NTI2010 Increasing Quality And Safety

Increasing Quality & Safety in Your

Organization: Utilizing IHI’s Seven Leadership

Leverage PointsTodd M. Grivetti, MSN, RN, CCRN, CNML

Clinical Nurse ManagerRegional Neurosciences Center

Poudre Valley HospitalFt. Collins, CO.

Housekeeping

• Cell Phones to Vibrate

• Pager to Vibrate

Session Information

• Class Code: 500• CE / Cat: 3 hrs / C • Times: 2:15 pm 5:15 pm

About Me

About the Organization

Learning Objectives

• Discuss and define IHI’s Seven Leadership Leverage points

• Describe how to incorporate IHI’s model into your organization for successful and sustained quality and safety improvement.

• Implement strategic plan to take back to your organization.

• Describe Toyota Process System

Overview – Seven Leadership Leverage Points• Framework

– Environment– Infrastructure

• Achieve Strategic Goals• Build Capacity• Manage Local Improvement

Leverage PointsExplained

• 1. Establish and oversee Specific System-level Aims at the Highest Governance level.

• 2. Develop an Executable strategy to achieve the system-level Aims and Oversee their execution at the highest Governance Level.

• 3. Channel Leadership Attention to System Level Improvement: Personal Leadership, Leadership systems and Transparency

• 4. Put Patients and Families on the Improvement Team

• 5. Make the Chief Financial Officer a Quality Champion

• 6. Engage Physicians• 7. Build Improvement Capability

Leverage Point One:

• Establish and Oversee Specific System-Level Aims at the Highest Governance Level – Establish solid measures of system-level performance• Hospital mortality rates• Cost per adjusted admission• Adverse drug events per 1,000 doses

– Ability to track monthly• Adopt specific aims for breakthrough improvement of those measures

• Establish effective oversight of those aims at the highest levels of governance and leadership

• Commit personally to these aims and communicate them to all stakeholders in way that engenders heartfelt commitment to achieving them.

Leverage Point One

• Whole Systems-Measure– Measures provide an excellent example of a balanced set of World-Class, system level (“Big Dot”) quality performance measures• Measures are intended to complement an organization’s existing– Balanced Scorecards– Measurement dashboards– Performance measurement systems

– Toyota Specifications• Breakthrough performance• Performance that exceeds previous believed “limits”

Leverage Point One Summary

• Responsibility of adopting aims and overseeing measures cannot be the sole responsibility of the board

• Aims must be focused and realistic• Data feedback is important for boards to track whether there is improvement or not. – Use consistent operation definitions– Be timely– Benchmark against other organizations

Leverage Point Two: Develop an Executable Strategy to Achieve

the System-Level Aims• IHI’s Execution of Strategic Improvement Initiatives– Four Critical Steps for Leaders

• Senior Team and Board must adopt a few focused breakthrough quality and safety aims.

• Senior Team must develop plan “rational portfolio of projects” with scale and paced needed to achieve

• Key projects must be resourced with capable leaders both large projects and at day-to-day microsystem level

• Management team must monitor and respond to data from the field at multiple levels in order to steer the execution of the strategy.

Leverage Point Two Summary• Framework for execution

– System-Level aims have a powerful influence on choices of projects.

– Ask the following questions: • How does what you’re already working on in your department support the system-level aim?

•What do we need to do in order to accomplish the aim?

– Large complex projects must be led by capable leaders who are given the time to do the projects or they will be unsuccessful.

Leverage Point Two Summary

• Successful leadership system for execution has two critical components:– Obtain data and feedback regularly on how: •The strategic project portfolio is being executed

•The strategy is working

– Have senior executives regularly review and respond to timely, useful data on these two questions.

Leverage Point Three: Channel Leadership Attention to System-Level Improvement• Personal Leadership

• Leadership Systems• Transparency

Leverage Point Three: Channel Leadership Attention to System-Level Improvement• Common practice:

– Executives constantly send signals about what they believe to be important – Some are NEGATIVE:•Arriving late to meetings•Starting meetings late•Not asking questions•Taking phone calls/check e-mail during the meeting

•Leaving early

Leverage Point Three: Channel Leadership Attention to System-Level Improvement• Personal Leadership

– Prioritize calendars• Change personal schedules to make time for data review, meetings with project leaders, and other activities that support the work.

