Sniff the Cheese Jim Hornell March 1, 2013
Handwriting on the wall • They keep moving the cheese • Get ready for the cheese to move • Smell the cheese often so you know if it is getting old • Quicker you let go of old cheese, the sooner you enjoy new cheese • Move with the cheese • Savor the adventure & enjoy the taste of new cheese • They keep moving the cheese !
Leadership The first role of a leader is to define reality
Health Care is a massive business Largest scientific enterprise in history of our species Also an act of love/compassion/comfort for people we don’t know Locally – 1500 employees; $155m+
Challenges in health care in the 21 st. century: • Safe • Sustainable • Affordable • High Quality • Accountable • Coordinated • Linked • Holistic • Confident
“Medicine used to be simple, ineffective and relatively safe. Now it is complex, effective, and potentially dangerous!” Sir Cyril Chantler
Anatomy of Health Care Environment • Most complex, difficult to manage org in the world • Multiple practicing professionals and experts merged into a single organization • Medical mystique • Different cultural backgrounds & values [Gen Y] • Divergent perspectives towards goals & objectives • Sophisticated, expensive ever-changing technology • Competition for limited resources in a service industry with an infinite capacity to consume
Anatomy Continued… • Demand is random, unpredictable and often supply generated • Increasingly turbulent external environment • Increasing public expectations [quality, safety, availability, speed, outcome] • Public misinformed about the factors that can have a significant impact on the health status of the population • Criteria/indicators for measuring outcomes & results not well developed nor agreed upon
Search for markers. Sniff the cheese!
BCHS - Surveys are Us! • Accreditation Canada : – Worklife Pulse Report , Patient Safety Culture Report • NRC Picker : – national, OHA/MOH Patient Satisfaction • Metrics@Work: – Employee & Physician Engagement Survey • Polarity Associates – strategic planning • Survey Monkey – Transitions, Board • Departmental – 100% departments with 40% response • Feedback Pro – compliments & complaints tracked • Social Media
General comments on surveys • Draws attention & encourages dialogue • Takes emotions out • Hard to argue with yourself! • Sets a tone [beware the cynics – we have earned it!] • Provides a platform for learning, reflection and action • Establishes a baseline • Planning tool [pre & post implementation of project (smoke free property): feedback concerns, barriers upfront v. reactive] • Guides through transition – helps OD speak to bosses • Opportunity to adjust or be proactive • Technology [done at home]
Surveys - Barriers • Staff concerns: – Confidentiality [shared links] – Brevity [little bites] – Curiosity [how to be used?] – Motivation [incentives] • Fatigue – too many! • Accountability [genuine – don’t ask my opinion if you are not going to use it ] • Accessibility : – Want paper – Access to hardware – On company’s dime • Practicality [don’t get too fancy & not have resources/steam to interpret & act] • Readiness – leaders rationalize results ; tough to take
Br Brant ant Community Community Healthcar Healthcare System e System 2011 2011 Employee Survey Results Senior Management Presentation June 28 th , 2011 Presentation by: John Yardley, Ph.D., President, Metrics@Work Slide 13
BCHS Bullying Frequency Supervisors, Managers, Senior Coworker as Perpetrator Management as Perpetrator Using this standard Using this standard 14.0% nearly 1 in 7 7.3% approx. 1 in 13 is a victim of a Is a victim of a Bully Coworker Bully Boss 1. “Once a week” and “daily” considered to be at a level where psychological health is likely to become impaired (Leymann, 1990; Mikkelsen & Einarsen et. al., 2002) 2. At that level “bullying” from a Coworker is nearly three times as frequent (N=114 victims) compared to from a Person In Authority (N= 57 victims) 3. More opportunity (time and numbers) for Coworker, so not directly comparable Slide 14
Mixed Messages • High employee engagement, • Enviable safety record • Financially stable • High quality care & providers, yet low % would recommend ??? • High wait times, complaints & loss of incentive$ • Top heavy • Staff & provider frustration, bullying, haves & have nots • Some broken and old processes, provider-centric, work arounds
Strategic Planning • Significant consultations, environmental scans • Turbulent and uncertain environment: – LHIN – MOH funding regime – IPC • Ear to the ground – high performing organizations
BCHS True North BCHS…Your partner in lifetime health Patien ient t Firs rst Gre reat Place ce to W o Wor ork Using Us ng Res esou ourc rces es Wisel ely No adverse events No injuries/harm Zero waste No waiting Developing top talent Innovation 100% patient Seeking better ways Data driven decisions satisfaction together Leading practices
The Challenge • The existing healthcare model is no longer sustainable – There is no more money – Our patients are not satisfied – Providers are frustrated • So how can we deliver better quality outcomes and experiences for patients, as well as better experiences for staff, with fewer resources?
