Hello good afternoon. Welcome to today's HRO presentation. We are here with the sequel. They say the sequels are always better than the first part. I think, uh, all of it is good. Uh, when you join us on the call today, so we're gonna cover the learning system part. 2 today. My name is Victor Gonzales. I'll be your host. It's my pleasure to welcome you. Uh, we, uh, have a pack crowd today, so we're glad that you shared your time with us today.
If you've joined us before, this is all old hat for you, but we're gonna cover a couple of details, uh, about the Webex experience to make sure that you have, uh, the best, uh time with us today, and you have an opportunity to ask all of your questions and make sure that we answer all of your concerns. So, we want to be sure that, uh, you are aware that you can chat at any time during this conversation. In fact, Jeff is notorious for asking impromptu questions, to keep you on your toes and make sure you, you know, where that chat feature is. So, you're gonna use it often today we're going to send you some information as well. But, if you don't see it, uh, it, you're going to click on that little bubble to the bottom right hand corner of your screen. It will add it to your participant panel and, uh, you can adjust the size by floating around the edges with your mouse. Uh, to make a little bit easier to read and follow along there. So be sure to use that often. We certainly will. We also want you to know that you can join the conversation verbally at the appropriate time. Raise your hand. That hand is an icon that you will see to the right of your name. When you click on it. We'll find a, um, a convenient time to. I mute your line and you can join the conversation verbally. We definitely love for you to participate and join the conversation.
All right, well, we're back with safe and reliable our friends. Um, Dr. Jeff Dunaway uh, I am going to do my best to try to give you a brief introduction, uh, about their accolades. So, give me 3rd. Let me make sure I pull up my notes here and we'll go ahead and get started. So, bear with me, we had a little blip before we started. And I've got some things to shut down, but here we go.
So, you know, if you've joined us before, you're familiar with, uh, Dr. Kennerly a physician leader who has focused half of his 40 year career on improving the quality and safety of patient care. After medical school and residency, he was a full time faculty member in internal medicine at University of Texas, Southwestern Medical Center where he taught students in residents did basic science research and implemented patient centered disease management program for parklands 20,000. Patients with asthma, seeing both the power and failings of health care led to executive work at the bailer health care system where he developed patient's safety program across its 10 hospitals and many outpatient clinics, he developed and published methods to measure patient injury. And led other improvements as bally's chief quality officer. After leaving executive work Dr Kennerly has spent the last 6 years sharing lessons, learned with consulting clients, committed to delivering care and we all would want for our own families.
Delivering care that we would all want for our own families. He's published 50 papers, or book chapters received a variety of national awards and grandson helped found 2 patients centered, nonprofit organizations. And just to the right, we have Jeff Dunaway. Jeff joined safe and reliable in March of 2020, and has a primary focus of supporting a variety of healthcare organizations on their journey to high reliability. He has practiced as a registered nurse for 2007 years with the last decade dedicated to the high reliability and continuous improvement he holds a black belt and lean 6 Sigma from Villanova University and a certification in change management. Jeff is passionate about helping healthcare at both a national and local level through the empowerment of frontline workers and training of executives. It brings a servant leadership model to all of his engagements and has a deep understanding that culture.
Each strategy for lunch every time I'm gonna repeat that I love it deep. He's got a deep understanding that culture each strategy for lunch every time. Hopefully you had a bite and you're not thinking about lunch, but you're thinking about the great information that we're going to share with you, gentlemen. Welcome to the call. We appreciate you having, uh, uh, having you on today. And you're on mute if you're speaking and I can help on mute here you got it. Thank you. It's really a pleasure to be back with you again. And, uh, we love, uh, our monthly get together on the NQIC program and really appreciate, uh, sort of convening this group.
Because, uh, again, what you folks are doing out in the, uh, the quote unquote, real world is really important. And so, our job is to help support you with information that can help you to be delivering the care that I know.
You want to be, uh, delivering for your patients. So, uh, we're going to be covering the 2nd, part of the learning system, and we started on that last month. So let's move on to the next slide victor.
You've seen this before this is really the journey that we're on will be you've seen this illustration before but because the concepts are really foundational, we'll review it just briefly at the top, we have to appreciate the inherent complexity when systems and humans interact and pursuit of failure free operations over time and the support of culture is essential when we're and we're not on a linear path and that's why we have the illustration in the right center there. That's really there's no expertise expectation of perfection, but we always want to be mindful of the system team and individual levels, and are continuously becoming more reliable as a result of improvement work. And so we offer in the lower left the framework for high reliability. We'll touch more on that in a 2nd, as a model for understanding current, the current state, and the ways of thinking about various domains and topics that will help all of us to do better in our work as time goes on next slide.