– Conduct Project Reviews• Senior executives send powerful signals by personally performing reviews with project teams; asking about aims, connecting the work of the team to the overall organization aims, focusing on results, helping the team overcome barriers, and providing encouragement.

– Tell Stories• Positive organizational “buzz” can be created – both informal and formal communications. Stories reinforce the culture changes and practices needed. Stories encourage more rapid adoption of needed patterns and practices.

Leverage Point Three: Channel Leadership Attention to System-Level Improvement• Leadership Systems

– Personal leadership must be supported by good leadership systems•The interrelated set of structures and processes by which leaders work. – Senior Executives could remake their calendars to include project meetings, conduct team reviews, and tell great stories that reinforce the desired culture changes and behaviors.

– What performance data is “top of mind”

Leverage Point Three: Channel Leadership Attention to System-Level Improvement• Finance

– Last Month’s Operating Margin– Customer Satisfaction Scores

• Nursing– Mortality Rate– Number of Hospital Acquired infections– Number of Decubitus ulcers

• Quality/Safety– Joint commission National Patient Safety goals

– Number of Surgical Site Infections– Number of Core Measures met.

Leverage Point Three: Channel Leadership Attention to System-Level Improvement• Transparency

– The fundamental force behind this method is simple and demonstrated in the following slides. •Public (Regulators, media, community, patients) are paying attention to all of your quality and safety performance data. – People inside the organization will tend to work with greater urgency to improve performance.

Leverage Point Three: Channel Leadership Attention to System-Level Improvement• All publically Reported data

now – – Joint Commission – www.jointcommission.org

– Leap Frog – www.leapfroggroup.org– HCAHPS – www.cms.gov– Health grades – www.healthgrades.com

http://www.jointcommission.org/

http://www.leapfroggroup.org/

http://www.cms.gov/

http://www.healthgrades.com/

Leverage Point Three Summary

• Health system leaders frequently express reservations about transparency because they fear loosing patients to other competitors.

• Recent studies of transparency do not support the fears of hospital marketing departments of shifts in market share and volumes, even when reports show the hospital in a bad light.

• There are no substantial findings to increased malpractice claims or loss of philanthropic monies when performance is poor.

Leverage Point Four: Put Patients and Families on the

Improvement Team• Get the right team on the bus “patients”– Real power and influence– Use wisdom and experience to redesign and improve care systems

• This principle aligns with the American Hospital Association (AHA) approach to Patient-and-Family Centered care:– All people (patients, families, and staff) will be treated with dignity and respect

– Health care providers will communicate and share complete and unbiased information with patients and families in ways that are affirming and useful

– Patients and families participate in experiences that enhance control and independence

– Collaboration among patients, family members, and providers occur in policy and program development and professional education, as well as in the delivery of care.

Leverage Point Four Summary

• Leverage four is an important force for driving the achievements and measuring results.

• It has the greatest potential to drive the long-term transformation of the entire organization.

Leverage Five: Make the Chief

Financial Officer a Quality Champion

• Why?– Connection between quality and business performance is still weak.

– Combination of pay-for-performance– Major changes to Medicare reimbursement

– Elimination of increase payments for “never events”

• These have placed quality and payment on the radar of many CFO’s

CFO Cost Reduction Efforts:

Health Care vs. Other Industries

Where Health Care CFO’s go to reduce

Costs

Inputs to CoreProcesses•Supplies•Staff•Equipment•…….

Core Processes•Evaluating•Diagnosing•Treating•Communicating•……

Outputs•Quality results•Safety Results•Costs•………

Where other Industries’CFO’s Go to Reduce Costs

Level Five Summary

• Health Care Organizations would be far more likely to achieve dramatic improvement in system-level measures of financial and quality performance if CFO’s were to become strong drivers of quality based elimination of waste, and if their commitment were translated deeply into the budgeting, capital investment, and innovation and learning systems of an organization.

