Leadership is a Team Affair - Nelson Mandela Children's ... · Leadership is a Team Affair:...
Transcript of Leadership is a Team Affair - Nelson Mandela Children's ... · Leadership is a Team Affair:...
Leadership is a Team Affair:Experience of Building Nurse Leaders and Impact on
Quality of Care
Cherilyn Ashlock DNP, RN, NE-BC
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• Building a common mission
• Building a collaborative team
• Adopting shared principles
• Adopting shared practices
• Accountability for sustainability
Our Journey to Excellence…a
Journey that Never Truly Ends
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No one discipline can do the work of
healthcare alone• yet we train independently,
• we meet independently,
• we conduct business independently
• and we wonder why?
The one thing we all have in common
THE PATIENT
Building a Common Mission
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Building a culture of excellence depends on a
multidisciplinary approach with a focus on two
equally important goals:
• Meeting the needs of the patient
• Meeting the needs of the people taking care
of the patient
Building a Common Mission
From the Patient’s & Family Perspective
1. Keep me safe
2. Heal me
3. Be nice to me
...in this order…
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• Evidence-based bundles
• Registries
• National collaboratives
– Children’s Hospitals Solutions for Patient
Safety
• Culture
• Team member-wellbeing
• Safety II
Key Initiatives and the Evolution of
Patient Safety
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• People first
– Physical and psychological safety
– Physical and emotional health
– Managing demands of work
– Resilience, joy and meaning
• Healthy work environment
• Resilient organization
• Environment that we can thrive in
The Team- Meeting the needs of the
people taking care of the patient
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• People greatly desire to be part of a winning team doing
meaningful work in an environment of trust.
• People desire to use their gifts, talents, and abilities to
produce great outcomes.
• Most people, when given clear expectations, exceed
them.
• Most frequently, the people closest to the work have the
most practical and possible solutions-they are just
waiting to be engaged.
Meeting the needs of the people
taking care of the patient-core
beliefs
Encourage & Empower
• Lead from any seat- but most importantly LEAD FROM THE SEAT YOU ARE IN
• Encouragement vs. empowerment– Encouragement – give confidence and support to
– Empowerment – giving (or taking) autonomy, authority to make decisions and to own the work
• Self-empowerment and empowering others
Proceed until apprehended.
Florence Nightingale
Culture and Safety
The shared values and beliefs of the individuals in the organization
(the way we act when no one is looking)
Behaviors
Culture
Outcomes
High reliability organizations (HROs)“operate under very trying conditions all the time
and yet manage to have fewer
than their fair share of accidents.”Managing the Unexpected (Weick & Sutcliffe)
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• Preoccupation with failure
• Reluctance to simplify
• Sensitivity to operations
• Deference to expertise
• Commitment to resilience
Weick & Sutcliffe, 2001
Chassin & Loeb, 2013
High Reliability Principles
Anticipation/
Prevention
Containment/
Resilience
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• Always learning
• Harm free vs error free
• Transparency
• Improvements sustain when focused
attention changes
Weick & Sutcliffe, 2001
HRO – Other Features
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• Safety as a core value
– Commitment to zero harm
• Trust, respect and inclusion
• Blame-free environment
• Collaboration
– 200% accountability
• Communication
– Speaking up for safety
– Questioning and welcoming questioning
Culture of Safety – Key feature of
HRO
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• Focus on event reporting as a learning tool
• Encourage (and recognize) reporting of
events and near miss events
• Close the loop on events
– Including with staff who reported/submitted
• Tell the stories
– Impact of reporting
Reporting Culture
Changing Behaviors
Set Expectations
Educate & Build Skill
Reinforce & Build
Accountability
© 2006 Healthcare Performance Improvement, LLC. ALL RIGHTS RESERVED.
• Reinforce & Build Accountability• Leadership Rounds
• Organizational Safety Check-In
• Use 5:1 Feedback
• Find & Fix Problems
• Unit Safety Huddles
• Top Ten Problem List With Problem Owners & Action
Plans
Adopting Shared Practices: Leadership
Methods for Performance Excellence
Reinforce &Build AccountabilityFor Compliance With Performance Expectations
“Attention is the currency of Leadership.”
Leadership Rounds
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• Walk the talk
– Demonstrate safety as a core value by how
time is spent
• Learn about safety concerns and act
to/provide support for resolution
• Identify what is working
• Opportunity for relationship building,
recognition, support, feedback
• 200% accountability for leadership
methods and error prevention tools
Leadership Rounds
5:1 Feedback
5 positive bits of feedback for every
1 bit of corrective feedback
Why It Works:• Positive is a more powerful influencer in managing resistance
and building habits
• Builds a relationship of trust and respect between employees and supervisors and among coworkers
• Enables individuals to more effectively give and receive corrective reinforcement for a behavior that needs to be changed
Not Giving Corrective Feedback
You are contributing to their failure
You are contributing to potential harm to patients or staff…..
• Timely
• Specific
• Situation, Behavior, Impact Model• Speak the error prevention language• For constructive/corrective feedback
• Lightest touch possible to achieve the desired results
• Private• Supportive
Feedback Tips
• Proactive and reactive
• Transparent
• Sensitive to operations – what’s
happening at the point of care and how do
we support?
• Shared mental model, shared problem
solving, shared accountability
Safety Check-in
Daily Safety Check-in• Happens every day• 15 minutes • Face-to-face or by phone• Led by senior leader• Every leader comes
prepared• Problems are assigned
owners
Unit Huddles• Happens every day or
twice daily for 24-7 areas
• 15 minutes • Face-to-face on unit• Led by unit leader• Staff come prepared• Problems are assigned
owners
The Details
Find & FixSystem ProblemsThat Make It Difficult for People to Perform Effectively
Top 10 Problem List
Top 10 Problem List
The Top 10 Problem List is a management method for:
• Shared awareness of issues
• Especially issues that compromise safety
• Focus attention and effort on solving problems and
problem causes to prevent recurrence
• When a problem is resolved, a new problem is
added so there are always ten on the Top 10
Top 10 List: Need Action Plans
1. Actions map to root causes of the problem
2. Single-person responsibility for action items
3. Timelines for completion
4. Keep stakeholders informed
FY 18: Journey to Zero Harm
CLABSI
• 30% reduction
• 12 fewer children harmed
Severe IV infiltrate
• 31% reduction
• 11 fewer children harmed
CAUTI
• 67% reduction
• 2 fewer children harmed
VPS SSI
• 67% reduction
• 2 fewer children harmed
Severe pressure injury
• 11% reduction
• 1 fewer child harmed
Why this matters to JHACH
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What will you
Stop?
Start?
Continue?
Change?
Reflect & Plan- Accountability and
Sustainability Starts with YOU
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• American Association of Critical Care Nurses. (2016). AACN Standards for
Establishing and Sustaining Healthy Work Environments: A Journey to Excellence
(2nd edition).www.aacn.org.
• Chassin, MR., Loeb, JM. (2013). High-Reliability Health Care: Getting There from
Here. The Millbank Quarterly, 91(3), 459-490.
• HPI Press Ganey. http://www.pressganey.com/solutions/safety.
• Makary, MA., Daniel., M. (2016). Medical Error – The Third Leading Cause of Death
in the US. British Medical Journal, 353, i2139.
• Weick, KE., Sutcliffe, KM. (2001). Managing the Unexpected: Assuring High
Performance in an Age of Complexity. San Francisco: Jossey-Bass.
References