Ajit Abraham MS, MA ( Medical Ethics & Law), FRCS, FRCS ( General Surgery)

Consultant HPB Surgeon, Barts HealthHealth Foundation Quality Improvement IHI Fellow 2011-12

QUALITY COLLABORATIVE

“Everyone in healthcare really has two jobs when they come to work everyday: to do their work and to improve it.”

Paul Batalden

The High Reliability - High PerformanceOpportunity

“The journey to becoming a world-class healthcare organization isn’t quick or easy, or for the impatient or faint of heart”

John Black - The Toyota Way to Healthcare Excellence

Necessary paradigm shifts!

The Ethics of Value Concentric to Linear - Patient-Centeredness

The Triple Aim Measurement for Improvement

The Idea of Complexity

Complexity demands

a

Learning Organization

Build Capability Within

EXECUTIVE Vision, Strategy

SYSTEM OF CAREIntegrated Care Bundles

SYSTEM OF MEASUREMENTMetrics for Improvement

SYSTEM OF IMPROVEMENTImprovement, Innovation, Safety

PATIENTS AND FAMILIESOutcomes & Experience

6. HIGH PERFORMANCE

CULTURE

STAFF OD

1.FOCUS

2. PLATFORM

3. KNOWLEDGE

4. ACTION

5. RESULTS

ChangeOrganization Culture

ChangeIndividualAttitudes

ChangeBehavior

Structure & MethodsStructure & Methods

Transformation: Changing Culture

Changing the old

Making the future attractive

Framework: Leadership for Improvement

WillIdeas

Execution

Establish the Foundation

Setting Direction: Mission, Vision and Strategy

PULL

PUSH

PULL

PUSH

1. Set Direction: Mission, Vision and Strategy

Make the status quo uncomfortable

Make the future attractive

3. Build Will• Plan for Improvement• Set Aims/Allocate Resources• Measure System Performance• Provide Encouragement• Make Financial Linkages• Learn Subject Matter

5. Execute Change• Use Model for Improvement for Design and Redesign• Review and Guide Key Initiatives• Spread Ideas• Communicate results• Sustain improved levels of performance

4. Generate Ideas• Understand Organization as a

System• Read and Scan Widely, Learning

from other Industries & Disciplines• Benchmark to Find Ideas• Listen to Patients• Invest in Research & Development• Manage Knowledge

Framework: Leadership for Improvement

2. Establish the Foundation• Prepare Personally• Choose and Align the Senior Team

• Build Relationships• Develop Future Leaders

• Reframe Operating Values• Build Improvement Capability

“Systems awareness and systems design are important for health professionals, but are not enough. They are enabling mechanisms only. It is the ethical dimension of individuals that is essential to a system’s success. Ultimately, the secret of quality is love.”

Avedis Donabedian

Go See, Ask Why, Show Respect!

Meta-Leadership !

Self AuthoringOwn FrameAgenda DrivenProblem-solvingIndependent

Self TransformingLeads to LearnMultiframeAmbiguity TolerantProblem-findingInterdependent

Robert Kegan, Lisa Laskow Lahey – Immunity to Change

“The courage to persevere comes through the service of others”

Eric Greitens, US Navy Seal, Humanitarian & Author ‘The Heart & The Fist’

1. Quality as a core goal

2. Use information to guide improvement

3. Develop organizational skills to support performance improvement

4. Have learning strategies to test improvement and scale it up when it succeeds

Ross Baker 2011

“We must be the change we wish to see in the world”

Mahatma Gandhi

Plan for change Execution of planned change