Getting by with a little help from my friends

Thanks to all who will keep the conversation going in my absence.

Make way for the guest bloggers!

CCRMC's Behavioral Health Redesign continues and our Safety Incident Detection and Response System Optimization begins Today

This week July 26-July 30th at CCRMC

In addition to the innovation work teams continue to work on this coming week aimed at increasing the visibility of our performance and improvement data here at CCRMC, we will also conduct two Improvement Events simultaneously!

1. Behavioral Health Improvement - "Discharges to Home/Community"

2. Safety Incident Detection and Response System Optimization

We are convening a team to begin evaluation (called a Value Stream Mapping) of our Safety Incident Detection and Response System. This means we are looking at our error detection system and our system response. We will have community members on this team and we plan to seek assistance from experts in the safety industry such as hazardous materials experts who work with local refineries and others.

All staff are welcome at the opening session on Monday July 26 at 11:00 AM to 1:00 PM at CCRMC Building One Conference Room One.

The report-outs will be held in the CCRMC Lobby on Friday July 30th at 10:00 AM.

At the report-outs, teams made up of staff and community members will share with you the progress they continue to make to streamline operations and improve the patient experience at Contra Costa Regional Medical Center. I believe that the effects of these improvement efforts will have a lasting impact on the health of our community.

Please support the work of your colleagues and our patient and family partners as they draw on science and the energy and creativity of each other to continuously improve our health system.

Anna

How are we doing? CCRMC innovation teams report on making performance visible

I can hardly find words to describe the report-out and work the innovation teams presented at Thursday's CCRMC Improvement Academy. It was truly out of the box thinking at its finest. There is video coming and it does include the "Just try it" (Team JTI) team's singing performance!

The JTI (try team) team demonstrated the value of conducting tests and simulation and measuring your results as you go. Their presentation ranged from a very clever song, to a skit where Beth played a holographic image who appears in the medical center lobby "virtual information kiosk" to assist a laboring mother who's "water" broke. If that seems a bit outlandish, check out this demo IDEO and BBVA show of an ATM redesign. You'll see how they actually have a person come on screen to help visually guide users.

The eyeView (look team) team presented a simulation of a touch screen device that directs patients, visitors and staff to needed information when visiting our medical center, including our performance data.

The Riddlers (ask team) spent the week interviewing staff, patients, system leaders and our governing boards offices.They learned that patients were interested in things like posting wait times and number of minutes your provider spends with you. Users also wanted to know about our performance in areas such as infection rates and errors. Staff wanted to know about the vision and strategy and to see how what they do ties into that.The Board offices said they would like simple indicators that are up to date, simply presented and for us tell them how we compare to other systems. All wanted performance data translated and presented in a simple way such as; good-better-best. Did you meet the goal(?), yes or no etc...

The Thinking Caps (learn team) conducted secondary review of literature and web search from airlines, museums, Apple, IDEO and many others. Based on IDEO's presentation of their featured work, they mocked and presented a "featured work" page of some of CCRMC's portfolio of performance improvement efforts - CHF, VAP, Palliative Care, Medication Safety etc, you get the idea. They arrayed our improvement efforts in a like manner creating examples of how our projects would look using IDEO's presentation style as inspiration. They even designed some of the pages you would see if you clicked on the project main picture.

The four teams they all identified similar themes to guide us in presenting our performance data.

• Keep it simple
• Keep it current
• Keep it relevant
• Make it easy

There was a build up of energy and synergy in the room as the teams presented. By midway through the presentations I thought the Director of Safety and Performance Improvement, Shelly Whalon and I were in jeopardy of needing tissue for tears of joy! The teams out did anything we could have imagined!

We received very positive feedback about the use of the IDEO Methods Cards. Teams found them easy to use and said they will use them again. Generally, teams liked the quick turn around time of one week. I did have one person tell me they wished there was more time to be a bit more thorough. We both agreed that the quick turn around time encouraged design of a test as opposed to a finished product that we intend to implement across the system. Some people said they felt relieved they were designing for a testing or simulation environment, explaining they felt they could dream and be creative knowing it didn't need to be ready to be implemented. Others have set off for design/innovation cycle number two (let's call it PDSA #2) and are developing prototypes of the electronic picture dashboard to place in a test environment by this coming Tuesday.

My description is not doing the presentations and the leaps in innovation justice. I began by saying I could hardly find the words. I hope others will share their experience to help describe what the teams presented.

