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Similar to GMCF Fall 2009 Regional Patient Safety Learning Session
Similar to GMCF Fall 2009 Regional Patient Safety Learning Session (20)
GMCF Fall 2009 Regional Patient Safety Learning Session
- 1. Welcome Georgia Medical Care Foundation’s Fall 2009 Regional Patient Safety Learning Session This material was prepared by GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 9SOW-GA-PSF-09-74
- 2. I n C ase of E mergency • Breaking the Ice – Take a card but don’t look at it – Once everyone has a card, you can look at your card – Group up into teams of card holders that come closest to 21 points without going over – Face Cards = 10, Aces are either 11 or 1 and numbered cards are equal their value. – You have 3 minutes
- 3. Debrief
- 4. I n C ase of E mergency • Breaking the Ice – Take a card but don’t look at it – Once everyone has a card, you can look at your card – Group up into teams of 5 to make the highest hand in Poker – Time, 5 minutes
- 5. Royal Flush Takes All
- 6. Agenda • Change Management – Setting the Stage • Where are we coming from, and what does it mean? • Teamwork Wins! – Role of the leader and the team Member • Deciding what to do – Survey says – Improvement opportunities – Knowing what works • Power Tool Time • Making it stick • Envision the new culture
- 7. Objectives • Better understanding of the issue • Discuss what is involved in creating a new culture that will improve resident safety • How to create a culture to improve – Communications – Mutual trust – Teamwork – Empowerment • Begin planning for the change in your organization
- 8. CHANGE MANAGEMENT: HOW TO ACHIEVE A CULTURE OF SAFETY
- 10. 8 Steps of Change John Kotter
- 11. Set the Stage and Create a Sense of Urgency • Get people’s attention! • Sell the need for change … sell the pain and the consequences of not changing • Immerse people in information about the change • Discuss ways to solve the problems people identify with the change – Empower people to solve the “problem”
- 12. How do we look? Have we improved enough?
- 13. Three Cheers for GA Nursing Homes
- 14. Do you feel a little out of control?
- 15. Share your Stories • Statistics will only take you so far in changing your culture • Vision, Passion and Pursuit of Excellence are the only things that will help you go the distance and change your world.
- 16. Questions? What is happening in your area? What has worked for you?
- 17. Pull Together the Guiding Team • Choose key players, especially staff-level managers • Multidisciplinary – Goal is informed; intelligent decisions are being made • Credibility and integrity of change leaders • Choose proven leaders who can drive the change process – Strong position power, broad expertise, and high credibility • Need both management and leadership skills – Management skills control the process – Leadership skills drive the change …TeamSTEPPS initiative should have a designated executive sponsor
- 18. The Success of the Change Initiative Depends on Having a Designated Executive Sponsor
- 19. Effective Team Leaders • Organize the team • Articulate clear achievable goals • Make decisions through collective input of members • Empower members to speak up and challenge, when appropriate • Actively promote and facilitate good teamwork • Are skillful at conflict resolution 19
- 20. The Role of Each Team Member is to…. • Apply specific teamwork skills to accomplish and fulfill the responsibilities and tasks • Communicate pertinent information to teammates and the patient/family efficiently and effectively • Demonstrate desired behaviors and skills • Possess the attitudes necessary to develop mutual trust and team orientation • Request clarification or additional information as needed • Make adjustments to behaviors based on feedback 20
- 21. Deciding What to Do Develop the Change Vision and Strategy Senior Leadership is responsible for: • Establishing the definition of a “culture of safety” aligned with expectations, core values, and shared beliefs • Informing the organization of these values and evaluating the culture • Leading the process of: – Translating values into expected behaviors – Establishing trust and accountability • Communicating a commitment to shaping the culture
- 22. AHRQ Survey of Patient Safety – Nursing Homes • 69 Nursing Homes completed survey • Stats: – 4017 staff responded to survey – 7551 were employed by these homes – 53.2% completion rate
- 25. Improvement Opportunities • Communication/Openness – staff’s ability to share ideas, concerns • Teamwork – respectful support of one another where help is offered and given • Staffing – adequate staff to perform work • Handoffs – critical information is shared with staff both inside and out to ensure quality patient care • Non-punitive Response to Mistakes – environment encourages reporting of error and support to prevent in future
- 26. What does this tell you? How can we improve?
