Strong leadership involves a series of behaviors and questions that manifest themselves in actions. For example, what ways does the organization train people for leadership positions? How effectively does the organization pursue succession planning? How much time and energy do senior leaders and the board spend on quality and safety topics at board meetings?
All those questions (and many more) are discussed in a new IHI White Paper, A Framework for Safe, Reliable, and Effective Care.
In addition to larger, strategic questions, the paper also focuses on practical, daily questions, including, are leaders committed to reviewing learning boards that document the problems people are having and what is being done to resolve them?
What is a learning board? And how can it help promote transparency? An excerpt from the white paper sheds some light:
Learning boards — digital or analog white boards used to visually display key processes, measures, and improvement tests at the unit level — are essential in promoting operational transparency because they offer a way for people to observe the learning process in action. Learning boards direct staff to specific processes or activities that will help achieve not only operational success, but also improvements in learning. They also inform the team about who is responsible for different parts of a task. Frontline teams must have the expertise to interact with the boards, so they can understand which parts of a process are working reliably and which are not. Organizations and managers must learn how to configure information on these boards so that they are of interest to frontline providers.
How a learning board might work may be best understood if applied to a real example, such as working to decrease surgical site infection by improving the reliability of perioperative practices. A learning board highlights some key steps — and the measures of those steps — that are known to influence surgical infection: ensuring that antibiotics are administered appropriately and on time as required; ensuring that patients are normothermic when they arrive in the recovery room; and ensuring that patients’ blood glucose levels are appropriately managed intraoperatively. Each day, anesthesiologists, surgeons, and nurses must get the right antibiotics to the right patients at the right time, keep patients warm, and monitor and manage blood glucose levels in diabetic patients. A robust learning board shows how successful these processes are, and have been, over time. A robust learning board also displays the improvements tested in the operating room, telling a visual and easily understood story that links the tests to the measures, generating insights into which actions influenced the measures. The board should also link the performance of each process to the overarching aims — in this case, linking antibiotic administration, intraoperative normothermia, and glucose management to the perioperative services surgical site infection rate.
Another example of how learning boards might be used in a community setting is in highlighting the effort to reduce unnecessary hospital readmissions after discharge. This is a problem with complex underpinnings; however, some very real and essential determinants of readmission in many communities include whether patients have access to a local pharmacy, have the money to obtain the appropriate medications, and then take those medications as directed. Other factors are specific to diagnoses — for example, whether patients with heart failure weigh themselves every day. Measures of how effectively caseworkers and community health personnel evaluate and manage these factors can populate learning boards to inform clinical groups of the effectiveness of support being given to particularly vulnerable patient subgroups.
The use of learning boards should be an integral part of daily work. Leaders must set expectations that managers will create learning boards to highlight and communicate about the ongoing activities and work in their areas. To this end, organizations must train managers on how to create, use, and respond to the boards.
Senior leaders need to routinely visit work settings to discuss the learning system components of the framework at the learning boards. During these visits, frontline providers and managers have the opportunity to describe the learning board, including the overarching aims, the tests of changes to achieve those aims, and measures of current performance. Senior leaders, through coaching in these sessions, can also highlight the importance of self-reflection and the desire to identify defects and make them visible.
Download the full white paper, A Framework for Safe, Reliable, and Effective Care.