High Reliability Organizational (HRO) Culture using Standardized Patient Simulation and Team. STEPPS March 8, 2017
March Team. STEPPS Monthly Webinar Rules of Engagement n Audio for the webinar can be accessed in two ways: 1. Through the phone (*Please mute your computer speakers) 2. Through your computer n A Q&A session will be held at the end of the presentation n Written questions are encouraged throughout the presentation and will be answered during the Q&A session n Slide 2 To submit a question, type it into the Chat Area and send it at any time during the presentation TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Upcoming Team. STEPPS Events n Master Training Courses n Registration for courses through June 2017 now open n Registration opening on March 15 for courses in July. September 2017 n National Conference n n Downtown Hilton, Cleveland, OH n Slide 3 June 14 -16, 2017 Registration open and almost to capacity! TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Help Line (312) 422 -2609 Or email: AHRQTeam. STEPPS@aha. org Slide 4 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Today’s Presenter(s) n Brent Ibata, Ph. D JD MPH FACHE Research Compliance Officer - Sentara Healthcare Adjunct Assistant Professor - Eastern Virginia Medical School Team. STEPPS Master Trainer n Patric Lundberg, Ph. D Associate Professor - Eastern Virginia Medical School Director of Bioinformatics Analytics - Eastern Virginia Medical School Team. STEPPS Master Trainer Slide 5 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Objectives 1. Understand the value of high reliability organizational culture in the design, development and execution of quality and performance improvement initiatives. 2. Demonstrate how to create and sustain a culture of creative inquiry to encourage healthcare innovation and achieve a high reliability organizational culture. 3. Describe how the use of Team. STEPPS with simulated patients can help to create and sustain a high reliability culture. Slide 6 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Experiential Learning n For the things we have to learn before we can do them, we learn by doing them. – Aristotle n Give the pupils something to do, not something to learn; and the doing is of such a nature as to demand thinking; learning naturally results. - John Dewey n See one, do one, teach one. Slide 7 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Agenda Evolution on Healthcare Innovation Fundamentals of High Reliability Organizations Rapid Cycle Innovation (Design Thinking) Our patient simulation experience Slide 8 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Evolution of the Hospital Slide 9 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Evolution of Reimbursement FFS Slide 10 HMO TEAMSTEPPS 05. 2 VBP
March Team. STEPPS Monthly Webinar Evolution of Patient Safety Slide 11 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Hospitals of the Future Highly reliable healthcare organizations share common core characteristics: n Encourage and support continuous change n Invest in staff development and staff self-efficacy n Transparent patient safety metrics n Patient centric focus Slide 12 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Hospitals of the Past Struggling healthcare organizations share common core characteristics: n Deference to the status quo n Limited staff development dollars n Blame-game accountability n Provider centric focus Slide 13 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar To Err is Human Institute of Medicine (1999) n At least 44, 000 Americans die each year as a result of a medical error (may be as high as 98, 000). n Total cost between $17 and $29 billion (lost income, lost productivity, disability and healthcare costs). Slide 14 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar To Err is Human Recommendations (1999) n Establish a national focus to create leadership, research, tools and protocols to enhance knowledge of patient safety. n Identify and learn from errors through mandatory reporting. n Raise standards and expectations for improvements in patient safety through oversight organizations, purchasers, and professional groups. n Create safety systems through the implementation of safe practices at the patient level. Slide 15 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Crossing the Quality Chasm n Institute of Medicine (2001) n Establish a New Environment for Care n Focus and align the environment toward the six aims for improvement. § Safe, effective, patient-centered, timely, efficient, equitable n n Slide 16 Provide, where possible, assets and encouragement for positive change. Align Payment Policies with Quality Improvement TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Timeline of Healthcare Reform • Medicare Prescription Drug Improvement and Modernization Act of 2003 (Pub. L. 108 -173) • • • Origin of Hospital Inpatient Quality Reporting Program Reduced annual payment update by 0. 4% to non-participating hospitals or hospitals that failed to meet criteria for reporting. Deficit Reduction Act of 2005 (Pub. L. 109 -171) • • Patient Protection and Affordable Care Act of 2010 (Pub. L. 111 -148) n n Slide 17 Increased reduction to 2% Authorized 1 st national Hospital Value Based Purchasing Pay-for. Performance program. Effective FY 2013 for discharges on or after October 1, 2012. TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Quality Improvement - Co. P • • Slide 18 § 482. 