- 27. Stretch Break – 5 Minutes
- 29. Call a Huddle • Why? – Loss of situational awareness – Change in conditions that impacts the team – staffing, vitals, environment, behaviors, etc • When? – Huddles are used in urgent situations – Should not be overused • Who? – Try to create an environment where anyone, once trained on huddles can “Stop the Line” and call one when they feel there is urgency or confusion that might cause patient harm
- 31. Advocacy and Assertion • When is it important Advocate for the patient? • Invoked when team members’ viewpoints don’t coincide with that of a decision maker. • Assert a corrective action in a firm and respectful manner • The Assertive Statement should: – Respect and support authority – Clearly assert concerns and suggestions – Use a structured assertive statement (nonthreatening and ensures that critical information is addressed) • Make an opening • State the concern • State the problem • Offer a solution • Reach an agreement 31
- 32. Seems different than usual Talks or communicates less than usual Overall appears much different Participated less than usual in activities Ate less than usual (not because of dislike of food) N Drank less than usual Weight change Agitated or nervous more than usual Tired, weak, confused or drowsy Change in skin color or condition Help with dressing, toileting, transfers more than usual
- 33. Please Use CUS Words but only when appropriate! 33
- 34. Conflicting Information Information Conflict Invoked when an initial assertion is (We have different information!) ignored… •It is your responsibility to assertively voice your concern CUS if you need to CUS ensure that it has been heard •The member being challenged must acknowledge •If the outcome is still not acceptable – Take a stronger course of action – Use supervisor or chain of command 34
- 35. Power Tool Time • Group into 3’s • Read over all 3 Scenarios consider application of Stop and Watch, Calling a Huddle, and CUS to be assertive • Round 1, – Observer critiques Coach/Staff Role Play • Round 2 – 1st Observers becomes 2nd Coach, 1st Staff becomes 2nd Observer, and 1st Coach becomes 2nd Staff – Observer critiques--Coach/Staff Role Play • Round 3 – 2nd Observers becomes 3rd Coach, 2nd Staff becomes 3rd Observer, and 2nd Coach becomes 3rd Staff – Observer critiques--Coach/Staff Role Play
- 36. Making it Happen • Communicate for Understanding and Buy-In – Provide supportive actions for fear, anger, and resistance – Encourage discussion, dissent, disagreement, debate … keep people talking – Tell people what you know―and what you don’t know – Acknowledge people’s pain, perceived losses, and anger – Value resisters • They clarify the problem and identify other problems that need to be solved first • Their tough questions can strengthen and improve the change • They may be right―it is a dumb idea! …communicate, communicate, communicate…
- 37. Making it Happen • Empower Others to Act – Develop a shared sense of purpose – Align structures with vision and goals – Train employees so they have the desired skills and attitudes – Confront high-level resisters An organization cannot be improved from the top only
- 38. Produce Short-Term Wins • Provide further impetus for change • Provide positive feedback – Further builds morale and motivation • Lessons learned help in planning next goal • Create greater difficulty for resisters to block further change • Provide leadership with evidence of success • Build momentum – Helps draw in neutral or reluctant supporters
- 39. Don’t Let Up • Acknowledge hard work • Celebrate successes and accomplishments • Reaffirm the vision • Bring people together toward the vision • Acknowledge what people have left behind • Develop long-term goals and plans • Provide tools and training to reinforce new behaviors • Reinforce and reward the new behaviors • Create systems and structures that reinforce new behaviors • Prepare people for the next change
- 40. Making it Stick
- 41. Don’t forget to Debrief Debrief Checklist TOPIC Communication clear? Roles and responsibilities understood? Situation awareness maintained? Workload distribution? Did we ask for or offer assistance? Were errors made or avoided? What went well, what should change, what can improve? 41
- 42. Create a New Culture • Develop action steps for stabilizing, reinforcing, and sustaining the change: • Develop performance measures to continually monitor the results from the change and to identify opportunities for further improvements • Make adjustments to the change vision and strategy to reflect new learning and insights • Challenge people to be open to new challenges, forces, and pressures for the next change
- 43. 8 Steps of Change John Kotter
- 44. Feedback • Please fill out your evaluations and educational credit cards, your evaluation and ideas are important to us. • If there are others that would benefit from this program, send them to one of the other regional meetings at:
- 45. Learning Sessions following GHCA Fall Council Meetings • Thursday Oct 29 – Holiday Inn Express, Athens, Ga.