So, again, you've seen this before, but I'll just and we've worked through a number of these topics, and we're focusing now on the lower left in the learning system and that system in involves trying to, to be accomplishing a number of things. We've come a long way. And completed many parts of the learning of the learning system domains, but we're going to cover a few more today. 1 of the things that's important in the culture. Domain has been, for example, having healthy work systems and speaking up being psychologically safe and helping with people to feel good about the work they do because I haven't knows we are in a tough time and have a lot of turnover. And so, as a result, we really recognize that a lot of these things really have profound impacts on the work that we do every day. Next slide. So, again, the key, uh, that we talked some about in session, 1 was focusing on the learning part of the 3 parts of the learning system, which, uh. Use the organizational priorities as a lens to view performance data in order to identify what issues might apply them to improvement efforts. And based on these areas of focus, we need to develop ideas about what we could be doing to improve the, how of improving the targeted outcomes that we'd like to do better on.
We introduce the concept of energy and motivation before. But we'll spend more time on that, during this learning system, and with energy and ideas, we can then employ any of a variety of improvement methods to incrementally improve. Today will focus on the methods we introduced last time on the how again, the, how to improve processes and culture and, uh, we'll also talk about how to think not only about these local projects,but also, that happened in units and departments, but also, on how to plan and implement projects that we hope will take place in the spreading to other units. So that every part of your healthcare system is doing better.
Excellent so just, uh, again a little a recap of, uh, of those, uh, the activities in the beginning before we hand this off to, uh, my colleagues, uh, we, uh, we want to always be reviewing data for concerning outcomes and look for things that, uh, you know, look like, they need some attention.
They might be general data or specific events walking. The floor is really important. I mean, you know, doing Gamba walks or other kinds of, uh, formal approaches is very helpful to see where the work happens and to see what's working.
Well, and what isn't 1 of the other things to be thinking about is when there are issues in a given part of the organization think about looking at other parts of it to see if things are working better. There is my wife says she, uh. Always start chopping in your own closet because there may be some really good things there. Estimate the difficulty of the local learning project, just because there's a problem it doesn't mean that necessarily it demands your attention. We all have limited bandwidth. And so we can't fix everything. So really try to do some evaluation of how hard this might be to do a local learning project and to be thinking about the priorities and the, uh, the units readiness using the concept that we'll talk more about today called ad car. It's a framework to really be considering how we can be a deciding on how to implement and creating the changes that we want.
And another topic of the we'll talk more about is consider ways to recover the time. That creates the bandwidth for your team members using what we call a stop doing approach and we'll talk more about that later. Because most of us, our plates are pretty darn full, and this is just a way to be able to to get us some of our time back. So, I think, uh, we'll, uh, we'll move. Uh, we'll move on now, um, to do you want to cover this 1 now? Thanks. Thanks, Don, I appreciate it. Thanks for setting up that foundation for this. Uh, we can go to the next slide. Uh, Victor um. For this presentation, and and just to give you, uh, uh, kind of take it back up to a 100,000 foot view, um, every, every month, um. This program brings you high reliability training with, uh. A safe and reliable and TMF and partnership and and the focus of each month is derived from the, the framework that you saw on on slide 3. we have 4 major components, uh, to the high reliability framework. Uh, it's leadership, culture, knowledge and data, and last month in this month, we're on the learning system. Uh, you often see that that we can't cover the entire, uh, learning system or parts of any 1 domain and in 1 session, uh, 11 hour session. And that's where it becomes very important to, to try to, to come on a monthly basis. You can always refer back to. To the recordings and TMS, uh, a website, but if you can come as often as you can, these build on each other. So so, Donna set us up perfectly uh, we. Covered, uh, uh, last month, the learning system at the learn, and we began to get into the improved, uh, sections and this month we're going to finish, uh, the improve and and get into the implement. So so, with all that, in in context, um, human factor principles, they, they really come into play very heavily in the learning system domain. We can't simply design good processes and and then just stop there. Uh, we, we don't have robots who are using these processes. We have to build in simple application and standardization in the processes and practices, uh, the use of forcing functions constraints and consensus. People are are prone to errors. And we will never stop harm by solely, depending on people we, we really must factor in the favorability of humans and go further. Uh, we must engage the, the energy and the ideas of our staff and and drive them forward into action, but factor in the, the characteristics that do lead to error. Uh, I want to put a big exclamation point on on that for you.
