Index – Becoming the Change: Leadership Behavior Strategies for Continuous Improvement in Healthcare

INDEX

Page numbers followed by f refer to figures.

Accountability, 67

Acknowledging, defined, 109

Adams, Jena, 114

Africa, 5, 59–64

Agendas for board meetings, 37–38

Agile, 195

Analysis (personal A3), 153

Andersen Windows, 74

Asking questions (radar chart), 165–166

Assessment, 119–139, 134f–136f

about, 120–121

of board of trustees, 51

of coaching relationships, 85–87

and course changes/fresh insights, 121–125

of executive behaviors, 130

five areas of inquiry in, 125–133

importance of, 12

initial, by leadership, 24

of leadership involvement, 127–130, 222f–224f

of newly formed health system, 133, 137–139

of organizational improvement, 131

questionnaire for board, 52f–53f, 216f–217f

of respect for every individual, 132–133

of teamwork, 131–132

Assumptions in coaching, 81–82

At-home care, 199–201

A3 personal improvement (see Personal A3)

A3 thinking:

within board of trustees, 51

with budgeting, 105

at Mercy Medical Center, 56

and problem solving, 28

in radar chart, 166

Carlos Scholz-Moreno experience with, 81–83

Atlas Project, 4–5

Atrius Health, 114–116, 195–199, 203

Author (personal A3), 147

Autocratic leaders, 2–3

Autoliv, 126, 126n5

Azevedo, Robert, 128–130

 

Background (personal A3), 148–149

Bacteria, 60, 64

Behavior, defined, 146

Behavior change:

in CEOs, 64–66

importance of, 26

Behavioral coaches, PI officers as, 72

Behavior-based interviewing, 38–39

Berkshire Healthcare NHS, 95–105

Beyond budgeting model, 105–107

Beyond Heroes (Barnas), 32, 123

Board assessment questionnaire, 52f–53f, 216f–217f

Board of trustees, 31–54

assessing, 51, 52f–53f, 216f–217f

behavior-based interviewing for, 38–39

and continuous succession planning, 45–46

disconnected from improvement initiatives, 9, 33–34

effects of, 50–51

finding new, 35, 38–39

importance of, 54

mentoring relationships within, 39

role of, 40

at St. Charles Health System, 35–40

at St.Mary’s General Hospital, 40–44

structure of, 34–35

at UMass Memorial, 46–49

Bogoshi, Gladys, 60–61, 64

Boston, Mass, 6

Breakthrough strategies (x matrix), 174, 176, 177f, 235f

Buddy systems, 59–64

Budgeting, 105–107, 106n3

Building credibility, 82

Building trust, 83

 

Canada, 34

Capacity-and-demand model, 105–106

Cardiac surgeries, door-to-balloon, 6, 6n5

Care in Place, 197–199, 203

Caregivers, xi, 191 (see also front line workers)

Center for Innovation, 199

CEOs (see chief executive officers)

Change:

board of trustees governing (see Board of trustees)

case example of, 17–19

leaders as barriers to, 3

model cell for, 23–24

motivation for, 19–23

values of, 72

Chaotic problems, 192

Charlotte Maxeke Johannesburg Academic Hospital, 60

Chief executive officers (CEOs), 55–69

buddy system between, 59–64

disconnected from improvement initiatives, 8–9

importance of, 58

reflection and behavior change in, 64–66

role of, with board of trustees, 34

standards of behavior for, 66–69

Chief medical officers, 17, 20

Civility, 69, 94

Cleveland Clinics, 32

Coaching, 71–88

analyzing the relationship in, 85–87

assumptions in, 81–82

at Berkshire Healthcare NHS, 100

building teams for, 82–85

in collaboration with HR and OD, 87–88

crowdsourced, 94

finding leaders for, 74–76

group, 78–81, 84

and hoshin kanri initiatives, 116–117

importance of, 71–74

one-on-one, 76–78, 84

in Personal A3, 147

in radar chart, 167–168

senior leaders and, 26

and standards of respect, 67–69

Collaborative Care, 192–193

Collins, Jim, 56–57

Color coding of decision filter, 182

Command-and-control leadership, x, 10

Communication:

defining effective, 109

in New Care Model Development, 204–205

Community Health Network, 65

Community needs, True North aligned with, 40

Company culture, 19–20, 49, 65–66

Complex problems, 192

Complicated problems, 191–192

Concept phase (New Care Model Development), 194

Conflict management, 108

Continuity of purpose, 34–35, 83–84

Continuous improvement tools, 29, 33–35

Continuous succession planning, 45–46

Correia, Kathryn, 74

Course changes after assessment, 121–125

Covid-19, ix, 188, 206

Credibility, 82

Crowdsourced coaching, 94

C-suite executives:

