BTOES Insights Official
September 21, 2020

BTOES Healthcare Live - SPEAKER SPOTLIGHT : Leaders Transforming Health Care: Activating Operational Excellence though Trust and Change Management

Courtesy of Joint Commission Center for Transforming Healthcare's Teena Wilson, below is a transcript of his speaking session on 'Leaders Transforming Health Care: Activating Operational Excellence though Trust and Change Management' to Build a Thriving Enterprise that took place at BTOES Healthcare Live - A Virtual Conference.


Session Information:

Leaders Transforming Health Care: Activating Operational Excellence though Trust and Change Management

Introduction: Operational excellence in healthcare is defined as delivering improvements in care quality and safety by the everyday, ongoing use of continuous improvement techniques that are driven and owned by staff.

The COVID-19 pandemic and its overwhelming impact on hospitals and healthcare workers have led to the deferment and postponement of many improvement efforts, which is understandable.

In addition, we know that disasters tend to exacerbate system weaknesses that already exist. So, what steps can healthcare leaders take to activate operational excellence? Establishing trust, demonstrating leadership commitment to these continuous improvement efforts and change management practices and tools can lead the way to activating operational excellence. While there are additional significant High Reliability Organizations (HRO) principles and actions leaders can take, this session will focus on 2 of the fundamental actions of trust and change management.

Healthcare organizations that have adopted the elements of establishing trust and change management in their process improvement efforts, have benefitted from the resilience of an empowered staff. Thus, building the capacity and capability to continue to activate and support operational excellence in challenging times. The session topics include 3 high level steps that leaders can take toward activating operational excellence.


1. Understand the Center for Transforming Healthcare’s High Reliability Model

2. The senior leader’s behaviors and roles in leading and supporting operational excellence

3. Establishing trust and change management in leading organizational and cultural transformation

Session Transcript:

Yes, I have Tina Wilson, coming to us. Tina is an executive leader of change management at the Joint Commission Center for Transforming Healthcare.

Tina is, has over 30 years of experience, helping organizations build a redesign, their systems and infrastructure, to support needed change, to drive innovation and transformation. She has 12 years of experience in developing, utilizing and teaching, robust process improvement, RPI methodologies, and tools to internal staff at the Joint Commission in Health Care organization.

Dayna, it's a real pleasure to have you with us very much looking forward to your presentation.

Hi, thank you. Great to be here.

It's great to be here this morning, as Josie said that I have 30 years experience of helping organizations design and redesign their infrastructure to support their business operations. I actually started in healthcare in higher ed, where I was working with colleges and universities with helping their faculty integrate technology into their teaching.

Fast forward to where we are today, it's just amazing now to see that elementary schools are using Zoom as a method for learning and training. So, I think I might've been a little ahead of myself with respect to being a master change leader, in working with health, and working with higher ed to begin this, this movement toward technology. But now, more importantly, though, in the past 20 years, I've been, I moved into the health care arena, when I started working at the Joint Commission and helping to build, here, internally within the Joint Commission, some technology systems and structures around training.

Then, in 2008, I joined the Center for Transforming Health Care, where I began to work directly with health care organizations and helping them integrate, wrote what we call a robust process, programming tools into their, everyday, into their everyday use.

So, our topic today is leaders activating excellence through trust and change management.

And I also want to kind of give you just a definition of what I mean by operational operational excellence, and I do find it as delivering improvements in care, safety and quality by the everyday ongoing use of problem solving techniques that are driven and owned by step. So, kind of put that in context as I began to go through our, my presentation today.

Screenshot - 2020-09-18T211741.746OK, I want to talk about going to talk about how the Center for Transforming Healthcare, how reliability model activates excellence, and the role that trust and change management plays in leading organization and cultural transformation, which is clearly needed for change to be sustained. And then, talk, I'm going to talk about how important it is for specific behaviors and roles that are necessary in supporting and leading ones, organization to operational excellence.

I'm going to start with a story.

This is a story about Mary.

Mary is a 62 year old black woman diagnosed with Stage four, Gallbladder, Cancer, with a Life Expectancy of 12 to 24 months policy at Tavern the Diagnosis. Mary was still quite lively quite active. I guess the side effects or the symptoms of that level of cancer hadn't really hit the way one would expect it to, you know, towards the end of the life of our line.

But it has as part of her initial treatment, the doctors scheduled A about Baila can get the word ... stent procedure.

