Case study for health care leadership class

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Chapter 8
Leading Quality Initiatives
Learning Objectives
• Describe the importance of leadership in creating a
quality-driven organizational culture.
• Identify the stakeholders and drivers of quality and
patient safety.
• Explain the strategies a leader can use to achieve and
sustain high performance levels.
• Understand the influence of public and private
agencies in setting the national quality agenda.
• Quality initiatives are essential in the healthcare
industry to promote high standards of care and
protect patient safety
• Must be evaluated using quantitative, objective,
reportable assessments
• New entities per the U.S. Affordable Care Act will be
rewarded (i.e. Accountable Care Organizations)
• Value-based purchasing incentives will go to
providers who produce high-quality outcomes and
disincentives to those producing poor quality
Institute of Medicine (IOM)
• AIMS for Improvement of Health Care
– Safe
– Effective
– Patient-Centered
– Timely
– Efficient
– Equitable
Institute of Medicine (IOM)
Address Quality Improvement on Four Levels
1. Patient
2. Health-delivery microsystems
– Teams or units
3. Health-delivery systems
– Hospitals, clinics, health care organizations
4. Regulatory and Financial Environment
Quality-Driven Leaders Must
• Visibly lead culture change toward a qualitydriven model
• Set strategic directions to achieve positive
• Facilitate and implement quality of care
• Serve as role models
• Inspire
Quality-Driven Leaders Must
Lead by example
Speak openly about quality and patient safety
Show dissatisfaction with the status quo
Enable and empower collaboration to
promote quality improvement.
Governing Boards
• Develop and implement effective quality
• Take a proactive and comprehensive approach
to guide and support senior leadership in
promoting excellence
• Commission subcommittees to address quality
and patient safety
Executive and Senior Leaders
• Must measure and evaluate the quality of
• Compare performance within the organization
and against top-performing organizations
• Establish policies and procedures supporting
evidence-based practices
• Encourage reporting of patient safety risks
Centers for Medicare and Medicaid
Services (CMS)
• Launched multiple quality initiatives
• Aligned with the IOM Aims for Improvement
• Support Transparency
– Publicly-reported results
Stakeholders: Patients and Families
• Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS)
– Publicly-reported patient experience survey
• Patient- and Family-Centered Care
– Patient-Family Advisory Councils
• Members on hospital committees
• Assist in identifying gaps in care
• Assist in designing and improving care systems
Stakeholders: Regulators, Accrediting and
Certifying Organizations
• Licensing, Accreditation, Regulatory
• Basic requirements to be met
• Linked to ability to bill Medicare and Medicaid
and other insurers
Public-Private Agencies, Professional and
Nonprofit Organizations
Help drive the quality agenda. Examples:
• Professional Organizations
– American Nurses Association
• National Database for Nursing Quality
• Agency for Healthcare Research and Quality (AHRQ)
• National Quality Forum (NQF)
Stakeholders (cont.)
• Employees
– Front-line staff – instrumental in care delivery
– The level of engagement and organizational
culture are important and established by leaders
• Patient Safety can be facilitated by
– Process design
– Infection prevention practices
Organizational Culture
“the specific collection of values and norms that
are shared by people and groups in an
organization that control the way they interact
with each other and with stakeholders outside
the organization.”
– Hills and Jones (2012)
Organizational Culture
The Role of the Leader is Critical
Joint Commission Leadership Standards require that:
• Leaders regularly evaluate the culture of safety and
quality using valid and reliable tools.
• Leaders prioritize and implement necessary changes
identified and indicated by the evaluation.
• Leaders provide opportunities for all individuals who
work in the hospital to participate in safety and
quality initiatives.
• Leaders develop a code of conduct that defines
acceptable, disruptive, and inappropriate behaviors.
Organizational Culture
The Role of the Leader is Critical
Joint Commission Leadership Standards require that:
• Leaders create and implement processes for
managing disruptive and inappropriate behaviors.
• Leaders provide education that focuses on safety and
quality for all individuals.
• Leaders establish team approaches among all staff at
all levels.
• Leaders create an environment in which all
individuals who work in the hospital are able to
openly discuss issues of safety and quality.
Organizational Culture
The Role of the Leader is Critical
Joint Commission Leadership Standards require that:
• Literature and advisories relevant to patient safety
are available for all individuals who work in the
hospital—and for their patients.
• Leaders define how members of the population
served can help identify and manage issues of safety
and quality within the hospital.
