Hsprn 17 March 2010 Lowe

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"Using common work environment metrics to create high-performing healthcare organizations." Presentation at Univeristy of Toronto, Health System Performance Research Network.

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Hsprn 17 March 2010 Lowe

  1. 1. How Work Environment Metrics Can Improve Healthcare Performance Presentation by Graham Lowe, Ph.D. To the Health System Performance Research Network, University of Toronto 17 March 2010 Project Title 1
  2. 2. Presentation outline 1. Urgency 2. Definition 3. Ingredients 4. Performance 5. Framework 6. Metrics 7. Progress © 2010 The Graham Lowe Group 2
  3. 3. Presentation outline 1. Urgency 2. Definition 3. Ingredients 4. Performance 5. Framework 6. Metrics 7. Progress © 2010 The Graham Lowe Group 3
  4. 4. Future HR risks Demographics Capabilities Human sustainability of healthcare Engagement organizations Wellbeing © 2010 The Graham Lowe Group 4
  5. 5. Absenteeism, all occupations and health occupations, Canada Average annual days lost per full-time worker 20 18 Canadian workforce Health occupations 16 14 12 Days 10 8 6 4 2 0 98 99 00 01 02 03 04 05 06 07 08 19 19 20 20 20 20 20 20 20 20 20 Source: Statistics Canada, Labour Force Survey. © 2010 The Graham Lowe Group 5
  6. 6. Source: Ontario Safety Association for Community & Healthcare, Annual Report © 2010 The Graham Lowe Group 6
  7. 7. Self-reported work stress levels, healthcare occupations compared with all others, Canada Q. “Would you say that most days were (not at all stressful, not very stressful, a bit stressful, quite a bit stressful, extremely stressful)?” RNs and nurse supervisors 58.9 Other health professions 46.3 Technical and related occupations in 39.5 healthcare Assisting occupations in healthcare 35.0 All other occupations 30.5 Source: Statistics Canada, Canadian Community Health Survey, custom 0 20 40 60 80 100 tabulation. Percent 'quite a bit' or 'extremely' stressful © 2010 The Graham Lowe Group 7
  8. 8. Unhealthy working conditions 2005 NationalSurvey of the Work and Health of Nurses: • Factors affecting the health, job satisfaction, and retention of nurses :  Job strain, supervisory support, respect, job autonomy 2004 National Physician Survey: • Physician supply and health care access are affected by working conditions:  Hours, workload, work-life conflict, stress, burnout, job dissatisfaction © 2010 The Graham Lowe Group 8
  9. 9. The costs of inaction…and action 1. What is the cost burden of absenteeism, LTI, LTD, stress and burnout? 2. What are the expected benefits of reducing the gaps with the rest of the workforce by 50%? 3. What would it take to do this? © 2010 The Graham Lowe Group 9
  10. 10. Presentation outline 1. Urgency 2. Definition 3. Ingredients 4. Performance 5. Framework 6. Metrics 7. Progress © 2010 The Graham Lowe Group 10
  11. 11. You need to get at root causes - Turnover, absenteeism, injuries, benefit costs, dissatisfaction WORK ENVIRONMENT © 2010 The Graham Lowe Group 11
  12. 12. A healthy healthcare workplace …is “a work setting that takes a strategic and comprehensive approach to providing the physical, cultural, psychosocial and work/job design conditions that maximize health and well-being of health care providers, quality of patient outcomes and organizational performance.” Quality Worklife – Quality Healthcare Collaborative © 2010 The Graham Lowe Group 12
  13. 13. Moving beyond wellness programs Workplace Health Healthy Organization DIMENSION: Promotion Target Individual Organizational Change model Health promotion Organization development Scope and focus Program-based Systemic and holistic Timeframe Short and medium term Long term Individual benefits Reduced health risks Quality of life and capabilities Organizational benefits Lower employee costs Higher performance Links to strategy Part of HR plan How the business operates Responsibility Formal roles Shared responsibility © 2010 The Graham Lowe Group 13
  14. 14. Presentation outline 1. Urgency 2. Definition 3. Ingredients 4. Performance 5. Framework 6. Metrics 7. Progress © 2010 The Graham Lowe Group 14
  15. 15. Converging perspectives & evidence Healthy workplaces High Organizational performance culture workplaces Wellbeing & Performance Strategic Learning human resource organizations management Service profit chain © 2010 The Graham Lowe Group 15
