Patient Flow Collaborative

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Patient Flow Collaborative
Belinda Moyes Principal Nurse Advisor/Director Nur
se Policy Branch Chair National Nursing and
Education Taskforce 1 April 2004
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• Welcome

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Patient Flow Collaborative Aims

• To tackle key constraints in the patient process
  identified by each health service
• To promote and facilitate the development of
  service improvement skills within each
  health service

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Patient Flow Collaborative
The challenge is to revolutionise our
expectations of health care to design a
continuous flow of work for clinicians and a
seamless experience of care for
patients. Donald.M.Berwick President and
CEO Institute for Healthcare Improvement
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Issues

• Excellent innovation in pockets
• Long waits in ED
• Elective surgery waiting times
• Inpatient delays

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House keeping

• Mobile phones and pagers
• Rest rooms
• Fire Alarm
• Informal ask questions

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Nurse Leaders Master Class Agenda

• 9.15 10.00 Ancient myths and modern magic,
  Kate Harmond
• 10.00 10.30 Morning tea
• 10.30 12.30 Innovation case study leadership,
  Lee Martin
• 12.30 1.30 Lunch
• 1.30 3.00 Leadership for improvement, Kate
  Harmond
• 3.00 3.30 Afternoon tea
• 3.30 4.30 Polarity management, Kate Harmond

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Questions
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Ancient myths and modern magic

• Kate Harmond
• Nurse leaders masterclass,
• Melbourne, April 2004

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The case for change

• I believe that public servants are working flat
  out but in a system that shrieks out for
  fundamental change If we dont get the systems
  and structures right we will never get to the
  roots of the problem, only prune its visible
  branches The key to reform is redesigning the
  system around the user.
• Tony Blair, 2001

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Policy context

• Public opinion
• Service failures
• Workforce pressures

• Access improvement
• Clinical governance
• Investment

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Changing culture

• Decisions based on training or experience
• Do no harm is up to each individual
• The system reacts to needs
• Professional roles shape the system

• Decisions are based on evidence
• Safety relates to the system
• Needs are anticipated and met
• Co-operation is an explicit priority

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Lessons from top companies

• Constant improvement
• Culture for innovation
• Team development
• Community involvement
• Client centred
• Open and blame-free environment

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Know your strengths

• If there had been three wise nurses instead of
  three wise men, they would have asked for
  directions, arrived on time, helped deliver the
  baby, cleaned up the stable, and brought
  something practical, like a nice casserole.
• Barbara Bush (adapted)

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Morning tea
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Patient Flow Collaborative
Lee Martin Collaborative Director Rochelle
Condon Improvement lead
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Leadership and behaviour styles case study on
leadership
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What is your style
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Expressive

• Verbal
• Motivating
• Enthusiastic
• Gregarious
• Convincing
• Generous
• Influential
• Dramatic
• Animated

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Amiable

• Patient
• Loyal
• Sympathetic
• Relaxed
• Mature
• Considerate
• Stable
• Trusting
• Team person

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Direct Driver

• Action oriented
• Decisive
• Problem solver
• Direct
• Assertive
• Risk taker
• Competitive
• Independent
• Determined

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Analyst

• Controlled
• Orderly
• Precise
• Disciplined
• Deliberate
• Cautious
• Diplomatic
• Accurate
• Fact finder
• Systematic

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Exercise

• Corners of the room are sign posted
• Move to the corner of the room that reflects your
  style

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Positive and Negative perceptions of Expressive

• Verbal inspiring
• Ambitious
• Energetic
• Enthusiastic
• Confident
• Friendly

• Talkers
• Overly dramatic
• Impulsive
• Undisciplined
• Excitable
• manipulative

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How to work with expressive people better

• Tell who first
• Be enthusiastic
• Allow for fun
• Support their creativity
• Talk about people and goals
• Handle the details for them
• Value feelings
• Keep fast paced

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Positive and Negative perceptions of Amiable

• Patient
• Respectful
• Willing
• Agreeable
• Dependable
• Concerned
• relaxed

• Hesitant
• Wishy washy
• Pliant
• Conforming
• Dependant
• Unsure
• Laid back

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How to work with amiable people better

• Tell why and who first
• Ask instead of telling
• Draw out their opinions
• Explore personal life
• Define expectations
• Strive for harmony

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Positive and Negative perceptions of Direct Driver

• Decisive
• Independent
• Practical
• Determined
• Efficient
• Assertive
• Risk takers
• direct

• Pushy
• One man/woman show
• Tough
• Demanding
• Dominating
• Insensitive
• Cuts corners

