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Amy Mervak Hospice Care of Southwest Michigan

"Spiral Learning" with Kata

By Amy Mervak

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As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy* grows.

TAKE AWAY:

* The perception of one's ability to reach a goal

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The PROCESS Learning Spiral

The STRATEGY Learning Spiral

Intentional practice = Intentional learning

Good processes produce important

outcomes

Storyboards are most effective when linked to

strategic priorities.

Strategic priorities must be focused & formally expressed.

Improvement efforts cannot

be separate from

management.

Reframe “missteps” as

experimentation

Spiral Learning

We take care of people who are dying, and their families.

Physical

Emotional

Spiritual

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January 2015

Director

Clinical Staff

Nurse

Manager

(1)

Director of

Client Care

After-Hours

RN Team

Hospice Aides RNs with Client Caseloads Resource/Irregular Part-Time RNs After-Hours RNs

Resource/

IRPT RNs

Primary RNs Hospice Aides

26

16

Resource/Irregular Part-Time RNs

Director

Manager Manager

Clinical

Staff

RN

Managers

(3)

Director

of Client

Care

Hospice Aides RNs with Client Caseloads After-Hours RNs

Homecare 1 Homecare 2 Homecare 3

Manager

After-Hours

RN Team

12 12 13

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December 2015

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Negative media coverage

Unclear Territory

Regulatory requirements

Competition Auditor scrutiny

Cost

Staffing challenges

Operating loss

Storyboards are most effective when linked to

strategic priorities.

Strategic priorities must be focused &

formally expressed.

Improvement efforts cannot

be separate from

management.

The STRATEGY Learning Spiral

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Our Improvement History

• Success with Projects using the IHI’s Model for Improvement

• Variability in sustainment of gains

Continual Projects does not equal Continual Improvement!

Improvement efforts cannot be separate from management.

Down is

better

75% of my To-Do List items will be

addressed by the end of the work day.

60 min/day are devoted to projects (tasks that can be delayed by day-to-

day work/fire-fighting).

Early Storyboards

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Storyboards don’t relate to the organization’s priorities.

Organization’s priorities are not sufficiently expressed.

Too many priorities (# in the 40s) and not well-defined.

40 priorities = No priorities

Storyboards are most effective when linked to strategic priorities.

2 Challenges

Strategic priorities must be focused & formally

expressed.

Priorities

Weekly Leadership Meetings

Storyboards

Advance Group

Alignment

As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy grows.

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Storyboards are most effective when linked to

strategic priorities.

Strategic priorities must be focused &

formally expressed.

Improvement efforts cannot

be separate from

management.

The STRATEGY Learning Spiral

Intentional practice = Intentional learning

Good processes produce important

outcomes

Reframe “missteps” as

experimentation

The PROCESS Learning Spiral

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By 11/24, create a 1st draft / worst map of a revised

protocol that reflects what we have learned to

date.

That it will be rough AND informative

AND be a step toward 11/30

due date.

Map completed!

“That this is doable ”

That a visual map is helpful

That this needs to be formalized. That we need

broad agreement on it.

Reframe “missteps” as experimentation

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• Change idea

Assumption: Email alone ensures understanding & execution

Assumption: Email is a part of ensuring understanding & execution

Our Pattern

• Staff meeting discussion

Intentional practice = Intentional learning

• Delay

• Expectation Email

• Guideline

• (Frustration)

• Evaluation

Our Latest Approach

• Change idea

• Expectation Email

• Guideline

• Adjust / Follow up

• Immediate evaluation

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Good processes produce important outcomes

Good processes produce important outcomes

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Good processes produce important outcomes

Intentional practice = Intentional learning

Good processes produce important

outcomes

Reframe “missteps” as

experimentation

The PROCESS Learning Spiral

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Our "Learning Edge"

5 Steps of Process Analysis

Bonus: Don’t skip the

process analysis steps

PROCESS STRATEGY

Virtual Storyboard

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Toyota Kata Process Analysis Steps HCSWM Example

1. What is the task unit? How much time do we have to complete it?

Having the conversation re: current statin. Discontinuing it or documenting reason why it will remain active in 2 weeks.

2. What are the typical patterns of work? (Draw it) How is the process currently operating (process measures)

See process map * 0 clients on statins (payer=HCSWM) * All clients have supportive documentation (payer=client)

3. Do we have any machine constraints? (Data) Phone call time with pharmacy

4. How many people are necessary if the process were stable?

Appropriate RN caseloads Good=10 Excellent=13

5. How is the process performing over time (Outcome measures)

Visual Management

Meet 2016 budget for non-formulary medication cost - $2.00 per patient day Reduce pill burden and side effects of unnecessary medications by DCing statins

PROCESS Learning Spiral

STRATEGY Learning Spiral

Intentional process = Intentional learning

Good processes produce important

outcomes

Storyboards are most effective when linked to

strategic priorities.

Strategic priorities must be focused & formally expressed.

Improvement efforts cannot

be separate from

management.

Reframe “missteps” as

experimentation

As we practice the Improvement & Coaching Kata, our knowledge deepens and our self-efficacy grows.

TAKE AWAY: