11/9/2016. Session Motivating Teams to do the Right Thing When No One is Watching. Session Roadmap. Nursing Management Congress November 2016

Transcription

1 Session Motivating Teams to do the Right Thing When No One is Watching The heart and science of medicine. UVMHealth.org/MedCenter Nursing Management Congress November 2016 Kate FitzPatrick, DNP, RN, ACNP, NEA-BC, FAAN Chief Nursing Officer University of Vermont Medical Center Burlington, VT Session Roadmap (Session presentation slides will be made available electronically following the conference) What is accountability? How is it different from responsibility and other related concepts? Professional accountability begins with personal accountability examining how lapses in accountability impact environments The role of leaders / leadership in establishing and preserving a culture of accountability? What are key strategies to support a culture of accountability: Recruiting for it, cultivating it, sustaining it 1

2 How Many Came Here To Answer This Question: HOW DO I GET MY TEAM TO BE MORE ACCOUNTABLE FOR OUTCOMES /RESULTS? What s MY role in establishing, cultivating and sustaining a culture of accountability? How Do I Get My Team To Be Accountable? Usually follows failure miss of a deadline, over budget, patient error, non contribution Here s the thing. Systemic accountability problems often have to do with us (leaders) because there is lack of Clarity & Coherence Clarity precedes competence and motivation In nursing. We can t forget about informal leaders & tiered accountability (charge nurse, preceptors, supervisors, etc) Accountability Mapping Moving from job descriptions to a more professional model that incorporates Accountability Statements for Roles Nurse Manager, ANM, Charge Nurse, Nurse Director, Chief Nursing Officer, Nurse Educator/Professional Development Specialist, etc Clarity in roles, required competencies and inter-relatedness of roles 2

3 I Found Money! What is Accountability? Letting your actions rise above your excuses External performance is ultimately a reflection of internal commitment If you had to name a nurse on your team who exemplifies accountability who would that be? What do they do? How do they do it? Commitment When do they do it? What don t they do? What s the impact? 3

4 Accountability vs. Responsibility The main difference between responsibility and accountability is that responsibility can be shared while accountability cannot. Being accountable not only means being responsible for something, but also, ultimately, being answerable for your actions Why Do We Care So Much About Accountability? Elevated Importance on Frontline Accountability Value Based Care Payment & Performance Link Important Contribution of Clinical Nurse Critical Expectations for Leaders 4

5 What is the Yield of A Culture of Accountability? Quality of patient care & value for money spent on health care Reduce overuse, misuse, and underuse of resources cost impact Increases use of EBM & performance measurement = reduction in inappropriate care, improvement in safety Feedback from performance measurement to improve processes/outcomes Utilization of EBP such as practice guidelines, enhance learning and reduce variability Employees and organizations that achieve a culture of accountability engender continuous assessment, learning and change Average performers are satisfied with their outcomes, above average performers are never satisfied Human Nature I know I should do X BUT (X, Y, Z get in the way) XYZ: I am tired It s not my job I am in a hurry I am late I am busy 5

6 Leadership Behaviors & Accountability A Shared Conceptual Model Human Error Product of our current system design At-Risk Behavior Unintentional Risk-Taking Reckless Behavior Intentional Risk-Taking Manage through changes in: Processes Procedures Training Design Environment Manage through: Removing incentives for at-risk behaviors Creating incentives for healthy behaviors Increasing situational awareness Manage through: Remedial action Disciplinary action Console Coach Consequence dapted From: The Just Culture Algorithm, Version 3.1, Outcome Engineering, LLC. Curators of the Just Culture Community. 6

7 Balancing No Blame with Accountability NEJM October, 09 Wachter & Pronovost Recommendations for suggested reasonable responses following a failure to: Adhere To Safety Practice for example: Intent Patterns of Behavior, Response to Coaching Self Reflection/Accountability 19 Mapping Accountability: Origins, Contexts (Newell & Bellour) On the concept of accountability: the right to demand and the capacity & willingness to respond to calls for accountability - assumes relations of power the very function of accountability is to ensure that those that wield or oversee power on behalf of others (aka leaders!) are answerable for their conduct. Institute of Development Studies, England 2002 Embedding Accountability Feedback, Feedback, Feedback Role accountability statements Your response to failures (Just Culture) Contribution as an expectation Hiring Advancement Clinical practice guidelines Professional governance Commitment to my co-workers Recruitment Behavorial based interviews 7

8 Contracts, Commitments, Agreements Develop A Shared Map of Accountability Destination Outcomes Sought & How You Know You Are There Trip Planning Resources Required & Plan If Outcomes are not Achieved Route Updates Continuous Feedback Along the Way To Monitor Progress & Support Alignment Irvine, Derek Talent Leadership & HR (TLNT) importance in mapping out employee accountability/ Recognition (specific) Drives the Accountability Map Destination highlight / acknowledge behavior that drives results and accountability Trip Planning public recognition of employees that go above & behond to secure resources, meet deadlines, or take initiative to deliver on commitments Route Updates immediate & frequent recognition power of peer to peer recognition Irvine, Derek Talent Leadership & HR (TLNT) importance in mapping out employee accountability/ 8

