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Leadership and Communication for Internal Spread Chinook LS 5 Mike Davies, MD FACP Mark Murray and...
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Leadership and Leadership and Communication for Communication for
Internal Spread Internal Spread Chinook LS 5Chinook LS 5
Mike Davies, MD FACPMike Davies, MD FACP
Mark Murray and AssociatesMark Murray and Associates
2Copyright Mike Davies, MD
Decreased Vision
Pre-op PE Questions RN over phone
F/U Phone Call
Optimist for glasses
Decreased Vision
Optimist for glasses
Ophthalmologist Dx Cataract & Completes Pre surgery Form &
Books Surgery
Surgery
GP Consults Ophthalmologist
Surgery
Post-op Ophthalmologist Visit
Nurse does PE Pre-op visit
Ophthalmologist Confirms DX
Optometrist DX Cataract/Refers to GP
12 Months vs 2 Months For Cataract Care
Simplification of the process in healthcare……….
3Copyright Mike Davies, MD
It’s NOT POSSIBLE to It’s NOT POSSIBLE to “Transfer” this “Transfer” this
Knowledge……. Knowledge……. Why?Why? Will to changeWill to change Leadership to create aimLeadership to create aim Involvement of allInvolvement of all Time to workTime to work Measurement of right thingsMeasurement of right things Unable to form new relationships Unable to form new relationships
neededneeded …….New knowledge not generated…...New knowledge not generated…..
4Copyright Mike Davies, MD
““Spread” is really adoption Spread” is really adoption (creation of new (creation of new
knowledge)…knowledge)… New knowledge must be created New knowledge must be created
by each team itself (adopted) by each team itself (adopted) rather than just “listened to” and rather than just “listened to” and implemented.implemented.
Adoption implies Adoption implies EFFORTEFFORT and and CHANGECHANGE
The knowledge The knowledge ONLY EXISTSONLY EXISTS in in the context of a teamthe context of a team
5Copyright Mike Davies, MD
Vision
Vision
Vision
Vision
Vision
Skills
Skills
Skills
Skills
Skills
ResourcesIncentives Action Plan
Incentives
Incentives
Incentives
Incentives
Resources
Resources
Resources
Resources
Action Plan
Action Plan
Action Plan
Action Plan
CHANGE
CONFUSION
ANXIETYGRADUALCHANGE
FRUSTRATION
FALSE STARTS
Managing Complex Change
6Copyright Mike Davies, MD
Late Majority
Early Majority
Early Adopters Historians
Innovators
Adopter Categories
2.5% 13.5% 34% 34% 16%
7Copyright Mike Davies, MD
Team ExerciseTeam Exercise
2-3 Volunteers to “sell” 2-3 Volunteers to “sell” somethingsomething
10-15 Volunteers to listen and 10-15 Volunteers to listen and decide if they want to buydecide if they want to buy
8Copyright Mike Davies, MD
What we learnWhat we learn
Diffusion curve shapeDiffusion curve shape Make a decision in 10 secondsMake a decision in 10 seconds Triggers of relative advantageTriggers of relative advantage People in the middle need more People in the middle need more
informationinformation People can be innovators on one People can be innovators on one
thing and laggards on another thingthing and laggards on another thing People don’t like to be called People don’t like to be called
laggardslaggards
9Copyright Mike Davies, MD
How you interact the How you interact the first 4 minutes dictates first 4 minutes dictates how your relationship how your relationship will go the rest of your will go the rest of your day will go.day will go.
