Keeping the Team Engaged: Making Things Stick N. Adam Brown, MD, - PowerPoint PPT Presentation

Keeping the Team Engaged: Making Things Stick N. Adam Brown, MD, MBA, FACEP Senior Vice President, Envision Healthcare- MidAtlantic Raleigh, NC - February 13 th , 2018

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The Red Queen Effect It takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that. - The R he Red ed Q Que ueen 6

Current Projects LWBS Decrease Reduction LOS 4/5 Decrease Decrease LOS Admit Door2Doc Decrease Decrease INC Readmissions 7

Agenda Behavioral Psychology ABCs Coaching Cases 8

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4 Things to Know about Behavior to be Successful (2 Statements / 2 Actions) 10

Thing #1 Behavior drives process and outcomes. 11

Thing #2 Behaviors are learned and conditioned through positive and negative reinforcement . 12

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Thing #3 Identify critical behaviors in the process. 14

Make critical behaviors… Simple Clear Real Happen Stick 15

Behavior Sanity Check Is the desired behavior high impact? Is the behavior one in which the team should not deviate? 16

What are critical behaviors for your projects? (Take 3 Minutes) 17

Thing #4 Align behaviors to align culture. 18

4 Things in Review about Behavior Drive Process Reinforced Must be identified When aligned  Culture Change 19

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ABCs: Applied Behavior Analysis Antecedent Behavior Consequence 21

ABCs: Applied Behavior Analysis Antecedent Behavior Consequence 22

ABCs: Applied Behavior Analysis Antecedent Behavior Consequence 23

ABC Model GOALS CRITICAL OUTCOMES METRICS ACTIONS TARGETS ACHIEVED DRIVE DRIVE and Other PROMPT (Decision and Other Prompts Point) Anchors (Environment) CONSEQUENCES BEHAVIOR ANTECEDENT

ABC Model ANCHOR GOALS CRITICAL OUTCOMES METRICS ACTIONS TARGETS ACHIEVED DRIVE DRIVE and Other PROMPT (Decision and Other Prompts Point) Anchors (Environment) CONSEQUENCES BEHAVIOR ANTECEDENT

Angry Patient v. Nurse Rachet 26

Visual Management Boards Daily, public tracking of specific behavior and desired outcome. 27

Visual Management Board 28

Visual Management Board 29

Visual Management Board 30

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Behavioral Consequences via Coaching Positive or corrective feedback Modifies or maintains direction Send desired message Allows behavior modification via feedback Avoids “command and control” 32

Mind the Gap Behavior Required Actual Gap Behavior Behavior 33

Managing Performance Gaps 34

Developing Coaching Contracts • Identify the Behavior Problem • Measure baseline • Pinpoint Specific Actions • Identify triggers for behavior • Define consequences of behavior • Define clear targets and outcomes 35

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Checklist for Feedback Give objective specifics Convey with good intentions Focus on actions Deliver ASAP Avoid linking Understood? 37

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Overcoming Resistance Understand the why Communicate need for change Get involved early Create opportunity for small, meaningful change Provide support Be patient Liberation may be necessary 39

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“Collette Reardon” 41

“Collette Reardon” 42

1 patient 3 hospitals 2 hours 43

2 Problems in 2015 Opioid Dilaudid Prescription Overuse Overuse 44

The ABCs of Opioid Administration Antecedent Behavior Consequence 45

Change the Antecedent Defined the Problem Scripting Support Alternatives  Ketamine, Fentanyl, Toradol Supported by hospital, nursing, and physicians Patient support/expectations 46

The ABCs of Opioid Administration Antecedent Behavior Consequence 47

Monitored the Behavior Communicate frequently desired behavior and support Immediate feedback Track Results Celebrate Successes The Candy Man 48

IV 2mg Vial Dilaudid Use at Baseline November December 2015 2015 Sentara 375 310 NoVA (45k) Sentara 310 180 LR (35k) 49

2mg Hydromorphone Vials Orders at SNV 45 40 35 <16mg 30 “D” Monthly 25 20 Count 15 10 5 0 January Feb March April May June July August September October November December January Feb March April May June July August September October November December 2016 2017 50

2mg Hydromorphone Vial Orders from SLR 120 100 <18mg “D” 80 Monthly 60 Count 40 20 0 January April May July September October November December January April May July September October November December Feb March June August Feb March June August 2016 2017 51

The Ripple Effect for Opioid Prescriptions 52 22% Reduction

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The Red Queen Effect 54

Set Measure Celebrate Coach Behaviors (VMB) Wins Behavior drives process. 55