Hello, good afternoon and welcome to today's event using score survey data to focus and energize improvement of reliability. My name is Victor consultants. I'll be your host, and it is a pleasure to welcome you back.
If you've done this before. Uh, it is probably old hat for you, but I absolutely love this topic. Uh, I think not only, uh, I love the title as well. I love data.
It is my passion, but here we have 2 action words, right?
Going to focus in energize so not only are we going to stare at the data for a long time but hopefully we're going to put some action behind it. Uh, take some, uh, um, opportunity to improve and, uh.
And use that score data to get our, uh. Journey moving forward, so with that, let me go ahead and give you a couple of housekeeping items that you're probably already very familiar with we want to be sure that you're familiar with our chat feature. That's the icon a little chat bubble down at the bottom right.
Hand corner of your screen, you can click on that to add it to your participant panel. We're going to encourage you to use it. Send us messages, uh, make comments answer questions that, uh, we might have and also we're going to use it to send you some information throughout our call as well.
So, make sure that you stay active in chat we'd love to hear from you as the call.
Uh, progresses if you are the chatty type and you want to join our conversation, there's gonna be an opportunity to do that at the end of our call. We'll pause, ask for questions and certainly hope to hear your voice at that time.
You'll find a hand icon to the right of your name. We want you to click on that.
It'll raise your hand, I will find you unmute your line and you can join the conversation. We look forward to those folks who have questions and when you ask a question, the entire audience benefits.
So it may be something that everybody's has on their mind. And you bring it forward in the conversation, it's going to be certainly encouraged and appreciate it.
Well, let's go ahead and get started, uh, these 2 smiling faces. If you've joined us before you, you'll recognize them, but let me give them their due and hopefully give them a proper introduction for you. So, we are joined by Dr. Don Kennelly.
Who's a physician leader? That is focused half of his 40 year career on improving the quality and safety of patient care after medical school in residency. He was a full time faculty member in internal medicine at University of Texas, Southwestern Medical Center.
Todd students and residents did basic science research and implemented a patient center disease management program for parklands 20,000 patients with asthma.
Seeing both the power and failings of healthcare led to executive work at the Baylor health care system where he developed patient safety program across its 10 hospitals in many outpatient clinics. He developed and published methods to measure patient injury and let other improvements as chief quality officer.
After leaving executive work Dr. has spent the last 6 years sharing lessons learned with consulting clients, committed to delivering care that we.
Well, we would all want for our own families. He has published 50 papers or book chapters received a variety of national awards and grants and help found 2 patients centered nonprofit organizations.
He's joined today by Duncanville is an Apr and experienced healthcare and patient safety expert who spends her clinical career in pediatrics and the emergency department. She spent the last 15 years dedicated.
The quality and patient safety and health, several operational leadership roles where she designed developed and implemented patient safety programs, using high reliability concepts for both freestanding and academic children's hospitals in Connecticut.
In Donna’s most recent role as director of patient safety and quality for the Connecticut hospital association. She implemented large scale, statewide improvement projects in all of acute care hospitals across Connecticut.
She received her bachelors of science in nursing at Sacred Heart University and our masters of science. And nursing from Yale University, current sheet currently, she lives in Sandy Hook, Connecticut with her family.
Welcome to both of you. It's a.
Pleasure to have you on and I'm going to go ahead and turn the microphone over to you.
Great, thank you for having us. We're excited to be here. Um, and we're going to spend some time focusing on the score survey data and really talk a little bit about how to use that data practically.
In your units on your units, so you can go to the next slide.
So, our learning objectives today are really to understand, sort of overall the functions and elements of the score survey recognize which findings are ones that we should be focusing on for.
Improvement understand the survey domains and which provide the most insight and connecting those concepts with practical methods and we're also going to talk a little bit about debriefing the score of findings. Next slide. Please.
So, for those of you who didn't know score is an acronym, and it stands for safety communication, operational risk, resilience and engagement.
And, uh, it's really a fascinating survey. It's built on the latest science. Really? What this measures is engagement, burnout and wellness resilience, improvement, readiness like safety.
Um, and the reason this is unique is a lot of the other surveys focus on either employee cultural domains, or safety domains, this is really a blend of both it has the ability to add custom questions to it.
But 1 of the things we want to highlight is that if you took this survey last year, if you were 1 of the participants last year, you will receive a report that has year over year data. So, you will have last year's data compared to this year's data, compared to the National benchmarks.
It has several different ways that it provides data visualization.
We're going to go over that and it is, uh, you know, really has a very strong, um, benchmarking, um, because of over 700 organizations are participating.
And it's the largest burnout benchmark that's available.
Next slide please, Don, did you want to add to that at all? Before I move on.
No, I think just probably to add that, I really appreciate everybody joining and we're going to be moving into, uh, not only understanding the survey, but giving you some real practical approaches to understanding where your biggest opportunities are and how you might want to, um, actually generate a interventions to try to drive improvement.