That was to for them to put a stent into her bio, to remove the blockage which would give her a better, better longevity, less suffering and so forth.

So da, her daughter took her into the hospital and the, for the procedure, as it turned out, Mary actually had to have two procedures. But after the first procedure, the physician came out and told her daughter that he was, wasn't as experienced as he should have been to do the procedure. And then he was unsuccessful, and that they weren't rescheduled, The procedure was a more experienced physician.

So, she goes back two weeks later with a daughter for the more experienced position to perform the procedure.

He comes out post procedure and tells the door the same thing, and he too was unsuccessful, but also gave the explanation that her filed up with block with too many tumors.

And so, that's why he was unsuccessful, So, they return home, and, later that afternoon, meris issues tired.

She laid down for, you know, take a map, which wasn't really unusual, and then she slept for quite awhile. Her daughter goes and checks on, mirrors, lintel unresponsive, but she's still able to get up and walk with some assistance.

She goes back to sleep daughter, goes back in and checks on our again and notices or realizes that she has a temperature called the doctor. The doctor says, you know, to give her some animals depositories. Madonna has the first, you know, go out and find the ... and come back.

So, the point here is, that, time is going by, so, she comes home, gets her, this ..., and hope that you bring the temperature down, would make a difference, and Mary would wake up.

well, through the night, Mary died.

So, you know, I'll go with, her daughter went and checked on her, and found her that she had better transition.

Btog CTAAnd, of course, you know, with that happening, her daughter wanted to know, what happened.

Did something go wrong during the procedure earlier? Was there a breakdown in communication that, if that was the case, did not feel comfortable and talking about it, or bringing attention to it? Or even worse, their communication? and the breakdown post? You know, when she left the hospital, was this something that she could have, her daughter could have expected? And could this happen again to another patient, or how can this prevent it from happening again?

And I shared this story with you because Mary was my mother.

And I do. I was the daughter in the narrative.

This experience is what has fueled my passion for the work that I do with health care organizations. And helping them to transform into a high reliability industry, where there are no high safety levels of excellence so that things like, this doesn't happen again.

So, when we talk about activating, excellence, activating excellence is all about making sure that an organization's, our systems and structures are in place that are strong and can help organizations transform to this high reliability and achieve the goal of zero harm.

So our work at this at the center is that we activate excellence by helping organizations build and strengthen their systems and structures, skills, and practices.

This is where I want to come in and talk about trust and change management, but the goal is to transform, transform to high reliability, achieve zero harm.

So when we think about it, talk about high reliability industries, we tend to think about, we tend to think about industries like the airline industry, nuclear power plants, amusement parks, and zoos. And as I was thinking about talking about amusement parks, I thought, oh my goodness!

Disney World must have a robust process and the they are really in that high reliability realm. And so the key here is what do these organizations have in common?

They operate in complex, high hazard domains for an extended period of time, without incident, accidents, or catastrophic failures.

And they have a culture and a set of operating principles that support an error free performance.

And I like this part. They have a collective mindfulness where staff look for and report on small problems or unsafe conditions that can be fixed right away.

It is part of their routine to look for these things and repair them, so that they don't call cause any future failures. So they are ahead of the game.

They also value the identification of errors so that they can learn from those areas, errors, I should say, of course, or learn from these errors or close calls.

Because there are lessons that they, the lessons from them, can provide them and show them weaknesses in their protocols and procedures before they even get to the point of being a big, big failure.

So the lessons are used to strengthen systems, can prevent future errors. So this collective organizing around safety helps to reduce the rate of errors increases, the level of a better performance, as well as low staff turnover.

We at the Joint Commission have sainted. We have not seen to date in the healthcare organization that has to reach that high level of safety and quality.

So recognizing that gap between high reliability principals and common practices and health care, Doctor Jansen and doctor Lope research high reliability, high reliability industries outside of healthcare to see if there were any key learnings that they could adapt and apply to health care.

So that hospitals could receive the same level of quality and excellence in their delivery of care, based on their work. The results from their work was then framed into our model for higher reliability in health care. And this work was published in the Millbank Quarterly article, as you can see here back in 20 13.

So what is high reliability?

So high reliability in health care is maintaining consistent levels of safety and quality over time across all healthcare settings and services. And the model proposes that there needs to be three domains of change to achieve this particular goal. So changes in leadership, safety, culture, and process improvement.

