Ethan Cumbler discusses guerrilla leadership in healthcare and the need for front-line teams and change. He describes how initially creating an educational service at his hospital failed due to a lack of system organization and support. Effective change requires system redesign including standardized protocols, interprofessional rounds, and geographic concentration of expertise. This creates the potential for high-functioning interprofessional teams that can drive measurable improvements in outcomes like staff satisfaction and quality metrics. Culture change towards continuous quality improvement is motivated when data is provided to front-line teams and recognition is given.

1. Ethan Cumbler MD, FACP
Associate Professor of Medicine
Institute for Healthcare Quality
University of Colorado School of Medicine
Director UCH ACE Unit
Guerilla Leadership:
Front-Line Teams
and Change in Health Care

2. Financial Disclosure
• No relevant financial relationships with
any commercial interests.
Ethan Cumbler MD, FHM, FACP

3. Vision
Quality
Culture
Teams

4. What is the leadership structure
of an ant colony?

5. Complexity
Hospitals Have Problems
And
Silos

6. What is a leader without a title?

7. Guerrilla Leadership 101

8. Years ago I started a new service at UCH
– Great educational curriculum
It was a failure…..

9. In the
Absence of
System
Organization
Individual
Brilliance Is
Inadequate

10. System Redesign

11. – Practical Brief Assessments
– Transition Communication
Standards
– Standardized Protocols
Order Set
– Geographic Concentration
• Nursing expertise
– Interprofessional Rounds
Creates the Potential
For a Team

12. TeamworkTeam

13. Teamwork

14. Teams versus Teeming
• Teams are stable groups united around a
common long term goal
• Hospital staff often engage in teeming
– Groups who form for a specific task, project,
or limited time interval

15. Communication
Open ended communication script
– From a _____perspective what are your
thoughts

16. Outcomes
Improved Staff Satisfaction
– 85% report improved job satisfaction with
interdisciplinary model

18. What Drives Hospital
Administration?
• Efficiency
• Visible Efficacy
• Measurable Quality
• Value Based Purchasing
What Motivates Front Line Providers?

19. Vision

20. Creating Leadership Teams

21. Continuous Quality
Improvement
• Performance data into the hands of front-line providers
• Mobilizing culture-shift towards patient safety
• Driving measureable improvement initiatives

22. Data Dashboard
Readmission Infection Falls Pressure Ulcers Delirium Satisfaction

23. 78%

24. • Ignaz Semmelweis
– Introduced hand washing on OB ward
Semmelweis
1818-1865

25. 0%
5%
10%
15%
20%
1841 1843 1844 1845 18461842
Annual Mortality Due to Child-Bed Fever

26. Championed concept of sterile surgery
Used carbolic acid
Hand wash and Instrument cleaning
Spray in the operating room
Received the greatest possible recognition
Lister
1827-1912

27. Go back to the good old days of spraying physicians
with acid from sprinklers mounted in the ceiling
What To Do With the Physician Who Does Not Mind Spreading
“Cadaverous Particles”

30. 2011 2012 20132010
Unit Leadership
Begins Monthly
Reporting
Real Time
Feedback
Medical Director
Contacts Repeat
Offenders
Hand Hygiene
Tickets
Candy
Token
Rewards
Begin
Hand Hygiene Adherence

31. Recognition

32. Culture

33. Culture

35. Samuel A. Stouffer, et al., The American Soldier: Combat and Its Aftermath,
Volume II, Princeton, NJ: Princeton University Press, 1949, p. 107.
“Men do not fight for a cause but because they do not want to let
their comrades down.”

36. Participating in a
Highly
Functioning
Interprofessional
Team
49%
Interprofessional
Respect
Interprofessional
Collaboration
Communication
Interprofessional
Relationships
Effective Teams
Culture
Quality
Improvement
31%
Sharing of
Innovation
Systematic
Quality
Improvement
Improvement
in Clinical
Care
Patient
Centric
Professional
Development
14%
Professional
Growth
Professional
Autonomy
Work
Efficacy
“It builds a
shared purpose”
“environment of
acceptance and
interest”
“The facilitator and other members of the committee listen to and value the
input from individuals of various disciplines”
“It gives me face time with our interdisciplinary
group and we achieve systems solutions
together”
“improving communication”
“I have formed professional bonds with nursing leadership, quality
improvement leaders, and QI-minded physician colleagues/mentors
that didn’t exist previously”
“serves as a visible
reminder of what team-
based care can and
should look like. “
“It creates a chance for
professional autonomy”
“To have control over the
vision for our daily work”
“ an important venue for my own professional
development (as a quality/safety/leadership
scholar) now and into the future”
“This group strived
to put patients first” “As opposed to the Interdisciplinary
rounds which addresses individual care
plans, the leadership team allows us to
systematically address the needs of our
acutely ill frail elders on a population
basis”
“allowed us to make real
improvements in care
delivery for the patients we
serve”
“I don’t have a
forum like this
on most other
units. It helps
me get my job
done”
“I see the leadership committee as a sort of incubator for
good ideas around quality and safety”