Fostering engagement and innovation
through leadership accountability
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June 16, 2015
Presentation Outline
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1. Ideas Matter
2. Rouge Valley Health System’s Approach to Idea Generation
• About Rouge Valley
• Getting Started
• Our Approach
• Leadership Accountability
• Recognition
• Results
3. Other Key Engagement Initiatives
4. Lessons Learned
Ideas Matter
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The Benefits of Staff Ideas
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• High Performing Idea Systems have been found to show several important benefits:
o Create a culture of daily improvement
o Address improvement opportunities that are difficult for managers to see
o Enhance staff engagement and increase morale
o Promote rapid organizational learning
o Close the gap between staff and leaders
• Baptist Health Care: 14,000 staff ideas lead to $5.5M in cost savings
• Key features of effective idea systems include:
o Ideas are integrated into everyday work
o The emphasis is on small ideas
o Front-line performance metrics focus ideas on what is important
o Both managers and workers are accountable for their roles in the idea process
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Workers become more engaged when they see their ideas being used. And
managers, seeing the impact of employees’ ideas, give employees more authority—
which leads to more and better ideas.
…frontline workers have better knowledge of the particularities of products, services,
and processes than managers do. They’re better positioned to spot problems and
opportunities.
Pushing decision making down to the front lines for as many ideas as possible leads
to better decisions, faster implementation, and lower processing costs; it also frees
up managers’ time.
Getting the Best Employee Ideas
Harvard Management Update
FEBRUARY 28, 2008
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“…studies across many industries have linked employee
engagement to higher performance. This linkage holds true
even within health care. For example, in 2012, the National
Health Service in the United Kingdom conducted a survey of
280,000 health care employees, which demonstrated that
employee engagement scores correlated with lower patient
mortality, higher patient satisfaction, lower staff absenteeism,
lower staff turnover, and even lower infection rates. Yet the
idea of “engagement” remains a relatively new and
understudied concept for management.”
Quality and Safety as the Spark for
Employee Engagement
Davood Abdollahian, MD, Paul Nagy, PhD
2014
Rouge Valley’s Approach to
Idea Generation
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Rouge Valley Centenary (RVC) Rouge Valley Ajax and Pickering (RVAP)
About Rouge Valley
2013-2014 Stats 2700 staff
300 active MDs
Program RVAP RVC RVHS
Outpatient Clinic (ACU) 90,722 158,544 249,266
Emergency 63,791 66,212 130,003
MRI Scans 7,037 8,930 15,967
Surgical Outpatients 5,168 9,491 14,659
Surgical Inpatients 1,592 3,167 4,759
Cardiac Catheterizations N/A 4,784 4,784
Births 1,471 2,163 3,634
Our Staff
9
2734
1509
709
391
73
52
2994
1587
839
406
92
70
Total
Regular Full-Time
Regular Part-Time
Casual
Temporary Full-Time
Temporary Part-Time
Total 2014-15 Total 2009-10
: - -
Four Pillars of Our Quality Framework
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STANDARD All of the following are in place:
• Process Control Boards
• Performance Trending
Boards
• 6S
• A3
• Rounding
• Kaizen Participation
• Leader Training
ADVANCED All of the following are in place:
• Sustainment of Standard
level
• Kamishibai
• Safety Calendar (could be
part of kamishibai system)
• Idea Board with problem-
solving huddles
• Department leads and
sustains its own kaizen
events (at least 2 per yr)
ROLE MODEL All of the following are in place:
• Sustainment of Standard and
Advanced levels
• Internal knowledge sharing (joint kaizen with another dept;
facilitator for another dept’s Lean
event; lead an in-service; internal
article or poster presentation)
• External knowledge sharing (e.g. joint kaizen event with
external partners; conference
presentation; published article)
• Use of one or more higher-
level Lean tools (e.g. Kanban,
Andon, SMED/changeover, etc.)