Institute for Healthcare Improvement, 2008

Level Point Six: Engage Physicians

• Physicians themselves cannot bring about system-level performance improvement– They are powerful in stopping it from moving forward

• System level improvement must be done with:– Enthusiasm– Knowledge– Cultural clout– Personal leadership of physicians


IHI Framework for Engaging Physicians• 1. Discover

Common Purpose• 2. Reframe Values and Beliefs

• 3. Segment the Engagement Plan

• 4. Use “Engaging” Improvement methods

• 5. Show Courage• 6. Adopt an Engaging Style


IHI Framework for Engaging Physicians• Discover a Common Purpose

– Improve patient outcomes– Reduce hassles and wasted time– Understand the organization’s culture

– Understand the legal opportunities and barriers


IHI Framework for Engaging Physicians• Reframe Values and Beliefs

– Make physicians partners, not customers

– Promote both system and individual responsibility for quality


IHI Framework for Engaging Physicians• Ask physicians what they need –

Physician Satisfaction Team– Getting started

•Gather the team•Gather data•Set goals•Take action•Evaluate and communicate results


IHI Framework for Engaging Physicians• Tips for Quick wins with

Physicians– Send thank you notes– Pass along compliments– Spotlight physicians


IHI Framework for Engaging Physicians• Segment the Engagement Plan

– Use the 20/80 rule– Identify and active champions– Educate and inform structural leaders

– Develop project management skills– Identify and work with “laggards”


IHI Framework for Engaging Physicians• Use “Engaging” Improvement

methods– Standardize what is standardizable, no more.

– Generate light, not heat with data (use data sensibly)

– Make the right thing easy to try– Make the right thing easy to do

Design

Design

Design

Design

Approve

Conference RoomsREAL WORLD

Implement

Standardizing Clinical Processes:

Typical Approach

DesignConference

Rooms

Approve (if necessary)

Real WorldTest and Modify

Test and Modify

Test and Modify

Implement

Standardized Clinical Processes:

Refine the Design using Small Tests of Change


IHI Framework for Engaging Physicians• Show Courage

– Provide backup all the way to the board.

– Never easy – especially when powerful voices speak out against it

Source: Reinersten, J. (2008). Engaging Physicians: How the team can incorporate quality and safety. Healthcare Executive. May/June. 2008. p.78-81.


IHI Framework for Engaging Physicians• Adopt and Engaging Style –

Suggested ideas– Involve physicians from the Beginning

– Work with real leaders– Choose Messages and Messengers Carefully

– Be Transparent, especially with data– Value their time with your time

Sample Implementation Process

Source: StuderGroup.com (2005)

Leverage Point Seven: BuildImprovement Capability

• Leaders must devote resources to establish capable leaders of improvement in every microsystem. – “Quality is everyone’s responsibility”

– W. Edwards Deming

• More that 90 percent of leaders believe their performance problems can be traced to failed executions strategies.


• Cited Leadership problems:– Short attention span– Inadequate resourcing– Too little executive oversight and monitoring

– Failure to address “political” problems among professional groups.


• Capabilities required of senior leaders to drive system-level improvement – requires both the ability to know, use, and teach:– The model of improvement and small-scale rapid tests of change.

– A coherent improvement strategy such as the Toyota Production System.

– Concepts and practices in flow management.– Sophisticated practices in flow management. – Concepts and practices of scale-up spread of improvements

– Concepts and practices of safety systems.

Self Assessment Tool for System-Level Results

• Discussion and action tool designed to help– Administration– Physicians– Nursing leaders

• Used to:– Design and plan work leading to significant reduction in one or two system level measures• Mortality rates• Harm rates• Nosocomial infection rates

15 minute Break

Yampa Valley near Steamboat Springs, CO. 2009 Photograph by Todd Grivetti ©

Leadership Leverage PointsSelf-Assessment Tool for System-

Level ResultsLeadership Leverage

PointsAction Needed / Action Planned

By Whom By When

1. Establish and Oversee Specific System-Level Aims for Improvement at the Highest Governance Level

Senior Leadership team has developed specific “how much, by when” aims for system-level measures of quality and safety.

