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Using a Rapid-Cycle Learning System to Tackle Turnover & Attrition [Webinar]

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Using a Rapid-Cycle Learning System to Tackle Turnover & Attrition [Webinar]

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See the recording and more: https://www.valuecapturellc.com/webinar-rapid-cycle-learning-system-turnover-attrition

Presented by two leaders from Duke HomeCare & Hospice:

Cooper Linton
Janet Burgess
Mike Radtke, from Value Capture, will also be part of the Q&A


Powered by a system-wide quest for zero harm throughout Duke Health, DHH leaders used this philosophy and accompanying principles to identify root causes, then build rapid-cycle learning into improvement and management systems. Investigation revealed poor staff engagement and excessive work-process burdens, leading to significant negative patient impact, referring-customer dissatisfaction, and financial harms.

To resolve these problems, DHH’s rapid-cycle learning system, rooted in the principle of respect, involved:

Understanding of current condition
Leadership behavior changes to quickly respond to staff needs, remove barriers, and coach problem-solving
Tiered-huddle management system to elicit and escalate problems, especially safety problems, and vitally, ensure psychological safety so frontline staff and managers raise issues
The willingness to shed traditional leadership methods, to experiment, iterate and be perpetual learners
So far, RN turnover has been reduced from 75% to 18% (annualized rates).

These lessons are transferrable to many different settings, so please attend if you work outside of home care.

Learning Objectives
This session will provide practical tips on how to design systems that produce:

Responsive, supportive, effective leaders
Empowered, engaged safe employees
Better patient and financial outcomes

See the recording and more: https://www.valuecapturellc.com/webinar-rapid-cycle-learning-system-turnover-attrition

Presented by two leaders from Duke HomeCare & Hospice:

Cooper Linton
Janet Burgess
Mike Radtke, from Value Capture, will also be part of the Q&A


Powered by a system-wide quest for zero harm throughout Duke Health, DHH leaders used this philosophy and accompanying principles to identify root causes, then build rapid-cycle learning into improvement and management systems. Investigation revealed poor staff engagement and excessive work-process burdens, leading to significant negative patient impact, referring-customer dissatisfaction, and financial harms.

To resolve these problems, DHH’s rapid-cycle learning system, rooted in the principle of respect, involved:

Understanding of current condition
Leadership behavior changes to quickly respond to staff needs, remove barriers, and coach problem-solving
Tiered-huddle management system to elicit and escalate problems, especially safety problems, and vitally, ensure psychological safety so frontline staff and managers raise issues
The willingness to shed traditional leadership methods, to experiment, iterate and be perpetual learners
So far, RN turnover has been reduced from 75% to 18% (annualized rates).

These lessons are transferrable to many different settings, so please attend if you work outside of home care.

Learning Objectives
This session will provide practical tips on how to design systems that produce:

Responsive, supportive, effective leaders
Empowered, engaged safe employees
Better patient and financial outcomes

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Using a Rapid-Cycle Learning System to Tackle Turnover & Attrition [Webinar]

