Mural Presentation

1. This is a title...
Innovation in AHS
Opening remarks
Executive Director
your facilitators
Rachael Erdmann
conversation conductor
Patty wickson
Why is framing the
problem important?
What have we
learned today?
Why did Emily's attempted
solutions not improve charting
and prescribing?
Opening Remarks
Innovation, Evidence,
Evaluation & Impact
Watch a short video to set the scene
Think about what you saw
and provide your comments
Discuss together
Gloubermann & Zimmerman, 2002
Baking a cake
setting the scene
Picture not available
How to
participate
Speak up! We'd love to
hear your thoughts
Write your comment in the
chat box - a sticky note
with your contribution will
be added
helping you Explore, understand & frame problems
What other issues can you think of that might be at play?
Kathryn Ambler
your emcee
Our Activity
Understand the importance of thinking broadly
and deeply about what issues are at play
May not be possible to have
expertise solving the problem
No definitive solution means
no experience available
"If I were given one hour to save the planet, I would spend 59 minutes
defining the problem and one minute resolving it"
Learning
objectives
After today's session you should...
Know about different types of problems
Have some ideas about how to
approach problems you face
Formula (recipe)
required to solve
No expertise
required
Standard outcomes
expected
Formula(s) are necessary
but not sufficient
High levels of a variety
of expertise needed
Similar outcomes
expected over time
Formulas have
limited application
Ability to solve the
problem does not
require experience
Ability to solve the
problem improves
with experience
Expertise helpful but not
necessary or sufficient
Ability to solve the
problem requires
diverse experience
Uncertain outcomes
due to unique situations
Formulas do not apply
Multiple, interdependent,
unpredictable outcomes
A Saturn V
rocket must be
landed at the
Sea of Tranquility
The bakery
does not
produce 10" red
velvet cakes
Some girls are not fully
educated and able to
live independently by
age 18
Cancer surgeries in
Canada are not
being done within 6
weeks of diagnosis
The issues Emily identified:
"We don't have
enough pens"
Did Emily have the right Type
of problem statement?
Instructions?
What problem statement
would you propose?
Expertise?
Experience?
Expected
outcomes?
To understand what type of problem
you're dealing with, list the issues
Problems
with charting
and
prescribing
Budget
overspend
staff
frustration/
morale
Errors/
patient
safety
Not enought
pens
People
charting at
same time
Inefficient
use of time
How else
could
charting be
done?
is
technology
the right
solution?
Fear of
technology
human
factors
issues with
pens
charting on
checklists vs
long hand
IPC
concerns
(esp Covid)
Where do all
the pens go?
What are
pens being
used for?
understanding
the WHY it's
not done
Staff morale
and
frustration
explore with
staff what is
preventing
them from
charting
how else
could
charting be
done more
efficiently
Explore
patient
safety
concerns
could have
looked for
interruptions
and where
pens get left
List the issues
Don't rush the process.
Dont' jump to a solution.
Give yourself time to
explore the problem.
Its going to be messy.
There are many
perspectives, values,
and underlying issues.
Think bigger.
Things are probably not
as simple as they seem.
Embrace uncertainity.
Be comfortable with
ambiguity and not
having all the info.
Seek out the unspoken.
Hear from the
people who may not
be at the table
What could emily do
to better understand
the problem?
What should emily do next?
Picture not available
dictating
charting
bring your
own pen
its not really
about pens ...
they are a
means to an
end
pens were
not the
problem
the question was
not the right
question/problem
Multi-factoral
issues at
play
a good
carpenter
does not
blame to tool
Emily identified a
simple problem
statement for a
complex
problem. It's a
journey ...
Keep asking
why
Talk to
people with
different
expertise
Understand
the lived
experience of
charting /
prescribing
Use a cause
and effect
(wishbone)
diagram
Survey staff,
talk to them
observe
them, focus
groups
Look for others who
have tried to solve
this problem and
what they did -
comparative
analysis with similar
groups or orgs
Need to
delve deep
... "unpack" a
bit more
Collect data,
especially
baseline
data!
Review
literature for
promising
practices
Checked
biases that
might impact
problem
exploration
Identify what other
perspectives/ voices
need to be included
How can we reduce
patient risk, improve
staff satisfaction and
morale and
accomplish and
maintain sustainability
re appropriate
charting?
How can we
improve patient
safety (through
use of timely
charting and
prescribing)?
Staff are having
a hard time
communicating
patient
information?
What other
tools can we
use for
charting?
What are the key
organizational
outcomes we
need to
consider?
How can we
increase
/improve
charting
practices?
Are the pens
the problem?
Are pens the
problem during
this task?
Why are there are
unacceptable
levels of adverse
events/near
misses?
How can we
create a work
environment
that supports
charting?
Explore what
about the work
environment
might need to
be investigated?
Start to map the
full process,
engage all
stakeholders, end-
to-end
understanding of
flow/process
document
processes
from
stakeholder
processes
Identify
critical
variables
during the
task
Use of
FEMA
Do a Design
Sprint
consider what the
organization's
strategic priorities
are and what other
initiatives are in
processcollect more
data
Prioritize
needs of front
line staff to
solve "their"
problem.
Challenge - the
framing of
questions is
often based on
our locus of
control
Challenge -
Identifying
the basline
data
Time constraints,
exploration and
consultaion are
important but very
time/resource
intensive
Need to predict
what measures
will respond to
your
intervention
Involve
leadership +
people from all
levels of the
organization.
Multi-level input.
Does this link
to plausibility
of having to
solve "sets of
problems"
May need to consider
micro, meso, macro
level approaches to
resolve problems.
Need to consider
resources, structures,
and processes ...
Issue variation
across province,
even after pulling in
stakeholders ...
different 'readiness'
at different
locations/settings
Silo'ed thinking
in organizations
can prevent
sharing of 'best'
practices across
organizations.
Problems like this are
handled by 'higher-ups'
... with little input from
front line staff. Need to
have representation
from all areas of the
organization including
front line staff.
.. but sometimes
there's not
consensus at the
front line. Need to
address, engage
with this tension.
Desire to minimize
budget can 'impact'
critical processes
like user
acceptance testing
Consider
innovation
adoption curve ...
not a lot of people
are early adopters
of innovation.