Career Development and Lifestyle Planning



|[pic] |Clinical Practice Improvement | |

| |2 Credits | |

| |BU.557.710.xx | |

| |Class Day/Time & Start/End date | |

| |Semester | |

| |Class Location | |

Instructor

Full Name

Contact Information

Phone Number: (###) ###-####

E-mail Address:

Office Hours

Day/s Times

Required Text and Learning Materials

Articles:

The following readings for Clinical Practice Improvement have been set up and may be accessed in two ways:

• from the course Blackboard site at ; click on the Ereserves link from the left side pane.  Or directly

• from the ereserves web site at (expect to be prompted to enter JHED ID and password).

 

Bataldan, P. Making improvement interventions happen: the work before the work. BMJ Qual Saf 2014;23:4-7.

Benneyan, JC, et al. Statistical process control as a tool for research and healthcare improvement. Qual. Saf. Health Care. 2003: 12:458-464

Edmonson, A, et al. Speeding up team learning. Harvard Business Review. 2001. 79(9): 125–134.

Garvin, D. Building a learning organization. Harvard Business Review. 1993. 71(4): 78–91.

Kotter, J. Leading change: why transformation efforts fail. Harvard Business Review. 73(2):59-67.

Plsek, P. Quality improvement methods in clinical practice. Pediatrics 1999;103:203-214

The Power of Creative Confidence

Tucker, A, et al. Why hospitals don’t learn from failures: organizational and psychological dynamics that inhibit system change. California Management Review. 2003. 45(2): 1-18.

Harvard Business Review Cases: Coursepack link:

Analyzing Low Patient Satisfaction at Herzog Memorial Hospital. Jack Boepple.

Body Scans and Bottlenecks: Optimizing Hospital CT Process Flows. Sunil Chopra; Scott Flamm; Sachin Waikar

Cincinnati Children’s Medical Center. Amy C. Edmondson; Anita Tucker.

Paediatric Orthopaedic Clinic at the Children’s Hospital of Western Ontario. Robert Klassen; Kellie Leitch; Manpreet Hora

Patient Flow at Brigham and Women’s Hospital. Anita Tucker; Jillian Berry

ThedaCare: System Strategy. Michael E. Porter; Sachin H Jain

Suggested Additional Readings

Hackman, JR (2002). Leading Teams. Boston: Harvard Business School Press.

Blackboard Site

A Blackboard course site is set up for this course. Each student is expected to check the site throughout the semester, as Blackboard will be the primary venue for outside classroom communications between the instructors and the students. Students can access the course site at . Support for Blackboard is available at 1-866-669-6138.

Course Evaluation

As a research and learning community, the Carey Business School is committed to continuous improvement. The faculty strongly encourages students to provide complete and honest feedback for this course. Please take this activity seriously because we depend on your feedback to help us improve so you and your colleagues will benefit. Information on how to complete the evaluation will be provided towards the end of the course.

Disability Services

Johns Hopkins University and the Carey Business School are committed to making all academic programs, support services, and facilities accessible. To determine eligibility for accommodations, please contact the Carey Disability Services Office at time of admission and allow at least four weeks prior to the beginning of the first class meeting. Students should contact Rachel Pickett in the Disability Services office by phone at 410-234-9243, by fax at 443-529-1552, or email: carey.disability@jhu.edu.

Important Academic Policies and Services

• Honor Code

• Statement of Diversity and Inclusion

• Student Success Center

• Inclement Weather Policy

Students are strongly encouraged to consult the Johns Hopkins Carey Business School Student Handbook and Academic Catalog and the School website for detailed information regarding the above items.

Course Description

This course teaches healthcare providers techniques for achieving better clinical outcomes at lower costs including techniques of clinical practice improvement (CPI). CPI is a systematic method to determine optimal care by linking relevant measures of patient characteristics, processes, and outcomes. The system is designed to generate valid statistical inferences about the operational elements of the process of clinical care. By using consensus combined with objective feedback, CPI eliminates inappropriate treatment variation for well-defined groups of comparable patients. In short, CPI is the rigorous application of the scientific method to the day-to-day practice of medicine.

Course Overview

Healthcare leaders must increasingly demonstrate the value of services: that is, what outcomes are achieved for a given cost. Healthcare value is the basis for much of payment reform in healthcare, and performance on processes and outcomes is the basis for most pubic reporting and pay for performance initiatives. Healthcare leaders must be able to identify and quantify the meaningful outcomes or indicators of their practices, departments, and/or organizations, and seek to continuously improve these outcomes. Clinical Practice Improvement is the identification and prioritization of areas for improvement, the rigorous application of the scientific method to the problem, the use of various leadership techniques to identify and test innovation solutions, and the sustaining and spreading of positive results.