Dr Dr PhilPhil
10Copyright Mike Davies, MD
Expert teamor individual
Receiving Team A
Receiving Team B
Receiving Team C
Knowledge
12Copyright Mike Davies, MD
The above maps represent the answers for two questions asked within the same physician network
Map of Technical Advice Seeking Network Map of Trust and Friendship Network
Figure 2
14Copyright Mike Davies, MD
SpreadSpread
“BETTERIDEAS
Happens over time
COMMUNICATED
Thru a SOCIAL system
Adapted from Rogers, 1995
In a certain way
(C) 2001, Sarah W. Fraser
15Copyright Mike Davies, MD
Spread Readiness Spread Readiness ChecklistChecklist
� Access improvement is a Access improvement is a key key initiative initiative
� Senior Leaders are Senior Leaders are responsible responsible for, and engaged infor, and engaged in spreading the spreading the access/efficiency improvementsaccess/efficiency improvements
� Clear Clear intentintent to spread the work of to spread the work of the pilot teamthe pilot team
� The pilot team is The pilot team is successfulsuccessful and and relatively self sufficientrelatively self sufficient
16Copyright Mike Davies, MD
Where to StartWhere to Start The single biggest problem with The single biggest problem with
communication is the illusion that it communication is the illusion that it has taken placehas taken place - Bernard Shaw - Bernard Shaw
Tri-abilityTri-ability Compatible with values/beliefsCompatible with values/beliefs Social SystemSocial System 15-20% at each site is critical mass15-20% at each site is critical mass Innovators not listened toInnovators not listened to Early adopters ARE listened to Early adopters ARE listened to Spend most time with leadersSpend most time with leaders
17Copyright Mike Davies, MD
Influencing LanguageInfluencing Language ““Toward” Toward”
(Achiever)(Achiever) ““Away” Away” (Problem (Problem
Solver)Solver)
““Internal” (Leader)Internal” (Leader) ““External” External”
(Follower)(Follower)
““Procedures”Procedures” ““Options”Options”
..achieve, accomplish..achieve, accomplish
..wouldn’t be too hard..wouldn’t be too hard
..you might consider..you might consider
..thousands of others..thousands of others
..step-by-step..step-by-step
..pick and choose..pick and choose
18Copyright Mike Davies, MD
Influencing Influencing LanguageLanguage
TraditionalistTraditionalist EvolutionaryEvolutionary RevolutionaryRevolutionary
..same, similar, ..same, similar, familiarfamiliar
..improved, better,..improved, better,
new, breakthrough!new, breakthrough!
20Copyright Mike Davies, MD
CultureCulture ““A force to be reckoned with”A force to be reckoned with” ““How we do things around How we do things around
here”here” ““Culture eats strategy for Culture eats strategy for
lunch every day”lunch every day”
21Copyright Mike Davies, MD
Culture is…Culture is… The unwritten values The unwritten values
reinforced every dayreinforced every day What it takes to “fit in”What it takes to “fit in” What it takes to “get What it takes to “get
along”along” Columbia/Challenger storyColumbia/Challenger story
22Copyright Mike Davies, MD
Observations About Observations About Medical CulturesMedical Cultures
Current CulturesCurrent Cultures Physician Physician
autonomy above allautonomy above all Financial Financial
incentives “magic incentives “magic bullet”bullet”
Consensus Consensus decision makingdecision making
Conflict AverseConflict Averse HierarchicalHierarchical Focus inwardFocus inward
Desirable CultureDesirable Culture Customer focusCustomer focus Continuous quest Continuous quest
for improvementfor improvement Collaboration Collaboration Personal Personal
responsibilityresponsibility AcknowledgementAcknowledgement
Adapted from Jack Silverstein
23Copyright Mike Davies, MD
The Way It Is With The Way It Is With CultureCulture
Culture change not for the Culture change not for the faintheartedfainthearted
QI projects alone unlikely to shift QI projects alone unlikely to shift deeply held culture values and deeply held culture values and behaviorsbehaviors
Senior leaders are key to shape Senior leaders are key to shape culture two ways:culture two ways: Signal generatorsSignal generators Hardwire into the organizationHardwire into the organization
Adapted from Jack Silverstein
25Copyright Mike Davies, MD
HardwiringHardwiring Leadership Leadership Structure for Structure for
communicationcommunication Structure for Structure for measuresmeasures AcknowledgementAcknowledgement and and
recognitionrecognition
26Copyright Mike Davies, MD
Leaders….Leaders…. Set prioritiesSet priorities Remove barriers and Remove barriers and
facilitate others taking facilitate others taking responsibilityresponsibility
Build trustBuild trust Go firstGo first CommunicateCommunicate
27Copyright Mike Davies, MD
Three Critical RolesThree Critical Roles
C h a m pio nC h a m pio n C h a m pio n
S po n s o r
A g e n t
28Copyright Mike Davies, MD
Key Change Team Key Change Team MembersMembers
Sponsors “I believe this is right”Sponsors “I believe this is right” Align resources – financial, people, Align resources – financial, people,
environ.environ. Monitor progressMonitor progress CommunicateCommunicate
Change agents “I will be the staff help”Change agents “I will be the staff help” No authority, but interpersonal skillNo authority, but interpersonal skill
Champions “I will sponsor change Champions “I will sponsor change locally”locally” Opinion leaders inside departmentsOpinion leaders inside departments
29Copyright Mike Davies, MD
Develop the Develop the MessengersMessengers
Choose the right messengersChoose the right messengersOpinion leaders Opinion leaders Connectors Connectors
Educate the messengers to Educate the messengers to deliver the messagedeliver the messageInclude peer-to-peer Include peer-to-peer communicationcommunication
30Copyright Mike Davies, MD
SHAREINFORMATION
SHAPE BEHAVIOR
“Marketing”flyersnewslettersvideosarticlesposters
PersonalAppealletterscardsPostcards
InteractiveActivitiestelephoneemailvisitsseminarslearning setsmodeling
Face-to-faceone-to-onementoringshadowing
Channels of Communication
PublicEventsRoad showsFairsConferencesExhibitionsMass mtgs
From Sarah W. Frasier
32Copyright Mike Davies, MD
I would…I would… Make reduction of delay one of the Make reduction of delay one of the
top priorities for the organizationtop priorities for the organization Establish an influential oversight Establish an influential oversight
committee (with resources devoted to committee (with resources devoted to support it)support it)
Develop organization or service wide Develop organization or service wide goals outlining the steps to goals outlining the steps to implementationimplementation
Develop a robust system-wide Develop a robust system-wide compass of measurescompass of measures
33Copyright Mike Davies, MD
I wouldI would (cont.)………..(cont.)………..