Thanks, thanks, Dan. Let's move to the next slide and I really want to encourage you all to use the chat function.
I know Victor mentioned it in the beginning very enthusiastically, and we are happy to watch the chat and answer questions as we go along. So, please be sure to put your questions there. Um, so.
The scores survey is a validated instrument. Each domain has each concept, has a domain and there are it uses a 5 point Likert scale to share. Whoever's taking the survey, share their opinions on healthcare culture and quality. It is endorsed and approved by all major regulators. So, if you do have a requirement to survey, this fulfills that requirement using the score survey. This is a really important point.
We're going to talk.
Talk more about this throughout the presentation, but the reporting of the data is done in percent positive. So, the way to think about this is the, it's the way you would want the person to answer the question.
So, its percent positive and it will make a little bit more sense as we go through. But it's a key concept. Um, the other thing that's really interesting. And 1 of the values of the score data is that.
Many of the domains and specific items are strongly associated with overall hospital performance and are associated with 5 star ratings. So, um, it really endorses sort of the science of the survey.
Um, and we're going to show you how to identify those areas that maybe you need to or suboptimal that you need to follow up on and provide some action items over.
Next slide please. Okay so this is where we're going to need to use the chat. So everybody get your fingers ready to type.
Um, 1 of the ways to look at the score data is to be in a key mindset. So, like, everybody to just think about this.
Um, when what would a work setting feel like.
If you were working there, if the responses were to an item were 40% positive. So specifically, if I asked you, if the survey asks you, I feel safe being treated as a patient here.
If 40% of the people on your unit said yes. To that what do you think it would feel like to work on that unit? And you could.
Put your answers in the, uh, the chat 1 word is fine.
What would you feel like working on a unit that 40% of the people felt safe being treated as a patient there? What would be? Not good. Thank you. Deborah?
Scary Tracy Kevin says concerned.
Great concerning and capital letters.
Thank you. All right so we're going to we're going to move down the scale. We, we've got more coming in scary, disappointed. So I think we all get the just that it would not be the best place, right?
How would you feel again? 1 word if 80% of the people on your unit answered. Yes I'd feel safe being treated as a patient here. 80% said yes to that question.
How would that feel? Let's put that in the chat as well. Progress. Awesome. Sandra. Great. Jennifer. Accomplished Kevin says almost fair. Love it.
Love it Kevin? Hi bar. Deborah says. Still not so hot. Lukewarm. Okay. All right.
That's a perfectionist that's good. tracy's saying getting there. So everyone, everyone gets the gist of this right that there's a big difference between how you would feel if 40% of the people were answered that positively in 80%. That's the mindset we're gonna keep.
When we go through these questions and learn about the results. Um, the other thing that's important to keep in context is that some of the questions are and answers and results are helpful and give context to a bigger picture.
Not really practical to take action on and that's really very specific to your unit or your hospital and it's going to be important to focus on the topics that show opportunities for improvement that feel right to you that you think would be most impactful.
Next slide please, thank you. Everybody who participated. That's great.
All right, so 1 of the ways that data is displayed in your results is on these scatter plots and the scatter.
This specific scatter plot is measuring, um, local leadership and improvement readiness. And I'm just going to explain to you a little bit how these many of you may know this. I'm just going to review how to read the scatter plot.
So you can see that in the lower left. Corner is a red or pink Square.
And then there's a band of beige to the middle, and then to the top rate is green light green, and then dark green. So, as you can well, imagine, I would assume you guys would get that the lower rate in the pink is less desirable, less desirable results.
And up in the green corner is more desirable results. Each circle that's displayed on the scatter plot represents a hospital.
Each cos each, the side of that circle represents.
Thank you Dan, the size of that circle represents how many people responded to this for those particular domains so, or questions. So, the larger, the circle, the more respondents, the smaller circle, the least respondents, the less respondents what? This.
Scatter plot demonstrates is that there is a very strong positive correlation between local leadership.
And improvement readiness so what that means is, as local leadership.
Goes up improvement, readiness goes up as well and what I did not mention which I should have at the very beginning if you can look at the title of this slide. This is actually 37 of the TMF hospitals that participated in 2021. This is actually your data from 2021, not the most recent survey. That's we hadn't we haven't been able to do that yet, but this is from last year. So this is actual results. So, what this shows is that. Is actual results so what this shows is that
You guys are doing pretty well here, there's limited opportunity.
It means that about 63% of the hospitals are in, you know, the higher, higher quadrants of the scatter plot and there's pretty, very little variation between the hospitals.
And you could tell that by how clustered those dots are together in the middle. The middle
John, did you have anything you wanted to add to the survey to the slide? Rather.