CEOs (see chief executive officers)

chief medical officers, 17, 20

coaching, 83

Culture:

company, 19–20, 49, 65–66

of compliance, 81

Curiosity (radar chart), 68, 165, 165f, 230f

Current state (personal A3), 149–150

Customer-centric value stream, 7

 

Daily management systems:

at Charlotte Maxeke Johannesburg Academic Hospital, 63

and coaching, 75–76

current use of, 1

defined, 2n2

developing routing through, 25

front line leaders using, 95–100

at King’s County Behavioral Health, 124

at New York City Health + Hospitals, 122

Dartmouth University, 4

Data collection, personal A3, 147–148

Date (personal A3), 147

Decision filter (x matrix), 173, 178, 180–182, 181f

Deep listening skills, 191

Delivery of healthcare, 189–190

Demand, 105–106, 189

Deming, W. Edwards, 9, 48

Denver, Colo., 6

Deselected (decision filter), 178

Deselecting initiatives, 79–80

Design Thinking, 195

Development value, 189–193

Dickson, Eric, 46–49, 65–66, 69, 91, 95, 109, 111

Digital dashboard of Covid-19 cases, x

Directors, role of, 90

Discomfort, 152

Discovery phase (New Care Model Development), 193

Disengaged leaders, 2–3

Divergent thinking, 194

Door-to-balloon cardiac surgeries, 6, 6n5

Dube, Grey, 59–63, 151–152

Duke University, ix

 

Education, 1, 7, 42

Effective listening (radar chart), 166

Ehrlich, Susan P., 26–27, 62

Eldercare, 195–199

Emms, Julian, 96, 102–103

Engagement of staff, 67

Escalation process, 97

Europe, 5

Evaluate for scaling phase (New Care Model Development), 195

Executive sponsor, 23–24

Executive teams:

assessing behaviors of, 130, 130n6

coaching with, 84–85

C-suite, 83

disconnected from improvement initiatives, 8–9

Expected behaviors, developing, 48

 

Failure, defining, 205

Fairview Health Services, 72, 78n3

Falconer, Andrew, 45

FDA, ix

Feedback:

for A3 follow up, 155

about Medically Home, 200

for accountability, 25

Fee-for-service model, 40, 188

Finance, 101

and budgeting, 107

continuous improvement principles in, 35

current state of, 1

managers of, 100

Five areas of inquiry in assessment, 125–133

Flu season, 26–28

Flynn, Laura, 109–110

Follow up (personal A3), 155–156

Forecasts, quarterly, 106–107

Fresh insights, assessment and, 121–125

Front line leaders, 89–100

importance of, 89–90

at UMass Memorial, 91–95

using daily management system, 95–100

Front line workers:

during Covid-19, ix–x

involving, 77

leaders, 28

Future of healthcare, 206–207

 

Gardner, Georgina “Gina,” 91–92, 94–95

Gauteng, South Africa, 60, 60n4

Gauteng Department of Health, 60

Geiger, Sandra, 114–117

Gemba, 8

defined, 8n8

and go & observe, 164–165

in leadership, 63–64, 77

and motivation, 20

observations during, 18–19

at St. Joseph’s Regional Health Center, 57

General Electric, 55

Gild, Alex, 102, 104–105, 107

Go & observe (radar chart), 164–165

Goals/targets (personal A3), 151–152

Good to Great (Collins), 56

Governing change with board of trustees (see board of trustees)

Great Britain, 3

Green belt training, 99, 99n4

Group coaching, 78–81, 84

Group reflections, 25, 67

 

Haase, Megan, 37–38

Hagene, Margie, 145

Harvard Business Review, 56

Health systems:

assessing newly formed, 133, 137–139

engaging the board, 50–51

Healthcare:

current state of, 1–5

delivery of, 189–190

past attempts at improving, 5–10

problems/inequalities in, 187–188

reinventing (see reinventing healthcare)

shift to population health model, 40

HealthEast, 72, 74, 78

Henhoeffer, Christine, 40–42, 44

Higgins, George, 196

High Performance Solutions and Consortiums, 45

Hoshin kanri, 115–116, 115n5, 115n6

Hospital Standardized Mortality Ratio (HSMR), 44

Hospital-acquired infections:

at Charlotte Maxeke Johannesburg Academic Hospital, 60, 64

reduction in, at St. Mary’s General Hospital, 44

South Africa reducing, 3

HR (Human Resources):

coaching and, 87–88

continuous improvement principles in, 35

partnerships with, 114 (See also partnerships)

and standards of respect, 67

Huddles:

at Berkshire Healthcare NHS, 104

at New York City Health + Hospitals, 123–124

at St. Mary’s General Hospital, 42–43

at UMass General, 91–92

Humility, 56–57, 63, 68, 128–129

Humility (radar chart), 164, 164f, 230f

Hylka, Kathleen, 93–94

 

