Deborah M Nadzam Ph D FAAN Joint Commission
Deborah M. Nadzam, Ph. D, FAAN - Joint Commission Resources Lorrie Jones-Hartley, MSN, CRRN-A - Durham Regional Hospital © Copyright, Joint Commission Resources Organizational Capacity for Change and Patient Safety
– Briefly describe Patient Safety Connections service – Provide background information about Organizational Capacity for Change – Describe application of OCC survey – Discuss findings and use of OCC at one organization Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Presentation Objectives
• Goal: To significantly increase the organization’s ability to take effective actions on safety risks and produce sustainable improvement in safety. • Collaborative assessment: Project Team including JCR consultants and client organization leaders Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Patient Safety Connections
• • Clinical patient tracers Shadowing clinicians and staff Adverse event reporting assessment Review of P. I. projects Group interviews Observations of practice Conversations with frontline staff Online surveys: AHRQ and OCC Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Collaborative Assessment Strategies
Organizational Capacity for Change – William Q. Judge – “OCC is a broad and dynamic organizational capability that allows the enterprise to adapt old capabilities to new threats and opportunities, as well as create new capabilities. ” (Judge, 2005) Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources – E. V. Williams Chair of Strategic Leadership and Professor of Strategic Management Old Dominion University, Norfolk VA
Organization Capacity for Change • Compares 8 dimensions across 3 groups • 8 dimensions = 4 dualities • Leadership must balance between dualities Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources • Executives, managers, frontline staff
• Trusting staff: Trustworthy Leadership • Capable Champions: Involved Middle Management • Systems Thinking: Systems Communications • Accountable Culture: Innovative Culture Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources 8 Dimensions: 4 Dualities
Trusting Workers Trustworthy Leadership presents a clear vision, inspires confidence, and upholds organizational values while encouraging change. Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Frontline workers are open to change, know how change will help them, and trust leaders to carry out change efforts.
Capable Champions Involved Middle Management Middle managers effectively connect front line staff with leadership, balance the need for change with the need to complete current work. Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Change efforts are led by champions with Interpersonal skills, leadership support, and the will and ability to challenge the status quo.
Systems Thinking Systems Communications People get the information they need in a timely way, across units and from customers. Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Change champions focus on causes rather than symptoms, the importance of aligning incentives, and the need to change systems.
Accountable Culture Innovative Culture The organization attracts and retains Creative people and support innovative changes. Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources People meet deadlines; they have clear Roles and responsibilities, and experience Reasonable consequences for their actions.
Organizational Capacity for Change (OCC) – Overall Trustworthy Leaders 40 35 30 28. 3 Capable Champions 25 Innovative Culture 30. 1 27. 7 24. 1 32. 1 29. 5 27. 0 24. 0 28. 5 25. 2 25. 1 21. 9 20 15 10 5 29. 6 24. 8 Systems Communications 0 23. 4 26. 1 28. 4 29. 3 26. 6 20. 5 23. 7 24. 0 26. 5 29. 6 22. 9 26. 0 28. 9 27. 0 Accountable Culture 22. 5 24. 4 27. 0 31. 0 Involved Mid-Mgt Trusting Workers OCC-Overall 1 st/2 nd Quartile Split 2 nd/3 rd Quartile Split 3 rd/4 th Quartile Split Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Systems Thinking
• • Research shows that a rating below the first quartile by any group, even when the overall score is in the first quartile, is related to limited change capability. The value of report is to: • challenge managers to look more closely into areas where there are differences in perception, even though their own perception is that there are no concerns, and • focus improvement efforts on the organizational capabilities related to executing change initiatives. For example, Durham may expand its review of frontline staff’s opinion related to systems communication. Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources What do these differences mean?
Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Durham Regional Hospital’s Opportunities for Change
Organizational Capacity for Change o 24 respondents Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources § 8 in the top group § 12 in the middle group (including physicians) § 4 in the frontline group
Trusting Workers Trustworthy Leaders Overall score for trusting workers 1 st quartile § § o Overall Score trustworthy leaders 2 nd quartile. § § o Executives and frontline staff scored them in the 1 st quartile Middle manager them in the 2 nd quartile. Executives scored them in the 1 st quartile, Both other groups scored them in 2 nd quartile. This represents an opportunity for further assessment and a plan for developing a trusting relationship Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources o
Capable Champions Involved Middle Management All staff rate involvement of middle management in the first quartile § Correlates with AHRQ findings related to supervisors do not sacrifice patient safety o Front line staff rate capable champions in the second quartile. o Improving the effectiveness of department champions would increase overall improvement capability. Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources o
Systems Thinking Systems Communications o Systems thinking (focus on causes rather than symptoms, change systems) § Senior staff and middle managers rate 1 st quartile § Front line staff 2 nd quartile § Correlates with AHRQ in that staff feel mistakes are held against them and working in crisis mode o Systems communication is rated overall in the 2 nd quartile § All groups rated 2 nd quartile o Developing effective, systematic communication mechanisms, and monitoring and improving their effectiveness is an opportunity for development o Communications survey, developing report from SRS system, revamped walk rounds Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources § Correlates with AHRQ findings around communication
Accountable Culture Innovative Culture All staff rate Durham in the first quartile for accountable culture, while front line staff rate innovative culture in the second quartile. § o Just Culture This suggests that front line staff perceive the work environment as having a stronger emphasis on accountability than on supporting initiative, innovation, or improvement at the front line. § Magnet journey, developing Patient Safety Champion Program Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources o
Current Strengths - A sample o The Board and Executive Team are driving patient safety o Communication from Senior Leaders o Medication Management Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources o Several safe practices have been implemented
More Strengths o Strong peer-to-peer support at the front line o The success of the Surgical Care Improvement Project Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources o Attention to employee morale and professional growth
Themes of Concern Alignment of the medical staff with the organization’s commitment to quality and patient safety initiatives. § o Staff engagement throughout the organization in patient safety activities § o New CMO, Revise Physician Peer Review, Compensate Physicians for Committee involvement Magnet, Patient Safety Champions, Walk Rounds Variation in clinical practice across the organization and in implementation of national patient safety goals. § Magnet, Stroke Program Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources o
Themes of Concern (continued) Interdisciplinary communication re: clinical issues § o Performance improvement and sustainability § o Redesigned PI committee, Six Sigma Oversight Communication channels for frontline staff to express concerns about quality and patient safety § o Flash Rounds, Transport Communication Sheet Revamp SRS system, revise Walk Rounds Reporting and analysis of patient safety concerns, adverse events and near misses. § Revamp SRS system with reporting capabilities Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources o
o Disseminate the results of the patient safety assessment and improvements underway o Prioritize focused areas posing greatest risks to patients o Develop specific strategies and timelines with the involvement of staff, physicians, executive leadership team, and Board o Act! Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Next Steps
Durham Regional Hospital – Patient Safety Connections. April 2007 © Copyright, Joint Commission Resources Questions & Comments
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