Let's look at the next slide. So so think about something important that you've changed in your life. These steps were almost certainly the way that you got there. It's been used by many organizations and is similar to the well validated psychological stages of change model. That was 1st developed to address addiction. It works just as well for positive goals. Uh, we begin with an awareness that change is needed. And we follow with a strong desire for change so, whatever it is that you're trying to accomplish in your facilities right now. It's easy to overlook, uh, to oversimplify. Um, and 1 of the high reliability principles that we teach is reluctance to simplify. You can't simply give your staff, uh, the best practice and tell them to go and do it and expect that it's going to work. You have to draw awareness around the, the need for the change and and create a desire.
That desire for change can either be from internal or an external motivation and often that we, as leaders have to provide that external motivation. Knowledge and ability are key steps in the change model and must be assessed along the way. And then finally we reinforce, uh, as as needed to assure sustainability of the change. Uh, this is. The, the, uh, ad car, uh, model for change um, it's not our intention to, to make you experts today. But, but rather in the learning system to acknowledge that it's not simply process improvement, but also change management that really has to be thought of as you go forward. Um, trying to make these changes. Let's go to the next slide and although the lean improvement methodology is widespread and and it's pretty well understood by many. It's not the only improvement methodology that's in use today. But it does do the lion's share of the work from my experience. And and Don, I believe probably your yours as well. We find a lot of organizations that that. That no pun intended lean in to lean um, uh. As a primary methodology for change that's going to interrupt you just yes, yes. Seeing is the ad per slide. Can go back 1 right here. Okay. Hmm.
Are you wanting to be on the lean side? Oh, I thought we were on the Winslow. I'm sorry. No, I think we're on the ICR side. Excuse me?
Mm, hmm. Okay. Can you go forward Victor a couple? There we go. Okay. I'm sorry, Victor up. Uh, I didn't queue you correctly.
hank you, Donna. You bet you. All right so so again. Many organizations do use lean as a primary, uh, improvement methodology, but. So why, if we're gonna talk about lean? Why did we bring up avatar? Why did we bring up, uh, change management? So. Change management is truly the people side of the equation and and lean is the process. It's like peanut butter and jelly. It's really hard to have 1 without the other. Um, and. I'd say for a while, but when we look at at culture as a primary, uh, component of of the framework for high reliability, we, we do lean heavily on change management.
People have to understand, uh, the the need for change the why? Behind it? We have to understand their their ability to change their readiness for change. Um, and we measure those components often. Uh, and then when we get into the learning side, we do lean heavily own, own lean and, uh, 6 Sigma and, uh. Teach you a many, many different, um. Improvement methodologies, um, in the chat, if you could, um. Maybe just put in the primary methodology that that you use, whether it's, um, AIM, or or lean or, uh, 6 Sigma. Um, some, some might just use a simple, uh, tool. Uh, but I'd love to see that in the chat from you trying to Prime, the pump here for engagement. So so, uh, so work with me and and tell me what you're using in the chat. Uh, let's go ahead and roll on to the next slide. And, uh, you confirm Yep, I think we're on the same 1. so, in the later steps of of the learning system, uh. We will have have tested our hypothesis in in the earliest steps. Yes. Same thing. Thank you so much Sandra and Stephanie.
So so when we, we get into the learning part of the, the learning system, and then the, the improvement we use PDS. I heavily. We understand the root causes of our problems. Uh, thank you. Y'all are doing great, uh, giving me this back. Uh, that is 1 of the fundamental tools, and methodologies that.
That use, so we understand our root calls is then we, we form hypothesis around there and we have to test those hypothesis and this is exactly what we use to test and improve. Our processes is same. Same thing. So. Again, in the later, uh, steps, we, we want to start to spread this so let's pretend that we have now, uh, covered, uh, steps 1, small test of change step 2 evidence of improvement step 3 implement and we want to scale this. And and we want to spread this, uh, well, it's, it's easy to spread too fast. And and you can actually, um. Calls a lot of harm by spreading too fast. If your initial problem was. Uh, within a 1 unit, then you only have to spread it to 1 unit. But if if. Other units in the hospital, or all affected by the same problem and you focused on 1 unit to run your. Then you probably want to spread to 1 other unit. 1st, uh, and and the. Rule of thumb is to just continue to double, um, the, the size of the spread. So 24816untilyou finally have hit everybody that was affected by the original problem. If you only test it on 1 unit, and you try to suddenly spread to 30 units. Uh, you're, you're gonna find points of failure, um, because you probably haven't got out in front of that spread fast enough with your change management and your communication plan. Uh, Which is is vital, so, so when we're very transparent about learning and improvement, uh, with our insights, we can really examine all the areas and then we can start to apply the learning and improvement and in all of these areas uh, thank you all so much.