Sure, and, you know, this is this can be kinda daunting, but I think Don has explained it really well, which is to say that, you know, this, uh, you will see, uh, when you get your reports where you are on this continuum in some way more towards the lower left and somewhere towards the upper. Right?
This is just a normal variation you expect between hospitals and some are a little further along in there, uh, their reliability journey and some not so much, but that doesn't change.
The opportunities that you're going to have to be able to make it better no matter where you are.
That's all right. Thank you, John. All right. Next question. And I think it's important to emphasize that point down. Thank you for. Bringing it up is that this is really about learning right? Learning where your strengths are, where your areas are that you need to focus.
This is, should it, it's hard not to, but you shouldn't look at this as sort of like judging but more like assessing and understanding.
So, can we go to the next slide? Please great. Thank you. So, this is a scatter plot that looks at the correlation between climate and teamwork.
So, what we see here is that as.
The safety climate score.
Is better, or is higher. The teamwork score will also be higher. These are positively correlated so, as 1 goes up. So does the other think about it? It makes sense, right?
If you have a strong sense of team, your safety climate is better. Um, and this shows that there's some opportunity here, right? We look at this, we see that most of the hospitals are clustered into that pink zone that red zone.
Um, and there's. A fair amount of variation here between 30 and 60%, um, positive there and there's an opportunity here. So this is 1 of the things that you all, depending on your results this year, we would want to look at and examine and think about how can you work on, um, teamwork or. or
Or safety climate, cause working on either 1 of those will raise the score of the other.
Next please great. So you will also receive in your results this section that has notable performance cultural insights.
So what you're going to see here are your top 3, cultural strengths, and then your top 3 cultural opportunities.
So, if you look here at this, these results, what the cultural strengths is showing, is that, in terms of perception of.
Your sort of work life. There's a very positive perception you are over the 50th percentile.
On all of these, so, you know, working arriving, home, wait from work working too hard people feeling frustrated. You score positively. Those are, you're doing well in those domains the cultural opportunities.
Shows that their resilience is low and I think that that's.
Not surprising, considering these are the 2021 results, you guys were just coming off a few very hard years of the pandemic staffing, et cetera.
So, if you look at those 3, your mood recovers, you recover quickly after difficulties, you can adapt those all are reflective of resilience.
And so there's an opportunity here to work on resilience with your staff in order to improve through their overall work experience. Their overall work experience
Next slide please. Okay. So these are like, my favorite part and I think probably the most useful graphs in the summary I'm going to just go through how to sort of read these.
And then we're going to take a look at 1, a little bit more closely. So these are your 10 key drivers of culture?
And you can see the disks in the center of the disk you'll see a percentage and then positive. So, let's look at improvement readiness. You'll see 67% displayed in the middle that's highlighted.
And that green band represents that 67% positive. Sixty seven percent positive
The gold band represents the neutral answers, and the red band represents the negative answers.
So, if we go to the next slide, let's take a look at teamwork a little bit more closely.
So, and this is where we talked about things being presented in the positive, this is where you have to, like.
Think about it a little bit, because it can be a little bit confusing.
This the question is communication breakdowns are common in this work setting. Now, remember we said the green is going to represent what we would want people to answer so we would want them to answer.
No, it's not common in this setting. We communicate. Well, 41% of the people that answer the question. The question.
Answered it in the positive that they do not believe communication breakdowns are common. It's a negatively reworded survey questions. A little tricky. 37% of the respondents answered.
Yeah, communication breakdowns are common in this work setting. That's not what we would want them to answer right? That's they're agreeing with the statement. We don't want them to agree with the statement. It's a negative. And then the 22% feel like yeah I don't know either.
I could go either way on it. Not feeling pretty neutral about that. About that
Do you guys understand that? You can just indicate it in the chat if it makes sense the way I'm explaining it if not I'll have John. Give a shot at explaining it. Okay. Deborah’s got it. Good.
Makes sense perfect. Thank you. Guys for the feedback. So just always ask yourself. How would I want my team member to be answering this question? That's the percent positive.
Okay, Dan, did you want to add anything further to that?
No, I think you've said it very well and I'll just add 1 thing, which is the, uh, the percent, uh, that's gold or yellow.
Um, are those who don't feel strongly 1 way, or the other, and they actually are an important target to, uh, to try to work to change their mind.
The work you do, may move them into green next time, their survey, and you certainly don't want them to move into red. And so as a result when there's.
Wideband on yellow that really is a nice opportunity to be able to show progress because those that are already green stay that way.
But you might get some of the yellow is moving into the green for the follow up survey.
That's right. Thanks Don. That's that was a really important addition to the explanation. Those are really those 20 twos are kind of your people that are most easily moved, I think, in either direction. So that was a good point. Thank you.
All right next slide.
Um, okay, so, um, in the score report, you're also going to get an a section that will provide automated action plans and those action plans are going to be based on those 10 key items that we saw a few slides ago.
