Culture change not as easy as it sounds canadian patient safety forum_october 2014
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This document discusses lessons learned from social movements and liberating structures that can help change organizational culture. It highlights that adaptive challenges require learning and input from stakeholders, unlike technical problems where authority can dictate the solution. A TRIZ exercise is presented to help teams creatively discuss how to avoid their worst ideas to improve outcomes. Power distance and its impact on communication and innovation within hierarchies is also examined. The goal is to help organizations become more adaptive and encourage ideas and commitment from all levels.
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Culture change not as easy as it sounds canadian patient safety forum_october 2014
- 1. Not as easy as it sounds! Lessons from Social Movement and Liberating Structures Christina Krause & Marlies van Dijk
- 4. Why Culture?
- 5. © 2012 Pascal Metrics Proprietary & Confidential 28333641454549495152556262 737580 98 0 20 40 60 80 100 CCU REHAB OR EMERG 5WEST 6WEST PEDS GERI DIALYSIS PERIOP PHARM 3WEST ICU NICU SICU PEDS OB Teamwork Climate Scores Across Facility HCAHPS 9250 Medication Errors per Month 2.06.1 Days between C Diff Infections 12140 Days between Stage 3 Pressure Ulcers 5218 Illustrative Data: Extracted from Blinded Client Data
- 6. Concepts central to culture: – Power Distance Index – Adaptive Leadership – Innovation and Ideas TRIZ: Liberating Structure in Action TODAY
- 7. “the most common cause of failure in leadership is produced by treating adaptive challenges as if they were technical problems.” Ron Heifetz
- 9. Kind of Challenge Problem Definition Solution Locus of Work Technical Clear Clear Authority Technical and adaptive Clear Requires Learning Authority and stakeholders Adaptive Requires Learning Requires Learning Stakeholders Ron Heifetz, The Practice of Adaptive Leadership 2009 Distinguishing technical problems and adaptive challenges
- 11. “The source of energy at work is not in control, it is in connection to purpose.” Don Berwick
- 12. Compliance Commitment A minimum performance standard that everyone must achieve A collective goal that everyone can aspire to Uses hierarchy, systems and standard procedures for coordination and control Based on shared goals, values, and sense of purpose for coordination and control Threat of penalties, sanctions, shame creates momentum for delivery Commitment to a common purpose creates energy for delivery
- 13. Christina Costello Babson Entrepreneur Experience Lab
- 15. The only thing that makes people and organizations great is their willingness to be not great along the way. The desire to fail on the way to reaching a bigger goal is the untold secret of success. Seth Godin, Tribes
- 17. Adaptive in Leadership Style • Ask more questions • Build extra time into meeting agendas • Expand the circle of individuals • Stay close to those who oppose your ideas • Try the “Balcony” and “Dance Floor Analogy” Ron Heifetz, Practical Tools and Tips for Adaptive Leadership
- 18. TRIZ DESIGNING A PERFECTLY ADVERSE SYSTEM THE WORST POSSIBLE RESULTS FROM YOUR WORK
- 20. Why do we use TRIZ? • Creative destruction • Challenge the status quo & sacred cows • Gives permission to discuss taboo subjects • Builds trust
- 21. TRIZ – First Step Be creative! Make yourself laugh! This is SERIOUS FUN….. Reflect in your small group, make a list of “to do’s” in answer to:
- 22. 1. How will we make the best ideas fail? 2. How will we stifle creativity in our staff? 3. How can we be sure that our staff morale is rock bottom? 4. How do we make sure patients are alienated? Pick one you like!
- 23. TRIZ – Second Step Go down the list and ask: Is there anything on this list that we currently practice, even remotely? Is there an element of truth in here? Cross out the ones that you are not doing EVER.
- 24. TRIZ – Third Step Look at your list…what items do you want to commit to avoiding? Pick your top two. What will you do to avoid those items? Be as concrete as you can.
