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The Ishikawa Diagram The Ishikawa Diagram From the Perspective of From the Perspective of

the Fishthe Fish

Celeste Chamberlain, BSN, MSCeleste Chamberlain, BSN, MSDirector, Clinical Quality Director, Clinical Quality ImprovementImprovementSt. Christopher’s Hospital for St. Christopher’s Hospital for ChildrenChildrenFebruary 23, 2011February 23, 2011

This Evening’s JourneyThis Evening’s Journey

Review shared professional Review shared professional experiencesexperiences

Apply a quality methodology to my Apply a quality methodology to my professional growth and professional growth and developmentdevelopment

Offer insights for application to Offer insights for application to help you develop a personal help you develop a personal strategy for accessorizing your fishstrategy for accessorizing your fish

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Cynthia Wollman

ParenteBeard LLC

Celia Berry

Milton Roy Company

Sharyn Mlinar

The Boeing Company

Celeste Chamberlain

St. Christopher’s Hospital for Children

American Society of Quality February 23, 2011

ASQ

ASQ

ASQ

ASQ

American Society of Quality February 23, 2011

Education

Professional Experience

Leadership

Quality Training

Certifications

Teaching

Attitude/Philosophy

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What if the Ishikawa fish could speak?

What would she say about you….about your company?

In my world…..

IBC Pay for Performance

www.hospitalcompare.gov

Back to the FutureBack to the Future

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Celeste Chamberlain, 1971 - 2011

Fill in your name, ???? – 2011 and beyond

Little Known Quality Formula

SC3

Self-Confidence

Content

CompetenceKeep this in mind as you accessorize your fish…

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0B.A.A.D.

B.S.N.M.S.

PhD(2012)

4 degrees below zero

5 degrees below zero!!!

EducationEducation

B.A. Liberal Arts: Boston University 1971B.A. Liberal Arts: Boston University 1971– French teacherFrench teacher– No jobs (worked in ED as ward clerk)No jobs (worked in ED as ward clerk)

A.D. Nursing: Lasell Jr. College 1975A.D. Nursing: Lasell Jr. College 1975– Aspiration: Emergency Department nursingAspiration: Emergency Department nursing– No jobsNo jobs– Moved to Baltimore to work at Johns Hopkins Moved to Baltimore to work at Johns Hopkins

Hospital (they had jobs!)Hospital (they had jobs!)1414

EducationEducation B.S. Nursing: University of Maryland B.S. Nursing: University of Maryland

19791979– This one was a “gotta”This one was a “gotta”

M.S. Emergency Health Services: M.S. Emergency Health Services: University of Maryland 1986University of Maryland 1986– Found this in the white pagesFound this in the white pages– How’s that for a thoughtful decision?!How’s that for a thoughtful decision?!

PhD. Candidate, Management: Walden PhD. Candidate, Management: Walden University (online) 2008 - ??University (online) 2008 - ??

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Clinical ExperienceClinical Experience Staff nurse: 1975 - 1986Staff nurse: 1975 - 1986

– Emergency departmentEmergency department Level 1 trauma centerLevel 1 trauma center

– Critical careCritical care Intensive care, coronary careIntensive care, coronary care Cardiothoracic surgery intensive careCardiothoracic surgery intensive care

– Post anesthesia care (recovery room) Post anesthesia care (recovery room) Clinical Nurse Specialist (1986 – 1989)Clinical Nurse Specialist (1986 – 1989)

– Emergency and Critical Care nursingEmergency and Critical Care nursing1616

Leadership ExperienceLeadership Experience

Nurse manager, Emergency Nurse manager, Emergency Department (1977 – 1979)Department (1977 – 1979)

Director Emergency Department/Level Director Emergency Department/Level 1 Trauma Center (1990 – 1998)1 Trauma Center (1990 – 1998)– AHERF system bankruptcy, 1997AHERF system bankruptcy, 1997– 8 hospitals “on the auction block”8 hospitals “on the auction block”– Tenet purchase/rescue of the Philadelphia Tenet purchase/rescue of the Philadelphia

health systemhealth system– ““Opportunity” in quality languageOpportunity” in quality language

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Leadership ExperienceLeadership Experience

Director Quality Improvement (1999 – Director Quality Improvement (1999 – 2011)2011)– Major change Major change – Adrenalin driven ED to “desk job”Adrenalin driven ED to “desk job”– Quality experience: ED process data/analysisQuality experience: ED process data/analysis– Able to stay at MCPAble to stay at MCP– ChallengesChallenges

IS systems gone (with bankruptcy)IS systems gone (with bankruptcy) Needed to rebuild the programNeeded to rebuild the program New to the formal quality role (low on SC3)New to the formal quality role (low on SC3)

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Leadership ExperienceLeadership Experience

More “opportunities”More “opportunities”– Reorganizations and staff reductionsReorganizations and staff reductions– Assumed other organizational Assumed other organizational

responsibilitiesresponsibilities Director Medical Staff Office (2001 – Director Medical Staff Office (2001 –

2007; 2009 - 2011)2007; 2009 - 2011) Director Regulatory and Accreditation Director Regulatory and Accreditation

Compliance (2003 – 2011)Compliance (2003 – 2011)

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Leadership ExperienceLeadership Experience

Still more “opportunities”Still more “opportunities”– Hospital closure announcement 2003Hospital closure announcement 2003– Hospital changed hands, 2004, then closed Hospital changed hands, 2004, then closed

for good, March, 2005for good, March, 2005 Director Risk Management (2004 – Director Risk Management (2004 –