2010/11
2011/12
2012/13
90%
100%
10%
100%
0%
10% 40%
67% 33%
The STAR Framework Corporately Defined Expectations for Lean Deployment and Sustainment
Reported on corporate balanced scorecard
Getting Started What to measure
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Ideas Implemented
Pros Cons
Linked to improvement
Leaders have an incentive to act on staff
ideas
Leaders have an incentive to empower
staff to take ownership for idea
implementation in order to get as many
ideas implemented as possible
Gaming is more difficult
Staff that bring forward ideas that are not
implemented (for whatever reason) may be
discouraged
Ideas for large scale change may drain
resources making it difficult to implement
smaller ideas
Big ideas and small ideas are counted
equally
May contribute to quick implementation
without adequate planning and risk
assessment
Ideas Generated
Pros Cons
Recognizes staff engagement in
bringing forward ideas regardless of
the feasibility or merit of the idea
Encourages risk taking and builds
trust in the team (there are no silly
ideas)
Acknowledges that there might be
barriers to implementation outside of
the team’s control (e.g. funding,
resources, competing priorities)
Gaming is relatively easy
Not necessarily linked to
improvement
Good ideas and not so good ideas are
counted equally; may not encourage
critical thinking around idea
generation
Does not incent leaders to act on staff
ideas (not acting on ideas will be
viewed as disrespectful of staff who
took the time to submit ideas)
Getting Started Target Setting
• There is wide variation in target setting practices
across organizations.
• In general, the advice is to be conservative with
target setting in early years and build over time
once the capacity of the organization to
implement changes increases. Targets are not
meant to be punitive and should consider the
organization's capacity to implement change
ideas as under resourcing places kaizen initiatives
at risk.
• Some of the questions that emerge are: – Should the target be the raw number of ideas or the number
of ideas per employee?
– How are employees defined and counted?
• FTEs vs. headcount? (the FTE approach gives higher
weight to FT employees, those who spend the most
time at the organization)
• Which staff groups are included – FT, PT, casual?
• Our review found that, for the most part, targets
are based on the number of suggestions per
employee.
• Manufacturing organizations use
a target of 3 suggestions per
employee per year, although
some feedback indicates that this
ranges from 2 - 50 suggestions
• St. Mary’s General Hospital
(Kitchener) set a target of 1000
suggestions per year
• St. Francis Health set a target of
1 suggestion per full time
employee in the first year
• Utah North Region of
Intermountain Healthcare did not
set targets for the first few years
of their programs. Over time, a
modest goal of 1 suggestion per
employee was identified
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Idea Boards at RVHS
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RVC Birthing Centre RVC Pharmacy
Layout of the Idea Board Im
pa
ct
Difficulty
Possible
Implement Challenge
Kibosh
New Improvement Ideas
PICK Chart
In Progress Work & Ideas
Almost Implemented Ideas
Ju
st
Do
Its
P
DS
As
Week 1 Week 2 Week 3 Week 4 Week 5
Implemented Ideas
Celebrations
Stephanie passed her AQ Exam!
Zero department pressure ulcers!
Idea Board Standard Work
Layout of the Idea Board Im
pa
ct
Difficulty
Possible
Implement Challenge
Kibosh
New Improvement Ideas
PICK Chart
In Progress Work & Ideas
Almost Implemented Ideas
Ju
st
Do
Its
P
DS
As
Week 1 Week 2 Week 3 Week 4 Week 5
Implemented Ideas
Celebrations
Start with work in progress:
a) Just Do Its – any barriers
to moving forward?
b) PDSAs – if the status
indicator is green,
acknowledge the work
and move on; if the status
is red, ask about barriers.