Um, this, I don't know what you all are doing in terms of action planning. If there's if you're if your individual hospitals are requiring action planning or if this is.
Just something you're all going to do, um, independently either way the generated action planning in the score survey that's provided is really meant to be used as a springboard, you know, look it over, consider it as a place to start.
Um, and evaluate, if you feel like those are actually resonating with your own experience on your unit, and, you know, you can use it to kind of pick and choose and sort of use it as a way to develop your own your own specific action planning. But it does come with your results, you will get it in there.
And again, it's based on those 10 key items that we saw a few slides ago.
Next slide please, I'm handing it over to time. Great done. Thanks. Very much nice job on explaining some, some complicated things.
And, uh, and what we're going to do is, although you have the automated action plans that focus on the lowest scores. That doesn't mean that that's just because they're lowest doesn't mean that that's the best place to start.
Um, and so Don, and I are going to be spending some time on trying.
Trying to give you a way to approach your data. So you can decide what you want to work on. Because 1 of the things I learned early on is if you're trying to do too many things, you won't get anything done.
So a lot of what we're doing here is trying to help you to think through prioritizing what you want to work on. And, um, so that although the automated things are fine.
I think what we're going to be providing is a little more sort of custom done in terms.
Of how you might approach this. So now, um, what I want to do is to, uh, is to say, I totally agree with teamwork being important.
And, um, but if you wanted to see the detailed teamwork items, not just the overall teamwork score.
Um, there's you have to go to a different part of the report and at the very end, you can see that there's this bar here that has, um, that says display.
Results for all survey items so I want to encourage you to go there click on that. And then when you do, uh, you'll see what's in the next slide.
So, here, this is I know you can't see this, because it's small, but what you'll get as a series of pages that have, in fact, all of the all of the domains listed here in bold and instead of being in a circle, these are, in what we call sort of a horizontal bar graph and so, uh, the greens are still there, but they're in the left, the orange or gold, or in.
In the center, and then on the far right are the undesirable responses those people who disagreed with things you want to have then agree on or the ones that agree about things you'd like them to disagree.
And so you can also see that. The percent agree is shown to the left of the green bar and so that's, uh, you'll be seeing that.
And you can see that for different domains uh, there are different patterns, uh, this, uh, domain on the bottom here you can see has a lot more red. So it might be something to pay attention to.
And we'll, we're going to cover those in just a minute, but I just wanted to let, you know, that there are about 3 other pages to cover all the other domains.
But you can look at them individually by just blowing them up a little on your screen. It's very easy to see them.
Detail, so, let's see what 1 of those looks like on the next line.
So we've talked about the teamwork is important and so here you've got the teamwork, uh, now blown up so that you can begin to start seeing all of the specific items on the teamwork domain.
And you can see that some of them are, are pretty have pretty good performance 77% on the top, um, that it's easy for a person here to ask questions. If there's something. There’s something
They're not, they don't understand and that's great. That points towards psychological safety.
What I've highlighted here on the bottom is not shown in the report, but I've added it are some areas where I think there are and again remember that. This is actually your data.
This is the data from all of the hospitals all lumped together as if it were 1 big hospital. Okay.
So this isn't how each of your individual hospitals look, but if you press that button to display, uh, all the items.
We'll get this that's specific to just your hospital and so, um, so you can see that there are 4 findings that, uh, I think are worth paying attention to, uh, that are highlighted there. And I think it's, um.
Again, about speaking up about patient care, it's about dealing with difficult colleagues and about communication breakdowns, either within the unit, or between the units.
So those are opportunities that I think are pretty significant that. And we'll talk a little bit more about how you can approach those next slide. Please.
So, um, and I'm going before I get to the, how of the teamwork domain, because I think that's a very rich area.
I'm going to share just a little bit more about something that is at the very end of all the items there's, this section called additional questions and the additional questions are really kind of interesting.
They don't fall into a domain, but they give you information and the bottom ones really relate to, uh.
People are doing with regard to coping with Kobe, and whether they've used organizational resources to help support them during this difficult time.
And I think that's worthwhile for you to take a look at, for each of your organizations and see how your staff are responding to those to give you sort of a general sense of how they're being impacted in this tough time. Excellent.
So now, um, we've shared the things that are part of the, uh, the standard summary report that you get, uh, there is a more detailed report that you can access and you'll have a link, uh, that will be available to you. Um, and it's a great reporting tool, but it's a little harder to use, um, and a little less user friendly and it uses what we call spider diagrams.
Um, and we'll. We'll go into what those look like, partly because I think they're going to help us to explain where we want you to spend some time where we think it'd be productive for you to spend time.
But, and we can bring this, uh, during our office hours.
One of the things I want to point out is that Donna, and I have time set aside in both September and October where we'll have an hour in each of those months to be able to both some.