  16. 16. Healthy work environment ingredients Key drivers of wellbeing and performance: 1. Respectful relationships based on trust 2. 2-way communication 3. Contributions valued and recognition 4. Supportive supervisors & coworkers 5. Job autonomy 6. Role clarity and demands 7. Decision input 8. Challenging, interesting work 9. Growth and development opportunities 10.Adequate resources 11.Fair rewards and processes 12.Safe and health-promoting environment © 2010 The Graham Lowe Group 16
  17. 17. Presentation outline 1. Urgency 2. Definition 3. Ingredients 4. Performance 5. Framework 6. Metrics 7. Progress © 2010 The Graham Lowe Group 17
  18. 18. Example: Stress and performance Learning, HIGH motivation, innovation Low strain Active Decision Latitude (control) Passive High strain Risk of Psychological stress Physical illness LOW Psychological demands HIGH Karasek, R. & Theorell, T. Healthy Work: Stress, Productivity, and the Reconstruction of Working Life: Basic Books, 1990. © 2010 The Graham Lowe Group 18
  19. 19. Magnet Hospital model NURSE OUTCOMES Hospital priorities and policies Nurse work environment (resources, administrative Process of care support, relations with physicians) RN:patient ratios Skill mix PATIENT OUTCOMES Source: Linda Aiken (2002). “Superior outcomes for Magnet Hospitals: The evidence base.” In M. McClure and A. Hinshaw (Eds.), Magnet Hospitals Revisited. American Academy of Nursing. © 2010 The Graham Lowe Group 19
  20. 20. Safety culture High quality work environments support safety, QWL and HR goals WORK ENVIRONMENT HR GOALS SAFETY • Team work Pride CULTURE • Fair processes Commitment  Report • Learning environment Job satisfaction Learn • Supportive supervisor Engagement Act • People leadership Source: G. Lowe, The role of healthcare work environments in shaping a safety culture. Healthcare Quarterly 11, (2) 2008 © 2010 The Graham Lowe Group 20
  21. 21. What matters to staff in the NHS —The resources to deliver quality care for patients. Results: —The support I need to do a good job. • provide quality care • patient satisfaction —A worthwhile job with the chance • advocacy of NHS to develop. —The opportunity to improve the way we work. Source: Ipsos MORI. (2008). What Matters to Staff in the NHS: Research Study Conducted for Department of Health. www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_085536 © 2010 The Graham Lowe Group 21
  22. 22. 13 of the “100 Best Companies to Work For in America” are in healthcare! Arkansas Children’s Hospital Baptist Health South Florida Children’s Healthcare of Atlanta Indiana Regional Medical Center King’s Daughters Medical Center LifeBridge Health Mayo Clinic Meridian Health Methodist Hospital System OhioHealth Scripps Health Southern Ohio Medical Center Winchester Hospital © 2010 The Graham Lowe Group 22
  23. 23. Presentation outline 1. Urgency 2. Definition 3. Ingredients 4. Performance 5. Framework 6. Metrics 7. Progress © 2010 The Graham Lowe Group 23
  24. 24. Common framework criteria A common framework for measuring and reporting work environment metrics must meet these criteria: 1. Comprehensive: measure determinants and outcomes 2. Inclusive: apply to all healthcare workers and settings 3. Uses common tools 4. Government-sponsored © 2010 The Graham Lowe Group 24
  25. 25. Existing frameworks RNAO Healthy Workplace Best Practice Guidelines Canadian Nurses Association QWL indicators Accreditation Canada Pulse Survey QWQHC indicators Magnet Hospital model AACN Healthy Work Environment Standards Health Promoting Hospital Healthy Workplace Standards © 2010 The Graham Lowe Group 25
  26. 26. NHS approach • Annual NHS Staff Survey administered in all Trusts • Informed by What Matters to Staff study • Department of Health sponsors • University and private sector partners • Care Quality Commission reports and monitors • Measures core performance standards targets • Survey results publicly available • Trusts do action plans with board accountability © 2010 The Graham Lowe Group 26
  27. 27. Need to align metrics Healthcare performance indicators have proliferated. —Result = ‘indicator-itis’. —e.g., there are 5 indicators of acute myocardial infarction readmission (AMIR) in Ontario Lack of alignment is inefficient and reduces potential for system-wide improvement. No jurisdiction includes HWE metrics in performance reporting. —Favourable conditions for HWE metrics alignment. © 2010 The Graham Lowe Group 27