- 26. A high power distance score accepts a hierarchical order in which everyone has a place that needs no further justification. The higher the power distance in a culture, the less likely those in subordinate roles will question the actions or directions of individuals in authority. Geert Hofstede’s Power Distance Index www.Clearlycultural.com
- 27. High Power Distance Index Cultures • Authority and demonstrate rank. • Subordinates expect clear guidance from above. • Subordinates are expected to take the blame for things going wrong (Collateral damage). • The relationship between boss and subordinate is rarely close or personal. • Class divisions within society are accepted. Ron Collins, 2014
- 28. Can hierarchy cause plane crashes?
- 29. Power Distance Index Canada = 39
- 30. Command “We are about to make a mistake that will harm the patient! Team Obligation Statement “Before we go any further, we need to verify which side this patient has consented to.” Team Suggestion Can we check the x-ray please? Query “Is that the correct x-ray?” Preference “I wish I was in another OR right now!” HINT “It would be nice to get through the day without making any mistakes.” Levels of Communication PositiveDeviance
- 31. Questions to ask yourself … • Are you aware of how others react to you? • Do they start or stop talking when you enter the room? • Do you feel you can not talk to higher levels in the organization without permission. • Does your organization encourage the use of titles and position
- 32. What do you see in a high power distance index? Geert Hofstede http://geert-hofstede.com • Senior-level people get no information • Senior leaders perceive that everything is going well • Junior-level people do not bring ideas forward.
- 33. Hierarchy makes innovation And change HARD!
- 34. Write yourself a postcard ! We will mail to you in a month • What do you want to remember about this workshop? • What can you do tomorrow?
- 36. • Lorelei Lingard. Collective Competence. TED Talk http://www.youtube.com/watch?v=vI- hifp4u40 • Rebecca Brooke. 3 page briefing note. Review of the Evidence for Culture Change: The Interpersonal Side of Healthcare. [scroll down page: http://bcpsqc.ca/clinical- improvement/teamwork/resources/ ] • Makary MA et al. 2006. “Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder. http://www.sciencedirect.com/science/article/pii/S1072751506001177 • Culture Change Tool Box. Rebecca Brooke. BC Patient Safety and Quality Council. http://bcpsqc.ca/clinical-improvement/teamwork/resources/ • Checklist Paradox Presentation by Lorelei Lingard. SQAN November 2013. http://bcpsqc.ca/resources-from-sqans-2013-annual-meeting/ • Ken Blanchard. Situational Leadership Technical Facilitator guide. http://www.kenblanchard.com/getattachment/Solutions/By-Offering/Government- Solutions/Situational-Leadership-II-(GSA-Approved)/SLII_Green_FG_Look.pdf • Geert Hofstede’s Power Distance Index http://www.clearlycultural.com/ • Ron Heifetz, Alexander Grashow and Marty Linsky. The Practice of Adaptive Leadership . Harvard Business Review Press. http://www.amazon.com/Practice-Adaptive-Leadership- Changing-Organization/dp/1422105768/ref=sr_1_1?ie=UTF8&qid=1411666918&sr=8- 1&keywords=the+practice+of+adaptive+leadership References
Editor's Notes
- Silence Kills Study 90% of JAHCO never events linked to communication 17 years to implement best practice Reviews of academic literature conclude correlation between culture & outcomes 1. Disease-Specific Care Certification – National Patient Safety Goals. Oak Brook Terrace (IL): The Joint Commission; 2008. Available from: www.jointcommision.org. Providing shitty care Haven’t moved the outcomes Culture of caregiver culture Is it “fuzzy” and fluffy? How many of your clinicians truly recognize culture as a key ingredient to change 17 years to implement new evidence Have a conversation about that today
- The teamwork climate domain of the SAQ survey has proved to be an effective predictor of various adverse events and patient satisfaction at the unit level We have data from >40 hospitals demonstrating this remarkable relationship These diagnostic insights point to specific training opportunities that our TEM program systematically address A very important correlations with HCAHPS which in the age of the ACO, has dramatic impact
- Adaptive challenges can only be addressed through changes in people’s priorities, beliefs, habits and loyalties
- Technical versus Non-technical/Adaptive/Culture – give a definition of “Culture” and “Non-technical skills” The culture side is the base of the iceberg
- Adaptive challenges can only be addressed in changes in peoples priorities beliefs habits and loyalties. Going beyond authoratative expertise to mobilize discovery and shedding entrenched ways, tolerating losses and generating the new capacity to thrive.