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How to work with direct driver people better

• Tell what and when first
• Keep fast paced
• Dont waste time
• Be business like
• Give some freedom
• Talk results
• Find shortcuts

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Positive and Negative perceptions of Analyst

• Accurate
• Conscientious
• Serious
• Persistent
• organised

• Critical
• Picky
• Moralistic
• Stuffy
• stubborn

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How to work with analyst people better

• Tell how first
• List pros and cons
• Be accurate and logical
• Provide evidence
• Provide deadlines
• Give them time, dont rush or surprise

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Under stress
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Fears about change

• analytical
• not enough information
• making a wrong decision
• being forced to decide

• driver
• loss of control
• failure
• lack of purpose

• amiable
• damaged relationships
• confrontations
• not being recognised
• for efforts

• expressive
• being ignored
• being asked for detail
• being linked with failure

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Change and learning

• Panic
• Zone
• people
• close up
• they
• freeze
• they dont
• learn

• Comfort Zone
• people stay here
• they dont learn
• they dont change

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Change and learning
Panic Zone
Comfort Zone

• uncertainty
• learning

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Change learning and comfort people respond
differently

• some feel its an adventure and are excited and
  stimulated
• some feel it is a mission or a duty
• some feel it is a forced march and are fearful
  and cautious
• some feel overwhelmed, depressed and demotivated

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Noers Response factor model
high
Learners
Entrenched
Capacity for change (ability to learn)
BSers
Overwhelmed
low
Comfort with change (learning readiness)
high
low
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Noers Response factor model
high
Learners
Entrenched
Clings to narrow learnings
Learns and grows
Capacity for change (ability to learn)
BSers
Overwhelmed
Makes it up high drive but low substance
Withdraws and avoids
low
Comfort with change (learning readiness)
high
low
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Can apply to individuals, groups, departments,
directorates or organisations
high
Learners
Entrenched
Clings to narrow learnings
Learns and grows
Capacity for change (ability to learn)
BSers
Overwhelmed
Makes it up high drive but low substance
Withdraws and avoids
low
comfort with change (learning readiness)
high
low
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Overwhelmed - low comfort with change, low
capacity for change

• Withdraws and avoids
• avoids confronting real issues
• retreats into old patterns that are perceived as
  safe
• hopes that things get better
• engages in passive / aggressive behaviour
• avoids thinking about or planning for the future

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Overwhelmed low comfort with change, low
capacity for change

• How overwhelmed feel
• unhappy or depressed
• frustrated, anxious, powerless
• bruised self esteem
• fearful of mistakes and failure
• needs approval, reassurance and stability
• What is needed
• help in coping with stress, fear and frustration
• phased transition and success loaded challenges

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Entrenched - low comfort with change, high
capacity for change

• Clings to narrow learning
• blames and complains
• acknowledges need for change but resists changing
• works harder than ever at previously successful
  behaviour
• tries to ride it out until things return to
  normal

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Entrenched low comfort with change, high
capacity for change

• How entrenched feel
• frustrated, anxious, angry
• unrealistically confident that past skills are
  valid
• reluctant to take risks
• What is needed
• understanding and help in coping with anger and
  frustration
• phased transition with a bridge from old to new

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BSer - high comfort with change, low capacity for
change

• Makes it up - high drive but no substance
• jockeys for positions of influence
• presses for quick solutions and actions
• may initially come across as a beacon in the
  darkness - ultimately becomes transparent
• often fools superiors

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BSers high comfort with change, low capacity for
change

• How BSers feel
• comfortable with need for change
• compelled to do something - anything!
• frustrated with the confused and whining
• confident in ability to function in any situation
• What is needed
• close supervision and close monitoring
• assignments which are safe for the organisation
  and push the employee

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Learner - high comfort with change, high capacity
for change

• Learns and grows
• finds silver linings behind dark clouds
• finds humour in difficult situations
• is very aware of both strengths and weaknesses
• expands boundaries of their comfort zone

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Learners high comfort with change, high capacity
for change

• How learners feel
• comfortable with need for change
• challenged, stretched, optimistic
• in control of own destiny / positive thinker
• not afraid of short term mistakes and setbacks
• What is needed
• protection, latitude, air time
• developmental roles and assignments with impact
• rewards and reinforcements

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How leaders can help
Entrenched - find ways to let go of old and
comfortable and learn skills
Learners - create an organisation to develop,
select and preserve learners
Overwhelmed - provide help and support during
neutral zone of their transition
BSers - identification (uninformed optimist and
the true hard core) and development
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Leading your team