Board has adopted the aims and is overseeing their achievement using system-level measures of progress against the aim.

Leadership Leverage PointsSelf-Assessment Tool for System-

Level ResultsLeadership Leverage

PointsAction Needed / Action Planned

By Whom By When

2. Develop an Executable Strategy to Achieve the System-Level Aims and Oversee their Execution at the Highest Governance Level

Senior Leadership team has developed a plan to achieve the aims that is focused on the right drivers, and had the necessary scale and pace.

Senior Leadership team has resourced the projects that are necessary to achieve the aim with effective leaders.

Summary of Seven Leadership Leverage Points for 2008

ChangesLeverage Points Key Changes in 2008One: Establish and Oversee specific system-level Aims at the Highest Governance Level

•Emphasis on the critical role of the board in quality.•Learning about the power of stories and data at the board level.

Two: Develop and Executable Strategy to Achieve the system-level Aims and Oversee the execution at the highest governance level

Learning what it takes to execute change on large scale. •Focus on one or two major aims•Rigorous steering of the execution plan using good data from the field•Resourcing strategic improvements with capable improvers and change leaders as their primary job responsibility.

Three: Channel Leadership Attention to System-Level Improvement: Personal Leadership, Leadership systems, and Transparency

•Confirmation and examples of the power of leadership attention to improvement aims. •A major new emphasis on the power of transparency to drive improvement and change.

Four: Put Patients and Families on the Improvement Team

•Original leverage point focused on establishing the most effective senior leadership team. •Revised leverage point focuses exclusively on the transformational role of patients and families on leadership and improvement teams.

Summary of Seven Leadership Leverage Points for 2008

ChangesLeverage Points Key Changes in 2008Five: Make the Chief Financial Officer a Quality Champion

•Learning about the potentially powerful role of the CFO can play in improvement once they see “reduce waste in core processes” as the primary driver of cost reductions, rather than the traditional approach of “reduce inputs to (defective) core processes”

Six: Engage Physicians •Developed an entirely new framework for engaging physicians in a shared quality agenda, with extensive examples.

Seven: Build Improvement Capability

•Continued reinforcement of the critical need to build capable improvers at every level as an important underpinning for the other six leverage points.

Improving & Executing System Level Change

Utilizing Leadership Frameworks &

Toyota Production Specifications

Framework for Leadership Improvement1. Set Direction: Mission, Vision, Strategy

Make Status Quo Uncomfortable Make Future AttractivePush Pull

3. Build Will•Plan for Improvement

•Set Aims/Allocate Resources

•Measure System Performance

•Provide Encouragement

•Make Financial Linkages

•Learn Subject Matter

•Work on Larger System

4. Generate Ideas

•Read and Scan widely, Learn from other industries and disciplines

•Benchmark to find Ideas

•Listen to Customers

•Invest in Research and Development

•Manage Knowledge

•Understand Organization as a System

5. Execute Change

•Use Model for Improvement, Design and Redesign.

•Review and Guide Key initiatives

•Spread ideas

•Communicate results

•Sustain Improved Levels of Performance.

2. Establish the Foundation•Reframe Operating Values *Prepare Personally *Build

Relationships

•Build Improvement Capability *Choose and Align the Senior Team *Develop Future Leadership

Source: IHI 2005.

Improving System Level Performance:

Setting Goals and Ensuring Results

• Four Components– Setting Breakthrough Performance Goals

– Developing a portfolio of projects to support goals

– Deploying resources to projects that are appropriate for the aim

– Establish an Oversight and Learning System to Increase Chance of Producing Intended Results.



• Setting Breakthrough Performance Goals– Generally set through strategic and business planning for the organization.•Efficiency – Consists of:

– Assuming responsibility for total cost of care– Cost per capita– VS –

» Hospital costs» Length of Stay (LOS)» Cost per case


• Set Milestones and Acknowledge Progress– Milestones allow you to monitor progress and help ensure you are on track

– Identify and address issues that cause delays

– Acknowledge and celebrate success/progress

– Thank Stakeholders for their support.

