How Senior Leaders Drive

IDEAL Care

Allen’s Culture Transformation Through

Adaptive Design

How does Adaptive Design work?

• Problem solving in real time with those closest to the work.

• Uses knowledge, training and the work itself to move to IDEAL CARE:– To develop people.– To problem-solve systems.– To achieve a unifying, common strategic

purpose focused on the patient.

John Kenagy 2009

Components of Culture Transformation

I. Create Vision

II. Define Strategy

III. Communicate

IV. Get the Right People in the Right Spot

V. Manage and Improve Culture

Bill Leaver – Des Moines Register, April 11, 2010

I. Create Vision

How we got started: • IHS Vision

Best Outcome for Every Patient Every time

• Defining Ideal CareGiving the patient what they need when they need it safely, without waste, while reducing costs.

• Implementation of Adaptive Design (AD)• Started as a Nursing Initiative to meet the IHS Vision to

standardize Med-Surgical patient care.• All IHS med-surg units to be up with AD methodology by 2012.

How did Rick Seidler CEO get involved in

IDEAL Care?

The C-Suite

I♥ALLEN

II. Defining Strategy

• Decision to focus on the patient and tie to strategic plan.

• Allen’s 4 Brilliances:True North Metrics– Clinical– Service– Relationship– Operational

• Developed Allen’s Frontline Design Initiative.

II. Defining Strategy, contd.

Strategy to roll out Frontline Design?• We knew it had to be management directed.

• All departments by the end of 2012.

• Development of Teacher/Coaches.

• Master plan for moving out adaptive design.

• Keep our focus on the patient and IDEAL care.

III. Communicate!

• Strategic Plan with Frontline Design (FLD) communicated to all Allen staff at quarterly forum.

IV. Get the Right People in theRight Spots

Identified Teacher/Coaches• Directors• Lean Specialist• Clinical Nurse Specialists

IV. Get the Right People in the Right Spots, contd.

Necessary leader characteristics:• Passion for moving the organization to IDEAL care.

• Strong effective communication skills.

• Ability to motivate and provide feedback.

• Encourage staff participation.

• Challenge people.

• Strengthen teamwork.

V. Manage the Strategic Initiative and Continually Improve

Assure Engagement and Participation• Administrative Team• Management at all levels.• Frontline Staff

V. Manage the Strategic Initiative and ContinuallyImprove, contd.

Administrative Team• Get educated.• Get involved where the work is: learn by doing!• Use scientific methodology as a team and individually.

Management• Educate• Learn by doing.• Use scientific methodology.

Staff• Educate• Focus on signaling problems.

V. Manage the Strategic Initiative and ContinuallyImprove, contd.

Methods to assure engagement andparticipation:

• Administrative Team – Routine scheduled education sessions.– Work through the A3 process.– Attend weekly report (out of A3s).– Begin to specify managers’ work.

How have we changed?It is all about solving problems!

• Completed 400+ A3s (safety and reduce waste).

• Performance Improvement

• Clinical Directors use A3 to resolve monthly budget variances.

• Weekly report out by all managers involved to date with FLD.

• Administrative Team completes observations on all new departments going up with FLD (honors work and supports staff).

• Executive Rounding changed.

• Specifying work for nurse managers and clinical directors.

The Administrative Team’s Journey

• Started in different places.

• Inpatient with no immediate cost reduction.

• Results not always tangible.

• Learning how to use the Help Chain.

• Learning to let go! Allowing frontline staff (closest to the work) to make decisions.

“Ideal is like the north star…

it is a direction, not a destination.”