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Leadership Accountability Demonstration Project (LADP)
Cohort 2 – Kickoff Webinar – Option I1 (intensive)
April 24th, 2014
© The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System
Goals for this project
• Develop deeper appreciation of the link between leadership and patient safety
• Select an area of focus for strengthening your efforts
• Implement the Model of Accountability with support from AI & VHA
• Learn, share, and sustain
3
Agenda
• Introduction to the program• The model, the evidence, and the plan
• The first steps• Choosing a harm area and geographic area(s)• Preparing for the site visit
• Learning from other teams
• Action items and discussion
Leadership Accountability Demonstration Project (LADP)Introduction to the model, evidence, and plan
Your cohort team: 2014 option 2 (intensive)
• Holy Redeemer hospital and Medical Center - Meadowbrook, PA
• INTEGRIS Canadian Valley – Yukon, OK
• INTEGRIS Health Edmond – Edmond, OK
• INTEGRIS Lakeside Women’s – Oklahoma City, OK
• INTEGRIS Southwest Medical Center – Oklahoma City, OK
• Jefferson Regional Medical Center – Pittsburgh, PA
• Swedish Covenant Hospital – Chicago, IL
• Southeastern Ohio Regional Medical Center - Cambridge, OH
Leadership at the highest levels matters
Keroack et al., 2007; Academic Medicine
Leadership at the local level matters
…the odds ratio for mortality increased
by 1.24 for the hospital.
For every 10% decrease in
perceptions of management items…
Huang et al., 2010
Evidence-based leadership for patient safety
1. Frankel A, et al., 2008, 2. Thomas EJ, et al., 2005, 3. Pronovost P et al., 2005, 4. Verschoor KN et al., 2007, 5. Keroack MA, et al., 2007
• Executive walk rounds[1, 2]
• Executive leader ‘adopt a unit’[3]
• Safety briefings[4]
• Patient safety strategic plan[5]
• Hands-on leadership style[5]
What are we working towards?
• Shared leadership accountability for patient safety and quality improvement
• A mutual sense of responsibility, contribution, and control related to organizational quality and safety improvement efforts
• Shared among both formal and informal leaders from different levels and areas of the organization.
Grounded in Leadership Model of Accountability
How we will work together
• Site visit conversation• Identify opportunities to optimize leadership
and accountability
• Monthly cohort calls• Model of Accountability content• Introduction of tools• Collaborate, share experiences and
troubleshoot with fellow cohort members• Action planning
• Monthly coaching (one on one)• Site specific consulting and support
• Build capacity• 2 members per site trained in the AI Online
Patient Safety Certificate
• Monthly feedback loops• Share progress and innovations across
organizations
Accountability Model + Tools
Site Visit Conversation
Cohort wide calls Individual calls
Data and Feedback
Adaptive leadership
Timeline
April May June July Aug Sept Oct Nov Dec
Cohort Calls
Kickoff Call
Site Visit Preparation Call
Patient Safety Certificate Program Call
Tool call 1:• Learning
tracer tool • Business
case tool
Horizontal Learning Call 1
Tool call 2:• Strategic
prioritization
• Safety comp
Horizontal Learning Call 2
Tool call 3:• Decision
making tool
Horizontal Learning Call 3
Site Visits and Coaching Calls
Site Visit Conversations Monthly Individual Coaching Calls
Surveys HSOPS & PSOA HSOPS & PSOA
15
PSOA Domain: Key Aspects of Safety (KAS)
1. Leadership• (L1) Demonstrate patient safety as a top leadership priority • (L2) Promote a non-punitive culture for sharing information and lessons
learned
2. Strategic Planning• (SP1)Routinely conduct an organization-wide assessment of the risk of error
and adverse events in care delivery processes • (SP2) The organization actively evaluates the competitive/collaborative
environment and identifies partners with whom to learn and share best practices in clinical care:
3. Measurement, Analysis and Knowledge Management• (MAKM) Analyze adverse events and identify themes across events
16
PSOA Domain: Key Aspects of Safety (KAS) - Cont.
4. Workforce Focus• (WF1) Establish rewards and recognition for reporting errors and
safety driven decision-making • (WF2) Foster effective teamwork regardless of a team member’s
position of authority
5. Operations Focus • Implement care delivery process improvements that avoid reliance
on memory and vigilance
6. Customer Involvement• Engage patients and families in care delivery workflow process
design and feedback
7. Results
Patient Safety Organization Assessment (PSOA) Cohort 1 Pre-Post Comparison
L1 L2
Lead
ership SP
1SP
2
Strati
gic Plan
ning
MAKMW
F1W
F2
Workf
orce Fo
cus
Operations F
ocus
Customer
Involve
...2.50
3.00
3.50
4.00
4.50
5.00
4.09
4.04
4.06
3.60
3.00 3.
30
4.22
3.55
3.48
3.51 3.
93
3.72
4.31
4.00 4.
15
4.01
3.75 3.88 4.
17
3.97
3.95
3.96
3.97 4.06
Pre ten hospital average Post ten hospital average
PSOA Cohort Pre-Post Comparison
3.50
3.70
3.90
4.10
4.30
4.50
4.70
4.90
3.95
4.40
3.904.00
4.23
4.56
4.21
3.82
Pre ten hospital average Post ten hospital average
Based on a 4-point scale
The first steps
Choosing harms and geographic area(s)
Planning for the site visit
What harm should we focus on?
For this project’s time frame, readmissions is not feasible.
What unit should we focus on?
• Where’s our biggest chance of success?
• Where’s our biggest challenge?
• What would make the most compelling success story (internally and externally)?
• What would position us best for spread?
Preparing for the site visit conversation
• Systematic way to gather ground truth• Non-judgmental• Confidential• Collaborative• Conversational
• Triangulates perceptions and knowledge• Senior Leaders• Clinical/Specialty Leaders• Unit Leaders
• Conversation + Observation + Reflection
Site Visit Conversation Template
Preparing for Site Visit Conversation
• Plan to attend site visit prep call in May
• Consider sharing (or collecting new responses)• Patient safety organization assessment (PSOA)• Hospital Survey on Patient Safety (HSOPS)
• Survey measure of safety culture• Can send to participating unit and 1 non-participating unit • Can share existing data if your organization recently took the
HSOPS
HSOPS and PSOA administration guidance
• Who should fill them out:• Everyone from the participating unit• Everyone from a non-participating unit
• How to fill it out• If you already have the data, we have a way to upload it
• If you don’t have it, we will email survey links to you, you can fill it out online
• When to fill it out• Before the site visit and after the last coaching call
• To evaluate your progress, we are offering the opportunity to administer these surveys at two points in time: Before site visit and +6months (Nov-Dec 2014)
• Report• If you collect new HSOPS data we will share reports for each unit
• We will summarize results and share with you after the project
Next Steps
1. Gain focus.• Develop internal consensus on your focus area (harm
and unit) for this project.
2. Build your internal team.• Select and invite your team to be part of this work.• Point a contact person.
3. Schedule your site visit.• Contact Alice (Xin-Xuan) Che: [email protected]
4. Prepare for pre-visit survey administration.
Open discussion
Please introduce yourself or your team
Has your team talked about or decided on which of the targeted HEN harm areas that they would like to
work on?
If so, which one? If not are there a few that you might be considering?
Discussion
• Any questions or concerns?
• Contact:• Alice: [email protected]• Michelle: [email protected]