d/e28: activating our rising leaders: students and...

D/E28: Activating our Rising Leaders: Students and Residents as an Engine for Change

IHI National Forum on Quality

Improvement in Health Care

The presenters have

nothing to disclose.

Wednesday, December 12

#IHIFORUM

Disclosure:

James Moses, Kate Hilton, Gina Deitz, Emileigh Canales, Becca

Engels, Nick Christian, and Michael Holbrook today have no

relevant financial or nonfinancial relationship(s) within the

services described, reviewed, evaluated, or compared in this

presentation.

Session Objectives

Explore the importance of leveraging student and resident

leadership to achieve system-wide transformation.

Learn how to co-design work with students and residents to

implement community and action-oriented improvement efforts.

Understand how to apply a quality improvement and community

organizing framework to build intrinsic motivation, engage key

stakeholders, and build momentum for change.

Workshop Agenda

Welcome, Introductions, and Overview

Bright Spot 1: Emory University

Bright Spot 2: PSU/OHSU

Discussion of Key Learnings

Leveraging the Open School Network for Large-Scale Change

Conclusion and Wrap-Up

Workshop Presenters

Becca Feistritzer Engels, MD, MPH

Medical Resident, Emory University

Gina Deitz

Open School Senior Program

Manager, IHI

Emileigh Canales, MPH

QI Analyst, CareOregon

Nick Christian, MD, MPH

Medical Resident, University of

Texas – Austin

Michael Holbrook, MBA

Medical Student, Wright State

University

Kate Hilton, JD, MTS

Founding Director and Senior

Consultant at ReThink Health and IHI

Faculty and Open School Advisor

James Moses, MD, MPH

Chief Quality Officer and VP of Quality

and Safety, Boston Medical Center and

Open School Advisor

Challenges in Engaging Students and Residents

Transient population

Varying skills / experiences

Investment of time upfront to orient them to the system

Lack experience in quality improvement and patient

safety

Need greater understanding of the system – it’s too early

in their careers for them change it

Generational Differences

Challenges in Engaging as Students and Residents

Unsure of relationships and opportunities outside of their

institution

Organizational hierarchy

Little space to lead and a “seat at the table”

Project opportunities are non-existent or misaligned with their

interests

Zero sum curriculum

Antiquated curriculum

Lack of IPE or team based approaches to learning

Mentor availability / time

Interests that students, residents and

professionals bring to partnerships

Students/Residents Professionals

• To lead

• To learn

• To make an

impact

• To gain

experience

• To be in

community

• To feel

supported

• To generate

results

• To connect

interprofessional

stakeholders

effectively

Collective

power

Assets that students, residents and professionals

bring to partnerships

Students/Residents Professionals

• Fresh ideas

• Energy

• Passion

• Time

• Experience

• Expertise

• Mentorship

• Resume-

building skills

• Networking

Collective

power

“There are two elements of prophetic

vision. One is criticality, recognition of the

world’s pain. Second is hope, recognition of

the world’s possibilities.”

-Walter Brueggemann

IHI Open School Mission

“Advance health care improvement and patient safety

competencies in the next generation of health professionals

worldwide.”

IHI Open School Launch - 2008

Shift to a bottom-up approach, a “revolution from the

basement”:

– Leverage students’ ability to create change in their local settings

– Introduce a disruptive innovation that would translate to a scalable

model to all universities

– Create the “other school” – an educational community that’s free

and open to students in all health professions no matter where

they are.

