Surgical Improvement Project



Surgical Improvement Project

Team 4 – Leadership and Culture

Meeting Minutes

February 1, 2005

Present: Mike Alotis, Alan Artru, Lisa Brandenburg, Peter Buckley, Janice Cherin, Fred Cobey, Julie Duncan, Joe Fitzgerald, Yuka Jackson, Dan Kaiser, Neil Kovacs, Susanne Loven-Skolnik, Melissa Marshburn, Jennifer Petritz, Abdul Ramzan, Cindy Riplinger, Chris Wahl, Ernie Weymuller, and Doug Wood.

Agenda:

Mike Alotis, Surgical Improvement Project Manager, welcomed the group and introduced Yuka Jackson, Lean Expert; and Julie Duncan, Director of Quality Improvement.

Opening Remarks:

Ms. Duncan provided opening remarks, “channeling” Ms. Brandenburg. She noted that the hospital had made a decision to try a method, called Lean, to make improvements in Surgical Services. She expressed how exciting it was that “front-line” people—the ones who do the work—are strongly represented in the Project and explained the roles of the five teams. She thanked everyone for their participation and underscored the efficient, timely, patient-centered efficaciousness of the Project to improve quality and safety. Finally, Ms. Duncan charged everyone with the challenge to become “Waste-ologists”.

Ice-Breaker:

Mr. Alotis introduced the Agenda for the meeting and then invited individuals to pair up for an “ice-breaking” exercise the object of which was to be able to introduce your partner and tell the group three things about the individual which you might not know.

The results:

Janice Cherin is from Spokane, has 3 boys, and has the WSU fight song on her cell phone.

Alan Artru is came to Seattle 24 years ago from Minnesota. He once was the lead guitarist for the rock band “Unexpurgated Addition”.

Joe Fitzgerald was promoted to Manager about a year and a half ago. His wife is German and he has a beautiful daughter.

Neil Kovac is Hungarian and was a Manager of Surgical Services and a Surgical Tech at Harborview.

Surgical Improvement Project

Team 4 – Leadership and Culture

Meeting Minutes

February 1, 2005

Ice-Breaker (continued):

Doug Wood crews. He’s Chief of Thoracic Surgery and started at UWMC in 1992.

Lisa Brandenburg is UWMC’s Chief Operating Office, has her MBA and MPH, is from California and put herself through school as a blackjack dealer in Tahoe.

Jennifer Patrice works in Human Resources and likes to talk about the challenges. She was president of her ski team.

Dr. Weymuller is the Chair of ENT and likes to talk business.

Mike Alotis worked on setting up the Surgical Improvement Project. He’s been at UWMC 18 years and was in Radiology for 14 years. He’s from Southern California and is a skier.

Dr. Chris Wahl is a surgeon. He went to Yale. It took him 6 years to graduate. He’s a ski nut, has seen a lot of ORs and is a “squeaky wheel”.

Abdul Ramzan is from Fiji and still has family there. He has 2 children, one graduating from high school and one starting kindergarten. He’s a Lead HA and bicycles.

Melissa Marshburn is an OR nurse on the OTO service. She has worked with Lean before. She loves to garden, has a degree from the University of Colorado in Psychology and bought a house in West Seattle a few years ago.

Yuka Jackson is the Lean Expert. She’s a Japanese citizen. At the Olympics in Atlanta she met royalty. Her professional goals include spreading efficiency by engaging people.

Susan Love-Skolnik is the Director of Surgical Services. She is a Canadian trying to become an American citizen. She has a 6 week old Mastif puppy and she takes leadership seriously.

Dan Kaiser is an RN3. His name badge says “Dang” in place of Dan. He’s from Michigan, has 4 children, is remodeling his home, and is a 2 handicap golfer.

Julie Duncan has a BS and MS in Nursing and has worked in Neonatal Nursing. She’s the Safety Officer for UWMC and the Director of Quality Improvement. She’s a speed skater, “won the silver skate award in Iowa”. She’s worked as a “tire bumper” and is a motorcyle speed rider with a 1000 Kawasaki.

Peter Buckley is from England, likes wines—thinking about winemaking. He’s a skier and he likes rugby.