Summarize some of what we just shared address any questions, but also to be talking about issues, like, this is more robust report and if you're interested to be able to access it for your hospital.
Uh, next slide so now we're going to be looking at what we referred to as a spider diagram and, uh, this is again, this is a little different and let me kind of walk you through this.
Um, this is a report that's available. But again, this shows all the culture domains in 1 grant, and the top is improvement readiness, and then work life balance at the 11 o'clock position. Local Leadership at about the 1 or 2 position, and the way you read a spider diagram, if you haven't seen 1 of these before, is that in the center is 0 and at the outside is 100%. So.you would really like to have a high score here and have, uh, you can see that for example, in, uh, improvement readiness. The value is 61%, which is sort of in the yellow. It's not.
It's not been especially strong, uh, area, but it's not a problem either.
And you can see, though that there are some that are in the red and when they're in the red that is caused for some concern, and that deals with burnout.
And, uh, and, uh, at the edge of safety climate, and really, the teamwork issue is, is in is low at 39% and so it's clearly in the red.
So, uh, so again, I'll, I'll just pause here to make sure that everybody understands the, the concept of a, uh, of having a, a radar diagram here. Diagram here
Could you put in the chat? Does this make sense or, you know, do we need to spend a little more time on this illustration? So you can understand what's going to be coming up.
Okay.
So, it sounds like people are generally good to go. And so, just again as a, um, we will cover this, uh, in the future in again, in the, um.
Office hours that will be having so next slide.
Please in the next slides, I'm going to be spending some time, uh, talking about, uh, the different domains and how you might be thinking about whether there areas that are worthwhile uh, thinking about improving.
1st, you can see that I've highlighted here, uh, 2 domains that are in the, uh, the improvement readiness and the local leadership and you can, I think of these, as the foundation for your organization.
Uh, that how well, leaders are available, uh, the degree to which leaders support frontline staff, and whether they have the same values as frontline staff.
And so there are a whole series of specific items in those. But the way I think of these is this is kind of the necessary foundation that organizations need to have in order to be able to be successful.
If these are low if these are below 50. Improvement is possible, but it's going to be, like, going up a steeper hill again.
It's not like climbing Mount Everest, but it will be harder work to climb a hill where the leaders and the improvement readiness is less than 50%.
So it doesn't mean again, you should say, oh, darn, we're not going to do any of this it just means that it's going to be harder or it might take longer and that's okay but that just helps you, with the context of whether you've got a strong foundation in your. The organization.
So the next slide please.
So, now we're going to be talking about, um, areas for impactful improvement. So, here, uh, I've shown in this blue highlight or, um, text area, the things that.
I feel, uh, and, uh, you know, our organization feels our areas for meaningful improvement, uh, particularly about the 2 on the right which are burnout climate and burn out and the ones on the left, which have to do with teamwork and safety climate.
So, uh, working to improve burnout and team, or will improve safety climate and also enhance, not only the, uh, organizational performance, but dramatically improve staff engagement.
And that is a key to a lot of this is making sure that the staff are really feeling that they're a part of all of this. And this isn't happening to them that they own this. And so working on these, uh, very powerfully. Uh.
Engagement as well, so Don can I can I just comment just to, for clarity for folks the difference between burnout climate and personal burnout.
Personal burnout is your perception of burnout, how you feel are you burned out and burnout climate is your perception of others like, do you look at other people and perceive they are burned out?
So, those are just the, the difference between those 2 sorry? To interrupt. No, I'm really glad you pointed that out. I should have mentioned that Thank you.
So, um, so now, if we move on to the next, sort of, um, set of, uh, cultural components, um, you'll see that I've now described them on the left as these are the outcomes of successful culture improvement when you've been successful at working on things like burnout.
Teamwork and a safety climate, those, uh. Things will, uh, will ultimately, then drive what we call emotional, thriving, emotional recovery and work life balance.
I like to think of these is actually the outcomes that you'll be measuring, but they will happen more slowly, uh, when the other ones have, uh, the impact of the other ones, take full hold.
So, we, we think that these are important for you to be thinking about as evidence of improvement, but not necessarily the. This is where you're going to work specifically.
To be talking about the 3 of these. Okay, um, Deborah has a question in the chat. Okay.
She's asking, do you know, do you or these surveys ever distinguish between perceptions of core staff and, like a traveler or a temporary staff member? Taking the survey?
That's a great question. And I think, um.
It depends on whether or not your organization decided to segregate them.
Separately, um, and most of the time, its course staff. Because if they are traveling, they may not have had an email address at the right time to then be surveyed. So, there may be some that are travelers.
Um, but most will be your core staff.
Okay, does that does that help. Okay, great. Uh, we'll, we'll keep going, but that's a wonderful question.
And, uh, and 1 of the things that it actually raises too is and, uh, Donna, and I'll talk a little bit about it at the end is when we is suggesting how you might debrief these data.
