WHA Improvement ForumFor June

“Tapping Front-line Knowledge”

Presented by Stephanie Sobczak and Jill Hanson

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.

2

Today’s Webinar

Agenda

The front line staff perspective Levels of Involvement Strategies for Feedback “Real Time” Improvement

Engaging Front-line Staff

“No one asked me to work on

improvement”

“I’ve been involved in the past, but I got stuck doing

most of the work”

“I was told I have to go

to meetings on my off

time”

Why?• Improved outcomes can only occur with

improved processes – “the work” of the staff.• Staff already know where the waste and

inefficiencies are in their processes.• Care giving staff are the eyes and ears of the

hospital.• “Culture eats strategy for lunch”!

4

5

How?

Setting the Stage for Engagement

Emphasize Teamwork

Emphasize High Reliability

Emphasize Participation

6

Teamwork

7

Success is only possible when everyone knows what is expected, and what is important.

Teamwork

8

Do your front line staff know that teamwork is greatly valued in your organization?

Is it obvious?Is it recognized?Is it praised?

High Reliability

9

The key is standardized approaches.

For the work: Use of checklists and written work instructions and systematic methods of communication (such as SBAR)

For the improvement: P-D-S-A or other improvement approach

Our HospitalWhere we do some of the

right things for some our patients some of

the time.

“Engage the Engaged”How do we know who is engaged?

11

Listen carefully to casual conversations:

Who loves working with the older folks? Or babies? Or is a stickler for handwashing?

You could ask directly, “Who wants to help?”

Who reads journals and publications and talks about it?

Who is going back to school?

OR

Who starts their sentences with “You know, we should…”

Levels of Involvement

12

Wise Words

A new way of doing something only sticks when it can be easily

integrated during the work day

Work on improvement during the work day

13

14

Lose the “Meeting Mindset”

15

Think This Through….

• What decisions need to be made in a committee or council.

• What can be done in informal feedback huddles– Okay to make decisions on small test of change outside

the meeting.– Discuss results of small test and adapt quickly.

• Ensure transparency through a notebook or whiteboard to document progress or concerns.

16

Benefits of Fewer Meetings

17

1. Avoids the need to schedule space.2. Allows people to meet as it is convenient for

them, so participation is more likely to happen.

3. Reduces “calendar conflict” problem - the #1 reason for slowing down progress.

4. Changed processes, new tools, etc. are going to work because they are really designed right in the middle of “the work”.

Staff Engagement through Small Tests of Change

18

19

1

2

34

5

Designing Tests and Trials

A. Begin with the smallest unit of change possible“Rule of 1’s”

B. Plan for easy and efficient collection of feedback from your testers - huddles

C. Spread by a few staff at a timeD. Work out the bugs along the way

20

21

Page 3-3 in the Improvement Workbook

22

Example in Workbook – Section 3

Case ExampleThe Implementation Challenge

A care transitions workgroup of staff from a hospital and two local long-term care centers have developed a new transfer form:

How will they ensure that staff at both facilities actually use the form?

23

What, Who, When - Overview

24

Identify the parameters of the trial period

What, When, Who - Detail

25

Making Progress

26

Insert hand written example

27

Don’t Give Up• Use pencil on this form and post-it for all to see.

• Even if testing goes well, keep going until you reach your target number of participants.

• If testing doesn’t go well – back up a step and try again.

28

So much better than assuming staff are going to change – then being disappointed when they don’t’.

Multiple Small Tests of Change

29

30

Test and Trial Examples

Patient Demonstrates Understanding of Discharge Instructions• Test medication teaching tools

HCAHPS – Patient Satisfaction with Discharge Instructions• Test large-font discharge instructions

Patient Received a Follow-up Phone Call within 3 days• Test new phone call script

Patient is Discharged with a Follow-up App’t scheduled• Test calling a designated primary care nurse to schedule hospital follow-up appointments.

Small tests of change are a guaranteed way to engage staff in

improvement

and

Have better buy-in and sustained results

31

Next Month:

32

Data driven Improvement Priorities

July 25Noon

From data to information “Data mining” your process measures Data driven decision making

References• Improvement Workbook Section 3

• The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, Langley, Moen, & Nolan

• WHA Quality Center Tools and Templates http://www.whaqualitycenter.org/PartnersforPatients/PfPTools.aspx

33

Thank You!Questions

Please complete 3 question survey when closing webinar window.

34