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IHI ExpeditionBuild Joy in Work and Prevent Burnout
Session 3: Stop Wasting My Time! I Have Important Work to Do
April 26, 2016Begins at 1:00pm EST
These presenters have
nothing to disclose
Barbara Balik, RNAndrea Kabcenell, RNLorra Browne, RCP
Helen Macfie, PharmD, FABC
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Expedition Objectives
At the conclusion of this Expedition, participants
will be able to:
• Document the engagement of their staff or identify
current engagement data.
• Describe the key leadership behaviors that raise staff
engagement.
• Identify the key changes in the system of staff
engagement.
• Institute or expand at least one intervention to assure
staff feel psychologically and physically safe.
5
Schedule of Calls
Session 1 – What is Staff Joy and Engagement? – The wind in your
sails
Date: Tuesday, March 29, 2016, 1:00PM – 2:00PM Eastern Time
Session 2 – From the Top – Igniting Passion and Purpose: Key
changes that raise joy in work
Date: Tuesday, April 12, 2016, 1:00PM – 2:00PM Eastern Time
Session 3 – Stop Wasting My Time – I have important work to do
Date: Tuesday, April 26, 2016, 1:00PM – 2:00PM Eastern Time
Session 4 – My Leader Cares About Me and What I Do
Date: Tuesday, May 10, 2016, 1:00PM – 2:00PM Eastern Time
6
Expedition Directors 7
Jessica Perlo, MPH
Senior Community Manager,
IHI Open School
Andrea Kabcenell, RN
Vice President, the Institute for
Healthcare Improvement
Today’s Objectives
Identify at least two ways that improvement activities can
raise joy in work and decrease burnout
Describe best approaches to making improvement part
of everyone’s job without making it a burden
Plan a small test to address the “stones in our shoes”
8
Today’s Agenda9
Action Period Assignment
How Leaders Nurture Joy in Work
Joy in Work Framework – Steps 1, 2, and 3
Lessons from the Field – Multiple ways to reduce
impediments to Joy in Work and engage team members
in daily improvement
Action Period Assignments
Expedition Faculty10
Barbara Balik, RN
Principal Co-Founder,
Aefina Partners
Lorra Browne, RCP
Master Fellow, Director,
Lean Resource Officer,
MemorialCare Health
System
Helen Macfie,
PharmD, FABC
Chief Transformation
Officer, MemorialCare
Health System
#2 Action Period AssignmentWhat did you learn?
Option 1:
Ask team – “What Matters to You?”– What makes a good day?
– What one thing can we test right now to make more good days?
Co-design actions to take– “Doing with”
– Use IHI Model for Improvement resources
Option 2:
Use daily huddles to identify stones in shoes for 3-5 days
Co-design actions to take– “Doing with”
– Use IHI Model for Improvement resources
Chat – What did you learn?
“What matters to you?”
What surprised you about your ‘what matters’
conversations?
What makes a good day?
What ‘stones’ did you learn about?
– What were local issues?
– What were organizational opportunities?
What tests of change did you try to remove the ‘stones’?
12
Please send your message to All Participants
Lessons from the Field – Making Work Life and Patient Care Better Stop Wasting My Time! I Have Important Work to Do
2. Address unique local impediments to joy
3. Commit to shared responsibility at all levels
4. Use systematic approaches to improve joy
1. Ask team members “what matters to you?”
Outcome:↑ Patient experience
↑ Organizational performance
↓ Staff burnout
Steps to Joy in Work
Making Work Life and Patient Care Better
#1 – Understand and identify through the eyes
of team members – genuinely care about team
members’ wellbeing
– What matters?
– What makes a good day?
What you learned in the Action Period
15
2. Address unique local impediments to joy
3. Commit to shared responsibility at all levels
4. Use systematic approaches to improve joy
1. Ask team members “what matters to you?”
Outcome:↑ Patient experience
↑ Organizational performance
↓ Staff burnout
Steps to Joy in Work
Making Work Life and Patient Care Better
#2 – Address unique local issues
– What gets in the way of a good day?
