GROOTE SCHUUR PERFORMANCE SYSTEM GPSapp.ihi.org/FacultyDocuments/Events/Event-2951/Presentation-16855/... · •Alignment of Annual Operational Plan to GPS •Alignment of reporting

Dr Bernadette Eick

February 2018

GROOTE SCHUUR

PERFORMANCE SYSTEM

GPS

© Western Cape Government 2012 |

GROOTE SCHUUR HOSPITAL - OVERVIEW – THE CONTEXT

1938 - official opening of GSH

GSH is a Central Hospital providing tertiary & quaternary care as well as regional care for direct surroundings

GSH is a Public Hospital, providing the teaching and research platform to UCT, CPUT, UWC and other HEIs

R 2.2 Billion Budget, 975 beds, 3700 staff

Ca 370 000 OPD, 58 000 admissions, 6 days ALOS


EXTERNAL ENVIRONMENT - THE BURNING PLATFORM

Economic

growth

Service

deliveryMigration Urbanisation

Sanitation, environmental toxins, unhealthy diets, economic resilience, violence, refuse

removal, housing density …


PROVINCIAL STRATEGY - HEALTH CARE 2030

Need transformational leadership and designated change agents

The intension is to develop:

Leaders who:

• Embody the organisational values

• Depend on interpersonal power (not hierarchy)

• Enable innovation

• Draw on inherent and potential capabilities of employees

• Are visibly collaborative in their

relationships

Reciprocal (mutual ) accountabilityinstead of top down culture

Organisational effectiveness using a competing values framework

Collaborate(People)

Create(Innovation)

Control(Rules)

Compete(Results)

MentorFacilitator

New ideasPartnerships

PlanAchieveTargets

ComplyMonitor

The competing values framework

Source: R E Quinn et al; 2010


LEADERSHIP AT GROOTE SCHUUR HOSPITAL

WHERE DO WE START?

HOW DO WE START CHANGING FROM BUSINESS AS

USUAL?


THE GSH JOURNEY TOWARDS GPS – THE INSPIRATION

Based on the principles and lessons learnt


THE GSH JOURNEY TOWARDS GPS – THE “divergent” START

Research by GSH Management member into various improvement projects at GSH

Provincial Flow Initiative focused on LEAN principles in the Emergency Centres, bed management

2011 Health Managers Development Programme indication of HRM potential of lean management to improve service delivery

2014 12 managers from MDT undergo a Lean Management Development Programme focusing improvement projects espon OPD folder, appointment and clinic and Pharmacy throughput times

2014 participation at LEAN summit – more ideas; more projects


THE GSH JOURNEY TOWARDS GPS – GOING “GLOBAL”2015

• Develop the skill sets

• In-house workshops:

• Value stream mapping

• A3 charts

• Toyota Kata

• LMDP

• Contracted Lean Institute Africa


THE GSH JOURNEY TOWARDS GPS – THE EXECUTIVE INITIATIVES

Quality care and improved

patient experience

Leadership development

Innovation and Change Management

Professional support

stewardship

Improved environment

& safety

Engaged staff

Service delivery

Finance:

Improve folder removal time

from records by 50%

Support services:

Improve ID application

process to 18 hrs

Clinical services projects:

1. Improve access from

Emergency unit to CT scanning

2. Improve discharge planning

3. Improve theatre starting time

at 08h00 by 50%

4. Unbooked patients at Gynae

OPD

Human resources:

1. Improve time to fill posts

2. Wellness strategy

Pharmacy:

Reduce time to issue meds

to discharged patients by

20%Engineering:

Reduce electricity and water consumption

Project mentoring

On the job coaching


THE GSH JOURNEY TOWARDS GPS – IMRPOVING THE PATIENT JOURNEY

Entrance to Hospital

Emergency Unit – NJ, EW, TC

Entry System/Triage/Waiting TimeDocumentation

OPD – OPD Mx team, HODs

Create Proto type / SOPs/ Standard of Work/Gynae roll out

WardsMedical : Visual Patient

Flow –Whiteboards Roll Out

(EW & Team)Surgical: improve on t/o of

beds(BJ & Team)

Transversal ServicesTheatre Starting Time – AK and

teamRadiology Time Shift

(EW,LN,SB,NP)

OPD Lean Clinic Team

Medical Records (NW)Reception (WB)Pharmacy (VN)

O & G: clinic throughput (HA,SD,WB)

Discharge Planning


SOME RESULTS


SOME RESULTS


THE GSH JOURNEY TOWARDS GPS – THE DEVELOPING VISION

LEADING INNOVATIVE HEALTHCARE

2016

Leading

Every staff member can be encouraged to lead

Managers require specific motivational, inspirational and knowledge skills

This will be met through a leadership development programme

Innovation

Providing staff with the space to find new solutions to problems and facilitating these into action