So the first domain is leadership commitment to zero harm for all our patients, patients, and their families, staff, and and visitors to the organization, and they also have need to have an unwavering commitment to the goal of zero harm, and I'm going to say one on the same level.

Cut, lit, unwavering commitment to any goal that they have that's going to make improvements within their organization.

And they wanted to, And high reliability organizations, have in common, is they have this goal of zero harm, where it kind of feeds into this continuous cycle of improvement, and they also continue to look for, are never satisfied with their current safety levels. They're always looking and seeking to improve them.

32Safety, culture.

Safety called the say, create to create and sustain a safety culture, is crucial to the success of creating your in this particular domain.

And safety culture means of creating an environment where staff feel comfortable in speaking up when they see unsafe conditions and speaking out without fear or retribution is the key to the empowering staff to speak up.

So in essence, you're going to look to include or make speaking up a part of folk's day-to-day work so that you can get this. I'm gonna get to this in a minute but get to this cycle of improvement that's essential to establish for your safety culture.

But we also want it to be, we also want all staff to feel comfortable speaking up from the frontline to the CEO.

So, no one is exempt, or no one is not expected to speak up, even if it's not. This doesn't stop at frontline's that. It includes all staff to be able to speak up when they see an unsafe condition that is going to happen or is about to happen.

So, when we think about what is going to take for leaders to create a culture of safety, we need to take a look at this trust report and improve, reinforce, insightful.

This cycle is adapted from the work by reasons, and hobs, and this is an illustration of the behaviors and actions that are crucial to creating a safety culture.

Also, this is crucial to creating safety culture.

This, the essence of this, again, it gets embedded in their day-to-day work, but it also creates this opportunity to have these, an environment where staff feel comfortable and speaking up.

And also, trust report and improve does work in a cyclical fashion truck.

Trust needs to be established within the organization when there is trust in your organization, staff feel comfortable about speaking up.

And this then leads into staff being able to feeling comfortable to report unsafe conditions, But when these reports come into leadership, it's leadership responsibility to respond positively to these reports and then also begin to make improvements. This whole cycle, this reinforces the cycle of trust report and improve.

Leaders also need to discuss, physically above these improvements to the organization, to staff, and to patients. Again, this continues to reinforce, this cycle of press of trust, and it also enforces this whole cyclical concepts so that staff can repeat this cycle of trust reporting, and we trust, reporting and improve.

And we call this the virtuous circle of trust, because it, it continuously happens.

Any continuous evolves when we think about, early, when I was talking about the, the collective mindfulness. This is very similar to that, and that, at this point, here's where you are beginning to create a culture that is looking for improvements that's interested in improvements.

And from a leadership perspective, you're building trust that this is the way we operate at this organization. So this makes a stronger and safer dynamic and it that inspires even more trust. And the work that results from these from these improvement efforts also lead into the frontline staff or addressing issues for the frontline staff and also address safety issues. So it also empower staff to continue to bring in that information.

And at the same time, while they bring, while they are also reporting, they're also identifying areas of improvement.

So when they identify those areas of improvement, as I mentioned before, it's the leadership's responsibility to respond and make those improvements.

So I mentioned earlier, I think, about how this also begins to create a high reliability mindset, which is also reflective of a culture change, and so with this high reliability mindset, when things like her. So let's say, for example, something happens. And so in the current state, pre high reliability set of principles, or understanding, the response would be cool, We got lucky that tag.

Instead, with the high reliability mindset, it says, what can we learn from this near miss?

Or that's not my job area or department.

A high reliability mindset says, I have the resources, training, and skills to help out.

And then finally, we've always done it this way, why change?

Instead, a high reliability mindset says we're happy with the outcomes. How can we improve?

The finally, the last domain is robots and robots process improvement. Organizations need to fully adapt and utilize the most effective improvement tools of change, Leading Sigma, change management, Lean, Lean six Sigma.

And the reason for that is because we know that complex health care problems.

And they do require systematic data approach to complex problem solving as well as implementation.

And also with sustaining changes, I used to run a program here part, the Kotlin, or a program, It was in a program where organizations that were mission, would submit their performance improvement projects. I ran the program for five years.

Every year, we get the same collection. It appears categories of improvement efforts. Every year, there was always handoff communication, there was always a hand hygiene compliance. There will always issues about pressure ulcers, how to reduce pressure ulcers, and reducing the rate of falls.