- Its folklore (stories that are important), its rituals (how new employees are welcomed into the company), its group norms (dress code), and its meeting protocols. All these cultural ingredients influence the organization’s adaptability.
- Marlies
- Marlies
- Marlies How do you form teams New ventures – build a great team vs. perfecting an idea. Success is dependent on the quality of the idea – but deeply dependent of the ability of the team to execute. What if you have no control over the team? E’s become great relationship and engagement manager. To understand the ability of good team members. Those can be used to leverage the sense of co-ownership See the sense of co-ownership. They have ability to pull others along with them.
- Who is brave enough to share your biggest bomb last month? Where did I make a mistep? Every Monday morning staff meeting an employee who learned the most from a mistake during the previous week shared what they learned. They then receive a funny prize and a round of applause for contributing to the team’s education. Empathy, humility, listening, compassion, situation awareness of what’s really going on.
- Ask more questions rather than issuing more directives Build extra time into meeting agendas so that the adaptive challenges do not get either bypassed in favor of more immediate concerns or treated with short-term technical fixes Expand the circle of individuals who need to be consulted in exploring possible solutions to the problem Stay close to those who oppose your ideas; spend time with them, ask for their input on your initiative, listen closely to their reality (especially when it differs from yours), and take their temperature. Ron Heifetz, Practical Tools and Tips for Adaptive Leadership
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- This dimension expresses the degree to which the less powerful members of a society accept and expect that power is distributed unequally. The fundamental issue here is how a society handles inequalities among people. People in societies exhibiting a large degree of power distance accept a hierarchical order in which everybody has a place and which needs no further justification. In societies with low power distance, people strive to equalise the distribution of power and demand justification for inequalities of power. Hofstede’s Power distance Index measures the extent to which the less powerful members of organizations and institutions (like the family) accept and expect that power is distributed unequally. This represents inequality (more versus less), but defined from below, not from above. It suggests that a society’s level of inequality is endorsed by the followers as much as by the leaders. For example, Germany has a 35 on the cultural scale of Hofstede’s analysis. Compared to Arab countries where the power distance is very high (80) and Austria where it very low (11), Germany is somewhat in the middle.
- On residential unit the healthcare aid – residential care Do healthcare aids feel comfortable speaking up in front of nurses. Do they feel empowered to challenge nurses? Korean Airlines Ferry off the coast of South Korea “Senior-level people get no information, and believe that they have nothing to improve upon, and junior-level people do not bring ideas forward. It’s hard to innovate under these conditions.”
- Korean air… Cultural representation on how people are based on culture. Increase of plane crashes – Malcolm Gladwell. Boeing designed for Two equal pilots. Korean airline one person in charge. The other person can not challenge. Story Malcolm Gladwell Not badly trained pilots – trained with same skillset – cultureal hierarchy. Asiana Airlines South Korea The pilot (3 captains and one first officer) – captain 48 years – 12,000 hrs of flying experience – 3,000 in a Boeing 777 first flight as an instructor. One more captain training and first time with instructor. One of the first time landing a Boeing 777. Pilot not able to question authority of the instructor.
- Highest power distance index is in Malaysia and Philippians
- Using the word doctor – Doug, our chair says that using the ‘doctor’ puts his patients at risk. It creates a barrier. I never refer to physicians by doctor –
- Sugar coating
- It’s hard to innovate under these conditions.