Healthcare

Being person centered:

Caring for the patient; the staff; the patient’s family; the community; the environment and ultimately, the prevention of disease

Healthcare in a holistic manner


LEADERSHIP DEVELOPMENT : GROOTE SCHUUR HOSPITALLeadership Development Sessions 2016

Session Date Subject FacilitatorExecutive Management Team

Development11-Jul-16 Orientation Session Belinda Ketel

Executive Management Team

Development19-Jul-16 Emotional Intelligence Belinda Ketel

GPS Review Session 25-Jul-16 InnovationSenior Management Leadership

Programme01-Aug-16 Module 1 Chris Breen

Senior Management Leadership

Programme02-Aug-16 Module 1 Chris Breen

Executive Management Team

Development15-Aug-16 Coaching and Mentoring Belinda Ketel

GPS Review Session 22-Aug-16 InnovationSenior Management Leadership

Programme 13-Sep-16 Module 2 Pre-meeting Chris BreenSenior Management Leadership

Programme 14-Sep-16 Module 2 Chris BreenSenior Management Leadership

Programme 15-Sep-16 Module 2 Chris Breen

GPS Review Session 26-Sep-16 Innovation

GSH Leadership Learning Session 10-Oct-16 Research and Ethics HREC/Marc Blockman

GPS Review Session 24-Oct-16 InnovationSenior Management Leadership

Programme11-Nov-16 Module 3 Chris Breen

Leadership Conference 27-Nov-16 GSH/UCT FHS





INNOVATION: AT GROOTE SCHUUR HOSPITAL


THE GSH JOURNEY TOWARDS GPS – STATUS 2016

LMDP graduates are coaching new improvement projects

Developing Daily Management System for front-line teams supported by Management Standard Workintroduced to address sustainability

Building capability in IMU to support managers with performance measurement and HR training to support frontline teams to implement the DMS


THE GSH JOURNEY TOWARDS TRUE NORTH - 2017

• Functioning GPS Review Committee

• On-going Steering Committee

• Developed and conducted coaching development program

• Executive Coaching by J. Touissant

• Opened GPS support office with 2 dedicated FT resources

• Setting up of Command Room


THE GSH JOURNEY TOWARDS TRUE NORTH - 2018

• Alignment of Annual Operational Plan to GPS

• Alignment of reporting structures of “projects” into the functional business reports

• Embed “7C” as the problem solving mechanism for GSH throughout the organisation


LEADING INNOVATIVE HEALTHCARE

Leadership

development

programme

Improved Person centered care

(Behavioural and organizational culture)

Creating an environment for continuous improvement

Patient centeredvalue

Organizational culture of Continuous improvement

Developing

the team(Capacity)

GPS management systemDeveloping

the self

• Number of leaders trained • GPS Management score

PRINCIPLES AND VALUES OF C2AIR2

I will respect you and you will respect me

QUALITY•Adverse events

• Organizational risk - measure

FINANCIAL•Financial stewardship – e.g. Cost

per PDE

CUSTOMER •Patient satisfaction

BUSINESS PROCESSES•Mortality rate

•Waiting time index

THE GSH JOURNEY TOWARDS TRUE NORTH


LEADERSHIP AT GROOTE SCHUUR HOSPITAL

What have we learnt thus far!


LEADERSHIP: GROOTE SCHUUR HOSPITAL : Lessons Learnt 1

• Understand your context and your business

• Have a strategy and alignment to external and internal stakeholders

• You need a vision / true north owned by the organisation of who and what you want to be and where you want to go

• Prepare for the journey

• You need a brought road map of how to get there

• You need a driving force

• Take stock:

• Skills , capacity, “equipment”



The difference

• THIS IS A NEVER ENDING JOURNEY

• Hard work every day

• Have a friend (MDT)

• Ask for help / guidance / direction on the way

• Start small:

• model cell

• Keep connected to your environment:

• GEMBA

• Be aware of the impact on patients & staff

• Adapt (PDSA)


GSH - VISION

LEADING INNOVATIVE

HEALTH CARE

It is better to lead from behind and to put others in front, especially when youcelebrate victory when nice things occur. You take the front line when there is danger.Then people will appreciate your leadership.