21 Condition of participation: Quality assessment and performance improvement program. The hospital must develop, implement, and maintain an effective, ongoing, hospital-wide, data-driven quality assessment and performance improvement program. The hospital's governing body must ensure that the program reflects the complexity of the hospital's organization and services; involves all hospital departments and services (including those services furnished under contract or arrangement); and focuses on indicators related to improved health outcomes and the prevention and reduction of medical errors. The hospital must maintain and demonstrate evidence of its QAPI program for review by CMS. TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Serious Safety Events (Never Events) n Retained foreign objectsn Procedural events n Wrong patient n Delay in treatment n Wrong side n Criminal events n Wrong procedure n Perinatal death/injury n Falls n Medication errors n Suicides n Fire-related events n Dialysis-related events Source: Becker’s Hospital Review (2014 -2015) Slide 19 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar AHRQ Becoming a High Reliability Organization (2008) Sensitivity to Operations (Situational Awareness) Reluctance to Simplify (Multiple Failure RCA/ACA) (Healthy) Preoccupation with Failure (Situationally Appropriate) Deference to Expertise Resilience (Members of the Team) Slide 20 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Stages of Change: n The data are wrong; n The data are correct but it’s not a problem; n The data are correct and it’s a problem, but it’s not my problem; n The data are correct and I own the responsibility to fix the problem. Slide 21 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Foundation of an HRO Culture 5 Ps We improve health everyday. BBEs Hourly Rounding Bedside Shift Report SBAR Situational Leadership Slide 22 RED RULE TEAMSTEPPS 05. 2 Safety Huddle HRO
March Team. STEPPS Monthly Webinar Sentara Commitments I commit to: n Always keep you safe n Always treat you with dignity, respect & compassion. n Always listen & respond to you. n Always keep you informed & involved. n Always work together as a team to provide you quality healthcare. Slide 23 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Sentara Behavior Based Expectations I commit to always keep you safe: n Pay attention to detail n Communicate clearly n Have a questioning attitude n Hand off effectively n Never leave my wingman Slide 24 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Collaborative Grant Program Rapid Cycle Innovation Training Grant in Healthcare Delivery Science and Health Services Research $20, 000 multi-institution grant: n 501(c)(3) hospital – Sentara – Brent Ibata n Medical school – EVMS – Patric Lundberg n Liberal arts college – College of William & Mary – Jim Olver Slide 25 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Plan Grant Timeline Act Do Study Develop Training Program (Plan) Plan Cohort #1 (Do-Study-Act) Act Do Study Plan Act Cohort #2 (Plan-Do-Study-Act) Study Plan Cohort #3 (Plan-Do-Study) Act Do Study Final Presentation(s) Slide 26 TEAMSTEPPS 05. 2 Do
March Team. STEPPS Monthly Webinar Planning Plan Act Stanford d. school Florida Hospital Innovation Lab Mayo Clinic Center for Innovation Team. STEPPS Master Trainer at Duke Slide 27 TEAMSTEPPS 05. 2 Do Study
March Team. STEPPS Monthly Webinar AHRQ Using Rapid-Cycle Research to Reach Goals (2015) Preparation Problem Exploration Implement Problem Test Knowledge Exploration Solution Development Solution Testing Develop Implementation & Dissemination Slide 28 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Innovation Cycles Plan Act Do Study Source: d. school and IDEO Slide 29 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar d. school Innovation Cycle Empathy Define Ideate Empathy Test Prototype Test Define Prototype Ideate Source: d. school and IDEO Slide 30 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Empathy (human-centered design) Empathy is the ability to be aware of, understand, and be sensitive to another person’s feelings and thoughts without having had the same experience. Empathetic design is a process that involves interviews, observations, and iterative rapid cycle prototyping. Empathy is key to design thinking. Slide 31 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Cultures of Innovation Built environment (social and spatial) Permission to fail (fail fast, fail cheap) Innovation space (multidisciplinary) Culture (plan to sustain momentum) Source: Brown, Tim. Change by Design Slide 32 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Sentara Heart Culture of Innovation Sentara Heart Operations Committee Sentara Heart Joint Operations Committee Sentara Cardiovascular Research Institute Cardiac Grand Rounds Cardiac Journal Club Rapid Cycle Innovation Boot Camp Slide 33 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Basic HRO Materials (pop-up workshops) Marshmallow ($25) n Spaghetti, roll-of string, tape measure. Wallet & prototyping ($3, 000) n Prototyping cart (cardboard, crayons, Play Doh, etc. ) Brainstorming Z-Rack Whiteboard ($500) n Z-Rack Post-Its (Priceless) Source: d. school. stanford. edu Slide 34 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Rapid Cycle Innovation Projects Wayfinding HRO Logo Physician Report Card HRO Bulletin Board Inventory Management HRO Flip Book 12 -Lead EKG AMI LOS HRO 8 ½ x 11 Poster Rapid Response Audit Team HRO Badge Card Bed Flow HRO Team. STEPPS - Leader Med Communication HRO Team. STEPPS - Monitor Seamless Discharge Falls HRO Team. STEPPS – Comm OR Safety HRO Team. STEPPS - Support Slide 35 TEAMSTEPPS 05. 2
March Team. STEPPS Plan Monthly Webinar Act Rapid Cycle Innovation Boot Camp Slide 36 TEAMSTEPPS 05. 2 Do Study