…Don Berwick, IHI “Every system is perfectly designed to get the results it gets. If we want better outcomes, we must change something in the system. To do this we need to understand our systems”
“ Faced with the choice of changing one’s mind or proving that there is no need to do so; almost everyone gets busy on the proof ”
A leader’s job is to look into the future & see the organization not as it is, but as it should be!
Pe Perfor rformance mance Ex Excellenc ellence at BCHS
Healthcare Benefits of Taking the Journey of Lean • Less waste leads to better patient outcomes with shorter stays • Decrease in incidents causing medical harm • Focus changes from being about money (whose cost centre is this from?) to the patient experience (patient-first) • For employees - a collaborative team focus, a no-blame culture and a spirit of improvement
The Toyota Lean Example “Brilliant process management is our strategy. We get brilliant results from average people managing brilliant processes. We observe that our competitors often get average (or worse) results from brilliant people managing broken processes.” Underpinned with a management system that develops every employee into a problem solver
The Three Divisions of Work PATIENTS FOCUS ON WHAT IS OF VALUE TO THEM! Non Value Added: Value Added: Activities that the patient Activities that the patient (funder) would (funder) would not want to pay be willing to pay for. for if they knew they were Med administration, Tests performed, Test happening. results Searching for equipment / supplies, redrawing blood Non Value Added but Necessary: 5% Any work carried out, which is necessary under current 40% conditions but not something the 55% patient (funder) would willingly pay for. Transcription / dictation
What is a Value Stream? • Value Stream – all the activities and actions (value added and non-value added, information and material) that are required to bring a patient through the essential requirements needed Value Stream (labour, equipment, supplies, support services, facilities)
Value Stream Improvement Operating Room Supply Chain Project • Goal – Optimize the flow of materials that support the Operating rooms while minimizing the inventory levels. • Project Pillars – Improved Communication – Improved Flow of Materials – The Right Person Doing the Right Job
Value Stream Improvement • Before • After
Value Stream Improvement • Before • After
Errors – MDR & Stores
Returned Items to Stores
Nursing Dollars on Supplies
System Improvement • Seeing the hospital as a collection of value streams, not departments Changing our structure to better reflect how patients receive care, how hospitals are funded, and how leading organizations are operating .
Care Support DI, Pharmacy, Lab, Infection Control & Medical Device Reprocessing Acute & Transitional Care CCU & C5, B6, B7 & B8, ISU / Rehab, CCIP Planned Care Maternal Child & Surgical Episodic Care Mental Health, Emergency & Urgent Care, Outpatient Clinics Knowledge & Information Finance & Supply Support People Development Support Quality, Risk & Professional AP/AR & General Finance, Contracts, Decision Support and IT Affairs HR, Payroll, Volunteers Home O2, Purchasing, Patient Registration & Information, Flow, HIM & HIS Occ Health & Safety, Float Pool, & Stores, Bio-Med, Environmental Services Scheduling and Nutrition Services Facilities and Maintenance Strategy Deployment (Phase 1) Community Engagement & Partnerships (Phase 1)
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