Pattie Skriba

VP - Business Excellence

to High Reliability

February 2018

RELIABILITY

The ability to sustain high performance during complexity, uncertainty, and the unexpected.

2

1.Giving the same result on successive trials

2.The ability to be trusted or relied upon for

accuracy, performance, etc.

3.The ability to consistently perform as intended

or required on demand and without

degradation or failure

HIGH RELIABILITY

The Business Dictionary

Being Counted On for Repeated Excellence

3

What Does Baldrige Say About High Reliability?

Leadership

Strategy

Customers Operations

Workforce

RESULTS

Measurement, Analysis, Knowledge Management

Integration

4

Key Cultural Attributes of High Reliable OrganizationsAligned with Baldrige Core Values & Concepts

1. Preoccupation with failure

2. Sensitivity to operations

3. Reluctance to simplify

4. Commitment to resilience

5. Deference to expertise

▪ Managing risk

▪ Systems perspective

▪ Management by fact

▪ Organizational learning & agility

▪ Valuing people

What Does Baldrige Say About High Reliability?HOW Do You

• Create an environment for long term success, achievement of your mission (Category 1)

• Ensure achievement of strategic objectives (Category 2)

• Sustain the key outcomes of your action plans (Category 2)

• Retain patients/customers (Category 3)

• Retain new hires (Category 5)

• Reduce variability and ensure processes meet customer requirements (Category 6)

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AND

An organization can’t achieve repeatable excellence

without integrating processes deeply into the culture

Category 7: Results

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✓ High performance levels

✓ SUSTAINED, beneficial trends

✓ Top performing comparisons

✓ Measures what’s important

High Reliability: A Non-Negotiable▪ Publically Reported Health Outcomes: ‘0 Defects’

Required. 99% = the new ‘fail’

▪ Aviation: Do you want the processes your pilot uses to be reliable?

▪ Employee Retention: What does it cost your organization when your hiring/retention processes aren’t reliable?

▪ Customer Retention: What’s the cost of losing ONE customer to your business?

▪ Product or Service: Are you happy with your cell phone service reliability?

▪ Education: 62% of high school seniors read at or below grade level; 74% below grade level in math (2014)

▪ Hospital Errors: 3rd Leading Cause of Death in U.S

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Betty’s Story

9

High Reliability Doesn’t ‘Just Happen’

Creating a Culture of Performance Improvement

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GSAM’s Ongoing Journey to High Reliability

Clinical &

Service

Excellence

Process-

Honoring

Culture

(Baldrige)

Broader

Deployment

of

PI Approach

Zero Harm by 2020

Value (LEAN)

Science of

Safety

2004 2006 2011 2013 2015High

Reliability

Units

Organizational

Transformation

Begins

Evidence-

Based

Management

Practices

2017

Engaging

Patients &

Families

Cycles of Improvement

“Moving from Good to Great”

DNV and ISO

ISO 2015

Adoption of A3

Culture Creation Begins with Leadership

• Old Chinese proverb:

“If we don’t change our direction, we’re liable to end up where we’re headed.”

• Transformational Leaders can change the direction of an organization

• Our success depends on Leadership’s ability to create cultures of high performance and reliability

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The GSAM Leadership System

1

Understand

Stakeholder Requirements

Accountability

for Results

PatientCommunity

Suppliers

Partners

Physicians

Volunteers

Associates

Families

Mission

Values

Philosophy

Integrity

Passion

Caring

Perform to PlanDevelop, Reward

& Recognize

Learn, Improve

& Innovate

Set Direction

Establish Goals

Organize,

Plan & Align

#1 Anchor High Performance in the Vision & Direction of the Organization

To provide an exceptional patient experience, marked by superior

health outcomes, and value

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0 Harm by 2020

#2 Systematically Enroll the Workforce in the VisionThe heart of change is the emotions. (Kotter)

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Apathy: Neither for nor against. No interest or energy.

Non-Compliance: Does not see the benefits and will not do what’s expected. Undermines through resistance and inaction.

Grudging Compliance: Does not see the benefits; does not want to lose her job.

Formal Compliance: See the benefits. Does what’s expected, no more.

Genuine Compliance: Does everything expected; Follows the ‘letter of the law.’

Ownership & Commitment: Wants it. Owns it. Passionate. Will make it happen. Will do whatever it takes. Inspires and enrolls others through actions & words.

“

Context Is Decisive

Why Improve? Why Change?

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“One of the most under-appreciated roles of the effective leader is the creation of context for their team or organization.” Last Word On Power, Tracy Goss

The ACTION of Leadership Is Communication

Associate Engagement

Patient Satisfaction

Physician Engagement

GrowthFunding

Our Future

Health /Safety

Outcomes

A Balanced Commitment to Excellence

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Strategy Executive Team – Hospital Goals

Director Goals

Manager Goals

Frontline Goals

Supervisor Goals

#3 Intentional Cascading of Goals: A Context for Improvement

✓ Senior leaders own the goal setting process

✓ Target: minimally 75th%ile

✓ Stretch: top decile performance

✓ Goal achievement tied to performance

review which ties to raises $$

✓ Staff ‘see’ their impact

#4 Transparency:

Platform to Improve

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61 Days Since the Last Serious

Safety Event

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#5 Rigorous Use of Data at All Levels of the OrganizationAnalysis and Use of QUALITATIVE DATA

0%

5%

10%

15%

20%

25%

30%

Time w/Doc:Rushed, Short,

None

Courtesy of Doc Hospitalist,Partner:

Who? Why?

