Suchman goren putting org proff into action saturday
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TFME 2013 Organizational Professionalism Conference
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Suchman goren putting org proff into action saturday
- 1. Putting organizational professionalism into action Lisa Goren, MS Tony Suchman, MD. MA Organizational Professionalism The Foundation for Medical Excellence
- 2. Meeting practices that support professionalism • Checking in • Co-creating the agenda • Co-creating ground rules including how to address breaches • Dialogue (listening, valuing difference) • Appreciative Inquiry • Measuring group relationships (eg: relational coordination) • Reflecting together on group process • Appreciative debriefing
- 3. Appreciative Inquiry: Accentuate the Positive 08/12/13 LEGACY HEALTH 3
- 6. Moving in a Positive Direction • Placebo Effect In many cases, placebos are as effective as a drug • Pygmalion Effect The teacher's image is the most powerful predictor of performance • Sports Imagery Visualization by athletes is often a significant contributor to victory • Inner Dialogue Our guiding image is the sum of +/- self-talk; healthy people maintain at least 2:1 ratio • Rise and Fall of Cultures Can predict 25 years ahead based upon the stories the culture tells about itself • Affirmative Capability The mind doesn't hold "not" so the image stays without the “no” Peggy Holman, peggy@opencirclecompany.com Steve Cato, scato@worldnet.att.net
- 7. Appreciative Inquiry • Involves the art and practice of asking questions that strengthen a system’s capacity to apprehend, anticipate, and heighten positive potential. • Instead of negation, criticism, and spiraling diagnosis, there is discovery, dream, and design. David Cooperider, 1999
- 8. Ap-pre’ci-ate 1. The act of recognizing the best in people or the world around us; affirming past and present strengths, successes, and potentials; to perceive those things that give life (health, vitality, excellence) to living systems 2. To increase in value
- 9. In-quire’ (kwir) 1. The act of exploration and discovery 2. To ask questions 3. To be open to seeing new potentials and possibilities
- 10. Prob·lem (prblm) 1. A question to be considered, solved, or answered 2. A situation, matter, or person that presents perplexity or difficulty 3. A misgiving, objection, or complaint 4. Difficult to deal with or control
- 11. Solving 1. The method or process of addressing a problem 2. The answer to or disposition of a problem 3. Payment or satisfaction of a claim or debt 4. The act of separating or breaking up; dissolution
- 12. Side by Side Problem Solving •Identification of problem •Analysis of causes •Analysis of possible solutions •Action planning (treatment) •Focuses on the past •Basic assumption: An organization is a problem to be solved Appreciative Inquiry •Appreciating and valuing the best of what is •Envisioning what might be •Dialoguing what should be •Innovating what might be •Focuses on the future •Basic Assumption: An organization is a mystery to be embraced
- 14. Typical Results • Assignment of cause or blame. • A few convince many of the need for change. • Lack of shared ownership. • Change is perceived as a disruption of ‘real work.’ • Quick to return to “what’s wrong” mindset or self- fulfilling prophecy—”I told you so.”
- 16. Assumptions • Something needs to change. • People and organizations are not broken, rather they are filled with assets and resources. • The questions we ask influence the answers we find. • Answers lie within stories and experiences. • The type of outcome reached will mirror the type of process used. • Working toward something positive is more energizing than working to overcome something negative.
- 17. The Power of Three • Understand- What is working for us? • Imagine- What can it be like? • Create- What will it take? B. Browne, AI Overview, Imagine Chicago
- 18. Understand: Tell Me About It • Tell me about a change that went really well. • Tell me about the most positive aspects of our organization’s culture. • Tell me about a time when your team was in sync and found ‘flow’ together. • Tell me about a time when the team collaborated well in order to make a meaningful improvement.
- 19. Imagine: A Brighter Future • One year from now, the New York Times has published an article about what we have accomplished. – What accomplishments does the article highlight? – What is the impact of our accomplishments? – Who is quoted in the article and what exactly are they saying? You go to sleep tonight and wake up one year from today and the organization’s culture is exactly as you imagined it could be. – What exactly is happening? – How are people interacting? – What are we accomplishing?
- 20. Create: What’s Possible • What was the part of the story that you want to replicate? • What is one key action we can take? • Identify successes. • Give it time. • For every criticism or barrier, identify three benefits or successes. • Commit to a time frame and stick with it. • Develop a strategy to stay motivated.
- 21. Stories We Tell • Stories have long been our primary mode of communication. • Stories create connection through common ground. • Stories provide order to the way we think. • Stories trigger genuine emotion and empathy. • Stories engage our right brain, which triggers imagination and change. PB Rutledge, The Psychological Power of Storytelling
- 22. Words Create Worlds – The questions we ask are fateful. – They determine what we find. – They create the world as we know it.
- 23. Your Story • Identify a problem or challenge your team is striving to overcome. • Use the three elements of Appreciative Inquiry to structure questions. – Understand – Imagine – Create 08/12/13 LEGACY HEALTH 23
- 25. Operations Agents Pilots Cabin Cleaners Caterers Baggage Agents Gate Agents Ramp Agents Ticket Agents Freight Agents Mechanics Fuelers Flight Attendants Passengers Flight departure process: A coordination challenge
- 26. Relationships shape the communication through which coordination occurs ...
- 27. Shared goals Shared knowledge Mutual respect Frequent communication Timely communication Accurate communication Problem-solving communication Relational Coordination
- 28. Effects of relational coordination on flight departure performance Nine site study of flight departures over 12 months of operation at Southwest, American, Continental and United Measured relational coordination among pilots, flight attendants, gate agents, ticket agents, baggage agents, ramp agents, freight agents, mechanics, cabin cleaners, fuelers, caterers and operations agents Measured quality and efficiency performance, adjusting for product differences
- 29. Relational coordination and flight departure performance Efficiency Quality Gate time/ flight Staff time/ passenger Customer complaints Lost bags Late arrivals Relational coordination -.21*** -.42*** -.64*** -.31* -.50** Flights/day -.19**** -.37*** -.30*** .13 -.22+ Flight length, passengers, cargo .79*** .45*** .13 .12 -.54** Passenger connections .12** .19** .09 .13 .00 R squared .94 .81 .69 .19 .20
- 30. Relational coordination and flight departure performanceQuality/efficiencyperformance index AMR2 AMR1 UNI2 UNI1 CON1 UNI3 CON2 SWA2 SWA1 Relational coordination
- 31. Case Managers Physical Therapists Nurses Attending Physicians Nursing Assistants Social Workers Technicians Referring Physicians Administrators Patients Patient care: A coordination challenge
- 32. Same study conducted in hospital setting Nine hospital study of 893 surgical patients Measured relational coordination among doctors, nurses, physical therapists, social workers and case managers Measured quality and efficiency performance, adjusting for patient differences
- 33. Relational coordination and surgical performance Length of stay Patient satisfactio n Freedom from pain Mobility Relational coordination -.33*** .26*** .08* .06+ Patient age .02 .00 .01 .04 Comorbiditi es .09* .07 .01 .04 Pre-op status .03 .01 .20*** .28*** Surgical volume .11** .10* .06+ .03 R Squared .82 .63 .50 .22 Observations are patients (n=878) in hospitals (n=9). Model also included gender, marital status, psychological well-being and race. Standardized coefficients are shown.
- 34. Quality/efficiencyperformance index Hosp2 Hosp1 Hosp7 Hosp3 Hosp9 Hosp5 Hosp6 Hosp8 Hosp4 Relational coordination Relational coordination and surgical performance
- 35. Relational coordination also improves worker outcomes Reduces emotional exhaustion Increases professional efficacy Increases job satisfaction Increases career satisfaction
- 36. Bibliography Relationship-centered administration Suchman A, Sluyter D, Williamson P. Leading Change in Healthcare. London: Radcliffe, 2011 Annotated bibliography available at http://www.rchcweb.com Appreciative inquiry Watkins JM, Mohr BJ. Appreciative inquiry: Change at the speed of imagination. San Francisco: Jossey-Bass/Pfeiffer; 2001 Relational Coordination Gittell JH. High Performance Healthcare. New York: McGraw Hill; 2009 Relational Coordination Research Collaborative http://rcrc.brandeis.edu
Editor's Notes
- Cooperrider ’ s original research looked across a variety of fields to uncover examples where the appreciative had already proven itself. He found it everywhere. Define placebo Tell pygmalion story Interviews with world-class athletes uncovered consistent use of running their race and crossing the finish line first or doing their routine perfectly as preparation Researcher [NOTE: confirm name] Mays found How I interpret something becomes my reality; that our guiding image of the future inherent in our inner dialogue; its the sum total of our +/- dialogue unhealthy 1:1 +/- self-talk; healthy requires 2:1 +/- self-talk [NOTE: find first name] Guttman research on long-term marriages: 5:1 +/- talk [NOTE: find first name] Pollack research: can predict 25 years ahead Culture is the stories we tell about ourselves Rising cultures: come together as a whole (large group forums) belief they can positively influence the future honor artistic, spiritual, creative qualities of life What's the guiding image of the future of the organization/community? Listen to the inner dialogue in the hallway conversations Carl Jung concluded that most problems are rarely solved, rather they are outgrown or something more intriguing is focused on. The human brain does not register or hear the word "not". Rather, to alter human behavior, it is more effective to positively tell the person what is expected instead of telling him or her what is not wanted. Returning to appreciative inquiry, as the individual and organization reveal "what works" within the organization, it is shifting the focus away from problem solving and things employees are not to do and towards positive examples of what is successful within the organization.
- 08/12/13 Copyright 2005 Brainy Betty, Inc. Traditional problem solving
- 08/12/13 Copyright 2005 Brainy Betty, Inc. Appreciative solution
- Stories are authentic human experiences. Stories leap frog the technology and bring us to the core of experience, as any good storyteller (transmedia or otherwise) knows. There are several psychological reasons why stories are so powerful. Stories have always been a primal form of communication. They are timeless links to ancient traditions, legends, archetypes, myths, and symbols. They connect us to a larger self and universal truths. Stories are about collaboration and connection. They transcend generations, they engage us through emotions, and they connect us to others. Through stories we share passions, sadness, hardships and joys. We share meaning and purpose. Stories are the common ground that allows people to communicate, overcoming our defenses and our differences. Stories allow us to understand ourselves better and to find our commonality with others. Stories are how we think. They are how we make meaning of life. Call them schemas, scripts, cognitive maps, mental models, metaphors, or narratives. Stories are how we explain how things work, how we make decisions, how we justify our decisions, how we persuade others, how we understand our place in the world, create our identities, and define and teach social values. Stories provide order. Humans seek certainty and narrative structure is familiar, predictable, and comforting. Within the context of the story arc we can withstand intense emotions because we know that resolution follows the conflict. We can experience with a safety net. Stories are how we are wired. Stores take place in the imagination. To the human brain, imagined experiences are processed the same as real experiences. Stories create genuine emotions, presence (the sense of being somewhere), and behavioral responses. Stories are the pathway to engaging our right brain and triggering our imagination. By engaging our imagination, we become participants in the narrative. We can step out of our own shoes, see differently, and increase our empathy for others. Through imagination, we tap into creativity that is the foundation of innovation, self-discovery and change.