– Work on improving – together
Camaraderie, Choice, Control
– We’re in this together — we can make a difference
What you’re working on based on “what
matters?”
17
2. Address unique local impediments to joy
3. Commit to shared responsibility at all levels
4. Use systematic approaches to improve joy
1. Ask team members “what matters to you?”
Outcome:↑ Patient experience
↑ Organizational performance
↓ Staff burnout
Steps to Joy in Work
Making Work Life and Patient Care Better
#3 – Commit to share responsibility at all levels
– Who owns what?
– What can I do to develop my own resiliency?
Levels: Organizational, Leaders, Site/Team,
Individual
Individual – share responsibility to cultivate own
resiliency
19
Resiliency
Stress Management and Resiliency Training (SMART) Program among Department of Radiology Faculty: A Pilot Randomized Clinical Trial. Sood A, Sharma V, Schroeder DR, Gorman B. Explore (NY). 2014 Nov-Dec;10(6):358-63. doi: 10.1016/j.explore.2014.08.002. Epub 2014 Aug 21.
Helen Macfie, Pharm.D., FABCLorra Browne, RCP
IHI Expedition: Build Joy in Work and Prevent Burnout April, 2016
“Putting Joy Back in Work”Leveraging Our Lean Mindset, Methods
and Management System
What/Where is MemorialCare?Southern California
Just the Facts
Total Assets $3.1 billion
– Annual Revenues $2.2 billion
– Bond Rating AA- stable
Hospitals– Patient Discharges 69,000
– Patient Days 288,000
– ER Visits 199,000
– Births 10,500
– Surgeries – IP/OP 32,900
Ambulatory Access– “At Risk” Lives/ACOs 246,000
– Seaside Health Plan 33,500
– Medical Group Visits 600,000
– Ambulatory Surgeries 35,000
Workforce– Employees 11,200
– Affiliated Physicians 2,300
– Employed Physicians 230
– Residents 165 (Year 1-7)
Strategic Focus & Evolution Two decades of testing & learning
Encouraging Creativity
Innovation is a GOOD thing!
What’s in a Name?
LEAN
Strategic Deployment
Lean is the Way We Do Things
Our People
How
What
Shaping CultureImproving Joy in Work through Lean
LEAN AND CULTURE
• Focus is on what matters
to our patients, customers– Breakthrough redesign
– Daily management
• Strategic imperative– Conserve use of precious
resources
– Productivity, Lean, Utilization
& Care Model Redesign
• Linking to Values– Focus on people, process
and relationships
“ At the beginning of this process, I
didn’t want to change anything. But now
I want to change everything! It makes
my workload manageable ”
Allan David, Lean team member
Lean Culture: An aligned
organization of individuals who are
continually learning together to add
value to the customer
The 3 Ms of LEANInterdependent
LEAN MINDSET, METHODS AND MANAGEMENT SYSTEM
Management
System:
Structures and
processes
used to
manage
systems
This is how we operate
Mindset:
The way people think and feel about their work and conduct themselves
I can’t imagine doing it any other way
Methods:
The tools that
are used
everyday –
This is what we do
Methods
MindsetManagement
System
Systematic ProcessesMethods
LEAN METHODS
• Cross Functional Improvement
– Rapid Process Design (RPD)
– Rapid Process Improvement (RPI)
• Daily Management / Continuous Improvement
– 5S (sort, simplify, sweep, standardize, sustain)
– A3 (PDSA)
– Gemba walks
– Visibility Boards and Huddles
• Strategic Deployment
– X-matrix
Examples of Joy ReturnedStories Making a Difference
CASE STUDY
• Ambulatory Clinic– Aim: To improve patient satisfaction by
designing work processes that support the
flow of patients while in the clinic
– What They Did:• Scripting developed• Medical Assistant role as patient navigator• Needed supplies reorganized, available• Workstation locations for physicians moved
closer to patients, U-shaped cell
– Big Wins: • Reduced wait times• Improved physician efficiency• Removed patient, staff frustration
• Improving patient satisfaction
– Team Feedback:• “Before Lean, I didn’t know the voice of the
patient”
• “There is a lot of retraining to be done”
• “A clinic is complex needs standard work!”
