans

©2014 MFMER | slide-10

Practice

Education

Research

Integration

Administrative Shared Services Rochester Arizona Florida

Mayo Health System

Other Business Units

10

Holding Company


Rochester Arizona Florida Mayo Health System

Other Business Units

Practice

Education

Research

Integration

Administrative Shared Services

11

Integrated Organization

CP1257641-16

Rochester

Arizona

Jacksonville

41 Specialty Councils

1 million unique patients from 145 countries and 50 states


13

Mission

Goals/ objectives

Vision

Mission

Goals/ objectives

Vision

Integrated Organization

©2013 MFMER | slide-14 Conductor-Concertmaster

Rummans. Leading Healthcare Organizations:

Physician-Administrator Partnerships Group Practice Journal, 24-28 June 2011

Delivering medical care is a business…

…taking care of patients is not.

Intrinsic Motivation and Employee Attitudes: Public Personnel Admin Dec 2012 382-406


Organizational Democracy


Newcastle University. Anthrozoos, Berg Publishing. November 27, 2008 Leader Selection Process

Leader Selection

Berry LL, Seltman KD: The enduring culture of Mayo Clinic. Mayo Clin Proc 2014;89(2):144-147. Leader Rotation

Muir, William (2005) Incorporation of competitive effects in forest

tree or animal breeding programs. Genetics 170: 1247-1259

Muir, W. M., 2005 Incorporation of competitive effects in forest

tree or animal breeding programs. Genetics 170: 1247-1259 McCallum. Leadership & Organization Development Journal 30: 2, 2009 152-166 MIT Study. Challenging

problem. Highest collective IQ groups vs. High social sensitivity. Empathy. Equal time to each other. No

domination by individuals. More women. Social Connectedness Matters. Helpfulness trumps intelligence.

Muir, W. M., 2005 Incorporation of competitive effects in forest

tree or animal breeding programs. Genetics 170: 1247-1259 McCallum. Social capital and leadership development Building stronger leadership through

enhanced relational skills. Leadership & Organization Development Journal 30: 2, 2009 152-166

…care about one another …commit to excellence …engender trust

Great Depression

The depression was the most unifying influence in Mayo Clinic history. Harwick Jesse Baldwin 40% 1/4

Attention matters

High-Impact Leadership Framework Where leaders need to focus efforts

Swensen, Pugh, McMullan, Kabcenell. High-Impact Leadership: Improve Care, Improve the Health

of Populations & Reduce Costs. Institute for Healthcare Improvement; 2013. Available: www.ihi.org. 18 leaders

Flying in the plane you service: patient-centered JACR. 2010 Mar;7(3):216-21

“The Needs of the Patient come First.”

From… “What’s the matter?”

to “What matters to you?”

Flipping Health Care: From ‘What’s The Matter’ To ‘What Matters To You?

Maureen Bisognano. http://commonhealth.wbur.org/2013/12/flipping-health-care-what-matters-to-you

Dilling, Swensen… Mayo Clinic Model of Diffusion. Jt Comm J Qual Patient Saf. 2013;39:167. Flipping Health Care: What’s The Matter - What Matters To You - Maureen Bisognano

Hess. Circ Cardiovasc Qual Outcomes. 2012;5:251-259

Uncertainty Anxiety LOS 1/3

Dudas. Uncertainty in illness among patients with chronic heart failure is less in

person-centered care than in usual care Eur J Cardiovasc Nurs January 9, 2013

Ekman . Effects of person-centered care in patients with chronic heart failure: the

PCC-HF study. European Heart Journal (2012) 33, 1112–1119

↓

You have to help me treat myself. I need to have control in my life.

Christian Farman

“There was no love in the

system.”

Grant. Psychological Science Hand hygiene prevents you/patients from catching diseases 22(12) 1494–99 2011

©2011 MFMER | 3085330-36

3.42 infections/1000 Patient-days

121 Patients with Hospital-Acquired Infections in July

Rates Counts

Nose counts…

Jimmy P.

Fall

Baby Boy S.

Wrong Procedure

John B.