- 46. Thank You! • Don’t forget to find out about the upcoming Cross-Setting meetings in your area. • Have a Safe Trip Home • See you in the Spring of 2010 if not before!
- 47. Personal Conflict That Most Difficult of Encounters When Behavior How you address it makes Becomes: a difference in future: • Hostile – Behavior of that employee – Behavior of other team members • Harassing – Your image of yourself • Hazardous – Other’s image of you – Employee satisfaction and turn-over • Threatening – Employee compliance to policies and procedures
- 48. DESC-It Let’s “DESC-It!” • Have timely discussion • Frame problem in terms of your own experience • Use “I” statements to minimize defensiveness • Avoid blaming statements • Critique is not criticism • Focus on what is right, not who is right 48
- 49. DESC Script modified • Do it Face to Face and in private • D—Describe the specific situation – Agree to the facts • Ask questions • Listen to the Answers • E—Express your concerns about the action – Criticize the action not the person – Explain why it matters • Agree to a remedy – S—Suggest other alternatives – C—Consequences should be stated • End on a compliment
Editor's Notes
- SAY: Pursuit of the goal for the safest and highest quality healthcare requires optimization of a complex and integrated delivery system that includes people and processes. To achieve this goal, the medical profession must evolve and adapt, using both new approaches and tools. These will include such process techniques as systems analysis, process analysis and reengineering, and individual skill training in improving communications. The adaptation necessary to achieve this goal will therefore require change, including recognizing the need for change, developing a culture that will accept change, and fostering actual change in individuals’ approach to the healthcare delivery process. Paramount in this effort is institutionalizing the concept that healthcare is delivered not by a series of people but by a coordinated healthcare team whose techniques and goals must be understood and aligned within a system. This module will help guide you through the phases and steps necessary for your organization to successfully change its culture. In this module, we will: Identify and discuss the Eight Steps of Change Describe the actions required to set the stage for organizational change Identify ways to empower team members to change Discuss what is involved in creating a new culture
- SAY: TeamSTEPPS stands for: Team S trategies and T ools to E nhance P erformance and P atient S afety. TeamSTEPPS focuses on specific skills supporting team performance principles, including training requirements, behavioral methods, human factors, and cultural change designed to improve quality and patient safety. Teamwork concepts are introduced that provide specific tools and strategies for improving communication and teamwork, reducing chance of error, and providing safer patient care. TeamSTEPPS is an evidence-based framework TeamSTEPPS is ultimately designed to optimize team performance across the healthcare delivery system. TeamSTEPPS is composed of four teachable-learnable skills: leadership, mutual support, situation monitoring, and communication; the core of the TeamSTEPPS framework. The red arrows depict a two-way dynamic interplay between the four skills and the team-related outcomes. Interaction between the outcomes and skills is the basis of a team striving to deliver safe, quality care. Encircling the four skills is the patient care team which not only represents the patient and direct caregivers, but those who play a supportive role within the healthcare delivery system. Team competencies required for a high-performing team, can be grouped into the categories of Knowledge, Skills, and Attitudes (KSAs). Team-related knowledge results in a shared mental model; attitudes result in mutual trust and team orientation. Adaptability, accuracy, productivity, efficiency and safety are the outcome of a high-performing team.
- SAY: Realizing that change is difficult, John Kotter has outlined an 8 step model for successful change efforts. Steps 1–4 help unfreeze the status quo, Steps 5–7 introduce new practices, and Step 8 grounds the changes in a new culture to ensure sustainability (Kotter 1996). Because we know that implementing and sustaining change is difficult, it requires a comprehensive strategy.
- SAY: The first phase in implementing change is setting the stage . As we noted previously, the first step is to create a sense of urgency. Ensuring a sense of urgency among people is crucial to getting cooperation for change. Unless individuals understand the urgency of a situation, complacency sets in, and change becomes very difficult, if not impossible. Think about the forces of complacency ― what are some of them? Begin thinking about who are the key stakeholders, groups, and individuals in the organization who must feel the need for change for team training to happen . Are they on-board yet? Talking about the need for change, the consequences of not changing, and ways to solve the problems is essential to making the case for change.