And before my experience with the Joint Commission, I used to wonder, why are we getting the same initiatives all the time over and over or through my work with the center? I learned. Because organizations have not been able to improve their or sustain the gains that they've made with, with their hand hygiene compliance. So, this is where the set of tools can help organizations sustain their improvements.

And this blend of tools we call robust process improvement at the Joint Commission. We use them here, and we're also spreading these tools to the partnering healthcare organizations that we work with.

So, robust process improvement, as I said before, is a blended set of tools and methods for improving.

And it includes formal change management, which promotes acceptance and accountability for change.

Lean six Sigma, Lean looks at reducing waste. And six Sigma looks for reducing variation, so these tools, collectively together act as the improvement engine for the improvement efforts that are fostered through the robust process, improve cycle.

Screenshot (4)So, why is this approach so, successful?

We know that healthcare problems are, are, are complex.

and that, they have been a lot of efforts in process improvement efforts, such as creating checklists and bundles for specific procedures. This checklist, toolkit or bundle process doesn't work for all applications.

So, if you have a process that you know, step by step by step, has to be followed.

Checklists and toolkit bundles work fine. But, when you have processes and procedures that vary across settings, that can vary across different areas within organizations.

You need to be able to find those key contributing factors as to why this particular incident is going on. And I'm going to use hand hygiene again as an example.

We know that there's a lot of variation in hand hygiene practices. They can vary from floor to floor. They can vary from organization to organization, and so you can't take a bundle and apply all of their solutions, and we all of those solutions to that particular organization, because there are many causes of the same problem.

We also know that organizations that use this collective process of improvement, what they're able to do with this and handling complex problems is that they are able to measure and discover their specific root causes. Are also able to identify variations within those process, and identify the ones that are there, specific cause, and then they can target those interventions to their specific causes, and then that allows them to, of course, be more effective, and also be more be more effective, But also, save time and money.

And then finally, because they, because they are targeting based solutions, they have, like I said before, targeted solutions that are being plot that are being applied to their specific costs. So, let's look at an example here.

The center partnered with eight hospitals and in working with discovering the most significant hand hygiene failure's for this collection of hospitals.

And what they came up with is, what you see here is this column on the left, these top 10, most, almost say most successful, but the most significant causes for failures, for hair, for washing hands.

And what you see, you have these eight hospitals, and these Xs represent these, the causes that were most significant for all of the hospitals.

If we were to treat this as a bundle, let's say, what you would see is for hospital, they would be spending time and money and resources in fixing something that isn't broken for their organization. So, this is how this collection of RPI tools work effectively. I'm gonna get into change management in a minute, which is kind of like what I call the bowl, that you put on the package to make it more effective or to maintain it.

So, setting, setting the course with change management. I like to call it this section.

And one of the things that we want to think about with this particular piece is that we need to be aware that what is change management?

You know, I get questions from folks, that, to me, culinary don't clearly don't have an understanding of what change management is.

They tend to think they, I don't know what they think, actually, but they, they present me with questions that make me think, that they don't understand exactly what change management is. So, what change management is, I like to say, that, change management is both a process and a skill set.

Key to this, though, is that, what I said before, when I gave you the description about what's included in RPI, and I said, that, change management focuses on promoting, acceptance and accountability. The key thing here is that change management focuses on the people side of change.

You can have, as an organization, the best solution in the world.

But if you don't focus on acceptance or accountability, it's very difficult for organizations to maintain that change and maintain a particular level of change.

And so, what organizations typically do is, when this happens, they go back and take a look at the technical solution and continue to work on that and make that better without paying attention to the acceptance and accountability. So, that's why we include change management in our model, because, as a process, we gave you. You have a structured set of tools that you work through to make sure that you get that acceptance and accountability by including people in the process.

It's a skill set for leaders. Imbed, once leaders understand the way in which to implement a change initiative.

By going through these tools and methods, it makes the change much more sustainable.

So, you have this skill set as a leader Now, in order to make a cultural change for your organization, You need to have a skill set, the skill set for the whole organization.

Screenshot - 2020-09-18T211741.746So, early on, when I talked about no trust and change management being activating excellence. These are key principles that organizations can use to start improving their processes so that they are sustained.

At the Joint Commission, we call our change model, our change management model facilitating change. And what you see here are the, the four components within our change model.

The arrow here indicates that the tools that are listed in each of these sections can be used at any time, so you can go back and forth. The key is understanding what it is you're trying to do.