This course spends equal time on improvement methodologies and on leadership techniques. Healthcare leaders engaged in improving clinical practice must have the knowledge, skills, and abilities to develop a shared vision, lead change, motivate teams, promote innovation and creativity, accept failures, and spread and sustain successes.

Student Learning Objectives for This Course

All Carey graduates are expected to demonstrate competence on four Learning Goals, operationalized in eight Learning Objectives. These learning goals and objectives are supported by the courses Carey offers. For a complete list of Carey learning goals and objectives, please refer to the website .

The learning objectives for this course are:

1. You should be able to utilize practice-specific (or organization-specific) national and local priorities for improvement to prioritize areas of practice improvement.

2. You should be able to identify relevant, quantifiable measures of administrative and/or clinical processes to maintain or improve quality patient care outcomes or healthcare value.

3. You should be able to learn and utilize data collection and analysis principles.

4. You should be able to utilize leadership techniques to manage group dynamics and lead change.

5. You should be able to employ CPI techniques to ensure optimal clinical care.

6. You should be able to design and deploy a (CPI) project.

Accreditation Statement

The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The Johns Hopkins University School of Medicine designates this live activity for a maximum of 30 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Full Disclosure Policy Affecting CME Activities

As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) to require signed disclosure of the existence of financial relationships with industry from any individual in a position to control the content of a CME activity sponsored by OCME.  Members of the Planning Committee are required to disclose all relationships regardless of their relevance to the content of the activity.  Speakers are required to disclose only those relationships that are relevant to their specific presentation.  The following relationships have been reported for this activity:

No speaker has indicated that they have any financial interests or relationships with a commercial entity whose products or services are relevant to the content of their presentation(s).

No planner has indicated that they have any financial interests or relationships with a commercial entity.

Note:  Grants to investigators at the Johns Hopkins University are negotiated and administered by the institution, which receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

Off-Label Product Discussion

No speaker has indicated that they will reference unlabeled/unapproved uses of drugs or products.

Attendance Policy

Attendance and participation are part of your course grade. Participants are expected to attend all scheduled class sessions. Class participation and regular attendance are expected. Full attendance and active participation are required for you to succeed in this course. The quality of each class experience is dependent upon student involvement and sharing of experiences. Class presentations are listed and attendance is expected. If an unforseen circumstance causes a student to miss a class presentation, an alternate, additional assignment will be provided to the student. Please discuss extenuating circumstances with the instructor as soon as you become of aware of possible conflicts.

Your full attention is expected in class. Please put pagers and cell phones on vibrate mode. Some students may have clinical or administrative duties and need to respond to business pages, but please be respectful of your classmates. Responding to email or surfing the internet during class is considered to be unprofessional and will reduce your class particitation grade.

Assignments

All students are expected to view the Carey Business School Honor Code/Code of Conduct tutorial and submit their pledge online.  Students who fail to complete and submit the pledge will have a registrar’s hold on their account.   Please contact the student services office via email carey.students@jhu.edu if you have any questions.

Students are not allowed to use any electronic devices during in-class tests. Calculators will be provided if the instructor requires them for test taking. Students must seek permission from the instructor to leave the classroom during an in-class test. Test scripts must not be removed from the classroom during the test.

1. Class Participation

The success of the course depends on the active engagement of all participants. Students are expected to have read the articles and cases before attending class and to take a proactive stance with respect to class contributions. While the instructor may sometimes use cold calling, students should not expect this to be sufficient for opportunities to make substantive contributions. Discussions are to be directed to the class rather than the instructor.

Students will be evaluated after each session their contributions. Class attendance is a pre-requisite for class contribution; therefore, students will earn a 0 on days they do not attend class. A minimal grade is assigned for attendance without active participation.

Rubric

Class contribution will be graded 0-5 according to the following subjective criteria:

5 = able to answer or ask questions with good examples from the readings and proactively makes several excellent points that reveals deep thought about the issue(s), and understanding of the readings and cases. Raises the level of discourse. This score is rare.

4 = proactively raises a number of good points from the cases and readings, less inspired than a 5, but reveals a clear understanding of the material, with the ability to apply it.

3 = proactively raises one or two good points, and shows a rudimentary grasp of the readings and cases. Essentially, attempts to draw some linkage with the concepts used in the class.

