UBLT Launch Management System Support for UBLTs January

UBLT Launch Management System Support for UBLTs January 14, 2016

Transformation OLD SYSTEM 2 NEW SYSTEM Putting out fires Planning ahead Multiple goals. Lack of clarity about how they connect to daily work. 4 -5 clear organizational goals with specific targets One project after another, hard to keep up Most work linked to organizational goals, associated with outcome and inprocess metrics Hard to know how the department is doing Visibility boards Many right ways of doing work Standard ways of doing work, systems thinking Leaders making decisions in meeting rooms, far from the actual work Leadership is coming to see; rounding

Leader rounding 2 1 Coordinating Projects to Maintain Focus Visible Data & Regular Rounding UCSF Goals Experience People Safety & Quality Value Daily huddle and visibility boards in Hepatology 3 2 Coaching and Mentoring 3 Growth

Management System New Roles for Leaders • Alignment of goals • Disciplined adherence to process • Standard Work: Visual Management • Coaching for Continuous Dyads at every level of the organization Improvement • Mark Laret and Talmadge King • Adrienne Green and Chief Nursing Officer (TBD) • Kim Scurr and Steve Wilson • Dave Morgan and Susan Smith • Medical Directors and Managers 4

Why Leader Rounding? Helps me understand what is going on; I can understand the space, staff, and workflows better by seeing them. Staff know that leadership cares about the organizational goals and about them. Provide focus on the 5 goals Spread ideas between locations Help remove barriers Promotes accountability 5

True North Visibility Board 6 Ties to UCSF Organizational Goals

Metrics Outcome 7 In-Process High level organizational goal Department level metric which should help the department achieve the organizational goal Example: 75% of patients will be able to get an appointment w/in 14 days Example: Late cancellations account for 15% of appointments in our department. If we can decrease late cancellations, we will improve access

Systems thinking “If a mistake happens once it may be fault of employee. If it happens twice, it is most likely the fault of the system. ” § Founder Ritz-Carlton 8

Why Standard Work Problem 1 Problem 2 Performance Target “It is impossible to improve any process until it is standardized” Masaaki Imai 9

“Waste comes cleverly disguised as useful work” Source: CUE RPI 3 Actuals Walk Patient and Nursing wait for a clean bed ES search for supplies and equipment 10 © 2011 Triad Results, Inc. Waste of Transport

It is not enough to be busy. So are the ants. The question is: What are we busy about? Henry David Thoreau 11

How does UCSF compare? UCSF Medical Center ranked #8 in U. S. News & World Report’s America’s Best Hospitals UCSF Benioff Children’s Hospital San Francisco (BCHSF) achieved National Ranking in 9 specialties in U. S. News & World Report’s America’s Best Children’s Hospitals Immediate adult cardiopulmonary resuscitation (CPR) survival rates 76. 1% compared to 48. 5% national benchmark. Hospital discharge rates after CPR 39. 1% compared with 15. 4% national benchmark. 12 Immediate pediatric CPR survival rates 87% compared to 53% national benchmark. Hospital discharge rates after CPR 53% compared with 27% national benchmark.

Need to Achieve Reliability 13

How does UCSF compare? an fo r C SF St U . . Ka is er C PM C . . . % of Patients who reported YES, they would definitely recommend the hospital 90 National Average 71% 80 California Average 70% 70 60 Average time patients spent in the emergency department before they were seen by a healthcare professional * A lower number of minutes is better UCSF 37 minutes CPMC 25 minutes Finance data to compare- UHC? 14 Data from CMS hospital compare. gov Stanfor d 14 minutes St. Mary’s 9 minutes

ICU performance 15 UCSF Performance Improvement Annual Report July 2014 - June 2015

UCSF People Scores Mc. Hugh and a team of researchers published a study last year in Health Affairs that found that the percentage of patients who reported they would “definitely recommend” a hospital to their loved ones decreased by 2 percent for every 10 percent of the nurses who expressed dissatisfaction with their jobs. Matthew Mc. Hugh, Ph. D. , RN, an assistant professor of nursing at the University of Pennsylvania 16

Staff Experience Scores 17

How Likely Are Our Physicians to Recommend UCSF As a Place to Work? High Performers Net Promoter Score (NPS) -100 +100 11 UCSF Physician Pulse Survey October 2014, response 42% 18 2015 Target 2017 Target

Patient Experience Scores 19

Let’s Do It! 20