The 4 Disciplines of Execution Quality Forum 2015

The 4 Disciplines of Execution Quality Forum 2015 BC Patient Safety Quality Forum – Rapid Fire Session February 19, 2015 Michael Mc. Millan, Chief Operating Officer, NI HSDA Suzanne Campbell, Director Community Services, Prince George Sherri Tillotson, Manager Surgical Inpatients, UHNBC

Improving Patient Flow - The 4 DX Approach -

The 4 Disciplines of Execution

The 4 Disciplines of Execution 1. Focus on the Wildly Important 2. Act on Lead Measures 3. Keep a Compelling Scoreboard 4. Create a Cadence of Accountability

WIG Wisdoms: The Whirlwind All the work that is required just to keep your operation going on a day to day basis… “The enemy of execution”

1. The Wildly Important Goal If everything else remained status quo, what is the one area where change would make all the difference? VERB, X to Y, by when?

2. Act on Lead Measures Lead Lag Predictive Retrospective Influenceable Unchangeable

3. Keep a Compelling Scoreboard

4. Create a Cadence of Accountability Mc. Chesney, C. , Covey, S. , & Huling, J. (2012) The 4 Disciplines of Execution. New York: Free Press

4 DX Prince George By Jan 31, 2015, increase from 35% to 55%, the # of patients admitted through the UHNBC ED being transferred to an inpatient bed within 10 hrs of triage Care Planning ALC designation Have a visible, and up to date care plan, from 0 to 100%, on medical & psychiatric patients by Jan 2015 No more than 15 net new ALC patients in hospital by Jan 2015 Complete a discharge screen on all patients Schedule discharge meeting date for patient identified as “complex” Host discharge planning meeting for patient identified as “complex” Estimated date of discharge on all patients Responsiveness of services Mobilize community services to meet urgent clients needs for home support within 8 hrs of identification 90% of the time by May 2015 Activate, on admission, a Plan of Care for 100% of patients Utilize Plan of Care documents in daily huddles and update as required

What Have We Learned - methodology Strengths Struggles Brings organizational focus Complexity of healthcare Builds discipline & accountability Success requires 20% of our time Measuring activity Measuring quality

How are we doing?

“You have to decide what your highest priorities are and have the courage - pleasantly, smilingly, unapologetically - to say no to other things. And the way you do that is by having a bigger “YES” burning inside. ”

Learnings and Benefits • • One Wildly Important Goal is difficult to define Discipline and focus is necessary for implementation A ‘Cadence of Accountability’ is necessary Other Projects – – – Increased residential bed capacity SAMI Programs Rapid Home Support High Acuity Beds Master Planning