Four Sources of Leverage

• Complex Systems Theory • Observed Performance of Leaders in Health Systems

• Hunches, Intuition, and Collective Experience

• Ongoing Research and Development of Management Theories and Methods

Complex Systems Theory• Complex adaptive systems cannot be specified and managed in detail (healthcare systems)

• Highly likely that small changes in certain critical aspects of these systems might bring about surprising and unpredictable amounts of improvement or deterioration in overall system performance.

• If leaders could choose the right system attributes (“leverage points”) and make small, but important changes; very large performance change might result.

Observed Performance of Leaders in Health Systems

• IHI’s Pursuing Perfection• IMPACT• 100,000 Lives Campaign• 5 Million Lives Campaign• Where has system level changes occurred?

– Does not occur without declared aim to achieve it.

• Leverage points based largely on qualitative data and stories of leaders versus solid base research.

Hunches, Intuition and Collective Experience

• Particularly those that surface as recurrent “difficult moments” for leaders.

• Sense that the business case for quality is still fragile in many healthcare organizations and if the Chief Financial Officer (CFO) were to somehow become a champion for system level improvement quality, dramatic improvement would be much more likely.

Ongoing Research and Development of Management

Theories and Methods• IHI has continued to provide research and gained valuable knowledge such as: – Execution– Governing Boards– Transparency– Physician engagement

Achieve Strategic Goals

Manage Local Improvement

BuildCapability

ENVIRONMENT INFRASTRUCTURE

Spread and Change

Provide Leaders for Large System ChangeSpread and Change

Provide Leaders for Large System Projects

Provide Day to Day Leaders for Microsystems

Core Elements for Process Improvement

Achieve Strategic Goals

• Strategic Goals Must:– Be aligned with organizational priorities

– Be associated with human and capital costs

• Boards, executives and clinical leaders proactively set goals for system level transformation. – Identify new opportunities for improvement

– Remove barriers– Celebrate Success

Manage Local Improvement• Plan for daily management of local

improvement projects– Support or sustain breakthrough aims to manage daily operations.

• Regularly and transparently review performance data– Frequent and open assessment of data

•Includes everyone involved•Builds joint accountability for progress.

Develop Human Capital

• Medical staff takes responsibility for clinical improvement– Physicians actively engaged in data review– Chief Medical Officer responsible for quality

• Creating a sense of ownership among medical staff

• Organization invests in human capital and continuous learning, building capacity at all levels.

• Successful organizations– Invest significant resources to develop staff– Develop middle managers– Provide training with safety officers and improvement advisors

“It is Leadership’s job to build the will for change

among busy professionals, implement systems to capture new ideas and

spread them to the right people within the

organization, and design and implement an effective

strategy”Bisognano, Schummers, McCannon

Whole System-Measures and Toyota Specifications –

System LevelIOM Dimension of Quality

Whole System Measure

Toyota Specifications

Patient Centered Patient Experience Score (Response to the question in the How’s Your Health Database, “They give me exactly the help I want (and need) exactly when I want (and need) it.”

72% of Patients report, “They give me exactly the help I want (and need) when I want (and need) it.”

Effective and Equitable

Self-Reported health status

5% of Adults self-rate their health status as fair or poor. (Response rate will not differ by income)

Efficient Per capita health care expenditures

$3,000 per capitaWhole System Measures and Toyota Specifications:

System Level. IHI, 2008



• Component Level– Looking at new ways of integrating several aspects of healthcare along the continuum•Hospital•Home Care•Primary care offices•Family

– All center on the unique needs of the individual patient

Whole System-Measures and Toyota Specifications:

Component LevelDimension Measure Performance Specifications

Evidence Based Care Pervasive Reliability Reliability Levels 102

Safe CareAdverse Events per 1000 pt. days

5 Adverse events per 1000 pt. days

Timely Access to CareDays to third next available appointment

Primary Care: Same Day AccessSpecialty Care: Within 7 Days

Effective CareHospital Standardized Mortality ratio (HSMR)