  28. 28. Benefits of using common metrics 1. Avoids duplication and confusion 2. Enables comparisons and benchmarking 3. Can identify effective management practices 4. Facilitates learning and diffusion of innovation 5. Supports HWE performance targets 6. Basis for recognition and awards 7. Inclusive approach raises the floor © 2010 The Graham Lowe Group 28
  29. 29. Healthy Work Environment Model ORGANIZATIONAL CONTEXT DRIVERS INDIVIDUAL OUTCOMES OUTCOMES Care quality  and patient  Work environment safety Strategy       Leadership      Culture factors Engaged  employees and  Employee and  physicians with  physician quality  Job factors of work‐life the capabilities  HR goals and resources to  deliver high‐ quality care and  internal services Human resource  supports Costs and  productivity © 2010 The Graham Lowe Group 29
  30. 30. Presentation outline 1. Urgency 2. Definition 3. Ingredients 4. Performance 5. Framework 6. Metrics 7. Progress © 2010 The Graham Lowe Group 30
  31. 31. Examples of selected healthy work-environment themes, concepts and indicators for performance reporting Theme Concept Indicator examples Reporting Source level Care quality Patient / client Multi-item scale score High Patient / client and patient satisfaction Multi-item scale score Mid satisfaction survey safety Safety culture “I am able to deliver the patient care I aspire to.” Detailed Staff surveys Perceived quality of Staff surveys care delivered HR goals Retention Annual rate of voluntary turnover excluding retirements High Employer Collaboration “Does your team meet regularly and discuss its effectiveness and how Mid administrative data it could be improved?” Staff surveys Costs and Lost time injuries Annual lost time injury rate High WSIB data productivity Absenteeism Annual absenteeism rate Detailed LFS; Employer administrative data Staff Engagement Multi-item scale score High Staff surveys capabilities Skill utilization “I am able to make improvements happen in my area of work.” Mid Staff surveys Staff quality Job satisfaction “I would recommend my organization as a place to work.” High Staff surveys of work life Work-life balance “My employer is committed to helping staff balance their work and Mid Staff surveys home life.” Work Decision input “I am involved in deciding on changes that affect my work area.” Detailed Staff surveys environment Communication “Communication between senior management and staff is effective.” Mid Staff surveys factors Respect “The people I work with treat me with respect.” Detailed Staff surveys Supportive “My immediate manager can be counted on to help me with a difficult Detailed Staff surveys supervisor task at work.” Supportive “I am [satisfied…dissatisfied] with the support I get from my work Detailed Staff surveys coworkers colleagues.” Healthy and safe Multi-item scale Detailed Staff surveys environment Feedback “I get clear feedback about how well I am doing in my job.” Mid Staff surveys Fair processes “Does your employer act fairly with regard to career Detailed Staff surveys progression/promotion regardless of ethnic background, gender, religion, sexual orientation, disability or age?” © 2010 The Graham Lowe Group 31
  32. 32. High-level indicators •Patient/client satisfaction •Retention •Lost time injuries •Engagement or job satisfaction © 2010 The Graham Lowe Group 32
  33. 33. Presentation outline 1. Urgency 2. Definition 3. Ingredients 4. Performance 5. Framework 6. Metrics 7. Progress © 2010 The Graham Lowe Group 33
  34. 34. HWE stakeholders F/T/P governance Provincial ministries Universities and quality agencies Professional associations & unions Boards Healthcare organization managers, employees & physicians © 2010 The Graham Lowe Group 34
  35. 35. How to make progress 1. Champions 2. Key stakeholder input 3. Leverage and link with related initiatives 4. Revise quality models 5. Build into accountability agreements 6. Develop common measurement tools 7. Produce annual HWE report card 8. Integrate HWE metrics into other reporting systems © 2010 The Graham Lowe Group 35
  36. 36. The big question What is your role in developing and implementing HWE common metrics? © 2010 The Graham Lowe Group 36
  37. 37. Questions& Comments © 2010 The Graham Lowe Group 37
  38. 38. Watch for my new book in April : www.creatinghealthyorganizations.ca For more information: Website: www.grahamlowe.ca Email: glowe@grahamlowe.ca Phone: 250.448.5636 © 2010 The Graham Lowe Group 38

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