Communicate the priority and goals at Communicate the priority and goals at every meeting every meeting
Communicate to key individuals privatelyCommunicate to key individuals privately Solve the problems effectivelySolve the problems effectively Celebrate success publicly and privately Celebrate success publicly and privately
by significantly acknowledging those by significantly acknowledging those responsible for changeresponsible for change
Promote leaders of like mind in this areaPromote leaders of like mind in this area
34Copyright Mike Davies, MD
Furthermore!Furthermore! Insist on regular meetingsInsist on regular meetings Rely on measurements to Rely on measurements to
improveimprove Continually look for Continually look for
improvement opportunitiesimprovement opportunities Acknowledge and celebrate Acknowledge and celebrate
successessuccesses
35Copyright Mike Davies, MD
VA Experience MDRC…VA Experience MDRC… 78 Medical Centers 78 Medical Centers Interviews, survey (3870 staff), Interviews, survey (3870 staff),
databases for wait time & patient databases for wait time & patient satisfactionsatisfaction
Found important predictors were:Found important predictors were:Extent of leadership supportExtent of leadership supportExtent of teams having & using Extent of teams having & using performance dataperformance data
Extent of knowledgeExtent of knowledgeTimeTime
Carol VanDusen Lukas, Mark Meterko
36Copyright Mike Davies, MD
How do we get How do we get there? there?
Your team Your team believes inbelieves in making Access work making Access work (WILL)(WILL) Your team makes reducing waits the top priority from now on Your team makes reducing waits the top priority from now on (WILL)(WILL) You must have the support of leadership You must have the support of leadership (WILL)(WILL) You must understand high leverage changesYou must understand high leverage changes (IDEAS) (IDEAS) Your “team” includes a physician, nurse and clerk at a minimum Your “team” includes a physician, nurse and clerk at a minimum
(EXECUTION)(EXECUTION) Your team has data – a compass of measures Your team has data – a compass of measures (EXECUTION)(EXECUTION) Your team tries and fails and tries again Your team tries and fails and tries again (EXECUTION(EXECUTION))
37Copyright Mike Davies, MD
Practical Strategies for Practical Strategies for Internal SpreadInternal Spread
38Copyright Mike Davies, MD
DefenderNeutralSupporter
Infl
ue
nce
Person A
x x
x x
Person B
x
x
xx
x x
x
x
x
39Copyright Mike Davies, MD
Bibliography and Bibliography and ReferencesReferences
Berwick. Berwick. A Primer on Leading the A Primer on Leading the Improvement of SystemsImprovement of Systems. . BMJ,BMJ, 312: pp 312: pp 619-622, 1996619-622, 1996..
Dixon. Dixon. Common Knowledge.Common Knowledge. Boston: Boston: Harvard Business School Press, 2000.Harvard Business School Press, 2000.
Fraser S. Spreading good practice; how to Fraser S. Spreading good practice; how to prepare the ground, prepare the ground, Health ManagementHealth Management, , June 2000June 2000
Gladwell. Gladwell. The Tipping Point. The Tipping Point. Boston: Boston: Little, Brown and Co., 2000.Little, Brown and Co., 2000.
