Connected Thinking Blog - NACHRI Conferences

Communication Strategies in Two Children’s Hospitals to Achieve Improvement Change

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Communication sciences show two distinct approaches - qualitative and quantitative - to achieve quality and patient safety goals. This session shared the experiences from two independent, tertiary care children's hospitals, Children’s Hospital of Wisconsin, Milwaukee, WI, and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN. Learn how each of these hospitals has developed a successful strategy of qualitative and quantitative communication.

 

The Certified Pediatric Nurse: Workforce Characteristics and Perceptions of Employer Support

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As the largest certification organization for pediatric nurses, the Pediatric Nursing Certification Board (PNCB) is in a unique position to study the characteristics and perceptions of those who voluntarily earn and maintain certified pediatric nurse status.

This sesion shared results of a new study of the current CPN population and explored the critical role responsibilities linked to CPN practice. Special focus included issues of job satisfaction as well as perception of employer job support.

Patient Safety Fridays: A Hospital-wide Initiative Improves Quality

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Morgan Stanley Children’s Hospital of NewYork-Presbyterian, New York, NY, a large urban hospital, introduced "Patient Safety Fridays" to raise awareness and improve quality and safety throughout the institution. This enormous undertaking requires the commitment of hospital administration, medical and nursing staff and all hospital services. It focuses on implementing clinical and environmental improvements to ensure everyone and every area of the hospital are always ready for the next patient, and consistent quality care is rendered to every patient.

Peter Hart Makes Election Forecast

Although Senator Obama may be up in most polls, with 19 days to go anything can happen, said Peter Hart, a top public opinion analyst and pollster for NBC News and The Wall Street Journal.  But Hart offered some key insights into the factors voters will use in picking a president next month.

"Voting is very personal," said Hart. And people usually tend to vote for people they like and can identify with. But, the economic crisis and health care is impacting voters on such a personal level that they are increasingly more concerned with the candidates' policies and vision over their personalities.

One way Hart tests public opinion is to ask voters which candidate they most wanted to have dinner with. Obama was favored well over McCain.

One of Obama's missed opportunities has been not focusing more on his life story so more people can say, "he is like me," said Hart. This has been the appeal of Sarah Palin, said Hart. It also helps if voters can find something humorous about a candidate because that humanizes them -- what Hart called the "Tina Fey effect."  But, while voters like her feisty personality, Palin's scores continue to drop on the question of qualifications, Hart said.

Each candidate still has hurdles to overcome for voters. The debates helped Obama overcome the experience hurdle with some voters, but race remains a factor in some geographic regions, said Hart. McCain is well respected for his military service and experience, but some voters think he can be erratic and age remains an issue.

Hart's forecast for health care reform is fairly bleak unless it is seen as part of the solution to reduce government costs and ease the economic crisis.

Discussion questions:

1. What makes the greatest difference to you when you vote for president?
2. Do you think voters will focus on policy or personality?
3. What will impact health care reform?

Share your thoughts in the comments area below.

How to Get a Bigger Bang for Your Quality Dollar

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Improve First was started by asking the question: How can we have the biggest, quickest impact on improving pediatric health outcomes? Simple: If you know what works, spread it.

The Alliance for Pediatric Quality launched Improve First by selecting four high impact, current ongoing initiatives that have robust methodologies and measures and show sustainable improvements to outcomes as a starting point for improvement:

• NACHRI Catheter-associated Blood Stream Infection collaborative
• Cystic Fibrosis Foundation Learning & Leadership Initiatives
• Trailblazer Improvement Collaborative for pediatric inflammatory bowel disease
• Improving performance in practice primary care through asthma collaboratives

Paul V. Miles, M.D., senior vice president of quality and maintenance of certification for the American Board of Pediatrics spoke on the Improve First collaborate as one of the best ways for hospitals to invest their quality dollars to see a high return on their investment. Miles shared "10 Money Smart Reasons to Improve First":

1. Improve patient care and outcomes
2. Improve faster
3. Implement what you know works
4. Save on design and development costs
5. Reduce ongoing costs and share infrastructure
6. Solves small sample, rare event problems
7. Take advantage of world class faculty and experts
8. Expand quality improvement capacity
9. Be part of effective, interdisciplinary teams
10. Maintenance of Certification opportunity for physicians

In sharing the advantages of the NACHRI CA-BSI program, for instance, Miles said: "This is the best quality improvement effort I've seen in the 20 years I've been working in quality improvement." In the short time the CA-BSI collaborative has been in place, it has prevented more than 300 infections, saved an estimated 30 lives, and saved more than $12 million.

