Studer Principles in Action Presenters Bobette J. Shay RN, MS, BSN, CNOR Director of Operations TRHS...

Studer Principles in Action

Presenters• Bobette J. Shay

RN, MS, BSN, CNORDirector of Operations TRHS

BettendorfInterim Director of Cardiology

Service Line

• Kevin M. Soeken, M.S.Customer Relations Management

CoordinatorFacilitator – TRHS Firestarters

• TRHS Board challenged Senior Team to drive cultural change toward “Best Outcome, Every Patient, Every Time.”

• CEO Selected Leaders & sent to Studer training

• Leaders empowered to select participants from leads, managers and directors with consultant input and support

“Journey to Excellence”

Why go on this Journey?

“In early civilizations, fire starters taught others how to keep the flame alive. If they were successful, the tribe lived. If they were not, the tribe died. It was that simple." Quint Studer

Author of Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference.

• AIM: To implement and sustain a permanent culture of service excellence.

• July 2009 began meeting – twice per month – 90-120 min

• Members from all levels of leadership

• Staff engagement through “ad hoc” committees

• Charter: Action/results oriented approach • Team Rules

– Specific, timed agendas– Assignments & Reports– Check titles at door

• Team Roles:– Core Leadership: Sponsors, Leader, Facilitator, Coach – Ad Hoc committees with specific tasks

• Senior Team communication through Executive Sponsors

Introducing the

Brad CrowderAmanda CrowellJodi DykemaKurt FreddyLiza KlineMichael Patterson – Senior LeaderLynn RipplePam SamuelsonBobette Shay – Team LeaderKevin Soeken – FacilitatorJewels StarkMarilu WinkKathy YadonVicki Felger - Coach Kathy Cunningham – Senior Leader

Timetable

AIDET

Hourly Rounding

Leadership Rounding

Leadership Development

HML

Standards of Behavior

AIDETAIDETHourly RoundingHourly Rounding

Leadership RoundingLeadership Rounding

Leadership Development Leadership Development

HMLHML

Standards of BehaviorStandards of Behavior

AIDET

• 2008 Pilot Classroom training – Bettendorf Medical and Surgical Units

• Certification Trial on Surgical Unit – Rock Island Campus– Not Successful but lesson learned:

• concepts simple but culture not ready

• AIDET Service Champion Team formed

AIDET

CNO - Sponsor• Director - Lead• CRMC – Facilitator• Units Chosen

– 6N - Surgical Unit– 4S - Oncology Unit– 5S - Rehab Unit

• “Service Champions” chosen– Hand-picked by Unit Manager– Responsible to certify cohort of 5 peers

AIDET

• Biweekly meetings during development phase, regular attendance from CNO (now VP Quality)

• Training program revised by CRMC & “fine tuned” by Service Champions Group

• Training & Certification for Service Champions and “Super-Champions” completed first

• Senior Team Members, Directors and Managers in attendance dispersed among many classes

• Unit Staff assigned to Service Champion Cohorts after attending class

• Integrated ancillary and support staffs from those units at the same time

AIDETAIDET

Hourly RoundingHourly RoundingLeadership RoundingLeadership Rounding

Leadership DevelopmentLeadership Development

HMLHML

Standards of BehaviorStandards of Behavior

Focused 5Focused 5

PATIENT PATIENT CENTERED CENTERED

COMMUNICATION COMMUNICATION BUNDLEBUNDLE

AIDET KWKTAIDET KWKT

BEDSIDE SHIFT REPORTBEDSIDE SHIFT REPORT

HOURLY COMFORT ROUNDSHOURLY COMFORT ROUNDS

WHITE BOARDSWHITE BOARDS

Acknowledge

Introduce

Duration

Explanation

Thank You

A

I

D

E

T

AIDET Incorporation

• Hourly Comfort Rounds• Explanations of tests and

treatments• Housekeeping • Therapies: Speech, PT and OT • Graduation Celebrations:

– VP, Director and Manager participation

– Individual and Unit Certificates– Firestarters Cookies!

AIDET Initial Results

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Q1 2009 Q2 2009 Q1 2010

Values between 50 - 95% will get some incentive payment.

• Establish Documentation of Classroom and Certification Process in advance

• Assess Manager availability to observe & coach staff to the standard (A3 Analysis)

• Plan for certifying 3rd shift and weekend staff

• Prepare to encounter Task Orientation vs Patient Centered Orientation

AIDET More Lessons Learned

AIDETAIDET

Hourly RoundingHourly Rounding

Leadership RoundingLeadership RoundingLeadership DevelopmentLeadership Development

HMLHML

Standards of BehaviorStandards of Behavior

Leadership Rounding

• Firestarters Team recommended rounding days/times for 2010:

• Leads/Managers:  Tuesday, 9AM-11AM

• Directors/VP's:  Thursday, 2pm-4pm.

• Thank You Notes: 30/Quarter Minimum 

Leadership Rounding

• Rounding Flowcharts to get process started

• Later developed spreadsheet which incorporates information on these forms and rolls up Rounding, Thank You Note and Stoplight Report issues from Manager to Director to VP

Leadership Rounding Lessons Learned

• May need to adjust schedule but NOT the frequency

• Leaders may object to minimum # of TYN (“too fake”)– Look outside their department– Look at support/ancillary depts.– LOOK!

• Must have accountability at all levels or it is destined to fail!

