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Are Pieces of your Puzzle Missing? Considering the Culture of your Worksite
 

Are Pieces of your Puzzle Missing? Considering the Culture of your Worksite

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Presented at the Optimizing Medications Workshop in Vancouver by Katie Procter

Presented at the Optimizing Medications Workshop in Vancouver by Katie Procter

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    Are Pieces of your Puzzle Missing? Considering the Culture of your Worksite Are Pieces of your Puzzle Missing? Considering the Culture of your Worksite Presentation Transcript

    • Are Pieces of your puzzle missing? Considering the culture of your worksite Innovative approaches for engaging your colleagues and generating ideas for improving care.
    • TRIZ • теория решения изобретательских задач, teoriya resheniya izobretatelskikh zadatch • it is a problem-solving, analysis and forecasting tool heavily researched from 1946 - 1985 • It was developed by the Soviet inventor and science fiction author Genrich Altschuller and his colleagues, from initial work with the Soviet Navy. • In English the name is typically rendered as "the theory of inventive problem solving" and occasionally goes by the English acronym TIPS.
    • Step One • How can we ensure that 100% of the time, we NEVER provide optimal medication care?
    • Step Two • Take each crazy or not so crazy idea and see if there is an element of truth within it OR is it something you currently practice. • Lift out that truth and write it in note form on your flip chart. • This is where you dive deeply into each statement made on the flip chart. • Be brutally honest with yourself. • Example – give all the staff a frontal lobotomy. This is pretty silly, HOWEVER, what are all the ways that we numb down/ dumb down the creativity in our staff?
    • Step Three • Go through your list of identified truths – start to separate the truths into themes; • Begin to prioritize how you might begin tackling the list to stop the practices that may be contributing to the care planning issue.
    • DISCOVERY & ACTION DIALOGUES A TOOL FOR GETTING STARTED WITH CONVERSATIONS
    • What is a Discovery & Action Dialogue? • Discover what people are already doing that works Positive Deviants
    • What is a Discovery & Action Dialogue? • Discover what people are already doing that works Positive Deviants • These deviants face the same restrictions as everyone else but find their own solutions Hidden and untapped solutions
    • What is a Discovery & Action Dialogue? • Discover what people are already doing that works Positive Deviants • These deviants face the same restrictions as everyone else but find their own solutions Hidden and untapped solutions • They gain support as colleagues see the solutions working and then adapt the new thinking/behaving Momentum spreads
    • The “DAD”: 6 Questions 1. What do you know about (the problem) / how do you know when it’s present? 2. What do YOU do about it? 3. What are the BARRIERS that prevent you from doing (the right thing/process) 100% of the time? 4. Who are the Positive Deviants that are overcoming these barriers? 5. WHO ELSE needs to be part of this conversation? (“Don’t decide about me without me.”) How do we invite them to join the action? 6. What other ideas do you have? Any volunteers?
    • The Details … Q1: How do you know when a resident is on inappropriate antipsychotics? (the problem is present) • Affirm that we all have existing knowledge of the problem • Provide opportunities to get questions on the table
    • The Details … Q2: How do YOU contribute to reducing inappropriate antipsychotic use? (solving the problem) • Focus on personal practices, NOT on what other people don’t do • Amplify / confirm the participant’s knowledge of effective practices
    • The Details … Q3: What prevents you from doing this or taking these actions all the time? • Identify real barriers and constraints • Ask: What prevents you? vs Why don’t you?
    • The Details … Q4: Is there anyone you know who • Establish that getting around barriers is possible is able to frequently address BPSD without inappropriate • Identify the existing-butmedications? uncommon successful strategies (solve the problem, overcome barriers)
    • The Details … Q5: Do you have any ideas? • Identify the supports that make the desired behaviour more likely • Provide an opportunity for participants to generate and share new ideas for enabling the desired behavior
    • The Details … Q6: What needs to be done to make it happen? Any volunteers? • Identify action steps, target dates & feedback loops for metrics • Invite volunteers for each action step (capture ideas that don’t yet have an identified action plan or volunteer)