If there's any questions, please don't hesitate, uh, Don, and I really love it. When we hear back from you feel free to, to raise your hand, put it in the chat. We'd love to answer any specific questions that you have.
So, go ahead Don. Yeah, we're really and I wanted to just echo what, uh, what Jeff has said, thanks so much for putting some things into the chat and and hope, uh, in response to jeff's question. But, uh, you know, we, I think is, uh, this, uh, has gone along. This has become more conversational over the months. And, and we really appreciate that. And we, uh, so if you have thoughts, please, uh, put them in or questions. So we'd love to hear from. Exactly, and and I can talk all day on this section, although, uh, uh. Love and respect every piece of the framework, the learning system with my, um. Lean 6 Sigma background is I could just answer all your questions and talk to you all day long about about this stuff. So let's see.
Let's look at the the next slide victor. So so again, in the later learning systems, we, we've. Tested, um, you know, our hypothesis and 1 more very important consideration in this work is to make sure that all the stakeholders, uh, feel heard, and that they have an opportunity for for improvement. And that's 1 of the major reasons why we don't just spread from 1 unit to 30 units uh, like a shotgun approach. You have to go slow with your spread and just let it build some momentum. And and the stakeholders really need to feel heard this creates greater buy in and and potential for adoption and sustainability. If you take this approach to it. And remember that that we need to know what we're shooting for what our end goal is, uh, with a future state that's limited by time and resources. We're not striving for perfection, but rather for incremental improvement. Um, and and that's an important consideration early on. Uh, we want to, uh. Improve falls in our patients. Well, even though our ideal state would be to eliminate falls, we have to set. Uh, realistic goals, smart goals, specific, measurable, attainable, realistic and and timely. So, so just set yourself up for, for success by a setting a goal that that is realistic and is attainable. Uh, if your leadership says, you know, by. Over the next 2 quarters, we need a 5% improvement and and. Whatever metric, uh, just understand that, as you walk through the learning and start to develop your hypothesis and your, uh. Keep keep those variables in mind that you don't have all the money in the world to solve this and you don't have all the time in the world to solve it that you may just have to think about incremental improvement and not. Um. Not caring world hunger, so. 1 of our colleagues, uh, Donna novella is with us, uh, today's with Don, and I, it's going to partner with us in the next few slides to, uh, to carry us forward. So, Donna, if you're ready and Victor, you can go to the next slide.
Are you with this done? Okay. Thank you, thank you. You got my sign language there to and I'm mute me. Thank you, Jeff. And John. So the next phase that we're going to talk about here is. How do we know that these changes that we made are actually resulting in improvement? Well, you know, and how do we know that those improvements are going to be sustained over time? And the way to do that is data right is to measure and have data. So, you might remember from 1 of the previous presentations that it was discussed in great detail in the law in the knowledge and data domain of the framework for high reliability. But, um, we're just going to review that here a little bit.
And I think 1 of the important things to remember is that you need to understand what type of data you're collecting. So, is it process versus outcome? How much data how to make it simple and easy to display and analyze and understand, because you can do all this measuring but if you're putting up these crazy complicated charts that no, 1 can read, it's not going to help you at all.
So, again, simplicity is the rule here, um, data transparency. I think Don alluded to this earlier, um, is key and it's it's key to engagement and it's the key to learning. So committing to share your data, regardless of what it's showing, as Jeff said, we're not going to be perfect out of the gate, make it visually appearing, visually appealing, share it with everyone on the team. Put it on the bathroom was, like, I used to when I was a manager, I used to put stuff up in the bathroom, because you have a captive audience in there, but send an emails talk about it during huddles staff meetings leaders.
When you're rounding, engage the staff and data discussions, like, make it your unit vernacular to talk about data, this will get the team invested in the project that you're working on, or the projects that you're working on. You can go to the next slide. Please, Don, do you have anything to add or Jeff to that? Oh, that's good. Thank you. Don. Okay all right so when you're collecting and displaying data, you must also understand that. Sometimes data doesn't need action. So when we're in this, like, sort of improvement mindset, you see a little blip and you're like, oh, my God. All the work that I just put in is, you know, something just happened remember we're going to look at data as it trends over time. There are things called special circumstances variation where you might get a little blip. Don't panic. Just understand what's happening. And as a general rule of thumb, you want to put your action and your energy into trends and shifts that happened over time again, you're gonna see some variation. It's not gonna be perfect try to differentiate between those special circumstances variations. And what's a change in the trend line? Um, control charts are a good way to display data that trend over time.