Surgical Improvement Project

Team 4 – Leadership and Culture

Meeting Minutes

February 1, 2005

Dr. Artru’s Welcoming Message:

Dr. Artru provided an overview of the goals of Surgical Improvement Team 4 referring to the Team Charter. He explained how three of the five teams have a specific area of focus and concrete operational issues, while Team 4 and Team 5 have less well defined responsibilities—Leadership and Culture (Team 4) and Strategic Planning (Team 5). He suggested that Team 4 will develop a “clearer definition of what we want to do with this team”.

“I come with a tremendous bias,” Dr. Artru noted, “Don’t hesitate to tell me so.” He told how when he was interviewing with Ed Walker, Medical Director, and was asked about his vision for the OR, he responded with his commitment to teams and team-building. Dr. Artru asked the group to not let him neglect other issues.

“You all are permanent members or consultants…invited or nominated by co-workers…I hope you are all voluntary and enthusiastic and that our time will be well spent to make the ORs better than they presently are,” Dr. Artru explained.

Returning to the Team Charter, Dr. Artru described the concept of “Scope”; In Scope are legitimate discussion items…Out of Scope are items being addressed somewhere else (another Team).

Turning to Ms. Jackson, Dr. Artru asked for an official definition of “Outcome Characteristics”. Ms. Jackson replied, “We don’t want to tell you what we wanted (the outcome to be), we wanted to let you know characteristics of what we wanted outcome to be.” Mika Sinanan, it was explained, described it as “the character”. Ms. Jackson continued, “Make sure that characteristics match the outcome.” Dr. Artru listed the characteristics in the Team Charter and said that they were “not restricted to any one group (Team). It’s for everybody.” Outcome Deliverables were explained as “the type of results—we are going to document what exists…document best practice.” The Team will be trained in Lean Process and “the Team will design the future state”. Dr. Artru emphasized, “We all have some vision of what would be ideal.”

Essential Metrics, another component of the Team Charter, was next explained. Ms. Duncan defined it as, “How do you know you’ve been successful?” [One component of Essential Metrics—no bumps—is to be moved to Team 3, per Ms. Jackson. Ms. Brandenburg provided an example however, “No cancellations for patient’s who’ve arrived and are ready.”]

Dr. Atru asked the Team if there were any questions about Charter review. Dr. Buckley asked, “Is this the committee that will look at incentives.” Dr. Artru provided his understanding of incentive as giving people the incentive to be productive during the day,

Surgical Improvement Project

Team 4 – Leadership and Culture

Meeting Minutes

February 1, 2005

Dr. Artru’s Welcoming Message(continued):

to work cooperatively and to work individually. Ms. Brandenburg responded, “We’ll do all incentives in Team 4.” “Our team covers all of the bases…one can’t separate productivity and team building…it’s all tied together. Success hinges in aligning teams on a similar track,” added Dr. Wood. Dr. Weymuller added, “It’s related to Essential Metrics…job satisfaction and retention of personnel are real metrics.” He and Dr. Wood both noted the need to attract and retain the best people and increase productivity with higher job satisfaction.

Dr. Buckley provided another question. He asked whether the School of Medicine Departments were part of the domain of Team 4, too. Dr. Weymuller responded, “It’s part of the governance structure…that reaches into the Department.” Dr. Wood agreed, “It isn’t out of scope.”

Strength Deployment Inventory:

Ms. Duncan led the group in a “style assessment”, “a powerful tool to maximize the strengths of team members…especially useful for dealing with tough issues and conflicts.” The Inventory was developed by a protégé of renowned psychologist Carl Rogers, Dr. Elias Porter. The objective of the assessment, Ms. Duncan explained, is to “get a sense of your strength…what we’re motivated by…what you bring to the team…what you are like under conflict.” She continued that it is important to know how people “deploy their strengths under conflict…some people get analytical, some rush forward.” Our motivational value system, “how we judge ourselves and others” is a key component of this understanding, Ms. Duncan said, and she reminded the group, “We do things because we get rewarded.” Ms. Duncan cautioned the group that “this is not pigeon-holding” but that “people generally have predominant strengths, predominant styles.” The assumptions of the Inventory, as explained by Ms. Duncan are: “1.) We all do what we do because we want to feel good about ourselves, 2.) We approach when things are going well…when faced with conflict we tend to deploy a different style, 3.) Any strength overdone or misapplied can be a weakness, 4.) We naturally perceive the behavior of others through our own motivational system.” Ms. Duncan provided the Team with the inventory, a two-part questionnaire that directed the individual to rate themselves first, “when they were feeling good” about themselves and then “when things are going wrong and you are definitely in conflict”. Her final instructions were, “Don’t agonize—go with your gut.”