Move completed work to the
“Improvement Ideas
Implemented” section
Review and record any new
improvement opportunities:
-e.g., opportunities identified
on stat sheet
-Ask staff what barriers they
are encountering in their day
• Use the PICK chart to get feedback from staff
about whether working on this will have high or
low impact and whether it is easy or hard to do
• If an opportunity falls into Kibosh, circle back
with the originator but do not place on the
PICK chart
• All patient or employee safety or quality issues
are immediately moved to be worked on
• If opportunity is related to existing PDSA,
driver, or other work in progress, move the
Improvement Opportunity form to that PDSA
to be incorporated
• As capacity becomes available, problems can
be moved from PICK chart to work in progress
• Assign resources to new work in progress with
owner(s), & mentor / coach
• Review the implemented ideas and if any
opportunities in sustaining them
• Discuss any celebrations on the unit.
• Monthly (+/- daily) tracking on a run chart
or simple bar chart
• Improvement Tickets and PDSAs get
moved over to this area once completed
Idea Board and Huddle Training
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Step 1: Classroom Training
• Review of objectives and standard work
• Overview of coaching role
• Participants practice leading huddles
Step 2: Gemba Coaching
• Experienced coach provides real time feedback
• Develop managers’ skills to coach staff
• Transition coaching support to operational leaders
Weekly Idea
Board Huddle
Rouge Valley Accountability Structures
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RVHS Quality
Improvement Plan (QIP)
Board SMT PETE
RVHS Corporate
Scorecard RVHS Leader’s
Personal Business
Commitments
Quarterly Reviews on Progress to Target
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Number of Departments with STAR
Requirements in Place by VP: Quarter 4
Ow
ner / V
P
Dep
artm
en
t Co
un
t
6S
Pro
cess C
on
trol B
oard
Perfo
rman
ce T
ren
din
g
Bo
ard
Kam
ish
ibai
Safe
ty C
ale
nd
ar
Idea B
oard
/ Perfo
rman
ce
Hu
dd
les
A3
Dep
artm
en
t Co
mp
lete
d
the E
ven
t / Pro
ject
Req
uire
men
t?
YT
D: N
um
ber o
f Ideas
Gen
era
ted
YT
D: N
um
ber o
f Ideas
Imp
lem
en
ted
Nu
mb
er o
f Dep
artm
en
ts
at S
TA
R (A
ll Crite
ria M
et)
Nu
mb
er o
f Dep
artm
en
ts
Satis
fyin
g 0
Crite
ria
Nu
mb
er o
f Dep
artm
en
ts
Satis
fyin
g 1
Crite
ria
Nu
mb
er o
f Dep
artm
en
ts
Satis
fyin
g 2
Crite
ria
Nu
mb
er o
f Dep
artm
en
ts
Satis
fyin
g 3
Crite
ria
Nu
mb
er o
f Dep
artm
en
ts
Satis
fyin
g 4
Crite
ria
Nu
mb
er o
f Dep
artm
en
ts
Satis
fyin
g 5
Crite
ria
Nu
mb
er o
f Dep
artm
en
ts
Satis
fyin
g 6
Crite
ria
Nu
mb
er o
f Dep
artm
en
ts
Satis
fyin
g 7
Crite
ria
Campos 3 3 3 3 3 3 3 3 3 55 48 3 0 0 0 0 0 0 0 0
Topaloglou 3 1 3 3 3 3 3 3 3 27 18 1 0 0 0 0 0 0 0 2
Brazeau 2 2 2 2 2 2 2 2 2 26 26 2 0 0 0 0 0 0 0 0
Gooding 6 6 6 6 6 6 6 6 4 242 56 4 0 0 0 0 0 0 0 2
Gowrie 6 6 6 4 4 5 6 2 4 131 56 2 0 0 0 0 0 3 1 0
James 20 18 20 19 19 20 19 16 17 888 662 13 0 0 0 0 1 0 2 4
Williams 18 18 18 18 18 18 17 18 17 301 224 18 0 0 0 0 0 0 0 0
McCutcheon 27 27 27 27 27 27 27 27 27 803 470 27 0 0 0 0 0 0 0 0
Dr. Mohan 1 1 1 1 0 0 1 1 0 18 8 0 0 0 0 0 0 1 0 0
Total 86 82 86 83 82 84 84 78 77 2491 1568 70 0 0 0 0 1 4 3 8
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Cumulative Number of Ideas Generated
(By Portfolio)
Note: New presentation of metric for 2014/15. Annual Target also broken down into quarterly targets for ‘Number of Ideas Implemented’
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Cumulative Number of Ideas Implemented
(By Portfolio)
Recognition
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Application for Idea Submission Deadline: Monday, March 23, 2015
IMPROVEMENT OPPORTUNITY Key Contact Name: Key Contact Phone:
Department: Date Idea implemented:
Describe the Idea
Is this idea: Fully implemented? If so, when was it implemented. In progress? Expected date of full implementation. Please provide a description of where this idea can be observed in action:
What are the actual/expected benefits from this idea: Describe the benefits from implementation of this idea – was there significant change to a process? Are there less steps in the process? What other changes have been observed? If applicable, please provide detailed before/after drawings of action plan with this application.