2007)2007) Enough “opportunity” alreadyEnough “opportunity” already

– Reorganizations and staff reductionsReorganizations and staff reductions– Hospital soldHospital sold 2020

Strike Rat, 2003

Teaching 1986 - 2011Teaching 1986 - 2011

CPR, ACLS, PALS, NALSCPR, ACLS, PALS, NALS– Provider and Instructor coursesProvider and Instructor courses– Affiliate faculty, American Heart AssociationAffiliate faculty, American Heart Association

Critical Care Course (developed and Critical Care Course (developed and taught) taught)

Adjunct FacultyAdjunct Faculty– Thomas Jefferson UniversityThomas Jefferson University– Hahnemann University Hahnemann University

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Teaching 1984 - 2011Teaching 1984 - 2011

Guest SpeakerGuest Speaker– Holy Family UniversityHoly Family University– Acadia UniversityAcadia University

National and Local LecturesNational and Local Lectures– American Healthcare Institute American Healthcare Institute – American Association of Critical Care American Association of Critical Care

NursesNurses– American Association of Post Anesthesia American Association of Post Anesthesia

Care NursesCare Nurses 2323

Related ExperienceRelated Experience

Medical/legal expert witness (1995 – Medical/legal expert witness (1995 – 2011)2011)

Textbook reviewer: Emergency NursingTextbook reviewer: Emergency Nursing Article publication: case study TetanusArticle publication: case study Tetanus All measures of SC3All measures of SC3

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CertificationsCertifications

Emergency Nursing (1980…)Emergency Nursing (1980…) Critical Care Nursing (1990….)Critical Care Nursing (1990….) Six Sigma (2007)Six Sigma (2007) Certified Professional in Certified Professional in

Healthcare Quality Healthcare Quality (2008)(2008)

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Awards/RecognitionAwards/Recognition Nurse Manager of the Year, 1996Nurse Manager of the Year, 1996

– Emergency Nurses AssociationEmergency Nurses Association Instructor Excellence, Advanced Cardiac Life SupportInstructor Excellence, Advanced Cardiac Life Support

– National Institute of Emergency CareNational Institute of Emergency Care Meritorious ServiceMeritorious Service

– Second Alarmers Association and Rescue SquadSecond Alarmers Association and Rescue Squad Volunteer of the YearVolunteer of the Year

– Medical Education Care AssociatesMedical Education Care Associates Honor Society of NursingHonor Society of Nursing

– Hahnemann University HospitalHahnemann University Hospital

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Role Models/MentorsRole Models/Mentors

When you are young – align yourself When you are young – align yourself with older, smarter peoplewith older, smarter people

When you are old – associate yourself When you are old – associate yourself with young, smart, motivated peoplewith young, smart, motivated people– EnergyEnergy– New ways, perspectivesNew ways, perspectives

Be a mentor for othersBe a mentor for others

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Thomas Jefferson University School of General Studies Emerging Alumni Award, 2010

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Mentor Colleague

Sounding Board

Gentle Critic

Oh yeah……Husband!

Mom and Dad

Thanks to my Mentors for:

Mom and Dad: paying for a college degree I never used

Cheryl: Learn from the Hamster of Happiness

Susan: Always know the name of the person that cleans your office

John: SC3; The technique of tact They are all “ceiling dwellers”

So..How To Accessorize Your Fish

It’s About DecisionsIt’s About Decisions

Prospect theory of decision makingProspect theory of decision making V=Σ(IIi vi)

– V = The overall value– II = Decision weights– v = Consequence values– i = Outcomes

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Shared Decision Shared Decision ChallengesChallenges

Which graduate degree is right for Which graduate degree is right for me?me?

Strategic career decisionsStrategic career decisions Professional goals and personal Professional goals and personal

philosophyphilosophy Promote qualityPromote quality Drive social changeDrive social change Expand your scope of influenceExpand your scope of influence

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Decision PointsDecision Points

Initial aspiration: ED nurse – save lives!Initial aspiration: ED nurse – save lives! Reasons for change/graduate schoolReasons for change/graduate school

– BurnoutBurnout– Shift work, weekends, holidaysShift work, weekends, holidays– Narrow focus versus expanding experienceNarrow focus versus expanding experience

Expanded clinical/organizational scopeExpanded clinical/organizational scope Retirement “jobs”Retirement “jobs”

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Develop a Personal Develop a Personal Methodology/StrategyMethodology/Strategy

Create your personal Ishikawa Create your personal Ishikawa diagramdiagram– Accessorize your fish with experiences Accessorize your fish with experiences

that will help you achieve your goalsthat will help you achieve your goals– Develop your own SC3 factorDevelop your own SC3 factor

Conduct a personal SWOT, PESTConduct a personal SWOT, PEST Plan for contingenciesPlan for contingencies

– What ifs, now what?What ifs, now what?3838

Recognize Signs of Recognize Signs of “Opportunity”“Opportunity”

Those within your controlThose within your control– Current trajectoryCurrent trajectory

Ceiling of growthCeiling of growth Possible stagnationPossible stagnation Possible burnoutPossible burnout

Those beyond your controlThose beyond your control– Layoffs, closures, restructuring, etc.Layoffs, closures, restructuring, etc.– Better to be the one left behind?Better to be the one left behind?

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Final ThoughtsFinal Thoughts

Accessorize your fish Accessorize your fish Influence your own future even if your Influence your own future even if your

cannot always control itcannot always control it Be ready for unsolicited “opportunities”Be ready for unsolicited “opportunities” Take advantage of great resources like Take advantage of great resources like

ASQASQ Professional support networkProfessional support network Expand your horizons and……Expand your horizons and……

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Soar to New Heights!!

Thank You!