2 = makes one or two points but does not attempt to apply what is learned in the readings or lectures, i.e., superficial common sense-type answers to questions that required more insight.

1 = shows up for class but does not participate as demsontrated by raising issues and/or responding to questions in class dicsussions.

0 = did not attend class

2. Homework assignments

Assignments will be based on assigned readings and cases to guide preparation for class, encourage critical analysis of the readings and critical thinking about managerial challenges, and assess content knowledge. Due one hour prior to the start of class. Most assignments, unless otherwise noted, should be submitted in 1-2 pages. Submit via email to instructor email address.

Each homework assignment will be graded 0-5 according to the following subjective criteria:

5 = Submitted on time and provides thoughtful and insightful answers to each question; includes a number of good points from the cases/reading; adds significant additional insight to responses; demonstrates excellent written communication skills. This score is rare.

4 = Submitted on time and provides thoughtful and insightful answers to each question; includes a number of good points from the cases/reading; adds some additional insight to responses and reveals a good understanding of the material, with the ability to apply it; demonstrates very good written communication skills

3 = Submitted on time and provides average answers to each question; attempts to draw some linkages from the cases/reading; and reveals a good understanding of the material, with the ability to apply it; demonstrates good written communication skills.

2 = Submitted on time and provides mostly superficial answers to each question; includes limited points from the cases/reading; written communication skills below average.

1 = Submitted later than one hour prior to class start.

0 = Homework not submitted within 1 week of due date.

3) Paper: Adaptive versus Technical Change (20% of final grade; due Session 7)

Students will research and prepare a 1600-2400-word paper (approximately 2-3 pages, single spaced, 12-point font) that synthesizes the leadership and quality improvement literature around the technical and adaptive changes that leaders face when making improvements. Students will then relate this to their experiences in implementing their CPI Project for this class: what combination of technical and adaptive challenges have you faced, and who (if anyone) is facing adaptive challenges; how have you addressed both the technical and adaptive challenges; in your experience, what is the relative importance of identifying and addressing adaptive challenges.

Paper should be emailed to the instructor (instructor email address) no later than 5 PM on the day the assignment is due.

Written paper scoring rubric:

10= professional level of writing and format. Outstanding insights that address all the components of the assignment. Includes significant additional insights and references not included in class. This score is very rare.

8 = well-written. Thorough and comprehensive, addressing all the components of the assignment. Includes significant additional insights and references not included in class. This score is rare.

6 = raises a number of good points, addressing most of the components of the assignment; less inspired than an 8

4 = raises one or two good points, and shows a rudimentary grasp of the material and the assignment. Essentially, attempts to draw some linkage with the concepts used in the class.

2 = reflects minimal effort. Disorganized and incomplete.

0 = did not submit assignment/ assignment not on time.

4) Final Examination

A final examination will be given in the last class. The final exam will consist of multiple choice, short answer, and/or short essay questions and is designed to evaluate your comprehension of the materials presented in the assigned readings and the materials reviewed in class.

Evaluation and Grading

|Assignment |Weight |

|Attendance and participation in class discussion |25% |

|Homework |25% |

|Adaptive versus Technical Change |25% |

|Final examination |25% |

Important notes about grading policy:

The grade of A is reserved for those who demonstrate extraordinarily excellent performance. The grade of A- is awarded only for excellent performance. The grade for good performance in this course is a B+/B. The grades of D+, D, and D- are not awarded at the graduate level.

Please refer to the Carey Business School Student Handbook for grade appeal information .

Tentative Course Calendar*

*The instructors reserve the right to alter course content and/or adjust the pace to accommodate class progress. Students are responsible for keeping up with all adjustments to the course calendar.

|Week |Content |Reading (Prior to class session; be|Due by 5 PM to [instructor email address] |

| | |prepared to discuss) | |

|1 |Introduction to Quality Improvement |Bataldan, P. Making improvement |Homework questions: |

| |National and international healthcare quality |interventions happen: the work |What is the most important quality, value, |

| |priorities and measures of quality |before the work. |or patient safety issue in your sphere of |

| |Deploy organizational strategy for clinical | |influence (e.g., department, practice, |

| |practice improvement |Plsek, P. Quality improvement |organization). How do you know? |

| |Tools and techniques of CPI |methods in clinical practice |Does this issue relate to any |

| |Adaptive and Technical Change in CPI | |organizational priorities? |

| | | |Why is it important to devote resources to |

| | | |address the issue? |

|2 |Designing a CPI Project |The Power of Creative Confidence |HBR case: Paediatric Orthopaedic Clinic at|