40Copyright Mike Davies, MD
Bibliography and Bibliography and ReferencesReferences
Langley, Nolan, Nolan, Norman, Provost. Langley, Nolan, Nolan, Norman, Provost. The Improvement Guide: A Practical The Improvement Guide: A Practical Approach to Enhancing Organizational Approach to Enhancing Organizational PerformancePerformance. San Francisco: Jossey-Bass . San Francisco: Jossey-Bass Publishers., 1996.Publishers., 1996.
Rogers.Rogers. Diffusion of Innovations. Diffusion of Innovations. NY: The NY: The Free Press, 1962, 1983, and 1995.Free Press, 1962, 1983, and 1995.
Scholtes. Scholtes. The Leader’s Handbook: A The Leader’s Handbook: A Guide to Inspiring Your People and Guide to Inspiring Your People and Managing the Daily WorkflowManaging the Daily Workflow
41Copyright Mike Davies, MD
ReferencesReferences
Attewell, P. Technology Diffusion and Organizational Learning, Attewell, P. Technology Diffusion and Organizational Learning, Organizational ScienceOrganizational Science, February, 1992, February, 1992
Bandura A. Bandura A. Social Foundations of Thought and ActionSocial Foundations of Thought and Action. . Englewood Cliffs, N.J.: Prentice Hall, Inc. 1986.Englewood Cliffs, N.J.: Prentice Hall, Inc. 1986.
Brown J., Duguid P. Brown J., Duguid P. The Social Life of InformationThe Social Life of Information. Boston: . Boston: Harvard Business School Press, 2000.Harvard Business School Press, 2000.
Cool et al. Diffusion of Information Within Organizations: Cool et al. Diffusion of Information Within Organizations: Electronic Switching in the Bell System, 1971 –1982, Electronic Switching in the Bell System, 1971 –1982, Organization ScienceOrganization Science, Vol.8, No. 5, September - October , Vol.8, No. 5, September - October 1997.1997.
Dixon, N. Dixon, N. Common KnowledgeCommon Knowledge. Boston: Harvard Business . Boston: Harvard Business School Press, 2000.School Press, 2000.
Fraser S. Spreading good practice; how to prepare the ground, Fraser S. Spreading good practice; how to prepare the ground, Health ManagementHealth Management, June 2000, June 2000
Gladwell, M. Gladwell, M. The Tipping Point. The Tipping Point. Boston: MASSBoston: MASSLittle, Brown and Company, 2000.Little, Brown and Company, 2000.
42Copyright Mike Davies, MD
ReferenceReference
ssKreitner, R. and Kinicki, A. Kreitner, R. and Kinicki, A. Organizational Behavior (2Organizational Behavior (2ndnd ed.) ed.) Homewood, Il:Irwin ,1978.Homewood, Il:Irwin ,1978.Langley J, Nolan K, Nolan T, Norman, C, Provost L. Langley J, Nolan K, Nolan T, Norman, C, Provost L. The The Improvement GuideImprovement Guide. San Francisco: Jossey-Bass 1996.. San Francisco: Jossey-Bass 1996.Lomas J, Enkin M, Anderson G. Opinion Leaders vs Audit and Lomas J, Enkin M, Anderson G. Opinion Leaders vs Audit and Feedback Feedback to Implement Practice Guidelines. to Implement Practice Guidelines. JAMAJAMA, Vol. 265(17); , Vol. 265(17); May 1, May 1, 1991, pg. 2202-2207. 1991, pg. 2202-2207. Myers, D.G. Social Psychology (3Myers, D.G. Social Psychology (3rdrd ed.) New York: ed.) New York:
McGraw-Hill, 1990.McGraw-Hill, 1990.Prochaska J., Norcross J., Diclemente C. In Search of How People Prochaska J., Norcross J., Diclemente C. In Search of How People Change, Change, American Psychologist, American Psychologist, September, 1992.September, 1992.Rogers E. Rogers E. Diffusion of InnovationsDiffusion of Innovations. New York: The Free Press, 1995. . New York: The Free Press, 1995. Wheeler, Donald J. Wheeler, Donald J. Understanding VariationUnderstanding Variation
SPC Press Knoxville, TN: 1993SPC Press Knoxville, TN: 1993
www.modern.nhs.uk/researchintowww.modern.nhs.uk/researchintopracticepractice www.sdo.ishtm.ac.ukwww.sdo.ishtm.ac.uk www.modern.nhs.uk/improvementguideswww.modern.nhs.uk/improvementguides