Delay in Diagnosis

Florita H.

Delay in Treatment

Joann E.

Wrong Site Surgery Baby Boy G.

Medication Error

Lorena W.

Post Procedure Death

Kathy W.

Post-Procedure

Loss of Function

Gwendolyn P.

Wrong Implant

Systems Issues

Huddleston. Learning From Every Death. J Patient Safety March 2014

Mosquito slide

Drain Swamp

Culture of Safety

mortality and harm reviews


Leape, Shore, Dienstag, Mayer, Edgman-Levitan, Meyer, Healy. Perspective: A Culture of Respect, The Nature and Causes of Disrespectful Behavior by Physicians. Academic Medicine, Vol 87,July 2012

0.0

0.2

0.4

0.6

0.8

1.0

Mortality Rate (Observed/Expected)

Huddleston. Learning From Every Death.

J Patient Safety Volume 10, Number 1, March 2014

1,266

As clever as that was, David Lee Roth may have been a bit cleverer – according, at least, to Mr. Roth himself. Here is how he tells the story in a Vimeo video. By the early 1980,s Van Halen had become one of the biggest rock bands in history. Their touring contract carried a 53-page rider that laid out technical and security specs as well as good and beverage requirements. The “Munchies” section demanded potato chips, nuts, pretzels and “M&Ms” (Warning – absolutely no brown ones). When the M&M clause found its way into the press, it seemed like a typical case of rock-star excess, of the band “being abusive of others simply because we could,” Mr. Roth said, But, he explained, “the reality is quite different.” Van Halen’s live show boasted a colossal stage, booming audio and spectacular lighting. All this required a great deal of structural support, electrical power and like. This the 53-page rider, which gave point-by-point instructions to ensure that no one got killed by a collapsing stage or a short-circuiting light tower. But how could Van Halen be sure that the local promoter in each city had read the whole thing and done everything properly? Cue the brown M&Ms. As Roth tells it, he would go backstage to check out the bowls of M&Ms. If he saw brown ones, he knew the promoter hadn’t read the rider carefully and that “we had to do a serious line check” to make sure that the more important details hadn’t been botched either. And so it was that David Lee Roth and King Solomon both engaged in a fruitful bit of game theory – which, narrowly defined, is the art of beating your opponent by anticipating his next move. Both men faced a similar problem: How to sift the guilty from the innocent when no one is stepping forward to profess their guilt? A person who s lying or cheating will often respond to an incentive differently than an honest person. Wouldn’t it be nice if this fact could be exploited to ferret out the bad guys? Freakonomics. Levitt, Dubner. HarperCollins Publishers. 1980’s Van Halen. 53-page rider. No brown ….2009

Freakonomics. Levitt, Dubner. HarperCollins Publishers. 1980’s Van Halen. 53-page rider. No brown ….2009

Weick KE, Sutcliffe KM. Managing the unexpected: resilient performance in an age of uncertainty. 2nd ed. San Francisco (CA): Jossey-Bass; 2007.

5 Safe Behaviors •Pay attention to detail •Communicate clearly •Have a questioning and receptive attitude

•Handoff effectively •Support each other

…shape culture

one behavior at a time…

Edgar Schein.Humble Inquiry: the gentle art of asking instead of telling" (2013)

How Healthy is our Culture?

Leape, Shore, Dienstag, Mayer, Edgman-Levitan, Meyer, Healy. Perspective: A Culture of Respect, The Nature and Causes of Disrespectful Behavior by Physicians. Academic Medicine:87, 7 July 2012

Team-based Engagement Model “What keeps you awake at night?”

Safety Survey Focus Group Interviews

Workshop PDSA

Touch point Meetings

Leonard, Frankel. Patient Education and Counseling. 80 (2010) 288-292

217 Units ~11,000 staff

↑ Morale (17%)

↑ Teamwork (12%)

↑ Handoffs (11%)

Clinton?

Chassin, Mark. Health Affairs. July/August 2002, Volume 21, Number 4, 40-51. 2004 41% reduction in mortality.

