The VA as a Learning Organization: Rx for 21 st Century Healthcare

1. The VA as a Learning Organization: Rx for 21st Century Healthcare Joy W. Hunter, VHA Chief Learning Officer Sue Dyrenforth, Director, VHA National Center for Organizational Health

2. VA’s Patient Centered Cultural Transformation Transform VA’s healthcare system into a fully engaged partnership between veteran, family & healthcare team through: • Organizational culture change • Reengineering of clinical & business processes • Reshaping the workforce • Redesigning physical plants

3. Transformational Goal: Distinguish VHA as a Learning Organization • Create a strategic learning culture that keeps VHA out front as a world class health care system • Recruit, develop & retain high performance workforce • Enhance adaptability to changing conditions • Quickly integrate latest innovations & best practices • Link continuous learning to performance excellence

4. A Learning Organization is Healthier for VA Employees • Garners independent thought • Increases ability to manage change • Improves quality • Develops a more committed workforce • Give people hope things can get better • Stretches perceived limits • Are in touch with fundamental needs to learn, improve our environment, be active vs. passive recipients Richard Karash (1995)

5. A Learning Organization is Healthier for Veterans • Strategically focused • Tool for organizational transformation • Learning is a tool for workforce development & culture change • Critical in achieving patient and employee satisfaction • Learning Leaders are strategic partners in achieving organizational outcomes • Competency vs. compliance drives learning needs

6. Treatment Plan: Provide Optimal Healthcare through a Dynamic Learning Culture Link Learning to Improved Organizational Health • Improved Employee Satisfaction • Improved Patient Satisfaction • Improved Patient Outcomes

7. Systemic wellness that nurtures success in complex and chaotic organizations A focus on the ‘how’ Not another thing to do: the way we do everything An incubator for transformation Healthy organizations are places where employees want to work and patients want to receive care. HOLISTIC ORGANIZATIONAL HEALTH: ALL THINGS CONNECTED

8. Transformational Workplace:All Things Connected Patient-Centric Employee Engagement Leadership Support

9. Significant Outcomes EMPLOYEE SATISFACTION PATIENT SATISFACTION TRAVEL TOGETHER EMPLOYEE SATISFACTION TRAVEL TOGETHER LOWER COSTS AND IMPROVED PERFORMANCE 9

10. Establishing VHA as a Learning Organization • Establishing Baseline Measures in 2008/09 • Harvard Learning Organization Survey • Scores from supervisors, managers, executives (n = 10,828) • Masie Voice of the Learner Survey • Scores from a random sample of VHA employees (n = 5,870) • Areas of the All Employee Survey matched by content to the Harvard Learning Organization Survey • Scores from supervisors, managers, executives (n = 20,814) • Scores from non-supervisory employees (n = 117,577) • Using measures in combination to establish a picture of the whole organization • Facility level correlations between survey instruments for groups matched at supervisor levels • Facility level correlations of instruments with selected Patient Satisfaction and Performance Measure scores

11. VA’s Learning Organization Health Assessment: Harvard Results (Management Perspective) • Supportive Learning Environment • Psychological safety • Appreciation of differences • Openness to new ideas • Time for reflection • Concrete Learning Processes & Practices • Experimentation • Information collection • analysis • Leadership that Reinforces Learning • Education & training • Information transfer

12. Harvard Survey: Emerging Themes and Trends • Psychological Safety sub-factor of the Harvard Survey • Measures how safe it is for employees to challenge authority figures and admit mistakes • At the facility level, reports of higher Psychological Safety by supervisors associated with higher patient satisfactions scores • Reports of higher Psychological Safety also associated with higher scores on performance measures

13. Important Relationships • Recent studies have found a link between psychological safety and vital clinical outcomes • The higher the Psychological Safety among staff, the shorter the stay in Intensive Care for veteran patients • The higher the Psychological Safety among staff, the lower the mortality in Intensive Care veteran patients

14. Relationships among Harvard Survey Variables and Patient Satisfaction Outcomes • Matched areas from the AES supervisor sample had several more significant relationships to outcomes with correlation values above .20 than the Harvard survey (10 vs. 3) • Slightly different patterns of relationships • AES relationships spread across outcomes • Harvard survey relationships concentrated in Appointment as soon as wanted for established patients • Matched areas from the AES non-supervisor sample had 30% more significant relationships with correlations above .20 vs. the supervisor sample • Similar patterns but the non-supervisor sample also had relationships with the All Things Considered and Appointments for established patients outcomes

15. Relationships among Harvard Survey Variables and Patient Satisfaction Outcomes • Moving below the 3 Top factors, the Psychological safety sub-factor from Harvard survey significantly related to 7 of 8 outcomes • All but All Things Considered • The following outcomes had the highest number of significant relationships with the 24 survey based variables (3 AES supv level, 3 AES non-supv level, 3 Harvard top factors, 9 Harvard sub-factors, 8 Masie items) • Inpatient overall quality (8) • Appointment as soon as wanted for established patients (10) • Appointment as soon as wanted for new patients (7)

18. Masie’s “VHA Voice of the Learner” Survey (Employee Perspective) • Response rate 6,052 (26%) from random cross-section of VHA field employees • ProClarity data cube available in May 2009 • Masie questions with significant correlations above .20 • Life at work is busier and I have less time to focus on learning – significant positive relationship with 5 of 8 outcomes (correlations range .21 to .26) • Higher demands associated with higher outcome scores • I expect how I learn will change dramatically in the next 2-3 years – significant negative relationship with 3 of 5 outcomes (correlations range -.20 to -.21) • Expected changes associated with lower outcome scores

19. Masie Survey Measures to Patient Satisfaction Outcomes • Masie survey questions with significant correlations above .20 • Life at work is busier and I have less time to focus on learning – significant positive relationship with 5 of 8 outcomes (correlations range .21 to .26) • Higher demands associated with higher outcome scores • I expect how I learn will change dramatically in the next 2-3 years – significant negative relationship with 3 of 5 outcomes (correlations range -.20 to -.21) • Expected changes associated with lower outcome scores

20. Implications and Next Steps • Early analysis of VHA level data indicate links exist between Learning Organization principles and outcome measures • Individual sites now need to examine their data and provide local context for the drivers of their scores • Proclarity Data cube access to Masie Voice of the Learner Survey (after 5/11), Harvard Learning Organization Survey, and All Employee Survey data http://aes.vssc.med.va.gov/Access/default.aspx