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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
0%10%20%30%40%50%60%70%80%90%
Co
mm
un
icat
ion
wit
h N
urs
es
Nu
rses
tre
at y
ou
wit
hco
urt
esy/
resp
ect
Nu
rses
list
enca
refu
lly t
o y
ou
Ro
om
Cle
anlin
ess
Co
urt
esy
of
per
son
cle
anin
gyo
ur
roo
m
Pro
mp
tnes
s in
resp
on
se t
o c
all
ligh
t
Nu
rse
Kep
t yo
uin
form
ed
Exp
lan
atio
ns
of
wh
at w
ill h
app
en:T
&T
Inst
ruct
ion
s o
nh
ow
to
car
e fo
ryo
urs
elf
at h
om
e
Ho
w w
ell y
ou
rp
ain
was
con
tro
lled
Nu
rses
exp
lain
ina
way
yo
uu
nd
erst
and
Tel
l yo
u w
hat
new
med
icin
ew
as f
or
%ti
le R
ank
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
Kevin M. Soeken, M.S.Customer Relations Management Coordinator
(309) [email protected]