Welcome to this Quality Improvement for Institutions Learning Center lesson titled Engaging the Clinical Team to Develop a Quality-Centered Program. This is lesson number two of a five-lesson series authored by NCDR participant expert Sheila Nichols, who is a Clinical System Analyst, HVTI, and Strategic Operations Administrator at the Cleveland Clinic. Sheila will be sharing her expertise from an academic system perspective. NCDR participant expert Andrea Price, who is from Indiana University Health System. Andrea will be sharing her expertise from a community hospital perspective. And Michelle Hare. Lesson two focuses on how to engage leadership to align goals and objectives within your organization. Let's talk a little more about typical leadership roles. The term leadership is dependent on the role in which you serve. All members need to be aligned on the course or path needed for improving quality. Executives need to see the bigger picture. How do these program goals align to the overarching corporate goals? How long will it take to achieve them and how long before impact is realized? Directors will want to understand how the goals affect the different departments and or service line, the financial and human resources needed, and how best to recognize and or prioritize tasks to accomplish the goals. Managers need to understand how and who needs to be involved in the impact to daily operations. A proven way to sabotage objectives is presenting goals to the broader clinical team without consensus from the leadership team. Many registry site managers and or directors skip this step and just get started trying to improve metrics only to have their leaders disagree and put them on another path. All the work is wasted. When surveyed, roughly a third of senior managers don't understand the reasons behind organizational or program goals. Everyone must have transparency into the strategy, issues at hand, and who is responsible for what in order to be successful, not only in aligning around goals, but also accomplishing them. For an example, a senior leader may be concerned with increasing revenue while you as a director know there are quality issues that need addressed. Having a conversation and gaining consensus with your leader on how improving key quality metrics can affect reimbursement, star ratings, reputation, and patient referrals will help assure objectives are met and latter to the corporate goals. Next, you need to think about how your leader will receive your recommendations and what questions they may have about your data and recommendations. Steps to getting approval or alignment. Always do your homework. As previously mentioned, strive to understand corporate and or functional goals to ensure that your recommendations logically and easily align. If you still need information on what is important to your leader before presenting your recommendations, ask your boss to describe his or her goals to gain insight. The more information you have on how your leader will be evaluated, the easier it will be to tailor your request to fit within those parameters. Next, use data to tell a story. Stories are more convincing than numbers. Data visualization in the form of a story helps us see new patterns. For example, when showing composite metrics, your documents or slides should highlight the individual metrics along with what could go wrong if they're not met. Provide current examples if you have them. It will then be clearer to all those involved what needs to be worked on for improvement. Human behavior studies have proven that we make decisions based on the fear of loss versus potential gain benefit or loss aversion. Consider does your recommendations emphasize burden relief or the prevention of loss, not some potential but maybe unlikely future gain. Develop proposals that demonstrate how the improvement in metrics or outcomes prevent loss of reimbursement or other quality achievement and awards the organization currently holds. The fourth thing to consider is the rule of reciprocity. The principle of reciprocity describes the tendency of human nature to want to offer something when something is received. If you know a recommendation is important for advancing quality, but it doesn't fit one of the criteria mentioned previously, you may have to get agreement to focus on one issue first while gaining approval to prioritize the initiative after. Lastly, pre-plan your answers to objections. Anticipate questions and objections and think through and document your responses in advance of making the actual request. Andrea Price shares best practice from a community hospital in the Indiana University Health System. Community hospitals often have executive leaders wearing multiple hats. Within our organization, the physician practices and hospital operations all fall under the leadership of the same executive team. Within our system, the academic health center has separate leadership oversight. While there is no one way to structure a healthcare organization, knowing the leadership structure is critical to ensure alignment. Our hospitals all use the system dashboard to determine initiatives. These initiatives are global efforts, including harm events. There are many efforts that are designed to improve overall hospital performance in these areas. The physician practice is where NCDR performance metrics may be adopted. Including registry metrics that influence the overall hospital mortality is an approach to ensure alignment. It may be easy to pick the actual mortality metric. Depending upon the maturity level of your QI culture, you may want to select evidence-based process metrics that could drive improved mortality. There are a number of AMI process measures, including aspirin on arrival, door-to-balloon times, that are shown to reduce mortality. If you are participating in a bundled payment program, cardiac rehab referrals and evidence-based discharge medications may align with organizational goals. It is important to know what data is important and used by which leaders when approaching them to gain alignment. Sheila Nichols shares her experience as a clinical system analyst, HVTI, and strategic operations administrator at the Cleveland Clinic. A gap analysis uncovered opportunities to improve the median time to immediate PCI for patients with an ST-elevation MI. Improvement of treatment times for heart attack requires alignment with internal and external leaders. Further investigation resulted in identifying decision-makers and champions for internal departments, such as the emergency department, the cath lab, pharmacy, nursing, and the cardiovascular service line, as well as from external EMS partners. After process and outcomes data were validated for accuracy using NCDR tools, the information was formulated into a recommendation. First, the recommendation was presented to the cardiovascular service line for alignment and approval to proceed. Leaders are particularly interested in the impact to reimbursement. From there, the workflow timing data was further broken into segments, pre-arrival, arrival to ED, or directly to the cath lab, cath lab to nursing unit. Improvement opportunities were evident in each segment to the treatment phases. The newly detailed process data and recommendations were presented to representatives from each of the key areas in the diagram. The outcome was increased collaboration between internal and external sources to improve ST-elevation MI patients receiving PCI within 90 minutes. This concludes Lesson 2, Engaging the Clinical Team to Develop a Quality-Centered Program, Engage Leadership to Align Goals and Objectives. Thank you for your participation.

Quality Improvement

Engaging the Clinical Team

Leadership Alignment

Corporate Goals

Data-driven Decision Making