You can also use data displays, like, days since last X you can fill in the blank. The message here is to be. Sure, as leaders, you understand what your data is telling you and what it means over time. Is it telling you to take action? Is it telling you, you need to change up what you're doing or is it saying you're sustaining it? Keep going do what you're doing this is working. Let's go to the next slide. Please. So, as as Don talked about in the opening and I think Jeff also talked about this. It's important to remember that higher liability and the framework that we're talking about here is completely Co, dependent and intertwined. It's not linear. So as you move through improvement projects, you're going to need to call up different aspects of the framework, and each part of this work.
Um, we talked about several pieces of that today, but right now I just want to refocus us on the learning system on this slide. You see, you see that there's lots of things to consider when you're implementing a process improvement project. Um, 1 of the most important steps is the 1st step, which is the scope and Jeff talked about that, keeping the scope of the project small and making sure you're doing it, right?
Before you spread it and making sure it's like, mature enough to spread is really important because you do not want to derail hard work by this anxiety around making sure everyone's doing it. Refine it get it to work.
Small, and then think about expanding it you have to think about what's the and our interventions. Are we really spinning our wheels or are we getting results? And is it worth? It is the result we're getting worth our effort.
What is the readiness of the units that you want to spread to? And how can you match up units so that they collaborate? Well, and don't hinder spread of the project. These are all things that need to be considered. Um, again, we talked about just keeping it a manageable size to learn and then scale, as as it's ready. And I think the other important thing that I want to mention here is that, you know, celebrate little successes, small ones along the way it will engage your team. It'll create enthusiasm. If you're not going to celebrate until you're at, like, 0, you're never going to celebrate. So, engage your team by keeping people, like, you know, celebrating that. There's a little win. That's really gonna make a big difference in engagement. So this is Jeff talked about this as well human factors leveraging human factors. Simple standardized design is the best approach, simple data, simple data collection. Um, I think 1 of the things that I want to emphasize here is that and that it's often under appreciated is, like, supportive workspace is really important. So you can design like this perfect process, but if your workspace puts up barriers, it's not going to work. Right? You have to make sure yeah. I think we might need to tell Victor to roll to the next slide. I'm sorry roll to the next slide. Oh, no, go back 1. I think we're missing 1. Oh, that's funny. This, like, is not in this deck that Victor has. That's okay, I can just shut our eyes and bonus material. Yes, material. So, um, so we're just talking about what are the ways that human factors are important in your improvement projects. And and as I was saying that, the work environment and making sure that your workflow design matches the environment, your environment is supportive of it is very important. Because your design will not be able to be executed if the work environment doesn't allow it to happen easily. Right? So now we're gonna go onto the, um. Implementation do you have the implementation slide Victor? Not this 1 it's, uh. I think we're missing a couple of slides. Can you go back 1? Slide? Uh, we're missing a couple of slides. Okay. We'll just go onto this last 1 this implementate, the implementation slide you have up here. So when people are accountable to participate in improvement, work and improvements are designed with human factors in mind. Um, and that the changes have been robustly tested in real world environments.
There's greater likelihood that your change is going to have a meaningful effect on the system. Overall. It's easy to think that if you've gotten to this point, right you've, you've designed, um, you've tested that like, you're, you're at the finish line. Well, actually, the hardest part is, um, is implementation and sustainability. So, um, making it making it easier to do. I'm sorry. Uh, making it the right combination of change management, making sure you've included the voice of the customer along the way we'll make implementation and sustainability more viable. So now the part comes, we have to think about making this into more standard work. How do you do that? You have to document your new process, adjust your policy. So that it mirrors the practice, train and educate everyone in the process. Add it to your orientation. You have to make it not a new way, but just the way it happens. Now. Now, it becomes embedded in how you do your work building accountability may mean looping in your HR department. It also includes things like, for sustainability, designing ways to track the data over time audit, which I hate that word. But sometimes you have to audit, um, make sure that you don't regress. Now, what I'm going to say here as well is again, there is natural drift that happens with design with improvement work.
So that's when you use those trend lines to, like, identify who drift is happening, we need to kind of bring everybody back to what the processes why we're doing it. You may need to do that on occasion. Um, there's, um, so that that's important. Um, I'm gonna hand it back over to John now to continue walking us through this next piece of, uh, of the presentation. Thank you. Great okay. Super next slide. Please. Okay so you've got something that's working and wanted to go different out to the rest of the organization and spread that success. And I think 1 of the things that I totally that I totally agree with, as far as Jeff has mentioned, is that the organic approach of 1 unit being, then the mentor for the 2nd unit where you do this and rolling it out there and then having those 2 units, each take 2 more that gets you to 4. that's that is a wonderful approach to doing things and often works very well.