- We can look at the data on the clinical indicators to see if that can make us see a need to change but sometimes the numbers look good when you group them together. Here is the Statewide High Risk Pressure Ulcer and Restraint trend lines compared to the national graph. Have we improved enough? Let’s take this percent and look at the number of residents that really is in Georgia. As of Quarter 1 2009, 1208 Nursing Home Residents in GA were restrained and 2595 had High Risk Pressure Ulcers, is that too many? What if it were your loved one?
- Northeast, Northwest, Metro Atlanta and East Central are still above the State and National averages but Southeast, Southwest, and Middle GA are below. All are trending in the right direction>
- From the standpoint of Quality Improvement, you look for 3 points to make a trend but you don’t see that here? Seriously, what can we do to bring this under control?
- Focus your Vision with Dewitt Jones Keep your Vision Focused Stop, Look and Listen Hold on to the best, Let the rest fall away Trust your intuition It’s not trespassing to Go beyond you own boundaries Make your vision big enough
- What are you doing in your homes that will
- SAY: For the change effort to be successful, a powerful group must lead the change; and members of that group must work together as a team. Key characteristics that must be represented on the team include power, leadership skills, credibility, communications ability, expertise, authority, analytical skills, and a sense of urgency. Remember that no one person can implement wide-scale change; a coalition is essential. Most organizations have a guiding coalition already in place. Think about our organization. Is there a guiding coalition already established? Do they have the right mix of skills, knowledge, and capabilities? Recommendation: Consider existing committees within the organization and designate the one most appropriate as a guiding coalition. Especially in larger organizations, a change team should be in place in each unit. These teams could all report updates to the guiding coalition.
- SAY: Team leaders must possess a set of effective skills regardless of the type of team that they lead. Team leaders should be able to effectively: Organize the team Articulate clear goals Make decisions based on input of team members Empower team members to speak up and openly challenge when appropriate Promote and facilitate good teamwork Resolve conflict Evidence also suggests that effective team leaders: Are responsible for ensuring that team members are sharing information, monitoring situational cues, resolving conflicts, and helping each other when needed Manage resources to ensure team performance Facilitate team actions by communicating through informal exchange sessions Develop norms for information sharing Ensure that team members are aware of situational changes to plans
- Effective team members: Are better able to predict the needs of other team members and are proactive versus reactive Provide quality information and feedback Engage in higher level decision-making Manage conflict s killfully Understand their roles and responsibilities Reduce stress on the team as a whole through better performance Effective team members “achieve a mutual goal through interdependent and adaptive actions.”
- SAY: An organization fosters a “culture of safety” with its practices, processes, and procedures. Patterns of behavior determine the commitment, style, and proficiency of an organization in relation to safety. A positive culture of safety has: Foundation built on mutual trust Shared perceptions on importance of safety Confidence in efficacy of preventative measures The second phase in implementing change is deciding what to do . Leaders must create a compelling vision―one that answers the questions “What do we want to achieve?” and “Where do we want to be in the future?” It’s important that the vision engage both head and heart. Leadership must also develop the strategy to make that vision a reality. It’s also important that the guiding coalition be instrumental in the creation of the vision and strategy. Michael Fullan writes, “The role of the leader is to help create a process that helps people see new possibilities that engage their emotions and thus change behaviors or reinforce changed behavior.” (Fullan 2004) ASK: Do we have a vision and strategy in place
- In Georgia, the homes that took the AHRQ survey, there was a more positive responses to Overall Perception of Resident Safety, Feedback and Communications and Supervisor Expectations and Actions Promoting Resident Safety than there were for Communications Openness, Staffing, and Nonpunitive Response to Mistakes.
- Taking a look at differences in perception, take a look at this slide, what does it tell us? Most of the people taking the survey that identified them self as administrators believed that the nursing home they worked in was having trouble with compliance to procedures while the Licensed Nurses and Nursing Aides and CNA thought they were doing a great job. What does that tell you? What do you think is happening? As for Teamwork, Administration thought this was a strength and licensed nurses and CNAs believed that there was room for improvement. Staffing, administrators seem to know that staffing might not be their strongest attribute but the clinical staff saw that there was a lot of room for improvement. Have you ever sat down with your staff and explained why the staffing level is what it is in GA? That GA has some of the lowest reimbursements for nursing homes in the nation? Take a look at Nursing Home Compare and share what you found with your staff. They are likely to be more understanding and willing to put in that extra effort of working at 100% instead of 50-60%(don’t tell them that but that is all most people put in on the job across the board)
- Overall weaknesses in Nursing Homes
- The huddle is a tool for reinforcing the plans already in place for the treatment of patients and for assessing the need to change plans. It serves as a tool for developing shared understanding between team members of the plan of care. It also provides team leaders with an opportunity to informally monitor patient and unit-level situations. Information will change over time and that will require monitoring and updating of the team. Note that a sudden increase in the activity level of an individual or the team indicates the need to reevaluate workload status. Workload distribution may need to be adjusted on the basis of this information. Information updates within the team should occur as often as necessary. Updates can take the form of a huddle at the status board or can occur between individual team members whenever new information needs to be shared.