| |Identifying good projects | |the Children’s Hospital of Western Ontario.|

| |Defining the Problem | | |

| |Project charter | | |

| |Problem statement | |Homework questions: |

| |Selecting A Project Measure | |How is variability affecting capacity at |

| |Setting the Goals/Aim | |the clinic? How can variability be |

| | | |controlled? |

| | | |Where is the bottleneck in the process? |

| | | |What are the capacity constraints at the |

| | | |clinic? |

| | | |What is the economic cost of wait times? |

| | | |What recommendations would you make, and |

| | | |why? |

| | | | |

|3 |Learning from data: |Benneyan, JC, et al. Statistical |HBR case: Body Scans and Bottlenecks: |

| |Understand use of run charts |process control as a tool for |Optimizing Hospital CT process flows |

| |Define and describe the types of variation |research and healthcare improvement|Homework questions: |

| |Understand use of statistical process control | |Draw the process flow map for the original |

| |(control charts) to understand variation | |CT scan process |

| |Identify leadership responses to variation | |What specific improvements might be made to|

| | | |improve the efficiency of the CT process |

| | | |flows? How would these improvements affect|

| | | |the margins? |

| | | |What level of scanning throughput could the|

| | | |hospital achieve after the recommended |

| | | |improvements? What hourly margins would |

| | | |result from using the new scanners with all|

| | | |the improvements in place? How would these |

| | | |margins compare with using the old |

| | | |scanners? |

|4 |Analyzing the process |Kotter, J. Leading change: why |HBR case: Analyzing Low Patient |

| |Identifying root causes |transformation efforts fail |Satisfaction at Herzog Memorial Hospital |

| | | |Homework questions: |

| | | |Create an affinity diagram from the |

| | | |negative patient comments in the Room |

| | | |category. Create a Pareto diagram from the|

| | | |results of the affinity diagram you |

| | | |created. |

| | | |From the patient comments, what items (if |

| | | |any) need immediate attention? |

| | | |What next steps would you recommend for the|

| | | |near-term (4-8 weeks). Consider what |

| | | |activities Tinsley can control or |

| | | |influence. |

|5 |Analyzing the process |Tucker, A, et al. Why hospitals |HBR case: Patient Flow at Brigham and |

| |Identify relative importance of causes |don’t learn from failures: |Women’s Hospital |

| |The importance of culture |organizational and psychological |Homework questions: |

| |Engaging the Team |dynamics that inhibit system change|What would you recommend that the hospital |

| | | |do to improve patient flow to the ICUs? |

| | | |Why do you think that several people didn’t|

| | | |follow the official procedure for |

| | | |requesting ICU beds that day? Do you think |

| | | |this is a big problem? Why or why not? |

|6 |Developing changes |Garvin, D. Building a learning |HBR case: Cincinnati Children’s Medical |

| |Testing changes |organization |Center |

| |Engaging the Team | |Homework questions: |

| | | |What are key differences between process |

| | | |improvements in healthcare organizations |

| | | |versus in manufacturing organizations? How|

| | | |should these differences impact CCHMC’s |

| | | |approach to improving quality? |

| | | |Consider Exhibit 3, Figure D. Which |

| | | |problem would you recommend they address |

| | | |first? Why? |

| | | |Moving forward, what would you recommend |

| | | |Kotagal do to sustain the hospital’s |

| | | |improvement efforts? |

|7 |Engaging the Team |Edmonson, A, et al. Speeding up |Adaptive versus Technical Change paper due.|

| |Sustaining Change |team learning. | |

| |Spreading Successes | |HBR case: ThedaCare: System Strategy. |

| |Project Impact Demonstration | |Homework questions: |

| |Project Return on Investment (ROI) | |How would you assess ThedaCsre’s evolving |

| | | |approach to process improvement? Is it |

| | | |improving? Why? |

| | | |What is the rationale underlying |

| | | |Orthopedics Plus? How is it different from |

| | | |other ThedaCare process improvement |

| | | |efforts? |

| | | |Why is Toussaint taking a leadership role |

| | | |in the two statewide information |

| | | |initiatives? |

|8 |Final examination | | |

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Copyright Statement

Unless explicitly allowed by the instructor, course materials, class discussions, and examinations are created for and expected to be used by class participants only.  The recording and rebroadcasting of such material, by any means, is forbidden.  Violations are subject to sanctions under the Honor Code.

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