For future learning:
NACHRI is hosting the Improve First Webinar Series from Oct. 7, 2008, through June 9, 2009 -- a series of seven 90-minute sessions to provide in depth information about different initiatives that are part of the Improve First effort. The Improve First Webinar series is all about spreading what works in quality improvement -- one of the most important steps the pediatric community can take to measurably improve children's health outcomes and transform how care is delivered.

Improve First is an initiative of the Alliance for Pediatric Quality, a collaborative which includes the National Association of Children's Hospitals and Related Institutions, the American Academy of Pediatrics, American Board of Pediatrics and Child Health Corporation of America.

What's New in Community Benefit Reporting

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Increased scrutiny by Congress and the IRS necessitate better understanding of how children's hospitals organize for and report community benefit activities, and how they will be impacted by proposed new reporting requirements. Over the past 18 months NACHRI has engaged with members, congressional and IRS staff, and other associations to represent children's hospitals in the development of new reporting guidelines and mandates. Survey responses returned from more than 60 percent of freestanding children's hospitals provided a starting point for strategizing for the future.

Eliminating BSIs: How Your Hospital Can Avoid a Payor's Never Event

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The NACHRI Catheter Associated Blood Stream Infection Collaborative has achieved remarkable results since it began in October 2006.

Collaborative leader Marlene Miller, MD, MSc, NACHRI's chief medical officer, demonstrated how participating hospitals achieved a 45 percent drop in BSI events, prevented an estimated 275 infections and 40 deaths, and saved $9 million in the first 12 months.

The key to these results is reliable performance of the insertion and maintenance bundle. "You can have policy and education but compliance is essential," said Miller.  But Miller also stressed that "the larger contextual and cultural issues matter as well, not just how long you scrub a cap." These other factors include team members knowing each other and senior leadership involvement in the quality improvement initiative. 

As NACHRI moves into the third phase this fall, participating hospitals will explore the contextual factors that influence the safety culture and test them individually.

Miller also announced that a Heme-Onc collaborative group is next in the pipeline with recruitment starting in spring 2009. 

Find out more about the NACHRI CA-BSI Collaborative.   

Poster Winners Announced

Four winners were named out of the 41 posters presented at the NACHRI Annual Meeting in Salt Lake City.

Overall Poster Winner

#27 Improving ED to Bed Times with SPEED
Lisbeth Fahey, RN, MSN
Children's National Medical Center
Washington, DC

Poster Winners

#16 Providing Continuity of Care Through a Multidisciplinary Approach
Janine Petitgout, ARNP
Kelly Nissen, LISW
University of Iowa Children's Hospital
Iowa City, IA

#17 Creation of a Virtual Psychiatric Crisis Intervention Unit to Reduce Emergency Department Overcrowding
Yann Poncin, MD
Brian Geyser, APRN-BC, MSN
Yale-New Haven Children's Hospital
New Haven, CT

#29 One Stone, Two Birds: Achieving Handoff Education Through Data Collection
Edgar Marcuse, MD, MPH
Georgia Colkitt
Seattle Children's
Seattle, WA

Leadership Transition and Succession Planning for Children's Health Systems

Every hospital will eventually face CEO transition; the challenge to hospitals is to be prepared to make the transition well and to implement long-term succession planning to ensure sound leadership for the future. Cook Children’s Health Care System CEO Rick Merrill shared about his own recent transition to Cook Children’s as a case study for succession planning. Two experts from Witt/Kieffer who helped with the process shared broader strategies for talent management and succession planning and offered specific advice for hospital boards, outgoing CEOs and executives interested in becoming children’s hospital CEOs to help all three parties understand what they need to keep in mind to prepare for leadership transitions.

