Virginia Mason
Promoting Safety: Creating the culture needed to achieve system improvement Gary Kaplan, M.D. Cathie Furman, RN, MHA International Forum on Quality and Safety in Healthcare April 24th, 2015 © 2015 Virginia Mason Institute Learning Objectives • Identify fundamental leadership methods and structure to promote a culture of safety • Design strategies to promote and enhance the culture in your organization • Explain how a culture of respect connects to the delivery of patient-centered, safe, high-quality care 2 © 2015 Virginia Mason Institute Virginia Mason Medical Center • • • • • Virginia Mason • Integrated health care system • 501(c)3 not-for-profit • 336-bed hospital • Nine locations • 500+ physicians Integrated healthcare system 336 bed hospital 6,000 team members Education & Research Eight Regional Centers • 5,500+ employees • Graduate Medical Education • Research Institute • Foundation • Virginia Mason Institute 3 © 2015 Virginia Mason Institute The Healthcare Culture Problem • Blame, denial, scapegoats • Hierarchical structure • Lack of trust, fear, victimization • Frustration, anger • Helplessness, hopelessness, resignation • Apathy Copyright © 2012 Virginia Mason Medical Center. All Rights Reserved. 4 © 2015 Virginia Mason Institute © 2015 Virginia Mason Medical Center The VMMC Quality Equation Q = A × (O + S) W Q: Quality A: Appropriateness O: Outcomes S: Service W: Waste Copyright © 2012 Virginia Mason Medical Center. All Rights Reserved. 6 © 2015 Virginia Mason Institute Requirements for Transformation Improvement Method Applied to ALL Processes Critical mass feels urgency for change Executives address technical AND human dimensions of change Visible and committed leadership New compact aligns expectations with vision Broad and deep commitment to shared vision Copyright © 2012 Virginia Mason Medical Center. All Rights Reserved. 7 © 2015 Virginia Mason Institute Vision Is Context for Compact • Societal needs • Local market • Competition • Organization’s strengths STRATEGIC VISION Physicians give: Organization gives: • What the organization needs to achieve the vision • What helps physicians meet commitment • What is meaningful to physicians Copyright © 2012 Virginia Mason Medical Center. All Rights Reserved. 8 © 2015 Virginia Mason Institute Align Expectations Physician Compact Leader Compact Board Compact 9 © 2015 Virginia Mason Institute The Road to Transformation Source: Gareth Morgan 10 © 2015 Virginia Mason Institute The Virginia Mason Production System 1. The patient is always first 2. Focus on the highest quality and safety 3. Engage all employees 4. Strive for the highest satisfaction 5. Maintain a successful economic enterprise 11 © 2015 Virginia Mason Institute Stopping the Line 12 © 2015 Virginia Mason Institute Patient Safety Alert Process • Leadership from the top • “Drop and Run” commitment • 24/7 policy, procedure, staffing • Legal and reporting safeguards 13 © 2015 Virginia Mason Institute Patient Safety Alert Goal: zero defects Based on VMPS Continuous Improvement 14 © 2015 Virginia Mason Institute Culture must support reporting Weick and Sutcliffe “Managing the Unexpected” 15 © 2015 Virginia Mason Institute A Defining Moment 16 © 2015 Virginia Mason Institute Count of PSAs Reported per Month All PSAs (Inpatient and Outpatient) SOS Process #2 1200 1000 New Leader Orientation 800 Mistaking Proofing Sharing of Immediat e PSAs Safety Briefings Kaizen Share Point Standard of Care Improvement Kaizen Respect for People PSA 3P Quick Entry Screen Good Catch Award Making Safety Local SOS Process #1 Lab PSA Entry Optimizing Trending Awareness Kaizen 600 400 200 Jan-15 Nov-14 Sep-14 Jul-14 May-14 Mar-14 Jan-14 Nov-13 Sep-13 Jul-13 May-13 Mar-13 Jan-13 Nov-12 Sep-12 Jul-12 May-12 Mar-12 Jan-12 Nov-11 Sep-11 Jul-11 0 50,000th PSA Reported September September 2014 2013 October 2012 50,000th July 2005 March 2008 February 2011 40,000th 30,000th 20,000th 1,000th 10,000th End of February 2015: 54,921 18 © 2015 Virginia Mason Institute Assist, Celebrate & Recognize People 19 © 2015 Virginia Mason Institute Share the Lessons 20 © 2015 Virginia Mason Institute Why Culture is Important First McClinton Award winner “Mary provided the face to all the statistics” “How do I tell them? I don’t ” even know what happened yet, what if they blame me?” A provider A surgeon recently had to use Seattle Surgical for a procedure and realized no other staff were engaged in the time out “I realized I can no longer practice without the surgery attestation we use at VM” “You began with “I am sorry,” “ I can’t tell you how important it and after that, I could listen was to stop the line - It was because I knew you cared.” amazing to see the resources A family member get pulled in to support us” One of the involved team members 21 © 2015 Virginia Mason Institute “Stopping the line” Organization-wide