The challenge is that in many organizations, the leaders are in such a hurry that they really want things to happen quickly. And so the other approach is to be piloting something and then kind of going big. And so I'm going to talk a little bit about some of the issues associated with, uh, with this in the next few slides. So, uh, again to do's and don'ts on this, uh, you know, there there are many. This is sort of a review of the previous slide, but here, success really depends on evaluating readiness because if a units aren't ready, there's no point in getting started there. Um, and you're going to be putting a lot of energy in and when you're going to a unit saying, hey, this is going to happen here creating good energy is essential in order to have them add this because this is an add to the things they have to do every day and, and as a result of creating sort of enthusiasm and hope for a good outcome is very important.
And very importantly, as well is, is to recognize that, in fact, when you are implementing the action part of this, there's a natural adjustment part of this as well. We have to be able to recognize that each unit will not be necessarily responding to the, uh, to the new change as readily as the other 1. so we need to be attentive to that next slide. Done yeah, so we've had a little, uh, thread going in the, in the chat here. Uh, Seth Gregory is trying to change a lot of things and I was asking them if there's any specific barriers that he was facing that, maybe we could, uh. You know, just just drive home form or give some insight too. And, uh, 1 of the things that he's facing is just generalized, strong resistance to change. Um, he's trying to find a mutual purpose and and give them a what's in it for me. But he said overall the culture just really doesn't see the benefit in all the extra work. Uh, do you have any advice? Well, that's a really challenging 1. I, you know, I guess, um, 2 things 1 is, um. Trying to make whatever. You are implementing, um. Manageable so if we're asking them to be doing something really big, that's harder uh, you can often take an improvement project and narrow the scope a little bit and it becomes much easier. And so there might be less resistance. But I agree with you that the, uh, 1 of the things that we we have to be doing is not only seeing the what's in it for me. But what's in it for the patient and trying to have stories that help to say this is why this is important and to appeal to the groups, professionalism and aspirations. I mean, heck, this is why we went into care, right. Is to make things better for patients.
Now, we recognize that we can't do everything, and so, as a result, um, we, we have to be focused and oftentimes leaders aren't as focused on how, uh, you know, hard. Some of these things are and they'll just, you know, zoom them out there. And make it tough on people and so 1 of the things that actually, um, I might share at this point, I think the next slide, if I'm not mistaken, um, Victor is to stop doing content 1 of the things that I encountered when I was doing, um, leadership work was that, um, we often, um, you know, people were incredibly busy at the bottom left. You say, you know, we always talk about it as your plateful. But that looks to me like a pretty full plate and there's no room for doing things. And so what we have to really be thinking about is having an approach that we use to take things off of people's plates and say, well, gosh, you know, what, what could that be?
Well, this top line talks about the, the concept of X innovation, if they're old things that people aren't doing very much of anymore. Let's get rid of them, you know, or if there are 6 ways to do it. But and some people use, most of the people use 1 or 2 then let's focus on that and make it easier. So, anything that we can do to make it easier is is really important. And I think what's key is in this box here that says remove or stop things that create waste or low value. That's part of the lean process. Right. Jeff.
I mean, you know, again, part of that is to get rid of waste, but 1 of the things that I want to briefly talk about here is something that we did. That's really based on Jim Collins. Who's a really a business consultant for many years and he has a, he suggests what's called to stop doing a list that is taking things off of people's plates and a program. Like, this actually starts with executive leaders and their direct reports. Well, how does this work? Every couple of months the leaders had their direct reports, propose 2 or 3 low value things that they'd like to stop doing and, uh, they, uh, and to get or delegate and, we started this at Baylor and the program identified lots of low value work. Huge time wasters for people and I almost always said, yes to the things they propose most of the time I didn't recognize how much time they were spending on these things and clearly that wasn't as important as other things that I was asking them to do as part of their work.
So we, we really were able over the years to, um, to get things off of their plates. And, um, we started lots of new projects and did so without expanding our staff over a 3 year, period, despite huge national requirements. If you will. And by doing this, the staff also really appreciates that you're sensitive.