- Modified version of the STEP tool Notes from Laural Baye Decatur GA The board is quite comprehensive. Below I have the areas but keep in mind there is discussion in each of these areas within the clinical team. Each chart is brought to the meeting as well. This allows the opportunity to document in the meeting. 1. New Admissions and Readmissions (name, PPD, admission note, assessments completed, diagnosis, comments) 2. Blood sugars Monitoring (name, RP and MD notified, documentation, care planned) 3. Blood Pressure Monitoring (name, RP and MD notified, documentation, care planned) 4. Antibiotics (diagnosis, length of administration, date, RP notified, 3 day follow-up) 5. IV fluids (diagnosis, length of administration, date, RP notified, documentation, care planned, follow-up) 6. Foley Catheter (name, RP notified, diagnosis, documentation, care planned) 7. New Skin Concerns (name, RP and MD notified, documentation, care planned, orders, treatment nurse evaluated, diagnostic testing as needed, consultation, etc.) 8. Appointments/Consults (name, date/time, type of appointment/consult, RP and MD notified, documentation, transportation) 9. Planned discharges (Name, date of discharge, order, home health care as needed, DME, medications for discharge) 10. Falls (name, date, incident report, MD/RP notified, neuro checks, Rehab, care planned, interventions, falls investigation, maintenance, follow-up documentation) 11. BM Concerns (name, RP and MD notified, documentation, care planned) 12. Accidents/Incidents (name, RP/MD notified, note, documentation, care planned, 3 day follow-up) 13. Significant Change (name, RP and MD notified, documentation, care planned, orders, diagnostic testing as needed, consultation, etc.) 14. Behavior Concerns (name, RP and MD notified, documentation, care planned, orders, diagnostic testing as needed, consultation, etc.) 15. Nutritional Concerns (name, RP and MD notified, documentation, care planned, orders, diagnostic testing as needed, consultation, etc.) 16. Diagnostic Testing (labs, x-rays,...) (name, related diagnosis or condition, RP notified, documentation, care planned, orders, consultation, etc.) It seems like a lot but once you have done it several times it gets easier. We can cover it all in less than one hour per day. Margaret
- SAY: The third phase in implementing change is making it happen . When the vision and strategies have been determined, they must be effectively communicated. Failure to implement change is often the result of under-communicating or communicating poorly. In addition, people must both understand and accept the vision and strategy. Creating a vision and implementing change are time-consuming and a great deal of hard work. It’s essential that trust be built in the early stages within and among the guiding coalition/change team, staff, and leadership. It’s also important that an environment be established where concerns can be brought forward and discussed without fear of retribution. Every communication channel available should be used to put forth the vision and the strategies in a planned way. It’s also essential that the guiding coalition and change team model the expected behavior of employees. Accept and plan for resistance. Resisters help to clarify the problem, and by addressing their concerns, you can actually improve the change. Use the following actions to overcome resistance to change: Acknowledge change as a process Empower stakeholders Encourage all stakeholders Set concrete goals Show sensitivity Model process skills Develop strategies for dealing with emotions Manage conflict Communicate Monitor process dynamics
- SAY: Leaders must change the systems or structures that undermine the change vision and also remove other obstacles to change. They should also encourage risk-taking and non-traditional ideas, activities, and actions. It’s essential that leaders remove as many barriers as possible so that those who want to make the vision a reality can do so. Give people freedom and direction Give people permission to find their own team-driven solutions Encourage people to speak up, even to differing views Encourage people to take risks Affirm and refine the vision—make room for others’ ideas Tell people as much as you know Encourage teamwork and collaboration Encourage personal reflection and learning Provide people with training and support Use existing quality improvement methods in your organization to track activities on a daily basis Set short-term goals
- SAY: Creating visible, unambiguous successes connected to the change effort as early as possible demonstrates success of the initiative. Plan and create the wins and be sure to visibly recognize and reward people who made the wins possible. Some additional issues to think through: Think through the power of short-term wins in the first unit to be trained or early adopters of the change Think of the method you use to integrate lessons learned into your own process modification. Will that method apply here? How do you plan to leverage lessons learned to drive change in the second unit to be trained? To design and drive change as you train up multiple departments across the organization? What measures provide evidence of success? It takes a lot of courage to openly communicate when resisters are present (e.g., at a staff meeting). What method do you find successful for communicating to staff where there are numerous resisters present? How can you leverage your change team to strategize, plan, and control the impact of resistance? What means or methods tend to build momentum? Is our facility a “story-telling” place? Are stories an effective manner to help staff hear and internalize the short-term “