    • The Details … Q7: Who else needs to be involved? • Who else can we bring in? • Widen the circle of people involved in discovering solutions, drawing in unusual suspects
    • http://bcpsqc.ca/blog/knowledge/discovery-and-actiondialogue/
    • Getting Started with a DAD • What is the problem you are going to talk about? – Inappropriate antipsychotics? – BPSD? – Culture? – Care Planning? • How will you get people to come? • When will you hold the meeting or meetings? • How will you follow-up with the information you learn?
    • Arranging Space & Materials for the Conversation • Where? When? With Whom?
    • Arranging Space & Materials for the Conversation • Where? When? With Whom? • Have someone else record the responses so you can facilitate
    • Arranging Space & Materials for the Conversation • Where? When? With Whom? • Have someone else record the responses so you can facilitate • Room set-up: – Chairs in a circle OR standing around a flip chart
    • Arranging Space & Materials for the Conversation • Where? When? With Whom? • Have someone else record the responses so you can facilitate • Room set-up: – Chairs in a circle OR standing around a flip chart • 5 – 15 people with diverse roles and experience is an asset, although one-on-one can be powerful too!
    • Everyone Who Touches the Resident Can Participate • Everyone interested in solving the problem
    • Everyone Who Touches the Resident Can Participate • Everyone interested in solving the problem • Look to your process map!
    • Everyone Who Touches the Resident Can Participate • Everyone interested in solving the problem • Look to your process map! • Multiple disciplines and different roles
    • Everyone Who Touches the Resident Can Participate • • • • Everyone interested in solving the problem Look to your process map! Multiple disciplines and different roles Who else? – Residents – Families – Volunteers
    • Everyone Who Touches the Resident Can Participate • • • • Everyone interested in solving the problem Look to your process map! Multiple disciplines and different roles Who else? – Residents – Families – Volunteers • Make sure everyone has an equal opportunity to participate
    • Facilitator “Do” Guidelines • Start with the purpose “We are here to _______________!” • “Give” the questions to the group, then wait at least 20 seconds for a response Sing Happy Birthday to yourself • Encourage quiet people to talk
    • Facilitator “Do” Guidelines How do you handle cynical responses? “If I understand you correctly, no one has ever done this successfully or well.” “What would you do if there was an opportunity for change?” “Can you please re-frame what you just said with a question beginning with ‘what’ or ‘how’? Include some kind of action.
    • More “Do’s” • Work through all or some of the questions without worrying about the order AND/OR • Follow the conversation with other questions
    • More “Do’s” • Work through all or some of the questions without worrying about the order AND/OR • Follow the conversation with other questions • Keep respect at the forefront of the conversation
    • More “Do’s” • Work through all or some of the questions without worrying about the order AND/OR • Follow the conversation with other questions • Keep respect at the forefront of the conversation • Have someone record responses on flip charts
    • Facilitator “Don’t” Guidelines • Don’t answer questions that haven’t been asked directly to you Even then, ask the group members to provide an answer (they are the wise ones who will have the answers) • Don’t miss opportunities to “catch butterflies” Record ideas that got missed in the conversation
    • More “Don’ts” • Don’t continue the conversation when others need to be present -“Nothing about me without me!” Invite them to the next dialogue
    • More “Don’ts” • Don’t continue the conversation when others need to be present -“Nothing about me without me!” Invite them to the next dialogue • Avoid responding positively or negatively to contributions You might ask, “How/What do others think or feel about this suggestion?”
    • General Tips & Traps • Hold the dialogue out in the open • Make impromptu invitations as you enter the area • Create an “informal climate”, starting with introductions and a story if appropriate • Maintain eye contact and sit with the group (not higher or far away)
    • General Tips & Traps • Talk less than participants, and encourage everyone to share stories and “sift” for action opportunities • Draw out stories that help people make a leap of understanding from a small example of behavior change to a larger shift in values and/or resource sharing • Demonstrate genuine curiosity in everyone’s offerings without answering the questions yourself
    • Questions? kprocter@bcpsqc.ca 778-480-5620