• Remember to consider your teams behavioural
  styles
• Analytical/processing
• Amiable/supporting
• Expressive/enthusiastic
• Driver/controlling

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Questions
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Aims

• Remove unnecessary delays in patient process
• Build innovation tools and techniques at local
  level

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Roll out plan
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Rigorous Diagnostics

• Program measures
• Sampling data tool
• Brainstorm tool
• Process mapping tool
• Patient, carer and relative involvement tools

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Simplify the complex system
What do we mean ?
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Simple tools in complex system
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Elements of the diagnostic pack

• Program measures
• Sampling data tool
• Brainstorm tool
• Process mapping tool
• Patient, carer and relative involvement tools
• Innovation intensive tool

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Identify leadership elements

• Small groups review the story and identify the
  leadership elements and risks
• Identify how you would improve on the process
  from the story and also from your experience
• You may want to take notes when we tell the
  story..

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The story

• Introduction - one afternoon, actual brief about
  45 minutes
• Identified who should be at brief and invited
• Short intro, discussion and then action plan
• Week later did exercise
• Three weeks later feedback was given

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Group work

• In small groups
• discuss the process, what happened who was
  involved etc
• What are the elements of leadership you can see
• What are the risks
• What would you do differently when you do the
  sample tool

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Feedback

• What did you notice
• What concerns did you have
• What styles stood out
• What do you think you would do differently

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Goldratt says.

• Any change is a perceived threat to security
• There will always be someone who will perceive
  the suggested change as a threat
• Any threat to security gives rise to emotional
  resistance
• You can rarely overcome emotional resistance with
  logic alone
• Emotional resistance can only be over come by a
  stronger emotion

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Manager or Leader?

• The manager administers the leader innovates
• The manager is a copy the leader is a original
• The manager maintainsthe leader develops
• The manager focuses on the systemthe leader
  focused on the people
• The manager relies on control the leader
  inspires trust

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Manager or leader?

• The manager has a short-range view the leader
  has a long range perspective
• The manager ask how and when the leader asks
  what and why
• The manager has an eye on the bottom line the
  leader has an eye on the horizon
• The manager accepts the status quo the leader
  challenges it
• The manager is the classic good soldier the
  leader is their own person
• The manager does things right the leader does
  the right thing
• 
  Warren Bennis, 1985

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Simple check Whats in it for me?
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Simple tools in complex system
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It going to be fun..
lets enjoy it!
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Lunch
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Nurse leadership for improvement

• Kate Harmond
• Melbourne 1 April

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Partnerships for improvement

• Clinicians and managers common agenda
• Investing in joint development
• Openness and honesty
• Reducing the hassle factors
• Socialising!

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Better care without delay

• Focus on the patient experience
• Analyse what currently happens
• Identify areas for improvement
• Small change cycles
• Spread learning
• Sustain improvements

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Benefits

• Access to accelerated training
• Process mapping and redesign
• Statistical control charts
• National expertise
• Leadership development
• Reduced delays

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Supporting activities

• Celebration days
• Clinical leadership
• Summer school
• National and international conferences
• Learn in lunch hours
• Art in hospitals

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Emerging needs

• Applying whole systems thinking
• Strengthening the capacity of general managers
• Communication and co-ordination
• Engaging the wider health and social care
  community, including voluntary sector and housing
• Spread and sustainability

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Attractors for clinicians

• Patient benefit
• Peer pressure
• Publications
• Presentations
• Praise
• Political awareness

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What do clinicians want from managers?

• Accessibility?
• Fewer e-mails?
• Less hassle?
• More evidence?
• Thanks?
• 10 MINUTES TABLE TOP DISCUSSION

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Side effects

• Clinical ownership
• Morale
• Conversion rates
• Can do mentality
• Eagles and donkeys
• Empowerment

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Clinical leaders

• Set patient goals eg mobility
• Clinical governance
• Research and development
• Standards for practice
• Education and training
• Role model

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Managerial leaders

• Set organisational goals eg activity
• Corporate governance
• Systems development and investment
• Quality standards
• Organisational development
• Role model

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Nurse leaders

• Patient advocacy
• Agitate
• Emotional tone and intelligence
• Team development
• Manage complexity and ambiguity
• Role model

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Look after yourself

• Be nice to yourself
• Write it up, not down!
• Treats and time out
• Stay well
• Celebrate
• Shoes and towels

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Thank you!
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Questions
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Afternoon tea
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Polarity management
Kate Harmond
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Feedback and close