- SAY: Press harder and faster after the first successes. Be relentless in instituting all the necessary changes until the vision is a reality. To realize the vision, you may have to change systems, structures, and policies that don’t fit together and don’t fit the transformation vision. You may need to reinvigorate the process with new projects, themes, and change agents. Kotter recommends that to solidify the changes you should: Hire, promote, and develop people who can implement the change vision Reinvigorate the process with new projects, themes, and change agents
- SUCCESs -- Excerpts from Making it Stick by Chip and Dan Heath Simple – Simplicity isn’t about dumbing down, it’s about prioritizing. What’s the core of your message? Can you communicate it with an analogy or a high-concept pitch? Unexpected – To get attention, violate a schema, to hold attention, use curiosity gaps. Before your message can stick, your audience has to want it. Concrete – To be concrete, use sensory language, paint a mental picture. Like Velcro, try to hook into multiple memory types. Credible – Ideas can get credibility from outside or from within, using human scale statistics or vivid details. Emotional – People care about people, not numbers Stories – Stories drive action through simulation and inspiration and help people see how existing problems might change.
- SAY: Debriefs include: Accurate recounting and documentation of key events Analysis of why the event occurred, what worked, and what did not work Discussion of lessons learned and how they will alter the plan next time Establishment of a method to formally change the existing plan to incorporate lessons learned Debriefs are most effective when conducted in an environment where honest mistakes are viewed as learning opportunities. Debriefs should be the subject of a brief (about 3 minutes or less) team event typically initiated and facilitated by the team leader. Debriefs are most useful when they relate to specific team goals or address particular issues related to recent actions of the team. Debriefs also maintain effectiveness by not assigning blame or failure to an individual. Although the debrief is meant to be a process improvement tool, at times it may be necessary to conduct a complete process review and system redesign if the same issues or events continue to reoccur. These recurring issues may be identified during a debrief and could then be mapped out and accessed at a designated time in the near future. While you strive to have a flexible and adaptive team, be cautious of creating workaround processes to accommodate certain issues As a practice, lets debrief the this learning session (session leader take notes on flipchart): Was the communications clear? Did we cover all the objectives of the meeting? Did it look as What did we do well? What could we do better next time? Was the workload distributed? What are your take homes? (hand out index cards and ask them to write them down – we will ask them in 6 weeks what they have implemented)
- Errors Common to Organizational Change Allowance for complacency Failure to create a sufficiently powerful Guiding Coalition and Change Team Not truly integrating the vision Allowance for obstacles Not celebrating “short-term wins” Declaring victory too soon Neglecting to anchor changes firmly in the culture Give people time to mourn their actual losses Provide skill and knowledge training Revise job descriptions Develop new reward systems Strengthen social connections and relationships Recognize and celebrate accomplishments
- SAY: Realizing that change is difficult, John Kotter has outlined an 8 step model for successful change efforts. Steps 1–4 help unfreeze the status quo, Steps 5–7 introduce new practices, and Step 8 grounds the changes in a new culture to ensure sustainability (Kotter 1996). Because we know that implementing and sustaining change is difficult, it requires a comprehensive strategy.
- SAY: Conflict is inevitable and can be caused by differences in clinical knowledge, work approaches, values, opinions, or personality. Resolution of conflict is necessary in the delivery of safe, quality care. Leadership skill in conflict resolution can enhance team effectiveness and performance. An effective team leader does not allow interpersonal or irrelevant issues to negatively impact the team. Instructor Note: The Mutual Support module provides specific strategies for resolving conflict (i.e., Two-Challenge rule and DESC script).