So, I'm going to go through each of these sections will give you an overview of each of these sections. I'm going to try not to go on. I don't have time to go into details of each one, but I want to give you, give you a good taste and a takeaway for what they can do. So when you're thinking about planning your initiative, as I was thinking about this presentation, that, that won't be a really good analogy. So I'm going to try this.

So when you are getting married, you have a wedding.

So, this is an initiative that you're working through.

You have to have a plan, so that I'll leave that right there.

So, when you're thinking about, you know, a project process, or an initiative such as helping your organization adapt high reliability principles, you want to think about the culture, What impact will culture have on my change initiative?

And I like to bring this up at this point, because oftentimes, we don't consider the impact of culture on our change initiative. And one of the things that we say is that wouldn't change goes up against culture.

Culture always wins. So, by assessing your culture and understanding how you change initiative, or how the aspects of certain, at, how certain aspects of culture will affect your change initiative, doing that at plan, Get too ahead of the game.

Wouldn't it be good to know the impact of culture on your change initiatives before you get started? At least having that conversation. You want to assemble a strategy. You want to understand who needs to be on your team. What other areas within the organization will be impacted by your change initiative?

Could that. In fact, because you don't address the impact that, that might be an area of resistance.

So, having those conversations and understanding why that is, in fact, the case is a great place to start as you're planning your initiative.

And I said before, getting the getting people involved is really the key in terms of, this is how you can build acceptance and accountability, because people are involved. They know what's happening.

Oh, at least from this planning standpoint, not everybody's involved. You're going to identify who you need to be on your team, and you're going to assemble a team as part of your strategy.

Didn't you gotta look into inspiring people? Who do I need? What kind of support? What kind of involvement do I need for my organization to get on board with this particular change? And, know, from a leadership perspective, I know that leaders have more strategic work that they have as opposed to focusing on initiatives, on process improvements at the project level. But since we're talking about cultural transformation here, organizational transformation, this is what brings us up to the leadership level. You want to get your staff involved. You want to communicate what's happening, and this is key. You want to communicate what's happening. You want to talk about what's happening, what isn't happening, when we started our process improvement initiative at the Joint Commission, And people kind of her head bits and pieces of information about Lean six Sigma, what it does.

Since we know that Lean, eliminate, waste and six Sigma eliminate or reduce variation, the first thing that comes in people's mind is the fear of being laid out.

So, that's why you want to get in, had a head of whatever kind of work that is being carried through your organization, so that you can communicate what is happening, what isn't happening, and sharing your vision, I'll get to that in a minute, but by, but communication efforts, You build trust and credibility and, you know, trust establishes. It lays the foundation, trust opens the door because people are ready to that's what people hold on to move forward. And, of course, visible sponsorship is the key, whether it's a sponsorship for this, over a huge initiative, or sponsorship for an improvement effort that staff brought before.

32Through to their manager or to their director, as a result of the trust report and report cycle.

Launching the initiative is key. Now remember we've done all of this work up to this point. We've done plan, we've done Simon's inspiring.

But how can you get the initiative off the ground? If you don't have the infrastructure, and the operations to support it? So, there's one thing that have the capability to for change, but you may not have the capacity. So you want to take a look at your systems and structures, such as policies that you might need to change to support the change or staffing that you might need, or some changes within IT, for example. So you want to make sure that you touch base on all of those areas to help build capacity.

So that you can maintain the changes that your organization is looking forward to do, the changes that your organization is looking to do as it begins, to implement and start using high with some of the high reliability principles. The high reliability principles that I've been talking about that I focus on a little bit is trust and change management.

And then communicate, Know? We can't communicate really all the way through, but how, what are some of the vehicles that you could use to communicate your change initiatives?

You may need to be a little bit more innovative when I talked back then about how that virtuous cycle of trial.

Know, reinforces that trust report and resume. And improve cycle. You want to think about how that drives innovation. Perhaps something innovative came out of that or comes out of that initiative, and so you want to talk about that and share that with the organization.

Something, I don't want to get ahead of myself here, but I want to try to remember to bring up a particular point about innovation.

So, cultural, we've totally different cultural assessment in plan. Now that we've launched the initiative and things are moving forward, looks like, you know, we have buy in from people. We have acceptance. We have some accountability.

