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Herding Cats.. Getting Everyone to do it the one Best Way!

Presented by:

Sarah Sheffield, MBA

Kim Blakey, MSN, RN

Norma Adorno BSNorma Adorno, BS 

©Copyright Lee Memorial Health System • All rights reserved

Video Source: Electronic Data Systems (EDS) advertisement, 2000

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Herding Cats

Not Easy… anyone can herd

Toughest thing ever done!

anyone can herd cattle!

Got these scratches today ... 

Not for everyone, but it is rewarding!

Objectives

• Enabling transformational change

• Where to start and levels of awareness

• Tackling roadblocks and strategies

• Practical applications of Job Instructionact ca app cat o s o Job st uct o

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Who we are?

• Four Acute care hospitals• Rehabilitation Hospitalp• Children’s Hospital• 1420 beds• Over one million patients every year• 300+ Physician Group • 10,000+ employees• Largest public health system in the state of Florida, receiving no direct tax support

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Where we started…

• Process Improvement with a project approach began 10 yearsproject approach began 10 years ago 

• Intervention approach lead to a culture of avoidance

• By 2012 we were in crisis! 

• Silos and fragmented across system

The turning point…

• Recognized we had subjective & 

individualized evaluations 

• Completed a Talent Assessment

• Bridged the leadership gap 

• Needed a framework for• Needed a framework for 

leadership development

• Selected a Lean Management 

System 

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Enabling Transformational Change

• Lean Transformation Timeline

bl h f• Establishing Lean Infrastructure

• Alignment & Focus

• Leadership Development  

• Visual Management 

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Lean Transformation Timeline

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Establishing Lean Infrastructure

2013 January 

April 2013Job Instruction  & Job R l ti

May 2013LeanTeam Building 

June‐ Aug 2013JI/JR Certified Trainers &  Job Inst. workshop 

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2012 Crisis Mode 

y

Hired‐Roger Chen, VP. 

Relations training

completed

Alignment & Focus

Rapid standardization across health 

Lean coaches for leaders 

Internal Job Instruction and Job Relations training 

systemLeadership competencies 

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Leadership Development

• Communicating Intentionally

• Coaching for Results 

• Leader Standard Work

• Job Relations & JobJob Relations & Job Instruction

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Leadership Development

350Job Instruction Workshop Completion 

83

43 46

300

100

150

200

250

300

20 18 23 2443

19 2446

0

50

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Visual ManagementTraining Timetable

• Alignment 

• Accountability

• Clear metrics

• Transparency

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Roadblocks & Strategies 1. Cats don’t like to be herded1. Cats don’t like to be herded

2. Cats prefer to herd themselves2. Cats prefer to herd themselves3. Cats understand they sometimes need to be herded… (doesn’t make it any easier) 3. Cats understand they sometimes need to be herded… (doesn’t make it any easier)

4. Cats do not appreciate being reminded that they are being herded 4. Cats do not appreciate being reminded that they are being herded

5. Harsh herding will have negative consequences 5. Harsh herding will have negative consequences 6. Positive herding doesn’t guarantee positive consequences …but it is worth a try 6. Positive herding doesn’t guarantee positive consequences …but it is worth a try

*Remember, we all need herding at one time or another…(and in fact, you really can’t herd cats)

*Remember, we all need herding at one time or another…(and in fact, you really can’t herd cats)

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We don’t need to change… but everyone else should!!

If people would just do what they are supposed to, we 

wouldn’t need this

We already have standards in our policies

What’s wrong with our current 

training? 

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Standard work is not for us, we are professionals… 

If we avoid it long enough, this too will go away… 

Roadblocks

• Buy‐in– Knowledge

• Not needed for us – Clinicians

– Skepticism

– No need 

• Excuses– Too Busy

– Too hard

– Professionals

– Any expert

• Resistance

– Cultural

Ch

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Too hard 

– Overwhelming– Change 

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Strategies

• Alignment  g

• Lean Methods & Tools

• Accountability

• Prove JI works

• Change ManagementChange Management

Alignment

• System 

• Facility

• Department 

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• Individual

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Alignment

• System 

• Facility

• Department 

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• Individual

Alignment

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Alignment

25

Alignment

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Lean Methods & Tools

• Plan, Do, Check, Act (PDCA) 

• Value Stream Mapping• 5S (Sort, Set in Order, 

TOOLSTOOLS

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Shine, Standardize, Sustain) 

STANDARD WORKSTANDARD WORK

Lean Methods & Tools

• Job Instruction• 10% Rule• Create “pull”• Training timetableTOOLS TOOLS

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• Job Relations 

STANDARD WORKSTANDARD WORK

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Accountability

• Tie use of JI to annualTie use of JI to annual performance evaluations 

• Organizational transparency

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• Leader Standard Work as a core competency 

Prove Job Instruction Works

• What vs. How

• Evidenced‐Based Practice

• Gemba

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Use 4 Step Methods

Source: The Bilas Group, LLC 

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Practical Applications of JI

• Critical component of patient and employee

Hand Hygiene

patient and employee safety

• Single most important factor in preventing the spread of infections

• Key Point often missed• Key Point often missed – Full pump

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Telemetry Monitoring

• Shifted responsibilities to nursing staffnursing staff

• High volume of phone calls

• Root cause analysis 

– Battery changes every 24 hours

– New electrodes

Ski P i– Skin Preparation

– Tape for ground lead

• Reduced phone calls by 80%

Scanning Chargeable Supplies

After Job InstructionScanning Compliance Impro ed to 75%

75%

20%30%40%50%60%70%80%90%

100%

Scanning Compliance Improved to 75%

% Charge

Base % Charge

Target

36

0%10%20%

Jul‐12

Aug‐12

Sep‐12

Oct‐12

Nov‐12

Dec‐12

Jan‐13

Feb‐13

Mar‐13

Apr‐13

May‐13

Jun‐13

Jul‐13

Aug‐13

Sep‐13

Oct‐13

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Central Scheduling

• PDCA revealed variation

Average Call Length in Seconds FY2013 through FYTD2014

• Staff trained in new workflows using Job Instruction

170

175

180

185

190

Average Call Length in Seconds

• Average Call Length reduced by 20 seconds 

160

165

Unit Secretaries

• Job redesign to Patient ( )Care Liaison (PCL)

• Includes 40 job breakdowns

• Breakdowns make up• Breakdowns make up the new job description

• Expectations are clear

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Patient Communication Boards

• Updated white boards 

• No formal training on how to use the boards

• Job Instruction used to standardize “how” to fill out board andfill out board and communicate with patient and staff

Quality Minute Taking

• May 2013 DNV citation for lack of standard processlack of standard process

• Job Breakdown created in August 2013

• Make Big Small

• April 2014 DNV commendation  & invite to h d bshare story and Job Breakdown at National conference 

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Conclusion

Questions?