HSMR = 57

HSMR - Risk Adjusted Mortality Rates 1998 - 2009

020406080

100120

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Years

Risk

-Adj

uste

d Ra

tes

US Overall

Jacksonville

Mayo Clinic Goal

Arizona

Rochester

Mayo Clinic Comparisons









HSMR = 57

Effective Care that Crosses Barriers

Hospital Readmission Percentage

30-Day Hospital Readmission = 4.69%

Safe Work PlaceOccupational Injuries and Illnesses

0.2 Cases with lost work days/100 FTE’s/Year

Efficient Utilization and Resource Use

Hospital Days per Decedent during the last six months of life

7.24 Hospital Days per Decedent during last six months of life

Efficient Care Medicare Reimbursement $5,026 per enrollee

Patient – Centered Care Patient Satisfaction81% of Patients are Satisfied

Leadership’s Role in the Execution• Successful execution of strategic

goals depends on a genuine sense of share responsibility.

• Execution remains the weak link in the framework for improvement

• Make the case for Change– Consider the reasons for the change– Describe current and desired states– Address the 5 W’s (Who, What, When Where, Why)

Leadership’s Role in the Execution

• Enlist Stake Holders– Look across the organization

•Departments/individuals interested in working on change

•Determine supporters and potential naysayers

•Invite Stakeholders to “come on board”•Make sure you have appropriate sponsorship/approval

•Put together the team who will plan, implement and define roles and responsibilities.

Leadership’s Role in Execution

• Communicate The Vision– Identify who are the best people to communicate the change

– Who do you need to communicate to?– What do you need to communicate and what action need to be take

– Communicate, Communicate, Communicate •Transparency is Key•Face-to-Face is best


• Expect Barriers to come up– Unexpected resistance– Lack of knowledge or Ability– Process issues– Technology issues

• Develop plan to remove/address• Utilize Change/Transition Blueprint to help identify.


• Why people resist change– Fear of the unknown

•Safety is challenged

– Loss of Confidence•Feeling of “significance” is challenged

– Lack of buy-in– Feeling overwhelmed

Leadership’s Role in Execution• Managing Resistance

– Change management right the first time• Effective change management can eliminate many causes of resistance before they occur.

– Expect it• Do not be surprised by resistance, expect it and plan for it.

– Identify root cause• Make sure you aren’t simply responding to the symptom

– Engage Support• Managers, Directors, and Executive support

– Consider the Culture• Leader support• Informal Leaders• Generational issues

Step 3: Key Stakeholders/CustomersWho may be affected by changing of the current

state? Example: Specific departments, people,

customers

Step 4: Context (External, Internal Factors Driving the Need for Change) Example: Why would changing from the current state matter?

Step 5: Approaches/ActionsWhat possible ways could this issue be resolved? Example: Education program, change in policy, PDCA team, brainstorming

Strategic Conversations

Step 1: Current StateWhat is the current situation that is driving the change? Example: What is not occurring?

Step 2: Future StateWhat would be the ideal situation after the change? Example: That particular “something” would be occurring.

Director evaluates for scope and validity

of issue

* PDCA?

more than department issue?

Director presents to Process

Improvement Team

*PI Team decision on

PDCA

PDCA initiated

Director decides on appropriate

resolution and explains “no”

decisons

Director maintains oversight of the

process

Issue resolved?

Report to Process Improvement Team

Consider using PDCA when:

A process already exists, but needs to be improved and you’re not sure on how to improve it.

The process must be studied to understand how all the parts fit together.

Changing the process could be expensive and hard to reverse.

Improvement ideas don’t readily come from literature or benchmarking.

Simple problem solving has shown itself ineffective

If any of the below apply, Use the Decision Support Process

VIC/Public/Forms/Decision Support

The idea introduces a new program or service providing care for patient groups not previously served by PVHS.

The new process would provide treatment of existing patient groups through a new technology.

The process includes the purchase of an existing business not currently owned by PVHS.

The idea dramatically extends an existing service/program that increases capacity for capturing additional volume for PVHS.

The idea expands an existing program into a geographic market not previously served by PVHS.