We promoted this really well, But, no, but you want to take a look at to see if there were any cultural roadblocks that came up after the initiative, know, a lot of things. Can you start out one way, but then things can change in the process? So, you could have some cultural roadblocks that crop up, as you, as a result of the movement through and through your change initiative. So, you want to monitor your progress and then sustain the gains that your organization needs. Monitoring progress is also essential because in change management, we say, you cannot take your eye off that you have to constantly monitor to make sure some of the things that happened back to the cause.

A shift in, in your progress that you've made, it could be the case that you have new staff and there was no carryover and training about how this particular procedure works.

So, you have a staff person that comes in, they're used to doing it the way, process the way they did at a previous organization.

So without that setup training, they there was some there was a decrease in the rates that you had with the progress that you were making in a particular protocol.

So as a leader, and you think about the changes that you've made in your organization, your action as a leader is to be the person in front to tell them that the change or the system is changing, or is processing. So it looks like it feels like, a top-down decision that's made with this typical change implementation model change.

And so as a result, the reaction that you'll have on staff is that they can ignore it. They don't apply the workaround.

Well, if you're working on something really essential, it's key that that the organization embraces. This works in this new weight. Change management helps you to avoid that change management, make sure that your success, or your acceptance, or the buy in, that you need, is not based on chance. It's strategic, its plant, and you work through that.

So, leaders and the roles, behaviors that's needed for leading and supporting change is key here as well.

So, successful change within your organization requires strong and active and visible leadership support, and vision is important. Again, it goes back to what I talked about with how we started out at the Joint Commission, but even how the organizations that we work with, they establish the vision for the organization.

They estefan establish the vision that they want to share with their leadership.

It's also essential that the, that you provide strong champions and sponsors.

And when I talk about this part of leadership role, that the concept that's kind of missing here is when you have a project, We have, you fill out a complete charter. And so, the charter identifies who the sponsor or the champion is.

That champion is the person that goes out and made sure that the team that's working on a project has the tools that they need, the remove roadblocks, they also show up, and they're visible and they're active. And there's a public commitment and support that goes back to in the trust report, advocate, improve cycle, where our leaders are visible when they're discussing with staff and patients alike about the improvement effort. That's visibility. That's also interesting, again, for staff to report and report unsafe conditions, because you're out there and you're talking.

When you're passionate about something, I've talked about my passion earlier, Issues that you give it time, and you focus on the effort. We have a tool called Calendar Test and the first time I did the test, you know, the way that it works is, you know, you write down the things that you're passionate about, and I wrote them on my list. And then the next step is, look on your calendar, and see how much time you've given that particular most items. How much time you've given them on your calendar.

And when I did that, I was really surprised to see that those things that I said that I was passionate about did not show up on my calendar. Then I did the way I thought they were. Then I did the reverse of that.

And I thought, well, what do I do, all the time. And that was the aha moment for me to us. Well. So, because one of my key things I know said, you know, I'm exercising and getting in shape. But that wasn't on my calendar, so I had to refocus that.

But then, you know, make sure that you, that you show up with your personal accountability, tell the truth.

Sometimes, I'll just say, I fall on my sword and just tell you, because that also helps to build credibility, that all. And so as you build that credibility, through telling the truth that.

It allows people to want to be, encourages people to want to be a part, be a part of the initiative.

So, as you think about, as you begin to think about spreading high reliability principles within your organization, you'll want to think about that you need to commit to zero harm and inspire people that this is important work.

So, you want to promote the value of proposition, and engage your stakeholders. And that means talking to your board, your leadership team, your middle managers, patients, and families. You don't want to leave anyone out of that conversation, because it's important that you engage those stakeholders. And identify gaps and align those resources are talked about earlier. How doctor ...

looked at how they compare high reliability industry principles with, with the common practices within healthcare.

Look for those gaps to see if there any changes that you need to make, so that you can align those resources appropriately to support your, your goal of implementing those principles of high reliability.

Empower your front line managers and empower your frontline managers to support the changes that are being reported up through to them, from their frontline staff. Nobody can address problems as well as those people being affected by the change. This is what you get with change management, because that's a key aspect of looking for solutions and involving folks in the work that you're doing. So, be transparent about performance, and like bullet the status quo, I know that you're the leader, but there are other people in other places that can get the work done better, because they are no expert in that particular area. one of the high reliability of a higher liability principles that I didn't talk about this, is this difference to expertise, let people, that know how to get the work done, do the work.

Of course, I mean, there's a little bit more to it than that, but at the high level, consider that. So, high reliability is not just the project or initiative, it's, it's how our leaders view it as a cultural transformation.