I will post the video as soon as possible.

Congratulations to all the teams and all those who helped them by providing input. You presented wonderful and creative ideas to test and build on and you made it fun.

Thank you!

Anna

REMINDER: CCRMC Innovation Teams Report Back Today at 9:00 AM

Inspiring Design: Teams at Contra Costa Regional Medical Center (CCRMC) are drawing inspiration from IDEO Method Cards to create a place, space, or mechanism that increases the visibility of our performance and improvement data here at CCRMC.

Some might ask why we want to do such a thing? To answer, let us look to the Associates for Process Improvement Model For Improvement (MFI), the model for change we use here at CCRMC.
The MFI consists of three questions:

1. What are we trying to accomplish?
Setting Aims
Improvement requires setting aims. The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected.

2. How will we know that a change is an improvement?
Establishing Measures
Teams use quantitative measures to determine if a specific change actually leads to an improvement.

3. What changes can we make that will result in an improvement?
Selecting Changes
All improvement requires making changes, but not all changes result in improvement. Organizations therefore must identify the changes that are most likely to result in improvement.
Source: IHI.org

If we can't see it, we can't measure it. If we can't measure it, we can't improve it. It is out of the deepest respect for those we serve and the talented and spirited staff, that we must understand our performance and ensure what we are doing is in fact leading to improvement.

Innovation teams will report back this morning at Contra Costa Regional Medical Center, Building One, Conference Room One at 9:00 AM.

I'm anxious to see what the teams have come up with and their thoughts on the use of the IDEO Method Cards. Please join me to hear what the teams have come up with. Your input is not only welcome, it's essential to our success.

Anna

Inspiring Design: Teams at CCRMC drawing inspiration from IDEO Method Cards

Motivated by a recent visit to Denver Health who prominently display their improvement data on the wall with a red/yellow/green-light system, I have asked the Improvement Academy participants to design a proposal to create a place, space, or mechanism that increases the visibility of our performance and improvement data here at CCRMC. We must "lower the water level" in order to see what lies beneath in our system. If we can't see it, we can't measure it. If we can't measure it, we can't improve it.

I'm anxious to see what the teams come up with at the upcoming CCRMC Improvement Academy this Thursday. Using the IDEO Method Cards for inspiration, teams divided into four categories:

• Learn: Analyze the information- look for patterns/insights
• Look: Observe, discover what people do rather than what they say they do
• Ask: Get input of others
• Try: Simulate and test to empathize with users and evaluate your design proposal

Image source: IDEO.com
The cards are meant to prompt thinking and encourage a "go to" or as we might say at CCRMC, "go and see" or "go and test" approach. I love the IDEO Method Cards. Elegant in their design, they are simple yet powerful.

We have two decks at CCRMC. One deck is in my office and the other is in the Innovation Office located in the medical center administration. Cards are available to teams and are borrowed on an honor system. Currently, my deck is with teams around the medical center who may be coming to you to enlist your participation as they design and test proposals for a visibility room (or space, or web presence etc) to display our performance data. You can find the iPhone or iPad application here. I think they're also available for purchase on Amazon but haven't checked myself. Additionally, you can find directions on how to purchase a deck from William Stout Architectural Books in San Francisco. I will warn you, William Stout has an old classic bookstore feel to it with amazing books. If you go there you may be like me and never want to leave!

Join us at the CCRMC Improvement Academy as teams report back and present proposals this coming Thursday July 22 at 9:00 AM at CCRMC, Building One, Conference Room One. All are welcome.

More soon

Anna

El Sistema in New England

I wanted to follow up on my post The promise of El Sistema and the promise of our system. It looks like José Antonio Abreu got his wish. In the Boston Globe today it's reported that El Sistema has come to the USA. At the New England Conservatory, the recently established El Sistema USA is trying to jumpstart a national movement dedicated to music education not as extracurricular enrichment but as a vehicle for transforming the lives of children in underserved urban communities. Bravo!!!

El Sistema USA Movie sample from ElSistemaUSAmovie on Vimeo.

At the center: it's about the patient

To all CCRMC Improvement Teams:

I would like to extend my heartfelt gratitude to all who attended last Thursday's CCRMC Improvement Academy. I found the discussion and disclosure both moving and exceptionally courageous. I left the meeting feeling extremely proud and privileged to work at CCRMC and to work with you.

To follow up on our discussion from Thursday’s Improvement Academy, I would like to remind all teams that I have asked that in the next 30 days you include a patient and/or family member on your team.