Leverage Points
• Institute for Healthcare Improvement (IHI)
– Seven leverage points for leaders
– Small changes can bring about substantial systemlevel positive results
Leverage Points
1. Establish and Oversee Specific System-Level
Aims at the Highest Governance Level
2. Develop an Executable Strategy to Achieve
the System-Level Aims and Oversee Their
Execution from the Highest Governance Level
3. Channel Leadership Attention to SystemLevel Improvement – Personal Leadership,
Leadership Systems, and Transparency
Leverage Points
4. Put Patients and Families on Improvement
5. Make the Chief Financial Officer (CFO) a
Quality Champion
6. Engage Physicians
7. Build Improvement Capability
Aiming for Reliability
• Many organizations are unable to reliably
maintain performance excellence over time
• Some doubt that 100% reliability can be
• Eventual attainment would be dependent on:
– Leadership commitment
– Fully implemented culture change
– Robust process-improvement tools and methods
Identify and Remove Barriers
• As healthcare organizations strive to improve
their performance and quality outcomes, they
often encounter barriers that may impair
progress and derail their efforts altogether
• It is a key responsibility of leaders to identify
and remove barriers to improvement
Strategies and Methods
• Transparency in reporting performance results
• Collaborative learning and improvement
• Lean
– Efficiency; remove waste, create value
• Six Sigma
– Eliminate defects
– Define-Measure-Analyze-Improve-Control
Strategies and Methods
• Baldrige Criteria for Performance Excellence:
Seven categories;
1. Leadership, 2. Strategic Planning, 3. Customer
Focus, 4. Measurement, Analysis, and Knowledge
Management, 5. Workforce Focus, 6. Operations
Focus and 7. Results
• Nursing Magnet Recognition Program
– Recognizes outstanding nursing care
Alignment and Sustainability Tools
• Collect and analyze data and information
– Assess performance of key processes, systems and
– Assess progress toward quality goals
– Use data to drive decisions and changes
Alignment and Sustainability Tools
• Create Alignment Across the Organization
– Align goals and objectives
• Balanced Scorecard
– Financial, Customer, Process and Innovation, &
Learning metrics
• Operational Plans
– Roadmap for deployment and implementation
Alignment and Sustainability Tools
• Performance Management Plans
– Mechanism for ongoing formal and informal
– Supported by Individual Development Plans
• National strategy launched to improve
healthcare quality
– Addressing needs of patients, families, community
– Encouraging collaboration and communication
between providers and patients
• Need dynamic healthcare leadership to set
the course and steer the industry
Case Study
• St. Francis Medical Center’s Quality and
Patient Safety Governing Board Subcommittee
• Commitment to continuous learning
• Adopted several innovative strategies to foster
culture of quality and safety
• Rounding
• Dashboard of metrics
Chapter 9
Collaborative Leadership
Learning Objectives
• Define collaborative leadership.
• Identify the characteristics, skills, and
behaviors of a collaborative leader.
• Define and explain how collaborative
leadership strategies are interrelated.
• Describe different ways to build collaborative
leadership skills.
• Collaborative leadership describes the skills
and attributes needed to successfully achieve
positive outcomes for common objectives
among different organizations and
Characteristics of a Collaborative Leader
1. Has confidence that the goals and objectives are
2. Has the skills to clearly communicate with
stakeholders regarding the issues needing to be
addressed as well as the potential approaches to
problem solving.
3. Has the ability to serve as an active listener.
4. Has the ability to share knowledge with the
collaborators and the authority to advance their
5. Has the ability to assess and handle varying levels of
risk in decision-making and implementation.
Principles Displayed by
Community Collaborative Leaders
Inspire commitment and action
Lead as peer to peer problem solvers
Build broad-based involvement
Sustain hope and promote participation
Lead as “servants”
View leadership as a process
Similar Leadership Styles
– There are many similarities in the behaviors,
traits, and skills observed in collaborative
leaders with those observed in other
leadership styles:
– Transformational Leadership
– Servant Leadership
Transformational Leadership
• Provides followers with a vision and motivates them
to go beyond self-interest for the good of the
• Implements value-driven change, innovation,
improvement, and entrepreneurship through vision
and inspiration.
• Incorporates both direct and indirect influence
through a variety of mechanisms which affect the
intellectual, emotional, and behavioral processes of
Servant Leadership
• Begins with a clear and compelling vision that
excites passion in the leader and staff and
engenders commitment from the employees.
• Values others’ strengths and talents and
encourages the use of these strengths and
talents for the betterment of the organization.
Emotional Intelligence (EI)
EI involves the self-assessment of one’s own feelings
and the interpretation of others’ feelings, which help to
guide one’s thinking and action. EI has five distinct
1. Self-awareness
2. Self-management or regulation
3. Self-motivation
4. Empathy or social awareness
5. Social skills
Strategies for a Collaborative Leader
Six key practices or strategies that are unique to
leading a collaborative process:
1. Assess the environment for collaboration
2. Create clarity
3. Build trust and create safety
4. Share power and influence
5. Develop people
6. Self-reflection
Building Collaborative Leader Skills
• Leadership skill development for healthcare
managers has been widely implemented over
the past decade:
– Healthcare Leadership Alliance
– American College of Healthcare Executives
Potential Pitfalls in
Collaborative Leadership
1. Collaboration may be a slow and timeconsuming process.
2. There may be a high degree of conflict
requiring management and mediation.
3. Collaborative leaders need to cede and share
power and authority and credit the group
rather than themselves for the positive
outcomes achieved.
• Collaborative leadership is a valuable tool to
promote synergy and successful outcomes in
today’s complex healthcare environment.
• Tomorrow’s healthcare collaborative leaders
will need to demonstrate a vision-based,
system-thinking, power-sharing leadership
Case Study #1: Barnabas Medical
• Academic medical center
• Fragmented services across the continuum of
• Dr. Antonio “Tony” Mornan, Associate Chief
Medical Officer
• Needed buy-in for new processes from major
• Improvements with ED process times and
patient satisfaction scores
Case Study #2: Willow Springs
Memorial Hospital
• Only hospital in community
• Dr. Till, hospital president, and active member
of community
• Reduction in hospital’s Medicaid
• Outreach to stakeholders for input
• Can a shared vision be achieved?

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