This is our trust. So, identify opportunities to build trust.

Screenshot (4)This is essential In terms of, you want to make sure that you present and listening, Being present, means, if you're in a meeting, be present, know, don't look at your phone constantly. Make sure that people see that you are approachable. Also, as a leader, as open and honest questions, you know, it's real easy for people to be suspect, you know. The leader is here.

A B says, I mean, but be open and honest, because that encourages people to, to speak up and talk to you, and look for those opportunities to go out and talk to them as well. Mean, what better way to learn about unsafe conditions, or, or near misses them, by going out and talking to people? It's also key that as you talk to them, they need to feel comfortable in their environment, where they don't have to feel like there's going to be somewhere ... that's associated with that. A key aspect of that trust report and reprove is this element of eliminating that fear retribution, but that's not to say that. that's not the case for all of the accidents That occur. But keep that in mind.

And then promote civility, be the model of the behavior, Ask for, and pay attention to your progress.

And I do want to come back and say, model that behavior, there's nothing worse than that. Some of you have heard this. Don't do, as I say, not as I do.

People are looking at you. When you become, And I'm going to put this out there, an agent of change. As you look to transform your organization, your staff is going to be watching you. So you want to make sure you model the behavior that you want to see in them.

And then as you manage your organization, for civility teach, for civility, try not to hire people that don't fit the expectation of what you want. I guess maybe a good way to say this is don't hire a bully.

Someone that has fully tendencies and a, you know, I'm trying to watch my words here, but you want to tie for stability where there is this common level of respect and willingness to be respectful. While at the same time, being capable of being transparent and say, what needs to be said in a respectful manner.

So, create group norms within your organization and then reward good behavior.

Um, We do that a lot at our organization.

And this is key I mentioned before, bullying behavior, but this is one of the not addressing intimidating behavior is one of the fastest way to disrupt your, your virtuous cycle of trust. It's a great way to disrupt or take your your initiative off track. It can derail it in a heartbeat.

So, continue to actively solicit safety concerns and set clear expectations, that there's nothing more important than keeping our patients and staff safe, mean, at one of our participating hospitals, the CEO had a webinar for all the staff to attend.

This is during Covert Times to talk about how important it is for their organization to make sure that the state so this is a message, This is a mode of communication that went out to the organization to share with them their value to them, This is another key aspect of trust and transforming your organization, so that people who've learned about where they are.

So, identify and manage your safety hazards, and address them quickly. I've talked about that before. And then provide feedback.

And this, I also mentioned this, where you want to coach counsel and console. Do it consistently doing it the same way, All levels of folks within your organization, particularly when you have to address an incident within your organization.

And reflect on lessons learned and celebrate. And then this reflection on lessons learned build your capacity for improvement. Learning from those.

From those mishaps, learning from those post called learning from small problems can make a huge difference as you begin to horse or as staff began to feel comfortable providing opportunities for true improvement around it.

And build your capacity for our PTI, build your capacity for improvement.

Remember, RPI is this blend of tools of Lean six Sigma and Change Management. These tools together can help your capacity to reach that goal of a chair, of achieving zero harm, reach that goal of activating excellence. So, focused on defining the problem, rather than managing the solution. I liked this particular piece as well, actually. I like Bulbous bow like this particular piece as well. Because in change management, we talk about, focus on the problem, focus on the issue, and not the people.

Oftentimes, the process is broken, it's not the people that's doing it incorrectly. So, it's good to focus on the process that helps to alleviate people feeling like they're being accused of something.

And it also keeps them open for change, and be an effective change agent and improvement, change agent, or improvement champion, I should say.

Um, and I like using this, again, the term change agent as a leader, you are working toward changing the organization last year. We had a program called Stories of Transformation, where we brought in frontline staff, who have been trained and RPI to share with us their success stories.

And I think one of the ones that, that in really the meat was, and this is when we talk about innovation, was an organization that included patients or families in their training module for our PI. So they had, they had an advisory council, so this is a group of nurses, staff that worked in the NICU Nick, ... Unit.

And they also included in the training parents, those parents became very effective as the organization created an advisory council that included the parents. This Advisory Count Council acted as those folks that gave an orientation to the parents of sick children.