• 32+ online courses, including set

of GME courses

• More than 5.5 million courses

completed

• More than 700,000 learners have

completed a course

• More than 145,000 learners have

earned the Basic Certificate

• More than 1,500 universities and

health care organizations using

the courses

IHI Open School Courses

Project-Based Learning

Leadership & Organizing for ChangeQuality Improvement Practicum

IHI Open School Community

• More than 920

Chapters started in 94

countries

• Over 50% of our

Chapters are

interprofessional

• Leading work to:– Train peers in quality and

safety

– Lead educational reform to

incorporate quality and

safety into their formal

curriculum

– Host events and facilitate

activities and learning

sessions

– Conduct local QI project

work

Ready to lead change together

8 Chapters worked together over the course of 10

months

Two sites: University of British Columbia and

University of Toronto with 400 attendees

6 keynote speakers, 2 panels, more than 20 workshop

sessions

27 Chapters in 8 countries worked

together over the course of 3 months

5,000+ pledges collected; topics

relevant to health initiatives in local

communities

International Pledge-a-Thon IHI Open School Canadian Chapter Network Conference

Deming’s System of Profound Knowledge

Deming’s System of Profound Knowledge

To improve, people are our fundamental source of value

and must be treated as partners. That requires offering

people the agency to make choices, tools to be effective,

and a learning system for continual improvement.

Psychology in Improvement

• People want to create value and are

our fundamental source of value

• Move from systems driven by fear

and extrinsic motivators to those

driven by intrinsic motivation

• Creating a culture that respects

people and treats them as partners

takes work and expertiseW. Edwards Deming

All improvers are change agents.

(But not all change agents are improvers.)

Rate at Which Change Spreads: People

AGENCY

The ability of an individual or group

to choose to act with purpose

Power

The ability to

act with purpose

Courage

The emotional resources

to choose to act

Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology

Psychology of Change

http://www.ihi.org/resources/Pages/IHIWhitePapers/IHI-Psychology-of-Change-Framework.aspx

Unleash Intrinsic Motivation

Tapping into sources of intrinsic motivation galvanizes people’s individual and

collective commitment to act.

Co-Design People-Driven Change

Those most affected by change have the greatest interest in designing it in ways that are meaningful and workable to them.

Co-Produce in Authentic Relationship

Change is co-produced when people inquire, listen, see and mutually commit to one another.

Distribute Power

People can contribute their unique assets to

bring about change when power is shared.

Adapt in Action

Acting can be a motivational experience for people to learn and iterate to be effective.

IHI Psychology of Change Framework

zzActivate

People’s

Agency

Organizing: People, Power & Change

• People-powered approach to (the psychology of) change

• Brings people together on the basis of shared values (i.e.

intrinsic motivations)

• Offers people agency to contribute their unique assets

• Unleashes people as partners in the co-production of change

(i.e. improvement)

Bright Spot #1: Emory University

Clarkston Community Health Center

• Clarkston, Georgia, USA

• “The most diverse square mile in America.”

• CCHC founded to provide primary/preventive care to refugee, indigent, underinsured, and uninsured

• One student with an idea

Initial Project

Building the Relationship

Adapt in Action

Adapt in Action z

z

Activate

People’s

Agency

Acting can be a motivational experience for people to learn and iterate to be effective.

Recommended Practices

1. Coach and Be Coached

2. Adapt a Growth Mindset

3. Fail Forward

4. Embrace Emergence



The Relationship:Communicating with each other



zz

Activate

People’s

Agency

Change is co-produced when people inquire, listen, see, and commit to one another.


1. Practice One-to-One Meetings

2. Ask Open and Honest Questions

3. Practice Appreciative Inquiry

4. Listen Deeply



The Relationship: Investing in Each Other

More Opportunities

Bright Spot #2: Portland State University and Oregon Health and Science University

PSU & OHSU IHI Open School Chapter

Bridges Collaborative Care Clinic

– Identified need for an

interprofessional student-

run clinic

–Recruited

interprofessional faculty

advisors

–Partnered with community

partner serving homeless

Bud Clark Commons

Bridges Clinic Timeline

January 2016 – began organizing students and community partners; mobilized leadership teams

September 2017 – established Board of Directors

October 2017 – opened BCCC health clinic

June 2018 – Access to 2 additional TPI Shelters

July 2018 - 501c3 status received

October 2018 – Dental Clinic opened

38

First Year Outcomes

39

• 100+ unique

participants seen

• 5,000 hours of service

donated by students

• 13 academic programs

represented

AGENCY

The ability of an individual or group

to choose to act with purpose

Power

The ability to

act with purpose

Courage

The emotional resources

to choose to act


Psychology of Change




zz

Activate

People’s

Agency

Tapping into sources of intrinsic motivation

galvanizes people’s individual and collective

commitment to act.


