Organizatinal Capacity fr Change and Patient Safety Debrah M. Nadzam, PhD, FAAN - Jint Cmmissin Resurces Lrrie Jnes-Hartley, MSN, CRRN-A - Durham Reginal Hspital
Presentatin Objectives Briefly describe Patient Safety Cnnectins service Prvide backgrund infrmatin abut Organizatinal Capacity fr Change Describe applicatin f OCC survey Discuss findings and use f OCC at ne rganizatin
Patient Safety Cnnectins Gal: T significantly increase the rganizatin s ability t take effective actins n safety risks and prduce sustainable imprvement in safety. Cllabrative assessment: Prject Team including JCR cnsultants and client rganizatin leaders
Cllabrative Assessment Strategies Clinical patient tracers Shadwing clinicians and staff Adverse event reprting assessment Review f P.I. prjects Grup interviews Observatins f practice Cnversatins with frntline staff Online surveys: AHRQ and OCC
Organizatinal Capacity fr Change William Q. Judge E.V. Williams Chair f Strategic Leadership and Prfessr f Strategic Management Old Dminin University, Nrflk VA OCC is a brad and dynamic rganizatinal capability that allws the enterprise t adapt ld capabilities t new threats and pprtunities, as well as create new capabilities. (Judge, 2005)
Organizatin Capacity fr Change Cmpares 8 dimensins acrss 3 grups Executives, managers, frntline staff 8 dimensins = 4 dualities Leadership must balance between dualities
8 Dimensins:4 Dualities Trusting staff:trustwrthy Leadership Capable Champins:Invlved Middle Management Systems Thinking:Systems Cmmunicatins Accuntable Culture: Innvative Culture
Trusting Wrkers Trustwrthy Leaders Frntline wrkers are pen t change, knw hw change will help them, and trust leaders t carry ut change effrts. Leadership presents a clear visin, inspires cnfidence, and uphlds rganizatinal values while encuraging change.
Capable Champins Invlved Middle Management Change effrts are led by champins with Interpersnal skills, leadership supprt, and the will and ability t challenge the status qu. Middle managers effectively cnnect frnt line staff with leadership, balance the need fr change with the need t cmplete current wrk.
Systems Thinking Systems Cmmunicatins Change champins fcus n causes rather than symptms, the imprtance f aligning incentives, and the need t change systems. Peple get the infrmatin they need in a timely way, acrss units and frm custmers.
Accuntable Culture Innvative Culture Peple meet deadlines; they have clear Rles and respnsibilities, and experience Reasnable cnsequences fr their actins. The rganizatin attracts and retains Creative peple and supprt innvative changes.
Organizatinal Capacity fr Change (OCC) Overall Trustwrthy Leaders 40 35 Capable Champins 32.1 29.5 27.0 24.0 28.3 30 25 20 15 30.1 27.7 24.1 28.5 25.2 21.9 25.1 Innvative Culture 10 Systems Thinking 29.6 23.4 26.1 28.4 5 0 24.8 20.5 23.7 26.6 Systems Cmmunicatins OCC-Overall Accuntable Culture 29.3 22.9 26.0 28.9 1st/2nd Quartile Split 27.0 22.5 24.4 27.0 Trusting Wrkers 24.0 26.5 29.6 2nd/3rd Quartile Split 31.0 Invlved Mid-Mgt 3rd/4th Quartile Split
What d these differences mean? Research shws that a rating belw the first quartile by any grup, even when the verall scre is in the first quartile, is related t limited change capability. The value f reprt is t: challenge managers t lk mre clsely int areas where there are differences in perceptin, even thugh their wn perceptin is that there are n cncerns, and fcus imprvement effrts n the rganizatinal capabilities related t executing change initiatives. Fr example, Durham may expand its review f frntline staff s pinin related t systems cmmunicatin.
Durham Reginal Hspital s Opprtunities fr Change
Organizatinal Capacity fr Change 24 respndents 8 in the tp grup 12 in the middle grup (including physicians) 4 in the frntline grup
Trusting Wrkers Trustwrthy Leaders Overall scre fr trusting wrkers 1st quartile Executives and frntline staff scred them in the1st quartile Middle manager them in the 2nd quartile. Overall Scre trustwrthy leaders 2nd quartile. Executives scred them in the1st quartile, Bth ther grups scred them in 2nd quartile. This represents an pprtunity fr further assessment and a plan fr develping a trusting relatinship
Capable Champins Invlved Middle Management All staff rate invlvement f middle management in the first quartile Crrelates with AHRQ findings related t supervisrs d nt sacrifice patient safety Frnt line staff rate capable champins in the secnd quartile. Imprving the effectiveness f department champins wuld increase verall imprvement capability.
Systems Thinking Systems Cmmunicatins Systems thinking (fcus n causes rather than symptms, change systems) Senir staff and middle managers rate1st quartile Frnt line staff 2nd quartile Crrelates with AHRQ in that staff feel mistakes are held against them and wrking in crisis mde Systems cmmunicatin is rated verall in the 2nd quartile All grups rated 2 nd quartile Crrelates with AHRQ findings arund cmmunicatin Develping effective, systematic cmmunicatin mechanisms, and mnitring and imprving their effectiveness is an pprtunity fr develpment Cmmunicatins survey, develping reprt frm SRS system, revamped walk runds
Accuntable Culture Innvative Culture All staff rate Durham in the first quartile fr accuntable culture, while frnt line staff rate innvative culture in the secnd quartile. Just Culture This suggests that frnt line staff perceive the wrk envirnment as having a strnger emphasis n accuntability than n supprting initiative, innvatin, r imprvement at the frnt line. Magnet jurney, develping Patient Safety Champin Prgram
Current Strengths - A sample The Bard and Executive Team are driving patient safety Cmmunicatin frm Senir Leaders Several safe practices have been implemented Medicatin Management
Mre Strengths Strng peer-t-peer supprt at the frnt line Attentin t emplyee mrale and prfessinal grwth The success f the Surgical Care Imprvement Prject
Themes f Cncern Alignment f the medical staff with the rganizatin s cmmitment t quality and patient safety initiatives. New CMO, Revise Physician Peer Review, Cmpensate Physicians fr Cmmittee invlvement Staff engagement thrughut the rganizatin in patient safety activities Magnet, Patient Safety Champins, Walk Runds Variatin in clinical practice acrss the rganizatin and in implementatin f natinal patient safety gals. Magnet, Strke Prgram
Themes f Cncern (cntinued) Interdisciplinary cmmunicatin re: clinical issues Flash Runds, Transprt Cmmunicatin Sheet Perfrmance imprvement and sustainability Redesigned PI cmmittee, Six Sigma Oversight Cmmunicatin channels fr frntline staff t express cncerns abut quality and patient safety Revamp SRS system, revise Walk Runds Reprting and analysis f patient safety cncerns, adverse events and near misses. Revamp SRS system with reprting capabilities
Next Steps Disseminate the results f the patient safety assessment and imprvements underway Priritize fcused areas psing greatest risks t patients Develp specific strategies and timelines with the invlvement f staff, physicians, executive leadership team, and Bard Act!
Questins & Cmments