This took the responsibility off of the nurses. So, as part, which was great, because now the nurses had more time to attend to the, to the, to the patient. And then the parents were acting as this agent, as an ambassador, if you will, for that particular area. Because you can imagine, how much trust is it is needed in that area. And how much comfort parents need for their sick children in that area subject to create a program where this is, where this happens, grew out of, this organization's RPI experience and training program.

So here, another quote from one of our leaders, it says, get people out of their silos. And to trust that working together is going to result in improved processes and reduce harm. So there's that trustworthy again.

So this is the RPI infrastructure that I talked about, which is this full adoption of Lean six Sigma and Change Management. You want to make sure that, but to, to do this well, you want to train all of your leaders, and all of your employees, in this training. And then, you'll want to foster widespread adoption.

So, as you reflect on this, given the principles that I've shared with the, with the principles that I have, with the high reliability principles that I shared, some of the change management tools that I've talked about.

Reflect on what would your organization look like? What would the day-to-day work look like if your organization, or to embrace some of these principles?

Or even all of these credentials? What would they look like?

So, some of the key points I want you to take away from this presentation is how important it is to build trust or ensure that Trust remains strong is a crucial leadership font crucial leadership Function. And I point this out at this particular point because we have an article that Emery ...

released and it dealt with how to build trust, or the importance of trust during the pandemic.

And so because you have a foundation and trust, with communication, with staff listening, by having this two-way communication, you're able, as a leader, to better support or provide stronger support to your workforce.

At this time, which we all know is crucial during this time of COPPA, You want to create a string for uptake. But we have, we have gone over the Dow, our allotted time for doing, OK. So I am actually think this is an awesome point, too bad, because the audience has a chance to see this summary that you have created here. Yep. That's excellent. So, if you could stop sharing the presentation at this point, we want to thank you for presenting on this incredibly relevant topic for the audience. Great presentation. And we were run out of time for the Q&A, but the key here is that there are some questions that came in. We can go on LinkedIn, just look under my name, is Joseph Paris, and I can post your comments and questions there. And I hope that Tina can go in there as well. And post comments, area, and answer questions. And there will be a great way of following up.

So, wonderful representation of what the Joint Commission is doing for transforming health care and the wonderful insights to really appreciate you taking the time to share that with today, with our global audience. Thank you. As I said, I'm passionate about this work. So, hard to stop talking about it. Absolutely. And that's, you know, as you said in your presentation. We need people with purpose, passion, discipline, resilience, to make this changes come through in the organization. So, thank you, for taking the time, and those insights with us today, OK. Thank you. Just say, bye. Bye.

Bye, bye.

Ladies and gentlemen, this wraps up our last session for they won. And it will take a quick look at what's in store for us tomorrow. Tomorrow, we start at the same time as the first session today, And we start with the art of data in digital transformation. So, you have a presentation from the leader of a technology organization, and in discussing the, the art and science of data, and the successful digital transformations, there'll be followed up by doctor Karen ..., will discuss, from a healthcare perspective.

How innovation labs can can, can ignite innovative thinking, and in health care organizations. So, Karen, doctor Karen has a very interesting insights, but also interactions that representation. You do not want to miss that. And then we'll wrap up with a couple of industry leaders.

one is a Senior Vice President and Chief Innovation Officer for Cambia on the elevation Flywheel and how to generate enterprise momentum in theater, and then we will wrap up the day with Steven Nicols was the Chief Clinical Technology Officer for S S, S, C, P, health. So look forward to seeing you tomorrow, great lineup of industry leaders, sharing your expertise and practical experience with us. Thank you for your time today. We'll see you back tomorrow, and have a great rest of your day.


About the Author

more (2)-Sep-21-2020-11-19-15-40-AMTeena Wilson,
Executive Change Management Coach,
Joint Commission Center for Transforming Healthcare.

Teena Wilson, is currently the Executive Change Management Coach, for the Joint Commission Center for Transforming Healthcare. Ms. Wilson has over 25 years of project and operational leadership experience. She is an experienced Joint Commission certified Master Change Leader and Green Belt with strong leadership and communications skills.

Ms. Wilson has more than 10 years of experience in developing, utilizing and teaching Robust Process Improvement (RPI®) methodologies and tools to internal and external audiences. Currently, she is responsible for teaching, mentoring and coaching on the Robust Process Improvement® tool set with emphasis on Facilitating Change™, Meeting Facilitation, and Advanced Meeting Facilitation methodologies, and tools to positively affect process improvement, change management, leadership effectiveness and team development.


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