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4/20/2017
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Nikki Medalen, MS, BSN, APHN-BCJean Roland, RN, BSN, CPHQ
Putting the Pieces Together~~~~~
Making Sense of All That’s Available
Objectives
Share highlights of January and February ND HRET HIIN hospital site-visits
Identify priorities, resources and strategies to facilitate the HIIN 20/12 reduction goal
Share Map of Actors tool, focusing on readmissions work.
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New Hospitals!
New Hospitals
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Diverse HIIN Team Unity Medical Center - Grafton
St. Andrew’s Health Center - Bottineau
Sanford-Mayville
Presentation Medical Center - Rolla
First Care Health Center – Park River
CHI Mercy Hospital – Valley City
Tioga Medical Center
Sakakawea Medical Center - Hazen
Trinity - Kenmare Community Hospital
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HuddlesShift Change Huddles:
Carrington Health Center
CHI-Valley City
CHI St. Joseph’s -Dickinson
First Care Health Center – Park River
Sanford Hillsboro
Heart of America - Rugby
Northwood Deaconess
Safety Huddles: CHI Mercy – Valley City
Post Fall Huddles: Northwood Deaconess
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HuddlesMulti-Disciplinary Huddles:
Heart of America – Rugby Sanford Hillsboro
Huddle Boards: Carrington Health CenterCHI-Valley CityCHI-Devils LakeCHI-Dickinson
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White Boards
Sakakawea Medical Center –Hazen
CHI Mercy Hospital –Valley City
Sanford Mayville Mountrail County
Medical Center - Stanley
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RoundingBedside Rounding:
Heart of America Medical Center -Rugby
Linton HospitalHourly Rounding:
Sakakawea Medical Center - HazenPresentation Medical Center - Rolla
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Patient and Family Advisory CouncilsSanford MayvilleCHI-Valley CityCHI-Devils LakeFirst Care Health Center – Park RiverSanford HillsboroSt. Andrew’s Medical Center - Bottineau
Carrington Health CenterNorthwood DeaconessSakakawea Medical Center - Hazen
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Prioritizing Readmissions Ashley Medical Center
Carrington Health Center
Cavalier County Medical Center - Langdon
CHI – Devils Lake
Cooperstown Medical Center
First Care Health Center – Park River
Wishek Community Hospital
Linton Hospital
Mountrail Medical Center - Stanley
Heart of America Medical Center - Rugby
Towner County Medical Center - Cando
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ReadmissionsProvider Champion: Implementing BOOST readmissions strategies – Towner County Medical Center Discharge Planning Checklist: CHI-Dickinson, Heart of AmericaCase Manager Post Discharge: Carrington Health Center, Cooperstown Medical Center, McKenzie County Medical Center, First Care Health Center-Park River
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Utilizing Change Packages in Swingbed PopulationCommunity Memorial Hospital-Turtle LakeGarrison Community Hospital Jacobson Memorial Hospital-ElginKenmare Community HospitalMountrail County Medical Center-StanleyNelson County Medical Center-McVilleNorthwood Deaconess Health Center
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Leadership Engagement
Executive Leadership Engagement
Patient Serving on Hospital BoardPembina County Memorial Hospital, CHI-Valley City, First Care Health Center, Sakakawea Medical Center, St. Andrew’s Health Center
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InnovationHeart of America Medical Center!
Telemedicine: Diabetes, Nutrition, Pacemaker clinic, Infectious disease, Mental Health Services
Expansion based on Community Assessment: Chemotherapy administration, Cancer Support Group
Utilization of Paramedics: Home Visiting, ER
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Acknowledging Barriers…
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Falls fatigue Sepsis protocols Need for follow-up post discharge Communication and teambuilding training Home visiting – payment (or lack thereof) Hiring freeze Teach-back training EHR challenges
Acknowledging Barriers…Presentation of data in a more meaningful wayProvider training on readmissionsHow do we coach up? (community culture
issues)How to build safety into facility design (built
environment)Resistance to bedside rounding/huddlesPolicies and processes – can we collaborate?Hand hygiene…how do we keep this fresh?