“I” statements (A3 planning), 154–155

Important (decision filter), 178

Improvement initiatives:

best leadership behavior during, 11–13

current use of, 1–2

issues sustaining, 7–8

leadership disconnected from, 8–9

lean methodology in, 9–10

limitations of current, 2

at Mercy Medical Center, 56

past attempts at, 5–10

results of, 5–6

Improvement workshops, 75

Inadequate supplies, 60–61

Infant mortality:

at Charlotte Maxeke Johannesburg Academic Hospital, 60

South Africa reducing, 3

in United States vs. South Africa, 60n5

Information access, 93

Initiatives:

deselecting, 79–80

improvement (see improvement initiatives)

in x matrix, 179f, 236f, 237f

Innovation, 190–191

Institute of Medicine, 4

Interviewing, behavior-based, 38–39

Introversion, 57

IT staff, 117

 

Jones, Dan, 59n3

 

Kaizen, 8

Kata, 78, 78n3

Kidney failure, 60–61

Kindness, defining, 110

King’s County Behavioral Health, 124, 124n2

Krusie, Kathy, 55–58, 64–65

 

Leader standard work (radar chart), 27, 169

Leadership:

assessment of, 121, 127–130, 133f–135f

autocratic, 2–3

as barrier to change, 3

best behaviors for, 11–13

for coaching, 74–76

command-and-control, x, 10

disconnected from improvement initiatives, 2–3, 8–9

importance of, during Covid-19, x

importance of behavior change in, 4

initial assessment by, 24

involvement of, 1, 127–130

lack of change in, 2

patient outcome affected by, 26–29

principles critical to, 58

pushback from, 77–78

self-assessment questionnaire, 222f–224f

standard work of, 27, 63, 97, 169

traits of, for model cell, 24–26

Leadership Assessment, 120

“Lean” emergency rooms, 6

Lean Institute Africa, 59–60, 59n3

Lean methodology and thinking:

and board of trustees, 35

current healthcare use of, 1, 6

and engaging board members, 50

industry transition from, 192

issues with, 9

at Leratong Regional Hospital, 59

at St. Charles Health System, 36

at St. Mary’s General Hospital, 41

at ThedaCare, 32–33

Lean Six Sigma, 1, 9

Lean Startup, 195

Learning review panels, 98, 98n3

Learning sessions, peer-to-peer, 27

Leratong Regional Hospital, 59

Level 5 leadership, 56–58

Line-of-sight, 104

Listening:

deep, 191

defined, 109

effective, 166

 

Management on the Mend (Toussaint), 73

Managers:

respectful feedback with, 220f, 221f

role of, 90

ward, 97, 97n2

Managing to Learn (Shook), 145

Marketing, 117

Marlborough Hospital, 50

Massachusetts, 6, 34, 65–66

Maternal mortality, South Africa reducing, 3

Medical error, 4

Medically Home, 199–201

Mentoring, 39, 65 (See also coaching)

Mercy Medical Center, 56

Mission critical (decision filter), 178, 180–182

Model cell:

of Charlotte Maxeke Johannesburg Academic Hospital, 60

defined, 23

strategic significance of, 23–24

Morningside Mt. Sinai, x

Mosaic Medical, 37–38

Motivation for change, 19–23

Munson Healthcare, 133, 137–138, 152

Munson Medical Center, 151

 

Networking, 35

New Care Model Development, 190, 193–206

about, 193–195

and at-home care, 199–201

creating a team for, 202–203

dedicating space for, 203–204

and eldercare, 195–199

New Care Model Development, continued

establishing governance for, 204–205

funding for, 205–206

planning the process for, 204

steps of, 202–206

New York City, 6

New York City Health + Hospitals, 81, 121–124

New York State, ix–x

Newly formed health system, assessment of, 133, 137–139

NHS Foundation Trust ratings, 102, 102n1

Obeya, 203

Observable behaviors (radar chart):