Examples of Joy ReturnedStories Making a Difference
CASE STUDY
• Mother Baby Bonding– Aim: To establish guiding principles and
processes for ensuring families (mother,
baby, and father) are kept together during
their post-partum stay
– What They Did:• Created standardized educational materials
on bonding and breastfeeding• Moved procedures “in room”• Standard work and communication
– Big Wins: • Increased time for mom and baby together• Increased exclusive breastfeeding rate• Improved staff and parents/baby wellbeing
– Team Feedback:• “LARGE undertaking … but we did it!”
• “Sharing problems was hard, but it helped create
our future vision”
• “We can do so much more as a TEAM”
• “Babies need their moms and dads!”
Examples of Joy ReturnedStories Making a Difference
CASE STUDY
• Care of Stroke Rehabilitation– Aim: To design Best Practice Care Model for
individuals who have experienced a stroke
that is consistently delivered by staff
throughout the continuum
– What They Did:• New workflows, clear roles & responsibilities• Rehab presence at every level of care• Timely evaluations, streamlined documentation
– Big Wins: • Voice of the patient honored• Reduced lead time to < 24 hours, LOS• Matched skillsets to patient needs• Improving functional independence
– Team Feedback:• “Everyone has something to offer”
• “The lean process is truly to improve a system and
add quality to the patient experience”
• “There are amazing discoveries when you take the
time to ask the right questions”
Po
st-A
cute
Acu
te
ED- Triage
- Treatment- Educate
- Order for Therapy- Best Practices
ICU- Treatment- Education- Consult
- Best Practices
Floor- Treatment- Education- Consult
- Best Practices- Outpatient Appointment
OP Rehab TRSHome Health
SNF-
Technology
EPIC/TechnologyEPICEPIC
EPIC/Technology EPIC/Technology
LTAC
HOME - Treatment
- Social Media- Wellness/Preventative Med
e-Chart Technology
Technology Technology
Outside Hospitals - Treatment
e-Chart Technology
10% 6% 24% 11%
37%
Diff. IRF
1%11%
IRF
EPIC
OTHER
EPIC/Technology
Examples of Joy ReturnedStories Making a Difference
CASE STUDY
• Sepsis Best Practice redesign– Aim: To achieve MemorialCare’s Bold Goal
for Quality to reduce mortality from severe
sepsis by > 50% by June’2016
– What They Did:• Set a BOLD goal• Best Practice Team sharing / collaborative• Standardized approaches & order sets – 3
hour, 6 hour, 24 hour• Flow algorithms, Best Practice alerts• Data mart with daily reporting & follow-up• Core measure set
– Big Wins: • Improved recognition and early intervention• Increased esprit de corps• Reduced mortality now by 55%• Reduced cost of care
– Team Feedback:• “We didn’t think it could be done”
• “Now we’re striving for a 70% reduction”
0%
10%
20%
30%
40%
50%
0
50
100
150
200
Mo
rtality
Ra
te a
s a
%
Nu
mb
er
of
Sep
sis
Mo
rtaliti
es
Severe Sepsis & Septic Shock MortalityIncludes pts ≥ 18 yrs. with Dx = 785.52 or 995.92, excludes deaths in ED
Mortality with Exclusions: data from Crimson, with Full DNR w/in 24h Removed
# of In-house Mortalities x -4.6% Multiplier, rounded, then Epic Sourced DataMortality Rate as a % without Full DNR (Rate adjusted by 4.6% for 2008-12 to adjust for DNR avg Multiplier for MHSFY'08 Baseline Rate Minus 4.6%Bold Goal Sepsis Mortality Without Full DNR (Less 35% for FY'14)
The Link to EngagementConnecting to Purpose
STARTS WITH ASKING
• Lean idea submission
• Participant feedback
• Shared Report Outs
• Leadership coaching rounds
– Talking with patients
– Huddling with staff
• Surveys & action planning
• Focus groups
• Fun at work!