To their needs, um, that in fact, you want to free them up to do the things that are important. And that's part of the leader's job is to create a focus and bandwidth for your team. And as a result of doing this, our group in quality and safety across the healthcare system, had the highest engagement scores in the organization because they felt like we were listening. So, I really would encourage something like this for your organization and if you're interested, we can talk more about this another time. Well, let's move on Victor. Can we go to the next slide? Uh, so, you know, again, in terms of thinking about spread, uh, team effort is is critical here, you know, having a spread team, uh, that if you're going to be going big, that is going from 1 unit to many have a team that's going to be doing that and, um, and have a little infrastructure to support it have a group that meets and says, hey, How's it going and having a champion for, you know, for the whole project so that those folks can, uh, walk around the different units and thank people for doing this recognize the adoption and, uh, and really, um, and then approving customization if that needs to happen, um, and, uh, check the data to see how that's going. Uh, again, the thing that you saw before that Donna was sharing was this long line, where not much is actually the outcomes aren't improving. If the outcomes aren't improving, we need to rethink what's going on. Maybe it's not working. Maybe it wasn't the right thing.
So, uh, be comfortable with having a team that can look at this and make some decisions about is this working well enough as opposed to just, you know, beating on folks to sort of, uh, do more and more and more work, harder and harder and harder. Excellent. So this slide is talking about communicating and really sort of the, the what why and how of news in progress uh, it's really important to say is to communicate broadly. So the, where a question there is everywhere never leave out a relevant group or person is better to do too much communicating, then too little, keep people aware of what's going on in this, uh, this project that you're trying to spread. So, that people have a good sense of where it's going again. Not trying to make people who are having a harder time, feel like they're behind, but just keeping them aware of of what's going on because communication builds energy and Jack. Well, who was the head of for many way. Many years said that his approach when he was doing something really important, was to find 6 ways to communicate a concept and doing it 6 times. And, uh, and when you do that, it's clear with the leaders focus and goals are and that those are going to be things that they're gonna be really interested in and helping to support. So, be sure to be, uh, adequately communicating. Next slide. So, uh, with the, I think we're, we're doing okay on time. And so, I think 1 of the things where we might do is just, uh, have a little bit of a group activity here, um, to be at, uh, looking at what are the barriers to succeed to success. Uh, you know, and the question we'll ask is what gets in the way of success with your local improvement projects. Um, and is there any difference between having a big, uh, multi unit, pro project, or just, uh, individual improvement projects? So, 1 of the things that, um, I'd like to suggest. Um, what does. Um, but actually. Silent here for a minute or so and ask you to put some things into the chat and then we're going to use that to sort of build some more conversation. Folks, this is the interactive part of the day here. We'd really appreciate. Oh, great. Excellent. That was that was actually made, uh, um. Okay, no, but I see Seth is saying we're preparing for accreditation and most of my efforts are seeing is only needed for accreditation and not as valuable. Well, you know, that is huge. Um, and, um, and I think it's important, uh, most of the accreditation objectives are, uh, well intended, uh, but sometimes they get pretty detail oriented and oftentimes the creditors are looking to find ways. You're not doing it. So well, 1 of the things that you may have a have to overcome, is that in some organizations, there is, uh, some people in the quality and safety arena, and basically say, listen, we just want to pass you know, this is just this is just something we have to do, and then we get over it, but I really, um, you know, if if it's all just join commissions, uh, objective or, uh, you know, that's that's not enough. Um, because, uh, really putting this in the framework of WH. Wh, what's good for the patient? Is there something here that we're working on? It's gonna be good for the patient and, uh, that's key to try to get that, uh, uh, surfaced. Done several more things coming into the, to the chat. Um, Irene said, no 1 wants to help. They. They say they're too busy. Uh, Nikki said people say that's that's not my job or department and and they don't want to have anything to do with it. Um, but things have been done incorrectly for a long periods of time. There's a reluctance to see that need to do things correctly. Um, people are unable to see the value. Um, they're finding it very difficult to hardwire improvements at the front line level. Yeah, that's hard. And if if if the many of those are these are very realistic and not infrequent things. So the things you're putting up, you folks are putting up here are not uncommon. I mean, this is not just a, an issue for your particular spot. Um, I think really, um, the, uh. The notion of of in a sense, the momentum of the past. Is a big deal and if the momentum of the past is doing things in a way, that's not really what's in the best or better interest of patience. Um, again, hoping to get people's aspirations up a little higher again saying, you know, hey, in the Golden rule of health care, only provide the carrier. You'd like to get yourself. And, um, and so really trying to always frame this as much as possible and what's good for the patients busy. Absolutely. Um, now I think that's that's where, uh, I talked a little bit about having a, um, stop doing program. Uh, not that that means people will suddenly, uh, you know, be having lots of time for, uh, you know, but it means they have time