A3 thinking, 166

asking questions, 165–166

coaching, 167–168

effective listening, 166

go & observe, 164–165

leader standard work, 169

partnering or buddy system, 167

reflection, 163

Observation without suggestions, 17–18

OD (organizational development), 87–88, 102

Omi, Joanna, 122–124

On the Mend (Toussaint), 32, 41, 193

One-on-one coaching, 76–78, 84

Opportunity statement (personal A3), 150–151

Oregon, 34, 37

Organizational development (OD):

at Berkshire Healthcare NHS, 102

and coaching, 87–88

Organizational excellence, 1

board of trustee role in, 54

defining, 12

and patient outcome, 29

at Zuckerberg San Francisco General Hospital, 26

Organizational improvement, assessing, 131

 

Partnering or buddy system (radar chart), 167

Partnerships, 101–118

at Atrius Health, 114–117

at Berkshire NHS, 101–107

beyond budgeting, 105–106

importance of, 118

and quarterly forecasts, 106–107

and Standards of Respect, 107–111, 112f, 113f

with strategic deployment, 114–118

training with volunteer corps for, 114

at UMass Memorial Health Care, 107–114

Patients:

chronically ill, 196–197

outcome of, 26–29

satisfaction of, 67

PDSA cycle (see plan-do-study-act)

Peer-to-peer learning sessions, 27

Performance improvement (PI) offices, 71–73

Performance reviews, 150

Perseverance (radar chart), 68, 166–167, 167f, 231f

Personal A3, 25n2, 143–156, 144f, 225f

about, 13, 143, 145–146

analysis, 153

and assessments, 129

assessments in, 120

author, 147

background, 148–149

coach, 147

current state, 149–150

date, 147

follow up, 155–156

goals/targets, 151–152

for leadership self-reflection, 25

at New York Health + Hospitals, 124

opportunity statement, 150–151

and organizational assessments, 138

plan/next steps, 154–155

proposed countermeasures, 154

sections of (see A3 personal improvement [sections])

title of, 146–147

traditional, 147

at Zuckerberg San Francisco General Hospital, 27

Personal protective equipment (PPE), ix

PI (performance improvement) offices, 71–73

Pilong, Al, Jr., 133, 137–139, 150–151, 153–154

Plan-do-study-act (PDSA) cycle, 9, 77, 85, 97, 111

Plan/next steps (personal A3), 154–155

Planning, succession, 45–46

Pollard, Nikola, 99–100, 105–107

Population health, shift towards, 40

Power-sharing model, 128

PPE (personal protective equipment), ix

Principles:

creating common, 20

driving behaviors, 124

Problem solving, A3 thinking-based, 28

Problems, types of, 191–192

Promotions, 132

Proposed countermeasures (personal A3), 154

Prototype phase (New Care Model Development), 194–195

Public trust, 1

Purpose, continuity of, 34–35, 83–84

Pushback, 42, 89–90

 

Quadruple Aim, 36, 36n3

Quality:

and behavior changes, 28–29

continuous improvement principles in, 35

of Medically Home, 201

meetings for, 98

partnerships and teams for, 117

principles of improving, 96

Quarterly forecasts, 106–107

Questionnaires, leadership self-assessment, 222f–224f

 

Rabino, Didier, 72–77, 79

Radar chart, 157–169, 158f, 218f, 226f

at Charlotte Maxeke Johannesburg Academic Hospital, 62, 62f

curiosity on, 165, 165f, 230f

effective questions for, 159f–160f, 227f–228f

humility on, 164, 164f, 230f

perseverance on, 166–167, 167f, 231f

purpose of, 157–158, 160

with scores, 162f, 229f

self-discipline on, 168, 169f, 231f

traits/behaviors examined in, 24–25, 162–169

using, 160–161

willingness to change, 162–163, 163f, 229f

Readiness for change, 119

Reflections, group, 25, 67

Reinventing healthcare, 187–207

at-home care, 199–201

development value in, 189–193

eldercare, 195–199

future implications in, 206–207

New Care Model Development for, 193–206

steps for, 202–206

Removing waste, 9

Research and discovery phase (New Care Model Development), 193–194, 205

Resources (x matrix), 182–184, 183f, 238f

Resources, inequity in allotment of, 4–5

Respect:

assessment of, 132–133

and company culture, 66–67

manager feedback, 220f, 221f

at UMass Memorial Health Care, 108

Responsibility, creating change, 25

Responsiveness, defined, 109

Rolling forecasts, 99, 99n5

 