Two units in your hospital um, but 1 of the most important things is to ask people does this feel right? Does this feel like what you feel here?
Does this seem off and most of the time it does seem right? But, on the other hand, uh, that's a time too when you can begin if there's been huge turnover in a given unit, or a lot of travelers.
Um, it may not. It may not now feel like, uh, what it did in the past.
So, uh, so to be aware of that, so that's a really good question.
Excellent so now we're going to shift over to just briefly talk about engagement before we begin to get into the practical Here's what you can actually do to try to make things better.
Um, engagement is a separate domain, uh, is Donna pointed out earlier, and it has, uh, 6 different.
Uh, excuse me it's a whole different area and it has its own, uh, 6 domains and, um, what I want to do.
Here's just sort of briefly talk about how, uh, at least I think about some things here, you can see that advancement is low at 19. Well, that means that many of the people don't feel like they have a likely chance of being promoted.
On the other hand, my experience is that most of the people who are.
Working in hospitals aren't looking for being promoted. You're going to if you're a nurse, you're going to standards and a staff nurse and so that being low doesn't mean that it's a bad organization.
So don't feel like that's something you'd have to necessarily worry about.
Um, but on the other hand, the 1 towards the bottom can influence decisions is 46%.
That's pretty important, because that has to do with whether the people, uh, where, uh, in your organization feel, as though they, they can participate in voice.
Are people listening to what the front line staff says that's really important? Um, now on the lower right? I've highlighted intention to stay as 86%. Six percent
And actually, uh, that's, uh, that is a, uh, you might say that's a good number because 14%, uh, only 14% are going to leave.
But, uh, but again, it's a, and during the pandemic, uh, that number may get worse.
Because, in fact, a lot of people are turning over right now and, uh, so, even though it's, you know, in the green doesn't mean, it's necessarily where you want to be. To be
Okay, so let's, um, let's go ahead and move past engagement in the next slide.
So now we're going to be beginning to drill down into the teamwork domain where I think we feel as though, uh, organizations have the most opportunities for improvement. So, um.
I like to think about these in 2 different categories 1 is the more doable things and the harder to do things less doable.
And so, the more doable things have to do with improving, uh, unit communication, resolving differences of opinion, in a respectful manner, being able to speak up and not have people, you know, whereas you for expressing a concern that is psychological safety, which is.
Is also reflected in it's okay to ask questions. These are things that are really you can do a lot with and we'll give you some examples of what you actually might do to try to drive success.
The less doable ones are, in my view, uh, the, the difficult colleague’s question, and you can see that that is in the red.
But on the other hand, that is a tough thing to approach because, uh, it's personal people. If you start addressing.
Well, who is who are difficult on our unit, you know, who the, the jerks turkeys the folks who always are negative.
Those, um, in fact, er, when 1 begins to start going down that path, it takes a lot of energy. And so we don't.
Typically encourage that until later in the improvement journey, and it's a very important thing it takes away from the unit's success, but it's something that the leadership has to be very supportive of stepping onto that path. And certainly, I've worked in organizations, have done a great job with that, but it is not easy.
Um, and, uh, some of those people are a powerful people. Their physicians may bring in a lot of revenue.
And, but be difficult and so, uh, the executive is sometimes in a funny spot in terms of trying to deal with that. And it is improvable.
But I just think it's hard and how well, people work as a team is very important. But, um, I think again, it's more of an outcome of improving the other things like communicating and sharing voice.
So we'll move on to the next slide. Because what we're going to do now is cover some things, uh, some examples on how we might want to start. Or do you have some things to add just to the sort of diagnostic part before we get into the kind of treatment plan.
No, I just want to the 1 thing I would emphasize though, is to make sure it feels right um, you know.
Sometimes between the time the surveys taken, and the time you get your results, something changes and people may feel differently.
So, it's always good to sort of take the temperature on the results before you dive into, you know, some big improvement thing. That isn't really going to be aimed at exactly what you need. So totally agree down.
Thank you. And I think the other thing that's going to happen is almost all of the organizations are now.
Finished the 2022 data, so it will, uh, it's being analyze now and so we will be able to to use that data to update all of these within the next 6 to 8 weeks. So, as we are beginning to do our, um. to do our um. Our office hours, uh, we should be able to update those, uh, those findings, uh, for you so that you have, uh, we call fresher data, uh, that reflect what people thought in the last few months not a year ago.
The tendency is for these, not to change incredibly quickly, but in some cases they might, especially if there's a new leader who is either doing well, uh, and getting everybody.
Be enthusiastic, or, uh, 1 who's sort of turns people off. So, again, I think you'll see, uh, fresher data, uh, soon. Um, but, uh, that we'll be able to.
But I think the same concepts still apply in terms of how you look at your data and think about what your opportunities are.
So one of the things that we've done in a number of organizations is, uh, is to improve unit level of communication again.
