Strategy, Policy and Change Workshop May 2014

• 1. Strategy, Policy and Change PHCM9391 Workshop Dr Brett Gardiner MBBS, FAFRM(RACP), MHA, FRACMA Director Clinical Governance & Chief Medical Officer St Vincents Hospital May 2014

2. What is the Problem? Hand Hygiene and Hospital Acquired Infection (HAI) is an important and growing National and International Issue for Health Care Organisations 3. Hand hygiene NSW 2010 - 2013 4. NSW Hand Hygiene Compliance October 2013 5. Hand Hygiene compliance rates for Doctors remains POOR 6. Is Doctor Hand-hygiene really a problem? Are low compliance rates really a problem? A problem to who? Is do nothing an option? What are the consequences? Who bears the risk? 7. And we have a Policy Directive! Why are staff not following the policy? Do staff know about the policy? Do staff know about the consequences of not following the policy? Why are the managers not enforcing the policy? Day/Month/Year Footnote to go here Page 7 8. Improved Hand-washing as a Goal Hand-washing compliance rates by doctors at XYZ Hospital will top the list against all NSW Public Hospitals Is the Goal SMART? Specific Measurable Achievable Realistic Time-bound 9. The GOST Model applied to hand-washing Goal (What to achieve general) Hand-washing compliance rates by doctors at XYZ will top the list against all NSW Public Hospitals Objective (What to achieve specific) Achieve 90% hand-washing rates (moments 1 and 5) by senior doctors in Q1 Strategy (How to achieve general) Educate all senior doctors in hand-washing techniques by 30 June Tactics (How to achieve specific) Senior doctors will be provided a list of times for education sessions 10. Strategy planning and evaluation Key Evaluation Criteria Potential impact Resource intensity required (staff, capital, time) Ease of implementation Scientific evidence available Scope 11. THE QUESTION Will this Strategy work? 12. What is Change? To create a different position, course or direction The central issue to creating change is never just strategy, structure, culture or systems. The core of the matter is always about changing behaviour of people how they see and think about what is new or proposed John Kotter 13. Kotters 8 Step Change Model Establish a Sense of Urgency Create a Coalition Develop a Clear Vision Share the Vision Empower People to Clear Obstacles Secure Short-Term Wins Consolidate and Keep moving Anchor the change 14. Change & Leadership (1) Change is more than developing a strategy and designing a policy Failures often due to people factors - lack of engagement, underlying culture and behaviours There is no strategy so brilliant, that people cant render it worthless Joseph Greeny VitalSmarts 15. Change & Leadership (2) Change demands leadership Leadership drives culture Leadership is influence Leadership is the process of influencing others to understand and agree about what needs to be done and how to do it, and the process of facilitating individual and collective efforts to accomplish shared objectives. Gary Yukl 16. Will you succeed? What other objectives, strategies and tactics will you need to develop and implement to reach your goal? 17. Planning questions for large scale change Source: NHS Institute for Innovation and Improvement What is your goal for change? What would it look like if that change had come about? What are the key themes that make sense to people and that they will feel passionate about? What might make a sufficient mix of reasons to engage? What are the multiple processes and systems that need to change? How would the change affect all the members of your system? Who are the key stakeholders who could lead the change efforts? How might we frame the issues in order to engage each of these? 18. Polarities to manage for change at scale Source: Bernard Crump/ Helen Bevan FOCUS ON THE ANATOMY OF CHANGE The structures, levers, systems and process to drive change FOCUS ON THE PHYSIOLOGY OF CHANGE The life forces that create energy, engagement, confidence, mobilisation for change COMPLIANCE Hierarchies, systems and standardised procedures for co-ordination and control COMMITMENT Co-ordination and control mechanisms based on shared goals, values and sense of purpose. 19. The Influencer Model 20. All Washed UP! http://www.youtube.com/watch?v=osUwukXSd0k 21. Professionalism and Self-regulation Source: Hickson GA Vanderbilt University School of Medicine It Starts with a Cup of Coffee Conceptual framework - professionalism Doctors have joined a profession Professionalism promotes teamwork Professionals commit to confidentiality, clear and effective communication, modelling respect, being available Professionalism demands self-regulation: personal, discipline specific, group, systems focused All require the skills to provide and receive feedback 22. Dealing With Unprofessional Behaviour Develop institutional policies to support management of unprofessional behaviours Establish surveillance tools to capture patient/ staff allegations Establish a model to guide graduated interventions Establish processes for reviewing allegations Provide multi-level professional/ leader training Establish resources to help colleagues with unprofessional behaviours Establish resources to help staff and patients manage colleagues with unprofessional behaviours. A Complementary Approach to Promoting Professionalism: Identifying, Measuring and Addressing Unprofessional Behaviours. Academic Medicine. November, 2007. Gerald B Hickson MD. Centre for Patient and Professional Advocacy at Vanderbilt 23. Other Strategies/ Targets? Display hand hygiene compliance by professional groups at ward level Identify senior doctor champions Establish awards for best ward compliance Place posters up in ward areas Provide patient brochures regarding hand-hygiene Education patient and families regarding requirement staff Sensors that alarm when people enter patient ward areas Undercover shoppers