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INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Adopt, Adapt, Abandon:
An Educational Plan Built on
Process Improvement
R. Gino Chisari, RN, DNP
Director of the
Norman Knight Nursing Center & Clinical
and Professional Development
The New Triple A

INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Guiding Principles
• This was more than the “usual” process
improvement strategy of the moment
• We would incorporate a known set of concepts and
tools and apply them in a structured but flexible
approach to designing a new reality
• All employees are included and encouraged to be
part of the process
• Leadership support is mandatory
• New ideas to improve the work and for the team to
learn together
INSPIRATION | INNOVATION | TRANSFORMATION

The Foundation – Plan, Do, Study, Act
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

The Three Questions
1. What are we trying to accomplish?
2. What change might we try that could result in an
improvement?
3. How will we know that a change is an improvement?

PDSA Cycle

Source: Langley et. al., The Improvement Guide
Lean – One Approach

INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

The relentless pursuit of the perfect process through
elimination of waste & through respect for the worker
Value/Waste in Process

Before

After

VALUE
WASTE
Lean Targets Waste In a Process

Key: The Focus Is On the Process Not the People

Source: GE Healthcare
INSPIRATION | INNOVATION | TRANSFORMATION

Lean Thinking – The Fundamentals
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

It’s About The Patient
• Define value from the patient’s perspective
• Identify the value stream – i.e. the patient’s
experience from beginning to end
• Standardize work processes in order to identify &
reduce unnecessary variation
• Establish and optimize flow
• Stop and correct defects, do not pass them along
• Continuously improve the process to perfection
Source: GE Healthcare
INSPIRATION | INNOVATION | TRANSFORMATION

Tips for Testing Changes

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

• Test with willing volunteers
• Avoid the need for total consensus for testing
• Pick relatively easy, non-controversial changes first
• Collect useful data during the test and reflect on the results
• Be prepared to end the small test of change
• When the test is completed, select one of the following:

Adopt, Adapt or Abandon

Adapted from IHI
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

The primary goals of the educational plan was
to provide each participant with a:
• Strong base of support from which to
successfully build upon, and actively engage
on the Innovation Units
• Consistent understanding and application of
the principles, concepts and other
transportable components of the project’s
aim across each of the innovation units
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Approach
• Self-study assignments and Proficiency
Evaluation of Acquired Skills (PEAS)
• Facilitated/Interprofessional
Workshops
• Unit-based modules
• Attending Registered Nurse Weekly
Meetings
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Tracks
• General – foundational, introductory
for all members of the community
• Role – domain specific, including a
leadership track
• Unit – team building/training
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Content Areas
• Quality & Safety
• Satisfaction: patients, families and staff
• Clinical Outcomes
• Best Practices
• Diversity
• Care Continuity
• Financial Outcomes
• Compliance Outcomes
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Ongoing and Continuous Development
• Support the paradigm shift
• Each member of the team is entitled to
professional development that raises the bar
on excellence in patient and family centered
care
• Designed on adult learner theory that
actively engages the learner, resulting in a
demonstrable change in behavior and
performance
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

The Challenge and Opportunity
• The need to continue providing
educational support to Phase I units,
while simultaneously on-boarding
Phase II and thinking about Phase III
and beyond
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Topic: Resiliency Training
Target Audience: All members of the
Interdisciplinary Team
Goal: To provide the opportunity for all
members within the interdisciplinary
team to develop skills necessary to
successfully adapt to the quick pace of
change
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Topic: Relationship Based Care
Target Audience: All members of the
Interdisciplinary Team
Goal: To provide a consistent and
uniform understanding of how each
member of the interdisciplinary team
has a unique opportunity to provide
excellence through their personal
contributions
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Topic: Conflict Engagement
Target Audience: Leadership
Goal: To provide the necessary skills to
effectively engage with conflict and
produce a positive and healthy
outcome and environment
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Topic: Presentation Skills
Target Audience: Attending RN
Goal: To provide an opportunity for the
Attending RN to develop skill and
confidence with their new and
emerging role
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Topic: Diversity
Target Audience: All members of the
Interdisciplinary Team
Goal: To understand how the needs of
our patients, families and ourselves
impact on our relationships
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Topic: HCAHPS
Target Audience: All members of the
Interdisciplinary Team
Goal: To provide a understanding and
meaning of patient satisfaction data
and how every member of the team has
a responsibility to “get the red out ”.
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Topic: Leadership Coaching
Target Audience: Innovation Unit
Leadership (nursing directors & CNSs)
Goal: To provide a dedicated support to
the unit-based leadership in managing
the complex nature of change at the
local level
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Evaluation
• Restate the goal
• Assess for communication & marketing
• Assess for availability and scheduling
• Assess the adequacy of the content
• Assess for personal goal attainment
• Assess for an example of how the
information has been used
• Comment section
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