One year time limit on PDCA team commitment

Quality Resources is available for consultation for decision support.

If the process improvement impacts patient safety, consider consulting with Quality Resources first.

* Review the statements that apply. Make a determination for using PDCA or business proposal process.Note: When the need for quick turnaround outweighs the risk of making changes without thorough upfront analysis, involvement of relevant Directors and SMG

is required.

Issue is identified and presented to director

Explain decision or escalate to

SMG

No

No

Yes

Yes

No

Yes

No

Yes

PDCA Decision Process

Share information with stakeholders









HSMR = 57

Effective Care that Crosses Barriers

Hospital Readmission Percentage

30-Day Hospital Readmission = 4.69%

Safe Work PlaceOccupational Injuries and Illnesses

0.2 Cases with lost work days/100 FTE’s/Year

Efficient Utilization and Resource Use

Hospital Days per Decedent during the last six months of life

7.24 Hospital Days per Decedent during last six months of life

Efficient Care Medicare Reimbursement $5,026 per enrollee

Patient – Centered Care Patient Satisfaction81% of Patients are Satisfied

IHI’s Triple Aim

• Improve the Health of the defined population

• Enhance the patient care Experience– Quality– Access– Reliability

• Reduce, control cost per capita cost of care

Triple Aim

• Components:– Focus on individuals and families– Redesign of primary care services and structures

– Population health management– A cost-control platform– System integration and execution

• Macro & Micro level integrators

Triple Aim

Design and Coordination of Care

Per Capita Cost

Population

Health

Individual

Experience

•Act with the Individual and Family

•Learn for the Population

Beasley, 2009. Triple Aim

References/Bibliography/Webliography

• Beasley C. The Triple Aim: Optimizing health, care, and cost. Healthcare Executive. 2009 Jan/Feb;24 (1):64-65.

• Bisognano M., Schummers, D., McCannon, J. Leadership’s role in execution. Healthcare Executive. 2008 Mar/Apr;23(2):66-70.

• Conway, J. 2000. Strategies for Leadership: Hospital Executive and their role in patient safety. Dana-Farber Cancer Institute.

• Conway J. Could it happen here? Learning from other organizations' safety efforts. Healthcare Executive. 2008 Nov/Dec;23(6):64-67.

• Improving Quality and Achieving Equity: A Guide for Hospital Leaders. The Disparities Solutions Center at Massachusetts General Hospital Boston, Massachusetts, USA.

• Massoud MR, Nielsen GA, Nolan K, Schall MW, Sevin C. A Framework for Spread: From Local Improvements to System-Wide Change. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2006. (Available on www.IHI.org).

• McCannon J. The key to winning the Campaign. Healthcare Executive. 2007 Sept/Oct:61-65.

http://www.ihi.org/

References/Bibliography/Webliography

• Nolan TW. Execution of Strategic Improvement Initiatives to Produce System-Level Results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org).

• Nolan, T., Martin, L, Mountford, J, Neumann, C, Schummers, D. A three-part approach to patient safety: Balanced strategy improves value, reduces costs. Healthcare Executive. 2008 Sep/Oct;23(5):70-74.

• Nolann T, Martin L, Mountford J, Neumann C, Schummers D. The Key to Winning the Campaign: How executive leadership can transform hospital care in America. Healthcare Executive. 2007 Sept/Oct. (Available on www.ihi.org).

• Pugh M, Reinertsen JL. Reducing harm to patients. Healthcare Executive. 2007;22(6):62, 64-65.

• Reinertsen J. Engaging physicians: How the team can incorporate quality and safety. Healthcare Executive. 2008 May/June;23(3):78-81.

• Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2008. (Available on www.IHI.org)

http://www.ihi.org/

http://www.ihi.org/

Conclusion

Thank you

?Questions?

Contact Information

Todd M. Grivetti, MSN, RN, CCRN, CNMLClinical Nurse Manager – Regional Neurosciences

CenterPoudre Valley Health System

Fort Collins, COE-mail: [email protected]: 970-495-8325

mailto:[email protected]

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Transcript of NTI2010 Increasing Quality And Safety