to do these important improvement things. And I think it's also important for the leaders to choose a few things to focus on. And not try to do too much. And so, I think the 1 of the things to take some courage on, the part of those who are in improvement is to, uh, again, select, what's most important to talk to the leadership about the idea that we have to be focused. We can't do everything, um, because, uh, in the pursuit of perfection, we wind up losing track of what's good. And I think the hardwiring question is a really good 1, too. Um, if there is, you know, if in a sense, there's really, you know, using the ad car kind of thinking, if the momentum is really to do nothing, that is no change. We're okay. We're not really wanting to do anything then that kind of thing kind of requires a, a leadership um. Conversation, I mean, whether they, it's a, and by that, I mean, you know, at a town hall or something like that to say, you know, folks, let's talk about. Why we're not making progress and if, and if these are the kinds of things, then, um, you know, I realize it's a hard time, but let's, let's let's try to, you know, lean into this a bit. And if we can't do 5 things, let's do 1 thing. And go ahead. Yeah, Don, in the last few minutes, I think it may be a great opportunity for us to pivot and say, you know, some of what you're you're seeing are not the root causes of, of the lack of the ability to improvement. But rather the symptoms, and as we start moving into our, our window of the score, uh, survey, it can start to give you great insights if your facility chooses to participate in this. Because when people are burn out, when, when they simply aren't in a position of readiness for, for change or to take on more, uh, the score survey can definitely help you to gain greater clarity and insight into what's happening with, with, with your frontline. And also with your, your leadership and Donna, I kind of set you up for for, for this. Maybe you can talk for the next couple of minutes about the score survey and the.
The value that it could bring. Oh, absolutely. Um. I think the score survey is less about percentile kinds of things, but more about starting good conversations. Um, and when, um, an organization, um, has information that suggests that the frontline staff aren't getting adequate feedback, or their, their managers aren't available. That's something that you can do something about. Um, I think 1 of the more powerful things is that, um, it often in the teamwork section, it talks about interactions where people have really some communication problems, either within their own unit, or between units in the floor and having, uh, finding that out gives you something to focus on, so it isn't just sort of a big fuzzy.
How do I feel about things but it actually points people towards things that they're they can work on. Um, 1 of the things that we often use from the survey was, uh, the issue of dealing with difficult people. And that's a challenge for everybody, and sometimes finding ways to stop the line, you know, if things aren't going well, you know, to say, hey, you know, this isn't okay and to have the courage to do it. And have the leaders be willing to say no, I'm going to stand up behind this person who says we're only going to do kind of the right thing. And so the score survey gives you information about what fraction of your, uh, your team members feel good about what's going on versus not feeling okay. About what's going on in many, many areas. And so I really think these cultural kind of, uh. Issues can often hold organizations back and so that we focus a little bit on the processes of rolling out change but I think Jeff is absolutely right if you're if you're stuck on kind of a cultural issue, then the score survey helps you get unstuck. I mean, that's that's like Colin, triple a, you know, you get a get that this information and it keys off good discussions. Thanks, Don, I appreciate it. And and we'll leave the last couple of minutes. What? You see, in the chat that B is putting out there for you is the once you make the decision that that your organization wants to utilize the score survey, um, the mapping process, and understanding your units and and how they, they line up in your organization. Uh, is the next step be feel free to to jump in here if you want to add any. Anything additional absolutely. Um, you should have received an invitation to take part in this opportunity to implement this score survey and see the value that it brings to your organization. Uh, we will be sending out another reminder, um, letting, you know, that those, um, mapping files are due, uh, next this month next week. So that our team would safe and reliable can set up your your survey and get you everything that you need to to actually implement the survey within your facility. But, um, for some reason that link is broken, when I try to put it on chat. But you can reach out to us directly and we can certainly get you, um, guidance and any information that you need to kinda get that going for, you. Thanks bye. Bye. Everyone Thank you for your time today, Don, thank you for your partnership. Uh, the learning system, as, as part of the framework for high reliability is, is it's a very tangible piece. Uh, it, it, it's something that you work with every day, whether you call it the earning system, or whether you don't, uh, we can certainly, uh, sympathize and empathize with everything. You've put in the chat today. Uh, W, we've at 1 point faced it ourselves, uh, with our improvement work. Um, communication, uh, is key to everything you cannot over communicate. You can't over empathize. Um, but you also can't take, um, at the end of the day uh, often you can't take. No, or I'm too busy as as an excuse because. Frankly, our patients deserve better and American health care and we want to help you, uh, to provide that, um, improved health care experience to to your patients. So thank you for your time. Uh, Victor. I know you got some less words. Well, I do, and I just want to start by thanking Dr Kimberly, you, Jeff and Donna for your thoughtful and insightful, uh, presentation. We do appreciate the time that you've spent.
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