The American College of Healthcare Executives has maintained data on hospital CEO turnover (all hospitals, not children’s hospital specific) since 1981, and for the last seven years, annual turnover has remained relatively stable at 14 – 16 percent, an average tenure of 6.7 years for hospital CEOs. In the close community of children’s hospitals, many institutions have been blessed with long-time CEOs who’ve devoted 20, 30 or even more years of their life to growing and realizing the vision of their hospital. The wisdom and leadership of these executives is cherished, but there will come a time when every hospital must transition to new leadership, and with proactive succession planning the vision and experience of the incumbents can be passed on.

Dan Fairley, executive transition and succession practice leader for Witt/Kieffer, stressed the most important competency considerations for preserving leadership continuity in hiring a new CEO. The incoming CEO must have strong communication, skills and effectiveness with stakeholders; must be effective in conflict management, persuasion and discipline; and must be an active, uplifting questioner. The questions a person chooses to ask gives you immense insight into their thinking and their character, and helps reveal whether they are likely to mesh well with the organization.

Succession planning dynamics are conducted by executives and shared with the board. It is essential to plan for job rotation, special assignments and job sharing during the transition process. In contrast, transition planning is conducted by the board with executive assistance, are requires well-crafted communications to outside stakeholders.

Marvene Eastham, senior vice president with Witt/Kieffer, was actively involved in the transition that brought Merrill to Cook Children’s, and emphasized some of the elements that made the transition run smoothly. Succession planning at organization is an opportunity for the board to tweak the hospitals direction; they must start from a well-defined organizational assessment and engage in a focused, efficient search for a new leader. Planning must address incumbent compensation and retirement issues as well as comprehensive compensation considerations for the incoming CEO.

Merrill shared the primary questions he asked himself when considering the move:

• Is this the right time to leave my current employer?
• Is the organization I am considering the right fit for me … am I the right fit for that organization?
• Is this the right move for my family?
• Am I running “from” or running “to”?

He also took into consideration the vision of Cook Children’s that was already in place, to see if it was a vision that he could buy into. He looked at the governing body of the hospital to make sure they provided effective governance; the financial consideration of the organization; the hospital’s clinical reputation; and a wide variety of other factors as part of his final decision making process.

After the decision to move is made, Merrill stressed the importance of honoring existing commitments to make a graceful, honorable exit from his former role; and working to listen and understand the new organization before making sweeping changes. He made a point of asking staff across all levels of the organization two questions:

1. What is going well that I shouldn’t mess up?
2. What isn’t working well that I can help fix?

Two questions all leaders – present and future – would be wise to keep in mind.

Questions for feedback:

• Does your hospital have a succession plan in place?
• Do you have a plan in place to nurture internal candidates for executive positions?
• What other transition challenges are being faced by your organization?

Covey Shares Keys for Greatness

Discussion questions for Stephen Covey’s keynote presentation, “Managing Change in Turbulent Times”

• What did Covey share that stands out most vividly in your memory?
• How is your hospital (or organization) dealing with the shift to a knowledge-based economy?
• Are employees in your organization likely to know what the overall mission is and what top goals they should prioritize?

Overview of the Opening Keynote Presentation
 
Stephen Covey, Ph.D., opened the morning on a personal note. The first words out of his mouth “We just had our 50th grandchild.” He then showed a slide of his grandchildren. The legacy these grandchildren represent were Covey’s example of how he has benefited from practicing the values and principles he has shared with the world.
 
In a talk that utilized personal stories, slides, statistics and short video clips, Covey suggested a paradigm for greatness that he believes applies equally to business and personal life. He sees each person as comprised of four key components: body, heart, mind and spirit. Bodies have a need to live; hearts to love and to engage in relationships; minds to know; and spirits to leave a legacy and find meaning. “Neglect any of these four parts,” Covey says, “and you turn a person into a thing.”
 
Covey, cofounder and vice chairman of FranklinCovey, the leading global professional services firm, is most recognized as the author of the international bestseller The 7 Habits of Highly Effective People. His famous seven habits were the underlying foundation for his thoughts, but he went beyond talking about habits to look at how leaders need to shift their values to continue to flourish amidst the cultural and economic seismic shifts brought on by the fourth age of civilization.
 
Hunter/gatherer societies were replaced by farm-based societies were replaced by industrial societies which are now being replaced by information/knowledge-based societies. In each previous paradigm shift, cultures had to master new skills and tools to make the change, and the return was approximately a 50-fold increase in production. It remains to be seen whether the move to a knowledge-based culture will yield the same return, but Covey expects that radical increase in production capacity to take place.
 