1. Public Narrative

2. Motivational Task Design

3. Play and Celebrate



Kick Off: January 2016

Actors: 36 students and faculty representing 7

programs and 2 community partners

Value and asset mapping



zz

Activate

People’s

Agency

Those most affected by change have the greatest

interest in designing it in ways that are

meaningful and workable to them.


1. Become Aware of Bias

2. Map Actors

3. Craft People-Driven Aim

Statements



Clinic Leadership Model

Clinic Leadership Model: Continued

45

Distribute Power

Distribute Power

zz

Activate

People’s

Agency

People can contribute their unique assets to

bring about change when power is shared.


1. Create a Shared Purpose

2. Develop Distributed Leadership

3. Establish Working Agreements

4. Cede Power



Distributed Leadership

Builds an equal status contract around a

shared purpose

Is commitment-driven, not compliance-based– Cultivating people’s agency to act increases joy

and improves health

Builds capacity that serves as an ongoing

asset for addressing other problems

48

Distributed Leadership

Leadership in Action

‘Leadership is accepting responsibility for enabling

others to achieve shared purpose in the face of

uncertainty.’

• A practice, not a position

• Authority is earned, not

bestowed

• Focus is on developing

others, not just yourself

What is Leadership?

Discussion and Review




Distribute Power

IHI Psychology of Change Framework

Adapt in Action

zzActivate

People’s

Agency

Discussion Questions

• How are you leveraging these strategies in your work?

• Where is there an opportunity for you to bring these strategies

into your approach with students and residents?

• How can you help students and residents bring these skill sets

into their work?

Leveraging the Open School Network for Large-Scale Change

The Nightmare

https://www.shatterproof.org/about-addiction

Our Dream

A world in which substance use disorders are not seen as a source of shame but as chronic

diseases that can be prevented, managed, and treated; in which individuals are free of suffering caused by

substance use disorders, communities thrive, and health care systems serve

patients equitably and compassionately.

Our Aim

The IHI Open School Recover Hope Campaign promotes

awareness, prevention, and treatment of substance use

disorders. Together, we will improve the lives of 50,000

people living with substance use disorders around the

world by April 2020. We will do this by engaging 150,000

members of our diverse, global network of change agents

and 150 IHI Open School Chapters to take action together.

www.ihi.org/recoverhope

Harnessing collective power through a campaign.

Student Opioid Coalition

= COAT

Take an Asset-Based Approach

(1) Who are our People?

(2) What Change do they want?

(3) How can they get the Power they

need to achieve that change?

Organizing = People, Power & Change

CommunityOverdoseAc onTeamPublicHealthDayton&MontgomeryCounty

ILLEGALOPIOIDSUPPYCONTROLBRANCH

EDUCATION&INFORMATIONBRANCH

PREVENTIONBRANCHTREATMENT&

RECOVERYBRANCHPRESCRIPTIONOPIOIDS

BRANCHHARMREDUCTION

BRANCH

Decreasethesupplyofillegalopioidsandotherillicitsubstances.

Raiseawareness&knowledgeofthedangersofopioidsandillicitdrugmisusebyimplemen ngpublicawarenessac vi es.

Preventopioidandillicitdrugmisuse.

Promoteuseofbestprac cesamonghealthcareprovidersforprescribingopioidsforacuteandchronicpain.

Expandaccesstotreatment&communitysupportprograms.

Increasecapacityofharmreduc onprogrammingtoprovideoverdosepreven on&engageclientsinsupportservices.

PHA MACY

N ING w POFE IONAL PYCH w OCIAL WO K

NDE G AD A E DIE w MO E…

DaytonOpenSchool

Distributing Leadership

Getting Started: Set an Aim, Build Capacity!

1. Aims: Stabilize and reduce the number of people

dying from drug overdoses in Montgomery County.

2. Capacity Built: Launch two projects in which

students can get hands-on QI experience before

May 26, 2017.

3. Leadership Developed: Have 20 health

professional student members representing at least

3 different professional programs involved in the

IHI Open School Chapter through the Student

Opioid Coalition by May 26, 2017.