It's really essential that people, uh, have accurate sharing of information. You have what you need in order to take care of your patients.
If you're a nurse, uh, and a, and you have to sort of know what what's going on is today a bad day, a good day or whatever. So, this has to do with.
Say, huddling, uh, and knowing kind of what what's going on with the game plan today and while there can occasionally be some disrespectful things. People say most of the communication gaps are kind of.
Innocent, they're just misunderstandings. I call them. I just assumed moments.
Where, uh, where when something bad happens, and, uh, people started looking around and say, well, I just assumed that she was going to do it. I didn't know that was my job. And so and that doesn't make somebody bad.
That just means that there was there was a gap in communication, and we suggested over about a week or 10 days, everybody anonymously write down each significant misunderstanding the experience, and put them in a box.
You don't need to be saying, who just what happened.
And at the end of that time, uh, the misunderstandings are sorted into 46 categories that you think are relevant and then you can choose 1 to 2 categories to start working on.
Um, and that may have to do with handoff communication, and they have to do with, uh. Uh
Uh, asking questions in, uh, for patients who have difficult families, for example, or whatever, and to make sure everybody is sort of on the same page for the past.
Okay, so we'll, we'll now we'll, we'll move along to another, uh, example, in the next slide and this is the, uh, increasing comfort in speaking up where we call psychological safety.
It's the same general concept here where, hey, you know, being able to speak out about a concern is in a unit or a unit concern. You know, something that happens more.
Generally, not just in individual clinical circumstance is really important. Uh.
Uh, for to have a healthy unit, and most of the time, um, I, people are kind of worried about being teased or criticized about the concerns.
They might share, you know, people that I rolling during huddles when someone says, hey, you know, I'm kind of worried about this or, you know, we still don't have those, uh, new machines that we're supposed to come into 2 months ago.
Uh, or we're running low on these supplies and, uh, and so there.
Their past experience, uh, might have involved, uh, before you do need this improvement work that people have I rolling, or they look away or look at the floor when someone shares a concern.
And 1 of the things that is really important will be for the manager. That unit to say, hey, no bad questions or concerns, because we need to have them to make sure we provide safe high quality care to our patients.
So we're going to actually celebrate when people ask.
Questions and, uh, and so, uh, that's going to be the new way. We deal with things.
So, uh, if during huddles, uh, having a scribe breakdown, um, uh, I should say, we'll write down the questions and concerns that people have.
And the nice thing about that is that those can be shared between different shifts and see, kind of what's going on at different times. So, uh, and but because it's important, the manager will commit.
Themselves to thinking people who share their questions or concerns and, uh, to shut down people who are being sort of nasty or rude to the people raising those concerns because we need people's, uh, observations to be able to get better Donna and the other thoughts about this as far as your, uh, your experience has shown, I can just say that, uh, having a manager that really, um, promotes.
People asking questions and discourages negativity around raising questions is a key to patient safety and, um, it is something that has to be done consistently, because you could encourage it 10 times. Have 1 I role 1 time and you're starting back at 0.
So, people really, as the managers or leaders really need to stay on top of encouraging it and praising it, because it's 1 of those fragile things. That's very easy to slide back.
Yeah, that's a great way to put it down. It is fragile. And what else?
Psychological safety, once it becomes well, established, can obviously be very durable because what then happens is that people on the unit look at the person who's been rude as an outlier.
And but that's only after everyone and the manager that made it clear that asking questions in order to get the to do the right thing. The 1st time is really.
So, fragile at the beginning, but.
Sturdy and later on so, um. Very good next slide. So, now, um, what I'd like to encourage you also to do is, you know, that you have narrative comments that are submitted by the people who take the survey.
And, um, and again, these are not quantitative visual, qualitative, but they often share people's heartfelt view of, uh, kind of situations that are upsetting.
Sometimes they're, they're positive, but more often than not, they, they share things.
The survey doesn't cover.
And I'd encourage you to take a look at those and to be thinking about what do they really mean?
You know, and, um, and they can be sanitized to avoid any personal issues that are personal and personnel issues that, uh, that the comment night raised.
But it really helps to often get, uh, top topics on the table.
So, uh, the 1 thing that I would also, uh, everybody is worried about staffing and I'm not saying that that's not an important concern.
But in my view, uh, you never can have enough folks who all have the, uh, positive, uh, goal of being able to make care better and you're oftentimes limited in terms of how much you have.
So, they everyone will complain about staffing. And that doesn't mean that that's inappropriate.
But it doesn't mean that that's something you'd have to act on because there are people who work on units that are very well staffed when you look at it numerically. And they still complain about this.
Um, and so, and in fact, their data that show that higher culture units, even with lower staffing ratios often, achieve better outcomes than those with higher staffing, but lower culture.