Lee Thomas Eulogy for a Quality Measure NEJM 2007; 357:1175-1177 9/7/2007 DOI: 10.1056/NEJMp078102

“You are excellent at everything, but not

everywhere…”

Maureen Bisognano

Mayo Clinic Diffusion Model Leadership

Culture

Sponsoring Body

Value Creation Team

Best Practice

Standardized Mayo Care Process Model D

iffu

sio

n

Te

am

Best Practice Owner

Order sets

Rules/ Alerts

Patient education

Staff education

Workflow changes

Operational Work Unit

Implementation

EMR/Dept systems

Brochures PAG, GPS

Ask Mayo Expert

Outcome measures

IT Liason and Infrastructure Support

Dilling , Swensen… Mayo Clinic Model of Diffusion. Jt Comm J Qual Patient Saf. 2013;39:167.

Berg. Pharmacist-Managed Anticoagulation Protocol. Pharmacotherapy. doi:10.1002/phar.1280

“One Size Does Not Fit All”

Swensen. Reliably Better, Faster, and Cheaper Soufflés. JACR. August 2006

Standardize only when it adds value

High-Impact Leadership Framework


of Populations & Reduce Costs. Institute for Healthcare Improvement; 2013. Available: www.ihi.org.

Swensen SJ, Dilling JA, Mc Carty PM, Bolton JW, Harper CM Jr.

The Business Case for Healthcare Quality Improvement. J Patient Saf 2013;9:44. $46

5:1

Perioperative Interventions to Decrease Transfusion of Allogeneic Blood Products. Ereth, Oliver, Santrach. Mayo Clinic Proceedings: 69; 6

Cook D, Thompson JE, Habermann EB, et al. From 'solution shop' model to 'focused factory' in hospital surgery: increasing care value and

predictability. Health Aff (Millwood) 2014; 33:746-755

7 minutes

Leaders matter

I’m going to announce to the world that

Lou Holtz is head coach at Notre Dame. Father Hesburgh

Nick Seybert Harvard Business Review June 29, 2013

Physician Leadership and Emotional Intelligence. J Grad Med Educ Mintz, Stoller Leaders derail when it is more about them than it is about the mission. Shape culture one behavior at a time. Currency = attention and role modeling Humility

Emotional & Social Intelligence Productivity Satisfaction Engagement Patient Outcomes Team effectiveness Goleman, D., Boyatzis, R., & McKee, A. (2013) Primal Leadership

Stein, S., & Book, H., *2011). The EQ Edge: Emotional Intelligence and Your Success. Stoddart Publishing, Co.

©2014 MFMER | 3351570-70

Leadership Impact

Shanafelt, Menaker, Buskirk, Gorringe, Swensen. 12 Leadership Dimensions . Mayo Clinic Proceedings. April 2015: 90(4); 432-440

(P<0.001)

(P<0.001)

Staff Perspective

Inst

itu

tio

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ersp

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Heat Map

Shanafelt, Menaker, Buskirk, Gorringe, Swensen. 12 Leadership Dimensions . Mayo Clinic Proceedings. April 2015: 90(4); 432-440


Consultants (Care Team Leaders)

Residencies

Medical School

BOG (12)

Mentor-Coaches

Executive Deans

(3)

Shield /Institutional Committee Leaders

(56)

EOT’s MCHS MT

(41)

Site CEO’s

(3)

Non-Shield Leaders

(26)

Center/Office/IMP Chairs (28)

Dept/Div Executive Committee Leaders

(90)

President (1)

SAC’s Officers &

Counselors (18)

Dept/Div Chairs (233)

Swensen, Gorringe, Caviness, Peters. Leadership by Design: Intentional Development of Leaders. JHM (In Press)