However, to see that spike in production and productivity, it is necessary to understand the mindset that has to change to move from an industrial- to a knowledge-centered economy. In the old economy, the primary driver for growth and success was machinery, and people were replaceable. In the new economy, the primary driver for growth and success are the knowledge and skills of individual employees and the ability of a leader to help create an environment that allows individuals to synergize with one another and put their unique abilities to use.
 
Leaders face the unprecedented challenge of trying to find common values among the five generations employed simultaneously in the workforce, and among the hundreds of languages and cultures regularly brought together by increased globalization.
 
To adapt to these challenges, Covey believes it is necessary to achieve greatness in three areas:

1. Personal greatness
2. Leadership greatness
3. Organizational greatness.

Personal greatness is grounded in finding your own voice. Leadership greatness is found in inspiring others to find their own voices. Organizational greatness comes from developing an institutionalized focus and strategy for execution; this is not dependent on people but on having a healthy structure.
 
The 8th Habit
Covey assigns an “xQ” – an execution quotient to the ability of leaders to create a “winning culture of unleashed people.” The Web site for The 8th Habit, Covey’s latest bestseller, offers a free 15-minute test to help each respondent “to identify the strengths and weaknesses that affect your organization’s ability to accomplish its most important objectives.” The report compares your responses to national responses. The site also makes available a variety of other resources, including the 15 short films that act as vivid visual metaphors for various principles Covey sees as components of greatness.
 
Covey stressed that greatness rules apply to families as well as to work. “No other success can compensate for failure in a family,” he says. For his family, he adapts strategies from the business world to his family life, including a mission statement he summed up as: “We serve God by serving others.” His family is organized around service committees that help execute that mission in daily life.
 
In his research, Covey believes that being able to communicate mission and vision is vital to succeeding in a information-driven, knowledge-based economy. Whether a business of a family, every person needs to know what the vision is and what top goals are in achieving that vision.
 
In one of his books, author Charles Hummel shares advice that was given to him: “Your greatest danger is letting the urgent things crowd out the important ones.” Covey’s research supports this sentiment. In the new knowledge-based culture, the danger of the urgent crowding out the important is greater than ever. This is why it is vital to create buy-in at all levels – of a business or a family or any other social structure – of what mission and what goals are most important. A clear understanding of what is important helps create ownership and direction and allows individuals to turn their unique knowledge and skills towards meeting mission and goals, even when specific actions may not be in their job description. What Covey calls “the whole person paradigm,” made up of body, mind, heart and spirit, provides a moral center from which greatness is possible.
 
Covey closed with a quote from French philosopher Teilhard de Chardin: “We are not human beings having a spiritual experience. We are spiritual beings having a human experience.”
 
The standing ovation from the 500-member audience suggests that, at least in part, they agreed. What are your thoughts?

What advice has changed your career in children's health care?

Did you ever have a mentor, colleague or friend give you advice that changed your career or your life? Tell us...

How will the national economic crisis impact children's health care in your area?

Tell us how you think the faltering economy will impact your hospital or children's health care in your area or nationwide.

What do you want to change at your hospital as a result of this meeting?

The NACHRI Annual Meeting is focused on helping today's children's hospital leaders change, adapt and lead. What do you want to change at your hospital? Leave a comment and tell us!

Stephen Covey Wants to Know...

Our keynote speaker, Stephen Covey, PhD, has asked us to describe children's hospital culture with respect to how staff relate to and work with one another.  Can you help? 

Reply in the comments area with your thoughts!

Presentations and Handouts Available

PowerPoint presentations for a majority of sessions are available on the NACHRI Web site. Please also check back the week following the conference as some speakers are still sending in their slides and other links. View educational session abstracts & presentations.

Risa Lavizzo-Mourey, MD, MBA to address NACHRI Annual Meeting

Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation (RWJF), will provide the closing plenary presentation for this year's Annual Meeting.  Her topic is "Building a Social Movement to Reverse Childhood Obesity."

You can learn more about the RWJF's initiative to reverse childhood obesity on their Web site.  In the meantime, share with us what your hospital is doing to reverse childhood obesity through our comments area!