Management Practices for Sustainability Module 3: Problem Solving and Escalation
Slide 1: Management Practices for Sustainability Module 3: Problem Solving and Escalation
Management Practices for Sustainability
Module 3: Problem Solving and Escalation
Slide 2: A Frontline Management System To Promote Safety Standard Work
Image: This image shows the interactions between the different elements of the frontline management system. The elements include standard safety work by staff, the daily safety huddle, visual management, escalation, observation of safety work, problem solving, and integration with leaders. The image shows how these elements are mutually reenforcing to effect sustained improvement.
Slide 3: What Is a Problem? What Is a Solution?
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Concept |
Example |
|---|---|
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Problem: An undesirable gap between an expected state and the actual state of a system. |
(1) Expected: Each operating room team will use an agreed-to script during procedure timeouts. |
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Solution: Closes the undesirable gap between the expected state and the actual state.
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(1) Type 1: Supervisor observing the surgical team on May 23 at 10:30 a.m. intervenes to ask team members to audibly confirm "ready." |
Slide 4: How Do Problems Get Flagged?
- Most problems are identified by staff or are observed by supervisors.
- The daily huddle gives you a place and time every day to speak up about problems observed by team members.
- Weekly observation of procedures and work methods by the supervisor, as actually performed, is another primary source. The supervisor can also bring observations to the daily huddle.
Slide 5: Four Problem Boxes
Image: Program Triage - This image categorizes different kinds of problems-- those that require immediate management attention versus those that don't. It then further categorizes those problems that don't require further management attention: those that can be fixed immediately by staff, versus those that need more dedicated improvement work.
Slide 6: Apply the Model for Improvement To Improve Your Problem Solving
- What are you trying to accomplish? Reduce the number of recurring problems.
- How will you know that a change is an improvement? Fewer problems of the same kind flagged in huddle and observed at work.
- What can you change to make an improvement? Try the Problem Triage flowchart as your initial guide.
Slide 7: Apply the Model for Improvement To Improve Your Problem Solving–2
- Plan: Lay out the specifications of your test.
- Do: Conduct the test.
- Study: Review how the test went and lessons learned.
- Act: Integrate your learning into your next test or into daily practice.
Slide 8: Escalation for Frontline Clinical Issues
- Safety issues arise at the front line that require immediate action by staff.
- Facilitate escalation by using CUS
– I am Concerned
– I am Uncomfortable
– This is a Safety issue - Example of the CUS-style escalation process is in the component kit for this module.
Slide 9: Tips
- Problem solving as we've described aims to achieve and maintain reliable performance.
- If your organization has a standard problem-solving method, learn to use it.
- Understand the tools for root cause analysis that your center applies to investigate and document harm events.
- Incorporate routine use of CUS into frontline work; ensure broad staff understanding and comfort with use.