Nelson Mandela

http://www.brainyquote.com/quotes/authors/n/nelson_mandela.html

Thank you

Thank you



Senior Leadership

Keep your focus on the True North

• The surprise:

True North is becoming the journey that never ends and our task as leaders changes to becoming “tour guides”

who are building a sustainable culture of continuous improvement

in which

People work together to adapt to what comes across their path

With a certain skill set which allows them to define solutions in a resilient and innovative way

In order to improve healthcare every time, all the time , everywhere


The GSH Journey to the GPS

• To keep the focus and make it sustainable

• Formed a Steering Committee

• Started to define True North

• Developed a Management (operating) System

• Started to develop standard work procedures

• Create an environment for sustainability


Lessons learnt2018/02/28

28

We need to develop and actively drive leadership

Commitment to improvement

Journey of continuous learning

We need a goal / vision / true north

We need a plan / route map


Lessons learnt2018/02/28

29

HOW:

Start small – experiment, built a model cell

Ask for help / guidance

Are we providing value and how are we measuring this?

Be constantly aware of the impact on staff

Bring it all together so that it speaks to the True North


Looking ahead – GPS

Changing mindsets

30

Process thinkingProcess mapping Process design

Generating ideas and

flow of activities visualised

Ability to identify the

strong drivers of the

problem

Creating new processes

Redesigning existing processes

People development

Through learning

Leading for continuous improvement – Building the habit by changing

behaviour


Looking ahead – GPS

The work to be done

Build multidisciplinary teams

Start thinking of yourselves as part of the system

Create a culture of addressing challenges using a problem solving approach

Creating a culture of finding innovative solutions to improve healthcare

Creating a culture of continuous improvement

Creating the capacity to become sustainable

Improving the patient experienceThrough becoming the leaders who strive to achieve

‘Leading Innovative Healthcare’


Leadership at GSH2018/02/28

32

VISION Leading Innovative Healthcare

MISSION Groote Schuur Hospital will remain a

beacon of service excellence by striving to

develop leaders who will build a culture of

continuous improvement through problem

solving in order to improve person

centered quality health care.

VALUES C2AIR2

BEHAVIOURAL

PRINCIPLE

‘I will respect you and you will respect me’

OUR MOTTO Servamus – We serve


Leadership at GSH

2013/14• Leadership, Innovation and Change

2014/15• Leading Innovative Healthcare

2015/16•Leadership development and GPS

2016/17

• Strengthening GPS and ongoing leadership development


GSH PERFORMANCE SYSTEM = GPS

Step 1: Set up a Steercom

Step 2: Understand what we mean by good leadership in our environment

Step 3: Develop and communicate the plan

Step 4: Agree on specific projects for each manager and set up project teams

Step 5: Develop a leadership training programme and SOP’s for each aspect of the

GPS.

Step 6: Project plans, A3 structure, Process observation standard work board, graphics

to monitor, etc.

Step 7: Include a larger team (Project members) to develop the A3, which is a

description of the problem, goal, gap analysis, countermeasures and results.

Step 8: Gemba visits; M&E tools; review periods; feedback and sustainability

Step 9: How do we know when we have reached our True North?

NB:

➢ Constantly keep the goal in mind.

➢ Team development coaching sessions

➢ Development of trainers and mentors


INNOVATIONS

▪ GSH HFB provided R2M to

promote Innovation

▪ Partnered with the

University of Cape Town

Business School Bertha Centre of Innovation and

Social Entrepeneurship

▪ Developed an Innovation

grand challenge program

▪ Reviewed 17 proposals, of which we have selected

15 for funding

▪ Dedicated a space for an

Innovation hub


MAPPING THE JOURNEY TOWARDS TRUE NORTH

GROOTE SCHUUR PERFORMANCE SYSTEM

(GPS)

Principles

Person centered

Quality of care

Values based

Improving the patient

experience


WHAT DO WE HAVE?

We can make a difference

We have a powerhouse of intellectual capacity

We are Partners with benefits

We have a strong and committed team


Achievement: Theatre


Achievement: EU Triage


The GSH Journey to the GPS

• Developed many projects with teams and team leaders

• Defined A3 – trying to find the right questions

• Observed -- Daily huddles and weekly Gemba’s

• Created value stream maps

• Started defining measurements

• Changed and started up again, allow time and experiment

• Review Processes


The GSH Journey to the GPS –Defining our Conceptual framework

PCE and PCC –Value stream for the Customer

Respect the knowledge and experience of front line staff

Ask the correct question

Started working on HRM In house training capability

GROOTE SCHUUR PERFORMANCE

SYSTEM

(GPS)


The GSH Journey to the GPS – The Road less travelled

ALIGNMENT STRATEGY: NB 2 MANDATES

• Academic Hospital:

• feeds into Recruitment strategy,

• Leadership

• competitive advantage

• Service Focus:

• PCE (Person Centred experience)

• PCC (Patient Care Continuum)

• Improvement Energy

• create Centre of operational Service Excellence`