The Leadership Pipeline


Blind auditions key to hiring musicians Marilyn Marks -------------------------------------------------------------------------------- Efforts to conceal the identities of musicians auditioning for spots in symphony orchestras significantly boost the chances of women to succeed, a study co-written by a Princeton economist suggests. Cecilia Rouse of Princeton's Woodrow Wilson School is the co-author of a study that confirms the value of blind auditions for orchestra musicians. Traditionally, women have been underrepresented in American and European orchestras. Renowned conductors have asserted that female musicians have "smaller techniques," are more temperamental and are simply unsuitable for orchestras, and some European orchestras do not hire women at all. Proving discrimination in hiring practices, however, has been difficult. The study by Cecilia Rouse, an associate professor in Princeton's Woodrow Wilson School of Public and International Affairs and the economics department, and Claudia Goldin, a professor of economics at Harvard University, seems to confirm the existence of sex-biased hiring by major symphony orchestras and illustrates the value of blind auditions, which have been adopted by most American symphonies. Their report was published in the September-November issue of the American Economic Review. "This country's top symphony orchestras have long been alleged to discriminate against women, and others, in hiring," Rouse said. "Our research suggests both that there has been differential treatment of women and that blind auditions go a long way toward resolving the problem." Florence Nelson, director of symphonic services at the American Federation of Musicians, described the research as a "very important statement, especially to those of us who have done auditions both ways -- behind a screen and without the screen." She has played flute and piccolo in major orchestras. Traditionally, new members of the great symphony orchestras were handpicked by the music director and principal player of each section. Most contenders were the male students of a select group of teachers. To overcome bias, most major U.S. orchestras began to broaden and democratize their hiring procedures in the 1970s and 1980s, advertising openings, allowing orchestra members to participate in hiring decisions and implementing blind auditions in which musicians audition behind a screen that conceals their identities but does not alter sound. Of the "Big Five" symphonies -- the Boston Symphony Orchestra, the Chicago Symphony Orchestra, the Cleveland Symphony Orchestra, the New York Philharmonic and the Philadelphia Orchestra -- only Cleveland still does not hold blind auditions. Use of the blind auditions varies among the other orchestras, with some holding them only in preliminary rounds. In their study, Rouse and Goldin examined lists of personnel from 11 major orchestras, including the Big Five, and actual accounts of the hiring process maintained by personnel managers in eight major orchestras. Among musicians who auditioned in both blind and non-blind auditions, about 28.6 percent of female musicians and 20.2 percent of male musicians advanced from the preliminary to the final round in blind auditions. When preliminary auditions were not blind, only 19.3 percent of the women advanced, along with 22.5 percent of the men. Using data from the audition records, the researchers found that blind auditions increased the probability that a woman would advance from preliminary rounds by 50 percent. The likelihood of a woman's ultimate selection is increased several fold, although the competition is extremely difficult and the chance of success still low. As a result, blind auditions have had a significant impact on the face of symphony orchestras. About 10 percent of orchestra members were female around 1970, compared to about 35 percent in the mid-1990s. Rouse and Goldin attribute about 30 percent of this gain to the advent of blind auditions. "Screens have been a very important part of the whole audition process," Nelson said. "My sense is that blind auditions have made a tremendous difference in the amount of hiring discrimination women face." Nelson recalled how sensitive she was to the gender issue while auditioning. She remembers being told in the 1980s to remove her shoes while walking to center stage behind a screen, so the judges would not hear the "clickety-clack" of a woman's high heels.

Chua, RY. The Costs of Ambient Cultural Disharmony. Academy of

Management. 2013, Vol, 56. No. 6. 1545-1577. Rouse. Blind Auditions.

September-November. American Economic Review. 7x. Search Committees. ~600-650 Stakeholder interviews. Dept & Institutional perspectives

Collective Intelligence. Market share. Darden. Organization Performance = Engagement x Diversity x Inclusion. Link with female musicians. MT Devil’s Advocate.

Take care of your people… and they will take care of your customers.

Design matters

Attention matters

Leaders matter

High Impact

Leadership for

Patients …the Mayo Clinic Story


Director Leadership Development

Senior Fellow IHI


High-Impact Leadership


Senior Fellow Institute for Healthcare Improvement

Mayo Clinic Director for Leadership and Organization Development


High Impact Leadership for Patients

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Transcript of High Impact Leadership for Patients