Please check off and describe any or all wastes that were impacted by this improvement: Transportation: was there less walking/moving for a person or object as a result of this improvement?
Defect/rework: Motion: was there a reduction in searching for supplies? Patients? Paperwork? Excess processing: Waiting: was there less waiting for information? Supplies?
Overproduction: Inventory: was inventory reduced because of this improvement?
Please circle any/all the corporate dimensions that your idea impacts Access Service Team Fiscal
Please describe how this improvement has enhanced patient or customer service:
How does this idea make RVHS better for our staff?
Do you see potential opportunities for this idea to be spread across other areas? If so, please explain briefly how/where this might happen: In this space, please provide pictures or diagrams that help describe the improvement idea
New ideas are a vital part of our continuous improvement culture at Rouge Valley. Our team of staff, physicians, midwives and volunteers come up with many ideas that help us provide a better patient experience. The patient experience/team engagement (PETE) quality committee is sponsoring an idea celebration on Tuesday, March, 31, 2015 at both RVC and RVAP from 12:00 to 1:00 pm. At this event, we will present an award for the top two ideas at each site as selected by the PETE committee. One grand prize per site will be awarded for the best implemented improvement idea. A second award will be given for one idea from each site that has been generated, but not yet fully implemented. The winners will be selected using the following criteria:
1. Originality of idea
2. Transferable (how easily can this idea be adopted by other departments)
3. Lean thinking (contribution to waste reduction, visual management, respect for people,
etc.)
4. Positive impact on patients (on access to care and service excellence), via team engagement,
and fiscal responsibility
5. a) Implementation has been completed (grand prize); b) Idea is generated, but not yet fully implemented (runners up).
Submissions may include ideas that have come forward from staff, volunteers, physicians, or midwives that have been implemented, or are in the process of being implemented, between April 1, 2014 and March 20, 2015. Applications must be submitted no later than Monday, March 23, and must be validated by the manager of the unit, or another staff member (charge staff, healthy workplace champion, etc.) who can confirm idea generation and implementation. Applications are available from the HR department at both sites, or
Access Application: On the Intranet under the Employee Centre Home Page Forward completed forms to: [email protected]
.
SHARE YOUR IDEAS!!
Cake and Beverages will be served
Video Clip of Example of Ideas at RVHS
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https://www.youtube.com/watch?v=erDFLWNS6H4&list
=PLI15kvPeM6uKIoC9VajCR0rwx_ZzIbe72&index=1
Results
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Cumulative Number of Ideas Generated and
Implemented at RVHS
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2013-14 2014-15
86 departments across RVHS report idea generation and
implementation on a quarterly basis
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Number of Departments with
STAR Requirements in Place
RVHS Staff Engagement Scores
In 2014:
• our overall engagement score increased by 7.2 points over 2012, and
is 5.7 points above the 2012 OHA average.