• Need to divide up departments among Senior Leaders– Balanced workload– Reasonable frequency of rounding– Stay focused on capturing wins at the Senior level

AIDETAIDET

Hourly RoundingHourly Rounding

Leadership RoundingLeadership Rounding

Leadership Development Leadership Development

HMLHML

Standards of BehaviorStandards of Behavior

Leadership Development

• Fall Leadership Seminar – Interactive… and FUN!– Format

• working sessions• learning sessions

– “Studer 201”• Studer 101 = “Hardwiring Excellence”

prerequisite to class (quiz results posted during session)

– Table activities: focus on Leadership priorities

• Obstacles• Things to add

Leadership Development

Table Discussion Priorities

Obstacles1. Leadership Turnover 2. Mistrust 3. Resistance to Change

Things to Add1. Teamwork across departments 2. Front-line staff buy-in 3. Dealing with Low Performers

Leadership Development

Firestarters A3 (High Level)

Problem Statement “Ideally leadership would be stable, trust would be high and staff would exhibit willingness to change but in this case leadership instability and a lack of accountability/prioritization of activities create a culture of mistrust which directly results in resistance to change (all levels).”

Firestarters A3 Problem Statement

1.Leadership Development (HML)

2. Senior Leader Priorities: Director/Manager/Lead Priorities

3. AIDET & Hourly Comfort Rounding Embedding

4. Accountability Tools

5. Rounding: Manager Rounding on Patients & Staff

Firestarters A3 Countermeasures

Firestarters A3s

• 5 independent A3 analyses drew same conclusion:

Lack of Senior Leader prioritization of organizational goals creates leader (Lead, Manager and Director) confusion on daily prioritization of activities.

Firestarters

• Current Countermeasures

– Nurse Manager/Manager redesign through Blueprint Unit (6North) critical to:

• AIDET• Accountability• Rounding on Staff and Patients

– Increased Senior Leader clarity around top TRHS Priority Activities (2010 Quality Plan)

2010 TRHS Goals and Priorities:Quality and Service

• Reduce harm by 25%– Leadership rounding for outcomes: drives staff engagement

• Hourly Patient Comfort Rounds• Manager/Employee Rounding for outcomes

– Post-harm huddle to capture root cause – Quality Huddle: Weekly at TMC, Biweekly at TVNHA

• Reduce Readmissions by 30%– Patient education and patient teach-back

• Improve patient satisfaction to meet established targets– AIDET– Staff Recognition– High-Middle-Low performer conversations

2010 TRHS Goals and Priorities:Quality and Service

• All activities filter back to one of the three priorities mentioned

• Each level of leadership seeks direction and clarification from their “one up” concerning priority of activity

• Moving toward taking the analysis out to where the action is (unit huddles, group observations, etc.; “Swarm” methodology)

AIDETAIDET

Hourly RoundingHourly Rounding

Leadership RoundingLeadership Rounding

Leadership Development Leadership Development

HMLHMLStandards of BehaviorStandards of Behavior

High/Middle/Low Performers

• All Leads, Managers, Directors and Senior Team required (and desired!) HML training

• Prerequisite assignment – Use 2009 Employee evaluations to classify

employees as high, middle, or low performers

• Lessons Learned– Many annual evaluations did not match up with

employees ratings on the HML continuum– Managers discovered that they had given employees

a ‘needs improvement” in the same areas two years in a row

Post HML Training Actions

• All Leads, Managers, Directors and Senior Team are being asked to:

1. Re-recruit high performers

2. Engage/challenge Middle performers

3. “Up or out” low performers with clear support from HR: “You decide who, we will help with the when and how.”

• Re-evaluation of Annual evaluation tool to incorporate/utilize HML principles

• Next Leadership Seminar: Hiring for Fit

AIDETAIDET

Hourly RoundingHourly Rounding

Leadership RoundingLeadership Rounding

Leadership DevelopmentLeadership Development

HMLHML

Standards of BehaviorStandards of Behavior

Standards of Behavior

• Objective of the Standards of Behavior Team–Create a positive and consistent culture by creating a mechanism that will support Trinity’s Mission and Vision.

–Create a culture that will be sustaining and continually evolving

–Create a living, breathing document for staff to re-commit to annually thus ensuring it does not become a “flavor of the month”

We, Trinity, promise to uphold these Standards of Behavior and

exceed expectations ensuring Excellence F.I.R.S.T. and “The

best outcome, every patient, every time” by adhering to these A.C.E.S

standards.

What are

A.C.E.S?

• Accountability• Appreciation• Attitude• Appearance

• Compassion• Consistency• Commitment• Confidentiality

• Energy• Etiquette• Excellence• Equality

• Safety• Service• Smile

A

C

E

S

ACES Initial Actions

• Presentation made to Firestarters on 3/29

• Presentation to Senior Leadership on 4/5– Standards Promise to be signed by Senior

Team• Presentation to Management Team on 4/21

– Standards Promise to be signed by all Leaders

ACES Phase I• Internal communications and engagement tools

• Tri-fold material• Certificate of Agreement/Commitment• Badge Buddies• Internet postings • Town Hall meetings• Posters• Recognition Cards• NetLearning modules

• Linkages:• Performance Assessment• TOPS planners• Hiring for Fit/Interviewing process

ACES Phase II

• Accountability Plan – Pledge of Peers– Manager’s Moments– Roll out timing

• Public Posting of ACES for general public

ACES Lessons Learned

• With tools and some guidance, front-line staff are very ready to participate and guide elements of their own performance

• Staff have some excellent ideas… just ask them!

• Managers and staff involved in the process are really looking forward to the Pledge of Peers” development

AIDET

Hourly Rounding

Leadership Rounding

Leadership Development

HML

Standards of Behavior

Summary

Questions and

Comments

For more information, contact:Bobette J. Shay

RN, MS, BSN, CNOR(563) 742-2616

ShayB2@ihs.org

Kevin M. Soeken, M.S.Customer Relations Management Coordinator

(309) 779-2995soekenkm@ihs.org