  1. 1. Profound change. Sustainable results. 2 Profound change. Sustainable results. 2 Using Rapid Cycle Improvement to Tackle Turnover Presented by: Janet Proctor Burgess, RN, BSN, CENP Cooper Linton, MBA, MSHA Duke Home Care & Hospice Hosted by: Mark Graban Value Capture Webinar December 6, 2022
  2. 2. Profound change. Sustainable results. 4 About Our Presenters • RN for 33 years • BS in nursing • Certified Executive Nursing Practice (American Organization for Nursing Leadership) • 20+ years in healthcare • Co-host of a podcast “Edge of Aging” • Masters in Healthcare Administration • Graduate Certificate in Gerontology
  3. 3. Profound change. Sustainable results. 5 Who is Value Capture? www.ValueCaptureLLC.com
  4. 4. Using Rapid Cycle Improvement to Tackle Turnover Janet Proctor Burgess, RN, BSN, CENP Director Patient Care Services Home Health Cooper Linton, MBA, MSHA Associate Vice President Duke Home Care & Hospice/Duke University Health System
  5. 5. Turnover Improvement 75% 19.73% 0% 10% 20% 30% 40% 50% 60% 70% 80% Percent RN Annualized Home Health Turnover Improvement Jun-20 Jun-21 Before After
  6. 6. Home-based Care and Lean Very limited penetration of lean principles in home-based care, i.e. home health, home care, home infusion, hospice. Challenges and perceived barriers: • Highly dispersed work force and challenges of “lone workers” • Incredibly heterogenous and uncontrolled care settings (literally thousands): • No standard design or condition for setting of care, i.e. no environmental services, not ADA compliant, staff safety issues • Care provider is a “guest” in the setting of care • No security staff • No ability to get immediate colleague support
  7. 7. What Does Duke HomeCare & Hospice Do? Three business lines: • Home Health: nursing, therapies, social work, aide • Hospice: In-home, free-standing hospice facility, and in-hospital • Home Infusion and compounding pharmacy: • Pharmacists • Drug compounding • Distribution warehouse “Pressure relief value” for Duke University Health System
  8. 8. Lean Timeline and COVID • Began our lean journey 4-6 months before COVID with tiered huddle, visual management system, leader training, and leader standard work • Significant refinement of tiered reporting system during pandemic • Provided a critical structure for rapid response • Re-re-re-refining during endemic stage
  9. 9. Symptom: 75% Nursing Turnover AND Its TRUE Cost Mission Impact: Mission failure for 2500 patients/year we couldn’t accept. (Clinical harm) The “hidden P&L” impact: >$20 M impact in revenue and expenses • Est. $4.5 M in annual expense directly tied to turnover • Est. $17.5 M annual revenue opportunity cost How would we respond if we received a $22,000,000+ “turnover” invoice each year?
  10. 10. PLUS Even More Financial Uncertainty… • the loss of control for “attributed lives” on risk-based payor relationships. • the impact on unnecessary acute LOS and lost back-fill revenue for DUHS. • the impact of additional emergency department volume for DUHS. • the impact on our other staff through overburden, dissatisfaction, staff disengagement, and culture. • inefficiencies and lower quality metrics resulting in waste. • reduced care outcome metrics and their impact on value-based purchasing payments.
  11. 11. Analysis of Turnover • Clinician Burnout • Ineffective workflows • Disengaged team members • Ineffective Orientation, training and learning • Leaders not eliciting feedback from front line staff • Lack of support to front line staff
  12. 12. Ineffective Workflows • Time and money spent on non-valued added activities • Increased cost due to uneven work and rework • Frustration from frontline and leaders • Staff feeling like their time didn’t mater
  13. 13. Move from Transactional Leader to Servant Leader Build open and trusting relationships Build culture of inclusiveness and consensus Empower and motivate Focus on patient, staff and caregiver safety and wellbeing
  14. 14. Shift from being the “Doer” to the “Coach” • Establish workgroups to address problems • Include team members doing the work at the front lines • Allow group members to work through the problem and target condition • Do a better job listening and acknowledging • Provide support and encouragement
  15. 15. 17
  16. 16. Eliciting involvement in dispersed and remote workforce • Use of Humble Inquiry to elicit feedback and identify current condition • Use of technology to improve involvement in front line staff huddles, improvement activities and work groups
  17. 17. Why Rapid Cycle Learning? • Ability to quickly test improvements and evaluate impact • Encourages continuous improvement • Provides timely information needed to make decisions(nimbleness)
  18. 18. Rapid Cycle Learning to Decrease Turnover • Redesign of workflow towards achieving ideal state • Reduction of wasteful activities in EMR/documentation • Orientation process improvements • Preceptor Learning and Training • Workload and Productivity modifications • Communication Improvements
  19. 19. Keys to Rapid Cycle Learning Success • Leader by-in and support • Keep track of improvement activities, progress, and results • Encourage and support engagement from staff at all levels • Use information analyzed and collected from evaluation of improvement activities to quickly pivot and make changes • Use Rapid Cycle learning as a catalysis for continual change. • Keep all staff updated frequently on improvement activities and outcomes
  20. 20. Rapid Cycle Improvement Impact • Improved workflows • Elimination of wasteful activities • Decreased frustration • Improved work culture and environment • Highly trained clinicians • Decreased Turnover
  21. 21. Turnover Improvement 75% 19.73% 0% 10% 20% 30% 40% 50% 60% 70% 80% Percent RN Annualized Home Health Turnover Improvement Jun-20 Jun-21 Before After
  22. 22. Questions, Comments, Observations?
  23. 23. Profound change. Sustainable results. 25 Thank You / Q&A Janet Burgess • janet.proctor@duke.edu Cooper Linton • cooper.linton@duke.edu Mark Graban • mgraban@ValueCaptureLLC.com More Resources: Free eBooks, videos, white papers… www.ValueCaptureLLC.com

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