• positive scores for every question were higher than our 2012 results,
and five of the six were higher than the 2012 OHA average.
• for the category “how would you rate RVHS as a place to work?” our
2014 rate was 0.6% higher than 2012, and 1.2 % higher than the 2012
OHA average.
The greatest difference between our 2014 rate and the 2012 OHA
average was in the category “this organization really inspires the very
best in me in the way of job performance.” This category also saw the
greatest increase (7.2%) from our 2012 rate.
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LMS Staff Feedback (Wave 1)
Note:
• A score of 6 or above indicates a positive response
• There were 56 respondents in the pre-LMS survey and 36 respondents in the post-LMS survey (See appendix for details)
4.4
5.1
4.5
5.0
5.1
7.7
4.7
5.7
6.2
5.7
6.9
7.3
6.8
6.8
7.1
8.2
7.0
8.0
8.0
7.1
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0
10. When changes are made in my unit/department, employees and physicians are involvedin the process
9. Visual displays of hospital performance data are regularly reviewed and used to driveimprovement
8. The organization facilitates regular knowledge/idea sharing forums acrossunits/departments that are related to hospital improvement
7. Employees and physicians understand how their area's performance metrics impact thewhole organization's performance
6. Employee and physician suggestions on how to improve department and/or hospitalperformance are actively solicited
5. Learning is an important part of our daily work
4. Senior Leaders are aware of front line issues and challenges (the way things really arearound here)
3. Department performance metrics are openly displayed and reviewed with front line staffon a regular basis
2. There are regular meetings on units/departments that focus on the review ofunit/department performance metrics and result in plans to improve processes
1. I understand what the department goals are for the next year
POST LMS Score PRE LMS Score
4.4
5.1
4.5
5.0
5.1
7.7
4.7
5.7
6.2
5.7
6.9
7.3
6.8
6.8
7.1
8.2
7.0
8.0
8.0
7.1
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0
10. When changes are made in my unit/department, employees and physicians are involvedin the process
9. Visual displays of hospital performance data are regularly reviewed and used to driveimprovement
8. The organization facilitates regular knowledge/idea sharing forums acrossunits/departments that are related to hospital improvement
7. Employees and physicians understand how their area's performance metrics impact thewhole organization's performance
6. Employee and physician suggestions on how to improve department and/or hospitalperformance are actively solicited
5. Learning is an important part of our daily work
4. Senior Leaders are aware of front line issues and challenges (the way things really arearound here)
3. Department performance metrics are openly displayed and reviewed with front line staffon a regular basis
2. There are regular meetings on units/departments that focus on the review ofunit/department performance metrics and result in plans to improve processes
1. I understand what the department goals are for the next year
POST LMS Score PRE LMS Score
Other Key Engagement Initiatives
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S.T.A.R.T. with Heart SM Respond with H.E.A.R.T.® Coach with H.E.A.R.T.SM
A resource for compassionate
and caring communication
S.T.A.R.T. with HEARTSM Goals
• Increase awareness of impact
of every patient, visitor and
employee interaction, every
day, every time
• Understand the role of the
employee, physician, or
volunteer is greater than tasks
associated with his/her job
• Understand that employees
should feel empowered to
deliver world-class care
“Before I care
how much you
know, I want to
know how much
you care”
[RVHS Patient]
Lessons Learned
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Lessons Learned
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• It is not just about the number of ideas implemented!! The
idea board and huddle have several objectives:
– Staff participation in idea generation and implementation
– Promote continuous improvement as part of everyone’s job
– Team communication and prioritization of opportunities
– Managing the work in progress to accelerate implementation
– To create coaching opportunities to develop problem solving
capabilities in our staff and to teach leaders to delegate and share
responsibility
• Effective huddles require coaching and support. Leaders
require feedback and encouragement to develop this new
skill