Survey Question
(0-5)
2007
Baseline
2015
Materials and equipment
4.09 4.17
Mission & purpose
3.97 4.17
Opportunity to learn & grow
3.82 4.16
My opinions count
3.43 3.77
Supervisor cares 3.91 4.20
Do what I do best every day
4.12 4.27
Engagementratio
2.4 : 1 6.1 : 1
Grand Mean 3.78 4.13
• Go See
• Ask What, then Why
• Show Respect
Grooming for SuccessTraining, Practice & Resources
INVESTING IN MANAGERS & STAFF
• Recognizing it’s a hard job
• Allowing to be part of something,
connecting to the bigger picture
• All managers trained in Lean
and Facilitative Leadership– Facilitative Leader – 3 days
– Lean Leader – 4 days with project
– 1% now Certified Lean Leader
• Shared learning
– Gemba events
– Yokoten sessions
– Intranet toolkit
Promoting VisibilityCelebrate, Learn, Harness and Improve
VISIBILITY BOARDS & HUDDLES
• Lean Management System
• “Standard flexible” format
• Metrics that matter
• Celebrate success, capture ideas,
create follow-up
• Huddle at frequency that makes sense
• Moving from manager led to staff led
Processing time (waste in process)
• 22 events reported reduction
• 24,502 total hours saved
• Allocation of 11,000 hours to perform top of the licensure activities
• 945.4 In-patient days saved
Patient Wait/Delay Time • 8 events reported reduction (annualized)• 35,343 hours total patient delay time
eliminated
• 141,924 days of appointment waiting eliminated
Level of Quality (defect rates)• 31 events reported quality improvements
• Avg “before” Level of Quality: 1 to 2– Defect rate of 80 to 100%
• Avg “after” Level of Quality: 3 to 4– Defect rate of 20 to 40%
• Avoidance Dollars: $6,315,000
Throughput (revenue & cost)
• 10 events reported capacity increase with same resources
• 380 more ED patients55 more Surgery patients3,556 more Outpatients600 more Inpatients
Materials (supply expense)
• 7 events reported material savings
• $538,482 total potential materials one-time savings (annualized)
Space (reallocation of space)
• 8 events resulted in reallocation of space
• 3,314 Sq. Ft. now used for pt. care space
• Cost Avoidance: $35,000 of construction/fees
Fiscal Year 2015 ExperienceReducing Non-Value-Added Waste
A Few OutcomesIn Support of the Triple Aim
M O R T A L I T Y
Ratio by
0.27 to 0.72For observed vs expected in-hospital mortality ratio
E R V I S I T S
to
14.4/1,000For Commercial lives, Medical Group. Comparative: 40/K
% 9 s / 1 0 s
to CMStop 25th
percentileFor Overall Rating
of Hospital Experience
Thank you!
Final thought:
• Helen Macfie, Pharm.D., FABC
• Lorra Browne, RCP
“This work takes vision,
leadership and great
partnerships. It’s about
Will, Ideas & Execution.
Please leave your ego
at the door…”
Questions/Discussion42
Raise your hand
Use the chat
Action Period Assignment
Devise and initiate further interventions to
reduce one frustrating work impediment to joy in
work + Celebrate successes
Continue to engage partners in expanding
support for Joy in Work
• Request for volunteers to share
Expedition Communications
• All sessions are recorded and will be emailed to
you
• Materials are sent one day in advance
• Listserv address for session communications:
• Pose questions, share resources, discuss barriers or
successes
• To add colleagues, email [email protected]
• The primary enroller for your organization was
automatically added
44
Next Session45
Title: My Leader Cares About Me and What I Do
Faculty: Steve Swenson, Barbara Balik, Andrea
Kabcenell, Chris Hayes, Hans Hartung
Date: Tuesday May 10, 2016
Time: 1:00 PM – 2:15 PM ET
Thank You!46
Jessica Perlo
Julie Landsman
Please let us know if you have any questions or
feedback following today’s Expedition.