Design
• Electronic survey focusing on
communication and marketing strategies,
availability and scheduling of educational
activities, content and attainment of the
desired outcomes of each activity
• Likert-type scale and free text responses
that will be used to establish themes. The
themes will drive further professional
development and on-going educational
interventions
INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

“People grow through experience if they
meet life honestly and courageously.
This is how character is built.”
Eleanor Roosevelt

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Adopt, Adapt, or Abandon: An education plan built on process improvement

  • 1. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Adopt, Adapt, Abandon: An Educational Plan Built on Process Improvement R. Gino Chisari, RN, DNP Director of the Norman Knight Nursing Center & Clinical and Professional Development
  • 2. The New Triple A INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Guiding Principles • This was more than the “usual” process improvement strategy of the moment • We would incorporate a known set of concepts and tools and apply them in a structured but flexible approach to designing a new reality • All employees are included and encouraged to be part of the process • Leadership support is mandatory • New ideas to improve the work and for the team to learn together
  • 3. INSPIRATION | INNOVATION | TRANSFORMATION The Foundation – Plan, Do, Study, Act THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT The Three Questions 1. What are we trying to accomplish? 2. What change might we try that could result in an improvement? 3. How will we know that a change is an improvement? PDSA Cycle Source: Langley et. al., The Improvement Guide
  • 4. Lean – One Approach INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT The relentless pursuit of the perfect process through elimination of waste & through respect for the worker Value/Waste in Process Before After VALUE WASTE Lean Targets Waste In a Process Key: The Focus Is On the Process Not the People Source: GE Healthcare
  • 5. INSPIRATION | INNOVATION | TRANSFORMATION Lean Thinking – The Fundamentals THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT It’s About The Patient • Define value from the patient’s perspective • Identify the value stream – i.e. the patient’s experience from beginning to end • Standardize work processes in order to identify & reduce unnecessary variation • Establish and optimize flow • Stop and correct defects, do not pass them along • Continuously improve the process to perfection Source: GE Healthcare
  • 6. INSPIRATION | INNOVATION | TRANSFORMATION Tips for Testing Changes THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT • Test with willing volunteers • Avoid the need for total consensus for testing • Pick relatively easy, non-controversial changes first • Collect useful data during the test and reflect on the results • Be prepared to end the small test of change • When the test is completed, select one of the following: Adopt, Adapt or Abandon Adapted from IHI
  • 7. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT The primary goals of the educational plan was to provide each participant with a: • Strong base of support from which to successfully build upon, and actively engage on the Innovation Units • Consistent understanding and application of the principles, concepts and other transportable components of the project’s aim across each of the innovation units
  • 8. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Approach • Self-study assignments and Proficiency Evaluation of Acquired Skills (PEAS) • Facilitated/Interprofessional Workshops • Unit-based modules • Attending Registered Nurse Weekly Meetings
  • 9. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Tracks • General – foundational, introductory for all members of the community • Role – domain specific, including a leadership track • Unit – team building/training
  • 10. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Content Areas • Quality & Safety • Satisfaction: patients, families and staff • Clinical Outcomes • Best Practices • Diversity • Care Continuity • Financial Outcomes • Compliance Outcomes
  • 11. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Ongoing and Continuous Development • Support the paradigm shift • Each member of the team is entitled to professional development that raises the bar on excellence in patient and family centered care • Designed on adult learner theory that actively engages the learner, resulting in a demonstrable change in behavior and performance
  • 12. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT The Challenge and Opportunity • The need to continue providing educational support to Phase I units, while simultaneously on-boarding Phase II and thinking about Phase III and beyond
  • 13. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Topic: Resiliency Training Target Audience: All members of the Interdisciplinary Team Goal: To provide the opportunity for all members within the interdisciplinary team to develop skills necessary to successfully adapt to the quick pace of change
  • 14. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Topic: Relationship Based Care Target Audience: All members of the Interdisciplinary Team Goal: To provide a consistent and uniform understanding of how each member of the interdisciplinary team has a unique opportunity to provide excellence through their personal contributions
  • 15. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Topic: Conflict Engagement Target Audience: Leadership Goal: To provide the necessary skills to effectively engage with conflict and produce a positive and healthy outcome and environment
  • 16. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Topic: Presentation Skills Target Audience: Attending RN Goal: To provide an opportunity for the Attending RN to develop skill and confidence with their new and emerging role
  • 17. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Topic: Diversity Target Audience: All members of the Interdisciplinary Team Goal: To understand how the needs of our patients, families and ourselves impact on our relationships
  • 18. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Topic: HCAHPS Target Audience: All members of the Interdisciplinary Team Goal: To provide a understanding and meaning of patient satisfaction data and how every member of the team has a responsibility to “get the red out ”.
  • 19. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Topic: Leadership Coaching Target Audience: Innovation Unit Leadership (nursing directors & CNSs) Goal: To provide a dedicated support to the unit-based leadership in managing the complex nature of change at the local level
  • 20. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Evaluation • Restate the goal • Assess for communication & marketing • Assess for availability and scheduling • Assess the adequacy of the content • Assess for personal goal attainment • Assess for an example of how the information has been used • Comment section
  • 21. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT Design • Electronic survey focusing on communication and marketing strategies, availability and scheduling of educational activities, content and attainment of the desired outcomes of each activity • Likert-type scale and free text responses that will be used to establish themes. The themes will drive further professional development and on-going educational interventions
  • 22. INSPIRATION | INNOVATION | TRANSFORMATION THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT “People grow through experience if they meet life honestly and courageously. This is how character is built.” Eleanor Roosevelt