Plan March Team. STEPPS Monthly Webinar Act Do Study FINAL Agenda – Day #1 n 0800 – Icebreakers n 0930 – Marshmallow Exercise n 1000 – d. school Wallet Exercise n 1100 – How might we design the ideal office visit? n 1200 – LUNCH n 1230 – Post-It brainstorm Q’s HRO Culture n 1330 – Empathy Hunt n 1500 - Debrief Slide 37 TEAMSTEPPS 05. 2
Plan March Team. STEPPS Monthly Webinar Act Do Study FINAL Agenda – Day #2 n 0800 – Icebreakers n 0830 – HRO Team. STEPPS n 0930 – Post-It brainstorm “dig deeper” n 1000 – Empathy Hunt #2 n 1100 – Debrief n 1200 – LUNCH n 1230 – Fail fast, fail cheap – Build prototype(s) n 1300 – Test Prototype(s) n 1500 - Debrief Slide 38 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Slide 39 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar How might we communicate HRO to front-line staff? Slide 40 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar How might we communicate HRO to front-line staff? Slide 41 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar AHRQ Team. STEPPS Slide 42 TEAMSTEPPS 05. 2 42
March Team. STEPPS Monthly Webinar Slide 43 TEAMSTEPPS 05. 2
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March Team. STEPPS Monthly Webinar Sentara Center for Simulation & Immersive Learning n The EVMS Sentara Center for Simulation and Learning is a 25, 000 square foot facility with over 12, 000 students attending 2, 718 classes in 2016 n Standardized Patients n Physical Exam Teaching Associates n Genitourinary Teaching Associates n High Technology Mannequins n Part Task Trainers n n Slide 45 High tech virtual reality trainers Low tech for less complex skills (ex. IV catheter insertion) TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Sentara Center for Simulation & Immersive Learning Slide 46 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Lessons Learned – Standardized Patients & Team. STEPPS n Empathy-based rapid cycle innovation can produce dozens of prototypes in a short period of time. n Front-line staff can be quickly taught design thinking tools to prototype innovative solutions to everyday healthcare problems. n Standardized patients in ‘real’ simulated clinical environments makes role-based scenarios easy, fun, without creating ‘stage-fright’ since the standardized patient is the focus. n Standardized patient scenarios bring alive Team. STEPPS skills. Slide 47 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Presenter Biography & Contact Info Brent Ibata, Ph. D JD MPH FACHE Research Compliance Officer for Sentara Healthcare Dr. Ibata has over twenty-five years of progressive healthcare leadership experience starting as an ER tech on the West Side of Chicago, moving through a decade at an academic teaching hospital in St. Louis, followed by three years as a director of a multidisciplinary clinic. Dr. Ibata is a Mensan and Team. STEPPS Master Trainer who has spent most of his career building and sustaining environments that inspire and reward innovation and quality. The seeds for his career in healthcare innovation were planted in Chicago as a graduate of Lane Technical High School and The Second City Training Center. Dr. Ibata has a Ph. D with an emphasis in health services research, a JD with a certificate in health law, and a Master in Public Health. He is the author of numerous journal articles in addition to dozens of presentations at regional, national, and international conferences related to innovation in healthcare. Email: baibata@sentara. com Phone: (757) 252 -9401 Slide 48 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Presenter Biography & Contact Info Patric Lundberg, Ph. D Dr. Lundberg is an Associate Professor of Microbiology and Molecular Cell Biology, Virology Section Leader, Course Director of Bioinformatics & Biostatistics and Director of Bioinformatics Analytics at the Eastern Virginia Medical School in Norfolk, VA. He is a Team. STEPPS Master Trainer and co-investigator for the 2013 -14 multicenter collaborative grant titled Rapid Cycle Innovation Training Grant in Healthcare Delivery Science and Health Services Research with Sentara Heart Hospital, the College of William & Mary, and the Eastern Virginia Medical School. Email: Lundbe. PS@evms. edu Phone: (757) 446 -5174 Slide 49 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Bibliography/References 1. Brown, T. (2009). Change by design. Harper Business. 2. Cleveland Clinic. A Lesson in Empathy. Available at: https: //youtu. be/c. DDWvj_q-o 8 3. dschool. stanford. edu 4. Hines S, Luna, K, Lofthus J, et al. (2008). Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. AHRQ Publication No. 08 -0022. Agency for Healthcare Research & Quality. 5. Ibata, B. (2009). Public Health Law & the Built Environment in American Public Schools: Detailed History with Policy Analysis. VDM Publishing. 6. Institute of Medicine (US) (2001). Crossing the quality chasm: a new health system for the 21 st century. National Academy Press. 7. Institute of Medicine (US) (2000). To Err is Human: Building a safer health system. Institute of Medicine. National Academy Press. 8. Kelley, T. (2007). The art of innovation: Lessons in creativity from IDEO, America's leading design firm. Crown Business. 9. Kelley, T. , & Kelley, D. (2013). Creative confidence: Unleashing the creative potential within us all. Crown Business. 10. Lanser May, E. (2013). The Power of Zero: Steps Toward High Reliability Healthcare Executive. 11. Wujec, Tom (2010). The Marshmallow Challenge. Ted Talk. Available at: https: //www. ted. com/talks/tom_wujec_build_a_tower Slide 50 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar Questions and Answers For more information, please contact our team at: AHRQTeam. STEPPS@aha. org Slide 51 TEAMSTEPPS 05. 2
March Team. STEPPS Monthly Webinar ? Slide 52 TEAMSTEPPS 05. 2
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