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March 26, 2015

Dial In: 877.668.4493 Code: 667 160 253

The Managers and Management We Need to Improve Care

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Dial In: 877.668.4493

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Getting Started

How would you identify your role in your organization?

Choose the option that best applies:

– Frontline Staff (doctor, nurse, other clinician, clinical staff)

– Middle Manager (supervisor, care manager, coordinator, team lead)

– Senior Manager (director, executive, CMO, CNO, administrator, C-

suite)

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If you chose Middle Manager, do you have the time and

support you need from supervisors to engage in quality

activity?

– Yes

– No

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Madge KaplanDirector of Communications

Institute for Healthcare Improvement

For resources & slides, visit IHI.org/WIHI

Dial In: 877.668.4493

Code: 667 160 253

Madge Kaplan, IHI’s Director of Communications, is

responsible for developing new and innovative means for

IHI to communicate the stories, leading examples of

change, and policy implications emerging from the world of

quality improvement ― both in the U.S. and internationally.

Prior to joining IHI in July 2004, Ms. Kaplan spent 20 years

as a broadcast journalist for public radio – most recently

working as a health correspondent for National Public

Radio. Ms. Kaplan was the creator and Senior Editor of

Marketplace Radio's Health Desk at WGBH in Boston, and

was a 1989/99 Kaiser Media Fellow in Health. She has

produced numerous documentaries, and her reporting has

been recognized by American Women in Radio and

Television, Pew Charitable Trusts, American Academy of

Nursing and Massachusetts Broadcasters Association.

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Dave MunchHealthcare Performance Partners

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Dial In: 877.668.4493

Code: 667 160 253

Dave Munch, MD, SVP & Chief Clinical Officer, Healthcare

Performance Partners (HPP) serves as the lead of all clinical and

Lean Healthcare engagements at HPP. In addition, he is an

instructor for the Belmont College Lean Healthcare Certification

program. Dr. Munch previously served at Exempla Lutheran

Medical Center as the CMO and CQO. He was an instructor for the

University of Michigan's Lean Certification Program for four years

and has served on the Agency for Healthcare Research and

Quality's High Reliability Advisory Group. Dr. Munch has an

extensive background in hospital operations, health plan

governance, physician organization governance and clinical

practice in Internal Medicine. He is on the faculty of The Institute for

Healthcare Improvement (IHI), teaching in the areas of patient

safety, leadership, and management.

You can reach Dave at Dmunch@hpp.bz

5 Myths about Building Quality Improvement Capability

1. Building Improvement is all about learning a quality improvement methodology

2. A strong quality department is all you need to make improvement

3. Building improvement capability is too expensive

4. The quality department should own improvement

5. Executives have the most important role in making improvement

Executive Leadership

Strategy Deployment

Developing/Coaching your Managers

Leadership Standard Work (Executive)

Org Dev. & Learning

Middle & Front Line Management

Visual Management

A3 Deployment

Developing/Coaching your Staff

Leadership Standard Work (Manager)

Front Line Staff

Standard Work

Surfacing & Solving Problems

Participate in Improvement

Continuous Improvement

and Operational Excellence

Improve Process & Performance while Developing People: “Learn by Doing”

The Interlinking Responsibilities of Continuous Improvement

The Quality ImprovementStaff act as a Catalyst for

this model

• Assessment

• Analytics

• Observation

• Interviews

• Mapping

Current State

• Create Standard Work

• Reduce Variation

• Eliminate Waste

• Improve Reliability & Quality

Process Redesign • Train & Develop

• Establish:

• Management Systems

• Operational Systems

• Governance

Deploy & Control

• Establish Deployment Teams

• Manage Tempo

• Create Reporting Structures & Data Systems

Scale and Spread

Example: Pareto Chart

Example: Pareto Chart

Example: Pareto Chart

Example: Pareto Chart

Example: Pareto Chart

Root Cause Analysis

Action Plan

Follow-up

Countermeasures

Future State/Target

Test/Cost/Benefit

Current Condition

Background

Issue

ExampleA3

Root Cause Analysis

Action Plan

Follow-up

Countermeasures

Future State/Target

Test/Cost/Benefit

Current Condition

Background

Issue

ExampleA3

Root Cause Analysis

Action Plan

Follow-up

Countermeasures

Future State/Target

Test/Cost/Benefit

Current Condition

Background

Issue

ExampleA3

Root Cause Analysis

Action Plan

Follow-up

Countermeasures

Future State/Target

Test/Cost/Benefit

Current Condition

Background

Issue

ExampleA3

Root Cause Analysis

Action Plan

Follow-up

Countermeasures

Future State/Target

Test/Cost/Benefit

Current Condition

Background

Issue

ExampleA3

Patient Experience

FinancialSustainability

Quality/ SafetyPeople and

PartnersCost of Care

ParetoKey Drivers of Performance

Problem Solving

Daily ManagementProcess Metric

HistoryPerformance Over Time

Example: Run Chart

Example: Run Chart

Example: Run Chart

Example: Run Chart

Example: Run Chart

x x x x

Example: Daily data

x x x x

Example: Daily data

x x x x

Example: Daily data

x x xx

Example: Daily data

x x x x

Example: Daily data

Performance Board: Tool for Situational Awareness

Enterprise VMB

A Story from a Middle Manager

• I work as a CN in a hyper-dynamic CVICU/Transplant unit. Just like in PICU, we are staffed with ICU nurses with very little or no CVICU experience. Due to the extreme acuity of the patients, the CN’s tend to be in “command” mode all the time. And since there is not really any time to check on delegated tasks, we tend to do everything ourselves. But I must admit, I realized very quickly that if the bedside nurses knew how to run the QC test on the ACT machine stat when they needed it in an emergency or how to operate the Defibrillator machine sufficiently during an emergency that I would not have to leave everything I am busy with to control the situation. So I started to delegate these tasks routinely to the bedside nurses to make them feel comfortable with working and touching these equipments. During this, I would sketch simple scenarios of problems that might arise and prompt them to come up with ideas of troubleshooting. This was not easy for me as I had to let go of something I was in control of. And I had to trust others to do it as well as I expect it from them. The first few times I had to let them operate the equipment was very daunting as I felt like taking over at any point but I stayed on the background and guided them verbally. Today, I can let them handle situations with this equipment in mind and not worry about it at all. This does indeed give me the extra few minutes to spend on other emergency situations

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Stephanie CalcasolaBaystate Medical Center

For resources & slides, visit IHI.org/WIHI

Dial In: 877.668.4493

Code: 667 160 253

Stephanie Calcasola, MSN, RN-BC, is the Director of Quality and

Medical Management at Baystate Medical Center. She has held a

variety of clinical and leadership positions over the last twenty

years including cardiac staff nurse, educator, nurse manager, and

clinical nurse specialist. In her current role, she is accountable for

the strategic planning, program development and operations for

clinical quality, patient experience and patient safety programs for

Baystate Medical Center. Her work has helped to transform care at

Baystate Medical Center, a nationally recognized leader in hospital

quality. Ms. Calcasola speaks nationally on issues of healthcare

quality, and is published in peer reviewed journals.

You can reach Stephanie at

Stephanie.Calcasola@baystatehealth.org

Healthcare Middle Manager like Roles

Clinical Supervisor

Lead Clinician

Manager/Assistant Manager

Employees advancing in recognition programs (high potentials)

Triage Coordinator

Care Manager/Coordinator

Leadership should be seen as a dimension of practice for all nurses, not just those in formal

leadership role (Scott & Miles, 2013)

IHI’s Leading Quality Improvement: Essentials for Managers, 2014

Baystate Medical Center Building Improvement Capacity

Improvement Expeditions/Projects

Unit Manager/Quality Mentoring Program

Manager/Medical Director Dyad Leadership Development

Easy access to improvement toolkits

Consultation Model

IHI’s Leading Quality Improvement: Essentials for Managers, 2014

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Kedar MateInstitute for Healthcare Improvement

For resources & slides, visit IHI.org/WIHI

Dial In: 877.668.4493

Code: 667 160 253

Kedar Mate, MD, Senior Vice President, Institute for Healthcare

Improvement (IHI), oversees the development of innovative system

designs to implement high-quality health care both in the United

States and in resource-limited settings abroad. He is also IHI’s

regional lead for the Middle East and Asia-Pacific regions.

Previously, he served as Country Director for the IHI South Africa

Program and he continues to be engaged in IHI’s work in this area.

Dr. Mate is an internal medicine physician, an Assistant Professor

of Medicine at Weill Cornell Medical College, and a Research

Fellow at Harvard Medical School's Division of Global Health

Equity. He advises numerous international initiatives aiming to

strengthen health systems to improve delivery of HIV, tuberculosis,

and maternal and child health services.

You can reach Kedar at Kmate@IHI.org

Identifying Roles

Which role description best matches what you do as a middle manager? – Implementer

– Synthesizer

– Influencer

– Adapter

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What makes a MM unique?

• “The distinguishing feature of middle management is not where they sit in the organization chart. What makes them unique is their access to top management coupled with their knowledge of operations. This enables them to function as mediators between the organization’s strategy and day-to-day activities”

– Wooldridge, Schmid & Floyd, 2008, p. 1192

• Strategy to operations is the essence of being middle manager.

Key functions of a MM

DivergentIntegrative

Upward

Downward

Information Synthesizer

ChampioningAlternatives

FacilitatingAdaptation

EnsuringImplementation

Floyd, S., & Woodridge, B. (1994). Dinosaurs or dynamos? Recognizing middle management’s strategic role. Academy of management executive, 8 (4), 47-57.

Marichal, K & Segars J. Leading from the Middle 2012 Antwerp Management School

Your Quality Department doesn’t have to go it alone!

Join Passport to accelerate your efforts to improve patient care and engage staff. The benefits of a $5,000 yearlong membership include:

• Unlimited participation in Expeditions (two- to four-month, web-based programs

• Registration for Leading Quality Improvement: Essentials for Managers

• A 25% IHI Open School online course subscription discount

• A 15% IHI National Forum discount

http://www.ihi.org/Passport

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Next up on WIHI:

April 9, 2015: All Hands on Deck to Reduce C. Difficile

April 23, 2015: Reducing Risks and Defects With Help From the Frontlines

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