Okay, so moving along now and we're on the on the sort of, uh, Bill lap here. Um, the purpose of a unit debrief is really is Don said the springboard for.
Discussion and understanding by the people who were there and so you'll have the data, and they will be very interested to know what you think it means.
And obviously, what we've tried to do is to give you some tools on how to focus because there's so much information you'll lose people if you try to share it too much. All nice.
So try to be thinking about being, um, sort of parsimonious about how you share your da+ta.
Uh, excellent, and, uh, what you want to do, uh, is to, uh, make sure that you create a space for the debrief. Um, again, uh, why would you need to do that? Well, because these are hard topics, right?
Um, and, uh, there needs to be a dedicated time for this focus and not where people are zooming in and out and having to do other things, have it be quiet, private and, uh, and I think it's important to have people.
We are going to be responsive and responsibility in their waiting to react to it.
And I think at the very beginning and this is this, I've Donald put together and I totally agree with it, which is at the beginning.
Make sure everybody understands that the goal here is not to feel bad at the end. The goal is to understand what to do.
And so as a result, they have to be part of the process to make decisions about what we're going to do on this unit.
Based on our findings and having some ground rules about, uh, the discussion is important. Trying to happy. I'll have an open mind is.
Those 2, I can't tell you how many times I talk with doc groups and he goes. Oh, this is, this is, I mean, this isn't right you know, you know.
My experience is different than that, and that's their way of kind of avoiding connecting with the issues but trying as best.
One, can, if you're leading 1 of these discussions is to simply try to move past negativity into well, let's talk about what we can do and what we, what these data might be excited to hear that as well.
And, uh, so we encourage you to, uh, you know, again, be recognizing that in fact.
Even though you've got the hospital data, the units will vary from each other.
So, um, so, in fact, what the hospital finds may not be true uh, everywhere. So the, er, might be different than labor and delivery might be different than surgery. So, uh, so keep that in mind.
And, um. And trying, not to just focus too quickly on what's not good is a turn off for people. And 1 of the things I really encourage is people having some time to reflect on what is going well.
And to say, we're going to be talking about this, and the survey, you know, shows all this data. But, you know, WH, what are you guys proud of?
What have you accomplished in the last 6 months or a year that you feel it's really move the needle for the patients that you serve and that sets things off on a positive start. So, um.
Excellent. And so we're going to wind up with this now, is that again? Pretty straightforward.
But, um, so we encourage you to use debriefs as a, a brainstorming opportunity to decide what the group wants to work on, based on your interpretation and suggestions but also on their own, there's no, exact, right a recipe for success here. And, uh, and to be, uh, prioritizing.
What you are planned to have sort of prioritization, kind of be the outcome of a meeting, but really, to be thinking that another different meeting is going to be on what you're going to do about it.
So, the 1st is just to all agree on what the findings are and what they mean and what things what areas are worthwhile for the unit to spend time on because.
This is a tough time. People don't have a lot of time. So you've got to really respect that and value it. And, um, and whatever is, uh, recommended or committed to action please be sure to actually follow through.
The worst thing in the world is to commit to do something and then not do it. It's better not to commit to it in the 1st place.
So, Donna, what else? I think we're at the end here. What else would you like to add?
You know, I think that's a, I think you covered it really well done. I think, um, the point that I again would emphasize what you just said is to make sure that if you say you're going to follow up on something that you do it.
And the other is, if you do decide to take action on a particular topic, when you are implementing the action items, make sure you're connecting the dots for folks on your unit that we're doing this in response to what you've said.
Sometimes people get so wrapped up in the implementation.
They forget to remind people, and it's really important for leaders to take credit for connect, you know, for the work that's being done and make sure that you get the dots connected for folks that their survey wasn't just, you know, their opinion into the abyss.
But you're actually, like, connecting improvement ideas. Absolutely. Because this is not about just getting some rating system here. You know, this is about learning.
And so these findings help you to engage with the teams and folks working on the front line to be able to decide what they're going to do.
So, to improve, because again, it's not just a report card.
So, Victor, I think you want to probably point us in this direction for following.
Thank you so much. Dr. Kelly and Donna appreciate your insight on this topic. I think, uh, there's going to be a lot of questions around this 1, in particular from experience.
We've seen some come through after the materials, um, digested a little bit.
So, if we didn't have time to answer your question today, feel free to shoot us an email, we'd be happy to pass that along or answer it for you or get you in contact with 1 of our consultants. We, thank you so much for taking the time.
Time to join us today, it's been a pleasure having you on and if you would please give us a little feedback at the end of the presentation you'll be asked to be redirected to our survey. It is completely safe and very brief.
We do appreciate you giving us a little feedback there. We'll look forward to hosting you on the next 1 and look forward to hearing from you. Very soon again. Thank you. Dr, Kelly and Donna. We appreciate you having you on each and every time.
Thank you everybody pleasure to take care of everyone.