Safety:

of Medically Home, 201

meetings for, 98

St. Charles Health System, 35–40, 51

St. Joseph’s Regional Health Center, 56

St. Mary’s General Hospital, 40–44

Satisfaction of patients, 67

Scaling (New Care Development Model), 195

Scholz-Moreno, Carlos, 72, 79–87, 121–124, 126–127, 132–133

Schuette, Daniel F., 35–37, 39

Seattle, Wash., 6

Seattle Children’s, 32, 126, 193

Secrecy, 202

Self-assessment questionnaire, leadership, 222f–224f

Self-discipline:

in leadership, 58

observing, 68

in radar chart, 168, 169f, 231f

Self-reflection:

in CEOs, 62–66

importance of, 156

in radar chart, 163f

and standards of respect, 67

Shilton, Don, 41, 43–45

Shingo Institute, 11, 81

Shingo principles:

at Berkshire Healthcare NHS, 97

within board of trustees, 37–38, 50

in leadership, 58

model of, 22f, 215f

Shook, John, 9, 145

Shulman, Eliza (Pippa), 196, 203

Simple problems, 191

Sluka, Joe, 37–38

Smith, Scott, 45

South Africa, 3, 59–64

Sponsor, executive, 23–24

Staff attitudes, 65–66

Staff engagement, 67

Standard work:

within board of trustees, 46

of leadership, 27, 63, 97, 169

self-discipline in, 68

Standards of behavior, UMass Memorial, 66–69

Standards of Respect:

card deck (sample), 109–110, 110f, 219f

partnerships and, 107–111, 112f, 113f

at UMass Memorial Health Care, 47–49, 67, 93–94, 108

Stepping Up Respect 360-degree reviews, 94

Strategy deployment, 75–76, 114–118

Strongwater, Steven, 116

Success, defining, 205

Succession planning, 45–46

Supply chains, x, 61, 188

Support, 189

Sustaining improvement, 7–8

Teams:

assessing, 131–132

for coaching, 82–85

creating New Care Model Development, 202–203

defining positive players of, 110

Test phase (New Care Model Development), 195

ThedaCare, 32–34, 41, 74, 192–193

3P (production preparation process), 192–193

360-degree reviews:

for leaders and managers, 110–111, 112f–113f

for self-reflection, 25

and standards of respect, 67

Stepping Up Respect, 94

Timelines, 88

Title (personal A3), 146–147

Tone of organization, trustees setting, 43–44

Toussaint, Ted, 196, 199

Toyota Production System, 5–6, 9, 47, 71, 73, 126n5, 192

Traditional A3, assessing issues through, 147

Traditional budgeting, 106, 106n3

Training:

green belt, 99, 99n4

for partnerships, 114

Trait, defined, 145

Transformation, leaders as barriers to, 3

Triple Aim, 36, 36n2

True North (x matrix), 174, 175f, 234f

assessment to identify, 24

board of trustee role with, 40, 51

and organizational assessment, 137–138

training for, 83

at Zuckerberg San Francisco General Hospital, 26

Trust, 1, 83

Tubing, ventilation, x

Tyrell, Neil, 91–92, 95

of Medically Home

UC Berkeley, 1

UMass Memorial Health Care:

board of trustees at, 46–49

engaging front line leaders at, 91–95

partnerships at, 107–108

process for board member hiring at, 51

and standards of respect, 65–69

360-degree reviews at, 25

United States, perception of healthcare in, 4

Utah State University, 11

 

Value stream, customer-centric, 7

Ventilation tubing, x

Virginia Mason, 103

Visual management, 57

VNA Care Network, 198

Volunteer corps for partnerships, 114

 

Wait list (decision filter), 178

Ward, Adam, 196

Ward managers, 97, 97n2

Warne, Rosemary, 96–99

Waste, removing, 9

Welch, Jack, 55

Western Sussex NHS, 103, 103n2

Wierenga, Alicia, 108

Wiesman, Tod, 108–111

Willingness to change (radar chart), 62–63, 68, 162–163, 163f, 229f

Windsor Castle, 95

Wisconsin, ix

Womack, James, 9, 59n3

Worcester, Mass., 65–66

Workshops, 114

World War II, 189

 

x matrix, 171–184, 172f, 173f, 232f, 233f

about, 171, 173–174

breakthrough strategies wedge, 176, 177f, 235f

decision filter, 180–182, 181f

and deselecting initiatives, 79–80

and hoshin kanri, 115, 115n6

initiatives, 178, 179f, 236f, 237f

resources, 182–184, 183f, 238f

strategy deployment tracking through, 76

True North wedge, 174, 175f, 234f

 

Zuckerberg San Francisco General Hospital (ZSFGH), 26