DocCommunication

Discharge Delays

% o

f C

om

pla

ints

Top 5 Physician-related ComplaintsDischarge Calls & Surveys:

Supplies in the

Critical Care

Unit

Nurse Satisfaction 2.77 on 5.0 scale

52% of labeling on cabinets/drawers is not accurate

24201612840

# of times a RN had to leave pt room to search (each dot is 1 shift)

Dotplot of Day Shift Observations

Means 3 nurses logged

having to leave room 8

times during their shift

Data You Can Only Get by Observing & Talking With People Who Do the Work#5 Rigorous Use of Data at All Levels of the Organization

Visual Management: Identifies Process Defects and Allows for Correction#5 Rigorous Use of Data at All Levels of the Organization

Surgical Registration:

Days Out

Monthly

Performance

Daily

Performance

Defects

Actions

to

Improve

Surgical Pre-Certs:

Days Out

Fully Deploy and Integrate a Performance Improvement and Sustainment System

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Box 1:Problem Statement

Box 4Root Cause Analysis

Box 7: Plan to Implement

Box 2:Current State

Box 5: Possible Solutions

Box 8: Confirmed State

Box 3:Target State

Box 6:Test Possible Solutions

Box 9:Learnings

PLAN

PLAN

PLAN

PLAN

PLAN

DO

DO

STUDY

ACT

GSAM’s Performance Improvement Approach: PDSA-A3

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Achieving Excellence Is HARD

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Sustaining Excellence Is HARDER

“Excellent organizations consistently do what mediocre organizations do occasionally.”

-- K & N Management

Tools That Enable Sustainment & High Reliability

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Observe & Coach CalendarVisual Management

ISO Process Audits

Standard Work

OFI Board

GSAM’s PI System: DeploymentTr

ansf

orm

atio

n &

Inn

ova

tio

n

Learn, Do, Coach, Mentor

24 month deployment

Value Streams

RIE

RIE

RIE

RIE

Leadership Development

A3 Thinking

Visual

Management

Leading in a

Lean

Environment

High Reliability Unit Training

Intro to A3

Thinking

Daily Im

pro

vemen

t

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Start the Shift Huddle: Managing for Daily Improvement

WINS….

What Yesterday Was Like?…

What We Need to Do Today to Have a ‘Good’ Day Today?

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0

20

40

60

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16

Unit 43 HRU Improvements

Improvements Goal

2016: 220+ Improvements

Engaging the Frontline in Safety & Improvement

Opportunity for ImprovementName: Date:

Issue:

Impact for patients and our unit:

How often does it happen?

Possible root causes:

WHY IS IT HAPPENING?

Respiratory Standard Work: Avoiding BIPAP Disconnect

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Keeping Patients Safe: Culture and Process Improvement

✓ Vision: “0 Harm by 2020”

✓ Leadership owned

✓ Leadership High Reliability training: 18 months

✓ HRUs: engaging the frontline in safety

✓ Defined Be Safe Behaviors; audits

✓ Stories

✓ Rigorous use of our PI approach

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11

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2

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1

3

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0.25

Baseline 1.25

0.52

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

0

1

2

3

4

5

6

7

8

Seri

ou

s S

afet

y Ev

ent

Rat

e

Co

un

t o

f Se

rio

us

Safe

ty E

ven

ts

Advocate Good Samaritan Serious Safety Event Rate (SSER)Rolling 12-month rate per 10,000 APDJanuary 2012 through December 2017

58.4% Decrease in Serious Safety Events

Longest Stretch With No Death or Permanent Harm: 15 months

Box 1:Problem

Statement

2011 Baseline 1.44

Vent Index

Too many patients unnecessarily on

ventilators causing distress to patients,

complications, deaths and avoidable

costs

✓ Cascaded goal

✓ A3 – Root Causes ID

✓ Standard Work

✓ Visual Management

✓ Rigorous use of data

✓ Leadership ‘pull’ – Lane Review

✓ Observe, Coach

Bottom Quartile Nationally

1.44

1.19

1.06

1.02

1.20

0.96

0.870.83

0.93

0.88

0.81 0.82 0.81

0.73

0.65

0.75

0.85

0.95

1.05

1.15

1.25

1.35

1.45

2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q4 2014 Q4 2015 Q4 2016 Q1 2017 Q2 2017

VEN

T R

ATI

O (

OB

SER

VED

/EX

PEC

TED

)

2011 – 2016

Source: APACHE

GSAM Vent Day Index

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Sustained Top Decile Performance

GO

OD

Hand Hygiene

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2Q2015 3Q2015 4Q2015 1Q2016 2Q2016 3Q2016 4Q2016 1Q2017 4Q2017

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“Try Harder”

+ Posters

1st Pass A3

Go

od

% C

om

pli

an

ce

Target: 90%

“True” Secret

Shoppers

89.3%

95%

48%

56%

✓ 2nd pass A3: group, data

✓ ID true root causes

✓ Standard Work

✓ Teach Standard Work

✓ Observe, Coach, & “Thank You”

✓ Leadership ‘pull’ – Daily Report out

80%

Continue: Observing

& Coaching &

Reporting Out

3rd pass A3

Closing Thought

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Thank You

Pattie Skriba, VP – Business Excellence

Pattie.skriba@advocatehealth.com

630-275-1495