Editor's Notes

  1. Stay a cycle ahead. When designing a test, imagine at the start what the subsequent test or two might be, given various possible findings in the "Study" phase of the Plan-Do-Study-Act cycle. For example, teams that are redesigning same-day admission criteria should also be planning how those criteria will be applied. Scale down the scope of tests. Dimensions of the tests that can be scaled down include the number of patients, doctors, and others involved in the test ("Sample the next 10" instead of "Get a sample of 200"), and the location or duration of the test ("Test it in Operating Room #1 for one week"). Pick willing volunteers. Work with those who want to work with you. ("I know Dr. Jones will help us" instead of "How can we convince Dr. Smith to buy in?") Avoid the need for consensus, buy-in, or political solutions. Save these for later stages. When possible, choose changes that do not require a long process of approval, especially during the early testing phase. Don’t reinvent the wheel. Instead, use changes tried elsewhere. For example, instead of creating your own atrial fibrillation treatment protocol, try modifying another hospital’s protocol Pick easy changes to try. Look for the concepts that seem most feasible and will have the greatest impact. Avoid technical slowdowns. Don’t wait for the new computer to arrive; try recording test measurements and charting trends with paper and pencil instead. Reflect on the results of every change. After making a change, a team should ask: What did we expect to happen? What did happen? Were there unintended consequences? What was the best thing about this change? The worst? What might we do next? Too often, people avoid reflecting on failure. Remember that teams often learn very important lessons from failed tests of change Be prepared to end the test of a change. If the test shows that a change is not leading to improvement, the test should be stopped. Note: "Failed" tests of change are a natural part of the improvement process. If a team experiences very few failed tests of change, it is probably not pushing the boundaries of innovation very far.