After tabulating the results of the Inventory, each participant was determined to be a Blue, Green, Red, or Hub “when they were feeling good” and then when in conflict. As determined by the Inventory, Blues are characteristically considered altruistic and nurturing, Greens as analytic and autonomizing, Reds assertive and directing, and Hubs as flexible, cohesive, willing to experiment, and open-minded. Ms. Duncan directed

Surgical Improvement Project

Team 4 – Leadership and Culture

Meeting Minutes

February 1, 2005

Strength Deployment Inventory (continued):

everyone to gather at an easel corresponding to their “feeling good” color code. Results: 7 Blues, 1 Green, 3 Reds, and 3 Hubs. Each group then collaborated in describing their characteristics. Then each group was asked to describe other “colors”. Finally, each individual was instructed to now gather with the “color” which corresponded with their “conflict” rating. Result: 2 Blues, 10 Greens, 1 Red, and 4 Hubs. Ms. Duncan closed her presentation with a reminder to “call upon one another to maximize your strengths”, and some gifts—Memory Jogger and Lean Enterprise booklets—provided by Judy Canfield and Lisa Brandenburg.

Immediate Goals and Timeline:

Dr. Artru began, “It’s time to unleash some closet Redness…to adjourn on time.” He outlined the need to determine when the next meetings would occur and how to “ascertain the current state of this domain of ours.” He pointed out that within the surgical, anesthesiology, nursing/leadership culture, and process flow the current teams, hierarchy, and incentives must be reported by the February 23rd Oversight Team meeting.

He recommended that sub-groups of the Team do the “analysis of what we have now, get together for a status report meeting and then an interim meeting.” The sub-groups which Dr. Artru recommended were Surgeons, Anesthesiology, OR Nursing, and In-Hospital Process. Dr. Wood suggested that sub-groups “need more interaction rather than in ‘our domain’—interlopers for reality testing. Isn’t there more to this than just teams in terms of where we are and where and what we want to be?” Dr. Artru provided that to measure the current state of Leadership and Culture, anesthesiologists, for example, “know anesthesiologists best” and argued for this methodology for the first assignment for the Team. Dr. Wood counterclaimed, “Even as a starting point we will be limited because we will only define our domain the way we want to define ourselves.” Mr. Kaiser offered a synthesis, “Nursing does nursing, and says this is how we (nursing) perceive surgeons, anesthesiologists, etc.” Ms. Brandenburg agreed, “Describe your own process and describe others’ process within your focus group.”

The Team determined there would be three meetings this month prior to the presentation to the February 23rd Oversight Team deadline:

1.) LEAN Education, February 9th,5:00-7:00 p.m.

2.) Team 4 Meeting February 10th, 5:00-6:30 p.m.

3.) Team 4 Meeting February 16th, 5:00-6:30 p.m.

Dr. Wood recommended that everyone think about “leadership…motivation—weakness and strength and factors that satisfy us for work.

Surgical Improvement Project

Team 4 – Leadership and Culture

Meeting Minutes

February 1, 2005

Immediate Goals and Timeline (continued):

Dr. Weymuller, who at the beginning of the meeting deferred making opening remarks, asked to speak. He explained that he has been a Faculty member since 1978 and how impressed he is by the hospital administration for recognizing that the OR environment is critical to the hospital. He emphasized, “This is a big time project.”

Action items: “Status Reports” by February 10th from the four subgroups: Surgeons = Wood, Wahl, and Cobey; OR RN/Tech = Kaiser, Loven-Skolnik, Kovacs, and Marshburn; Anesthesia = Artru, Buckley, Domino, Peterson, and Fitzgerald; and In-Hospital Process = Brandenburg, Cherin, Gerber, O’Brien, Riplinger, and Ramzan.

The meeting adjourned at 7:17.

Confidential: this document has been created as part of a Quality Improvement work product at the University of Washington Medical Center under the protection of RCW 4.24.250 &70.41.200(3)

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