Outcomes to date

55 students engaged in the Student Opioid Coalition

in the first year

5 project leaders identified

NARCAN TRAINING EVENT

7+ disciplines involved

Medicine, pharmacy, nursing, social work, public health,

professional psychology, pre-medicine

MEDICATION DISPOSAL KIT

PROJECT100+ students attended

70+ doses of Narcan distributed

in the community

40 pharmacy locations

500 disposal kits stocked

Buprenorphine Team

The “B-Team”

An interprofessional and multidisciplinary group that:

1. Screens appropriate patients for buprenorphine induction,

2. Assists in the starting of this treatment while patients are hospitalized,

3. Facilitates linkage with an outpatient MAT clinic, and

4. Provides institutional education in an effort to reduce stigma and raise awareness about opioid use disorders.

Engaging Trainees

In three months time…

– 3 residents, 3 medical students, 1 pharmacy

student

– QI Data Collection: referrals, outpatient

transition

– Added capacity for staff education

– Improved patient education on community

resources

Spreading Hope

"I wanted to share with you all that during the assessment,

he became quite emotional, started crying to the point

where he could not talk (not just tearful), and expressed a

lot of gratitude for everything you all have provided there,

for him. He acknowledged that he was so relieved to not

have been kicked out after having been caught using in the

hospital, but more importantly, it really seemed to be about

his feelings, and almost disbelief, that 'they actually really

care about me.' It was kind of heartbreaking, but very

awesome that you all have made such an impact.”

-Sarah, LPC from outpatient clinic

Let’s Recover Hope.

“They actually really care about me.”

July 2018: More than 25 Chapter Leaders attended the Open

School Leadership Academy to launch campaign projects.

Recover Hope Campaign Projects

University of Toronto: To engage 200 members of the

Toronto community in raising awareness and reducing

stigma associated with substance use disorders by building

the capacity of interprofessional students at UofT and

creating a platform for individuals to share their personal

narratives (direct or indirect) by June 2019.

Brock University: Improve rapid access to

emergent care for individuals suffering from

a substance-related overdose through

bypassing the emergency department (ED)

and moving directly to the rapid access

addiction medicine clinic (RAAMC) for care.

Others are:

Hosting NARCAN trainings

Launching video challenges to as a

platform to share stories and reduce

stigma around substance use

disorders

Changing prescription patterns for

patients admitted for an overdose

Building partnerships with local

student-run health clinics to launch

improvement efforts


IHI Open School Recover

Hope Work Streams

We aim to improve

the lives of 50,000

people affected by

substance use

disorders by April

2020.

AWARENESS

Raise awareness

and reduce stigma

with a focus on

equity

TREATMENT &

RECOVERY:

Improve treatment

for individuals with

substance use

disorders

1. Change the Narrative

Sharing stories to raise awareness

of substance use disorders as a

chronic disease, reduce stigma,

and confront systematic oppression

underlying substance use

2. Save Lives from Overdose

Train individuals to recognize

overdoses and intervene by

administering naloxone

4. Reform University Curricula

Promote education and training on

prevention, diagnosis, and

treatment of substance use

disorders into university curricula

PREVENTION

Prevent substance

use disorders and

unhealthy

substance use3. Improve Pain Management

Support best practice opioid

prescribing and alternative pain

management in health systems

Will you join us?

Immediate opportunities to

get involved:

– Connect with your local

Chapter to advise their project

work, partner on new work

through your institution, or

simply learn more about their

efforts locally.

– Take the pledge at the

National Forum to


Next Steps

Leverage your local network of students and residents

Connect with a local Open School Chapter to engage them with

project work at your institution:

Connect with a local Chapter

with the click of a button

www.IHI.org/OpenSchool

Build capacity at your organization

Basic Certificate in Quality & Safety

– 13 core courses in QI and patient safety

Leadership and Organizing for Change

– Learn more at www.ihi.org/lead

– Next offering: March 14 - May 22, 2019

www.IHI.org/OpenSchool

http://www.ihi.org/lead

Psychology of Change White Paper

www.IHI.org/Psychology

Thank you!Questions? Want to connect with the Open School or one of the presenters? Email [email protected].

mailto:[email protected]

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