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Adverse Drug Events (ADEs) Catheter Associated Urinary
Tract Infections (CAUTI) C. difficile Infections (CDI) Central Line-Associated
Blood Stream Infections (CLABSI)
Injuries from Falls and Immobility
Pressure Ulcers (PrU)
Sepsis
Surgical Site Infections (SSI)
Venous Thromboembolisms (VTE)
Ventilator Associated Events (VAE)
MRSA bacteremia events
Hospital Patient Safety Culture
Readmissions (12% reduction)
20/12 Reduction
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Fellowship EnrollmentPatient and Family Engagement
Kathy Skager – Sanford Hillsboro Megan Thompson – First Care Health Center Jamie Nienhuis – Cavalier County Memorial
Hospital April Johnson – Cooperstown Medical CenterCohort 2 Kathy Knudson – Sanford-Mayville Charlene Hanson – Southwest Health Care -
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Fellowship EnrollmentQuality Improvement – Foundations
Amanda Jordan – Sanford Mayville
Beth Hetletved – Community Memorial Hospital
Denise Beaver Eslinger – Cooperstown Medical Center
Diana Neva – Cooperstown Medical Center
Kathy Skager – Sanford Hillsboro
Lisa Luft – Mountrail County Medical Center
Marie Loven – Presentation Medical Center
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Fellowship EnrollmentQuality Improvement – Accelerated
Jessica Linderman – Carrington Medical Center
Ann Nelson – Tioga Medical CenterColeen Bomber – Northwood Deaconess
Health Center
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ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
Map of ActorsMapping actors: Used to develop and implement a relational strategy to build collective leadership capacity and enlist stakeholders’ commitments to a shared purpose
ValuesInterestsResourcesPower
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Map of Actors
ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
INTERESTS INTERESTS
ASSETS ASSETS
1. What change do we want? (What is our interest?)
2. Who has the assets to create that change?
3. What do they want?
4. What assets do we have that they want?
YOUR AIMS C
C = Commitment
YOUR MAP OF ACTORS
Power Analysis
ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
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Map of Actors
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What is the difference between a constituent and a stakeholder?
ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
To recognize people as our greatest asset! To understand our system through our stakeholder’s values, interests,
assets & relationships
To develop a strategy for building & engaging a core team
To build power ‘with’ – instead of doing ‘to’ or ‘for’
To see constituents and stakeholders as partners in health
To illuminate momentum builders & roadblocks
To promote reciprocity & mutual respect between stakeholders with power differences
To generate collective power to co-produce health
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Map of Actors: Why?
ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
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The right people
A compelling
purpose
An enabling structure
Effective Team
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Power isn’t something you have…it’s a relationship with others.
This strategy is based on turning the ASSETS we
have into the POWER weneed to get the CHANGE
we want!
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Map of Actors
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Map of Actors: Candidates
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ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
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Map of Actors
ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
4/20/2017
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CoachingCan you be more specific in certain places by
naming people by name, not just organizations?Are there other influential stakeholders missing
from this map? Consider community, county, regional and statewide partners.
What consideration have you given to the power dynamics at play in your map?
Will you/team go back to map the values, interests and resources of each actor?
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ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
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Interests:• What do they want?• Look at their mission
statement• Who funds their work?• Who do they serve and what
are their goals?• What are their passions?• What drives them?
Actor Analysis
Nightmare:• Current nightmare they
live and want out of?• Nightmare they are trying
to avoid?
Dream:• What is their motivating vision?
Assets: • Think beyond money….• Influence?• Connections?• Staff?• Meeting space?• Programs?
What values do we connect on?• Where is the common
ground?• Where do we want the
same things?What assets do we have that can help them address their Nightmare/ Dream/Interests?
Our ASK:• STRONG, CLEAR, based on shared
values• “Will you join me…?
ReThink Health and QIN National Coordinating Center, Leadership & Organizing in Action, 2016
Our OFFER:• Based on what THEY want & need,
NOT on what we think they should have or care about….
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Map of Actors: Lessons LearnedUnderstand values and interests in relation to
actors and assets to create a basis for mutual exchanges
Actors can have multiple identities (support, constituency, opposition, etc.)
It is a ‘living map’ – Update as you goThe map itself is an asset!Assume that you will need to lose a bit of
control for much, much more power
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From our team to yours: Best wishes on your HIINovations!
Jean Roland701-852-4231
Nikki Medalen701-537-5548
Jon Gardner701-852-4231
We need your picture!
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HIIN Resources Innovate ND Newsletter HRET HIIN Resources: www.hret-hiin.org
Encyclopedia of measures HRET list-serves Virtual educational events (all recorded) Change Packages and Checklists Fact sheets Case studies Guidelines/criteria Toolkits
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Our Commitment To leverage prior project successes and
learnings To communicate early and often
Innovate-ND NewsletterInnovate-ND WebsiteHRET HIIN Website
Collaborate with in-state partners to provide optimal support and achieve project goals
To move as quickly as we can to achieve the 20/12 percent reduction in harm!
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Our Request of YouRemain focused on Reducing Harm
Across the BoardDo more of what is already workingAuthentically and fully engage your
patients in the improvement workCollaborate to serve as catalysts for
change
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