Each day we are learning more about the value of including patients and families from the teams who have partnered with them in decision making, design and testing of improvements. We have discovered that we have much to learn from those who use our system and that both patients and family members are essential and valuable as advisors and partners in improving care practices and systems of care. We have also learned that there is no more powerful accelerant of improvement than to include those who use our system in shared decision making and design.

I am asking all teams to accelerate your improvement efforts and include patients and families on your teams to help you design and test changes that aim to deliver safe, effective, efficient, timely, equitable and patient and family-centered care to everyone, every time.

On August 19th improvement teams will report their progress at the Improvement Academy with an aim that all teams have included, or have invited, patients and families to join their teams. I have asked the Healthcare Partnership and our Patient and Family Advisor Coordinator, Lynnette Watts to support your efforts. They are ready, willing, able and extremely excited to help you, as am I. You can find contact information for Lynnette and The Healthcare Partnership in this week’s Improvement Academy minutes posted on iSite.

This is of the highest priority to me and to our system. Please feel free to contact me directly with any questions.

More very soon.
Anna

Reminder:
Tomorrow, Thursday July 8, we will continue our summer break discussions at the CCRMC Improvement Academy located in Building One, Conference Room One from 9-11am.

To clarify, this and every Improvement Academy session is open to ALL staff and members of our community.

In preparation for this discussion, please read Don Berwick's Yale School of Medicine Graduation Address given last week.

If you can't make it, I encourage you to read Dr Berwick's speech when you have time.

I hope to see you there.

Anna

Beyond right and wrong

Beyond right and wrong there is a field.
I will meet you there. -Rumi
Dr. Jon Stanger ended his talk Thursday,"Beyond Right and Wrong: Six Parables for Medical Ethics" with this quote.

I can't help but reflect on Jon's talk and wonder about the implications of applying this thinking to the creation of a safe and just culture at CCRMC?

With the publication of the 2000 Institute of Medicine (IOM) report, "To Err is Human," patient safety and quality improvement have taken a prominent position in provider and public attention. There is now a prevailing acceptance that medical injury due to complications of treatment is occuring at an alarming rate. According to a 2009 publication by Lucian Leape, medical injury continues to affect approximately 10% of hospitalized patients, causing tens of thousands of preventable deaths each year.

Leape, commonly recognized as the father of the modern patient safety movement in the United States, calls for a departure from a culture of blame to a culture of safety. The organizing principle he says, is that the cause is not bad people, it is bad systems. It is further noted and supported by the work of many safety experts that to transform to a safe and just culture, we must engage in work in the following six areas:

1. We need to move from looking at errors as individual failures to realizing they are caused by system failures;
2. We must move from a punitive environment to a just culture;
3. We move from secrecy to transparency;
4. Care changes from being provider (doctors) centered to being patient-centered;
5. We move our models of care from reliance on independent, individual performance excellence to interdependent, collaborative, interprofessional teamwork;
6. Accountability is universal and reciprocal, not top-down.

Leape L.Errors in medicine. Clinica Chimica Acta,6 June 2009,404(1)2-5

To further complicate matters, systems for identifying and learning from patient safety events need to be improved. Safety reporting systems are often laborious and cumbersome. Health care providers express fear that findings may be used against them in court or harm their professional reputations. Many factors, such as concerns about sharing confidential data across facilities or State lines, limit the ability to aggregate data in sufficient numbers to rapidly identify important risks and hazards in the delivery of patient care. More work is also needed to develop measures that capture the underlying processes and conditions that lead to adverse events and the practices that are most effective in mitigating them.(AHRQ, NHQR 2009)

It can feel very complicated and even overwhelming at times. Yet I wonder if the highest walls we must climb are within ourselves? Although it's tempting to think fixing the individual pieces of our system is the way forward, we are not here to merely fix/optimize our current system. I have experienced many distractions along my journey but none more powerful than my own beliefs about what is possible, what I am capable of and what we are capable of. To settle is not an option. If we fall down seven times, we will get up eight. We are here to transform our system, to find the field. We are here to make a new world.

Anna

Behavioral Health Kaizen 2 Summary now on iSite

Here is the link to the summary of the Behavioral Health Kaizen #2 week from June 14-18.

You can find the video on iSite.

Keep an eye out for our next TWO rapid improvement events this month. One will continue the work in behavioral health and the other will begin work in our safety and response systems.

More on that area of work very soon....

Anna