Involvement Number of PSAs Reported per Month 1. Staff report issues using the Patient Safety Alert System 2. Leadership investigates and resolves issues 3. Board Quality Committee review/ approve closure of high-severity issues 1000 900 800 700 600 500 400 300 200 100 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 0 22 © 2015 Virginia Mason Institute Effectiveness of Safety Program 12000 100 90 10082 86 10000 79 80 9277 78 70 70 67 8000 66 60 60 6196 6000 50 5386 40 4322 4000 3500 30 3079 2954 2726 2697 23 19 2000 16 20 10 0 0 '04-'05 '05-'06 '06-'07 '07-'08 '08-'09 PSAs Reported (Excludes claims closed without payment.) © 2015 Virginia Mason Institute '09-'10 '10-'11 '11-12 '12-13 '13-14 Reported Claims 23 Leaders Sustain the Rigor Tuesday Stand Up Friday Report Out Standard Work for Leaders 24 © 2015 Virginia Mason Institute Standard Work for Leaders Virginia Mason Leaders Have Two Jobs 1. RUN their business 2. IMPROVE their business 25 © 2015 Virginia Mason Institute Change is Hard “People change what they do less because they are given analysis that shifts their thinking than because they are shown a truth that influences their feelings" John Kotter 26 © 2015 Virginia Mason Institute Leadership on Genba “It’s just saline.” 27 © 2015 Virginia Mason Institute Respect for People Patient Safety Curriculum 2010 2011 Mandatory Service Training Respect for People 2013 2012 Mandatory RFP Training Lucian Leape Visit Transformational Leadership 2014 LEADERSHIP ROLE AND ACCOUNTABILITY Integration of RFP Change Management TeamSTEPPS 28 © 2015 Virginia Mason Institute Defined as: How we treat one another as we work together to create the perfect patient experience 29 © 2015 Virginia Mason Institute Top 10 Ways to Show Respect Listen to understand Share Information Speak Up Walk in their shoes 30 © 2015 Virginia Mason Institute Aligning Vision with Resources Long Term Vision Annual Goals VMPS Priorities Department Priorities 31 © 2015 Virginia Mason Institute It is a Journey − Mrs. McClinton − Adopted TPS − Implemented PSA system − First culture of safety survey − Implemented First 5 year Strategic Quality Plan 2002 2003 − Adoption IHI 100,000 lives campaign 2004 − Established CME course – EBM − Created Must Do Measures criteria, information flow and accountability − First Top in region Leapfrog survey − HealthGrades Distinguished hospital award − 2nd series of Disclosure workshops − Revised PSA database − Just Culture training − 1st major decrease in central line infections − Falls ST PRA 2006 2005 − One goal − First clinician disclosure training − Adopted mandatory flu vaccine policy − CPOE adopted across the inpatient setting − Top Hospital of the Decade 2008 2007 − Published peer review article on PSA system − CDC Immunization Excellence award − QOC began reviewing all red PSAs 2010 2009 − Surgical time out ST PRA held − SSI team McClinton Patient Safety Award winner 2011 − First Worker Safety Risk Register − First Good Catch Award − Respect for People Training − Standard of Care Process Kaizen 2012 − PSA 3P − Completed first Patient Safety Risk Register 2013 − ACPOE − 50,000th PSA − 108 Patient Family Partners 2014 − Established Synchronized Ongoing Support Process − Achieved target of 1000 PSAs reported in one month − Began PSA Pointers 32 © 2015 Virginia Mason Institute Strive for the Highest Satisfaction Levels Medical Center Overall Satisfaction and Likelihood to Recommend Hospital Patient Overall Satisfaction and Likelihood to Recommend 100 100 91st Percentile 95 90 30th Percentile 22nd Percentile 90 89th Percentile 85 80 95 76th Percentile 15th Percentile 85 67th Percentile 23rd Percentile 80 75 75 70 70 2007 2008 2009 2010 Hospital Patient Satisfaction 2011 2012 2013 Likelihood to Recommend 2007 2008 2009 Clinic Patient Satisfaction 2010 2011 2012 2013 Likelihood to Recommend 22 © 2015 Virginia Mason Institute Maintain a Successful Economic Enterprise $60.0 $55.0 $49.4 $50.0 $45.0 $40.9 $ (Millions) $40.0 $38.0 $35.5 $35.0 Shared Success Program $30.0 $29.4 $25.6 $25.0 $22.5 $18.4 $20.0 $15.0 $12.0 $10.0 $5.0 $3.2 $0.7 $0.0 2000 © 2014 Virginia Mason Medical Center 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Safety Culture Question Staff Speak Up Freely* 82% 81% 80% 80% 79% 78% 79% 79% 77% 78% 76% 76% 74% 74% 72% 70% *Question: Staff will speak up freely if they see something that may negatively affect patient safety – using the AHRQ rating method © 2015 Virginia Mason Institute 35 Lessons Learned Large scale organizational change requires leadership, perseverance and alignment Communication is not sufficient Accountability Reinforcement Training Focus on continuous improvement 36 © 2015 Virginia Mason Institute Questions? 37 © 2015 Virginia Mason Institute A lean journey is a learning journey.TM © 2015 Virginia Mason Institute
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