9 Increasing Engagement Enhances Accountability Work environment supporting nurse empowerment for decision making related to practice Survey to understand current level and trouble areas Matching skills/passions to roles and work Recognize those that are engaged Invite naysayers to co-lead Use peer review as a means to provide feedback on contribution UVMHealth.org/MedCenter Other Leadership Competencies to Support Accountability -Feedback / Communication -Positive Reinforcement -Establishing Culture 9

10 Effective Communication State what is EXPECTED with specificity delivered in non-punitive tone State what is OBSERVED with specificity delivered in non-punitive tone Ask why a GAP exists LISTEN to learn and LISTEN with empathy Decide if MOTIVATIONAL or ABILITY problem 28 Effective, Ongoing Feedback is the Secret Sauce People vs Work Systems Behaviors Motivation Ability 29 Motivation Problems Implies lack of willingness Must communicate to achieve compliance Present consequences to achieve compliance To the work To others affected by the work not getting done right To the schedule To the patient/family 30 10

11 It s about intention Motivation: Achieving Compliance Not Sure of Closure: You don t sound like you really want to get it done Positive Closure: Does this mean that I can count on it getting done 32 Ability Problems Ability problems imply lack of skill to do job Ability problems have many reasons Person willing, but not able Solve ability problems by: Ask for their ideas for the solution Brainstorm the solution together or Get a 3 rd person involved to reach the solution Determine who does what by when 33 11

12 Speaking with Specificity & Authenticity Verbal, visual and vocal alignment of message Adhere to principles and values of the organization Be direct, specific and non-punitive Follow problem solving protocols 34 Positive Reinforcement for Above Average Performance Communicate the positive behavior/situation Last months Press Ganey survey comments mention you specifically as doing excellent teaching Communicate the consequence of the action + patient responses help build confidence in our care and are linked funding for our mission Reward/recognize the appreciation thank you for your care / leadership 35 Opportunities to highlight & spread accountable behavior All Leadership Meetings Leadership rounds Online publications Staff Meetings Nursing/Staff Award Programs Daisy Grand Rounds 12

13 The heart and science of medicine. UVMHealth.org/MedCenter People Value What We Pay Attention To Lessons from Officer Down Memorial Power of Peer Review on Accountability It s a competency as important as physical assessment We need to train and practice Realtime, non-anonymous, in person best Built in to clinical practice 13

14 UVMHealth.org/MedCenter Leadership: Establishing Culture of Accountability Accountability Ladder Seeking 200% RN Accountability I am responsible for patients assigned to me Versus I am responsible for ALL patients Source: Advisory Board Co Nurse Executive Center 42 14

15 100/0 100% Accountability 0 Excuses Source: John Izzo 6 Choices to Lead to 100/0 vs 0/100 Stepping UP vs Stepping Back Choice # 1 Be positive and optimistic vs. negative and pessimistic.. Choice # 2 Be an initiator NOT a victim. they should instead of I will. Choice # 3 Focus on what you CAN do instead of what you can t do. Choice # 4 To speak UP constructively, instead of staying silent. Choice # 5 Listen in vs. tuning out. It means to seek & focus not on being right but rather on learning. Choice #6 100/0 means to put the goal first and be collaborative rather than putting yourself first, - getting the goal accomplished by collaborating with others. Source: J. Izzo 100/0 J. Izzo 15

16 Culture Matters: High Reliable Organizations TOP Performers: Shared sense of purpose Hands on leadership style Accountability system for quality and safety Focus on results Culture of collaboration Learn from mistakes Average Performance are Satisfied..Above Average Performers are Never Satisfied Keroack, MA et al. Organizational Factors Associated with High Performance in Quality and Safety in Academic Medical Centers, Academic Medicine Vol 82, No. 12 December, 2007 Direction, Alignment, Commitment Direction: Agree on what we intend to accomplish, understand what success of the group looks like Alignment: Individuals take on different tasks in group but combined work fits together. Work of each individual is coordinated with work of others Commitment: We make the success of the group, not the individual the priority. We take responsibility for the welfare of the group Source: McCauley, C & Fick Cooper, L (Center for Creative Leadership) Direction, Alignment, Commitment: Assessing Where You Are Assessment Tool 3 Sections Direction, Alignment, Commitment 5 statements per section Scoring of 1-5 Not Descriptive (1) Completely Descriptive (5) Available on Center For Creative Leadership 16

17 Nursing Professional Shared Governance & Accountability Shared vs self Collaborative Promote alignment Imbed ongoing peer feedback The Oz Principle 17

18 UVM Medical Center s Mission and Vision Mission UVM Medical Center s mission is to improve the health of the people in the communities we serve by integrating patient care, education and research in a caring environment. Vision Working together, we improve people s lives. Our Strategic Plan is focused on our Patient and Families, our People and our Community. Goal. Create traffic jams on the high road Select References: Accountability Rachel MM (2012). Accountability: A concept worth revisiting. American Nurse Today, Vol 7(3). Staub R. Accountability and its role in the workplace. The Business Journal. January 13, The Advisory Board Company: Instilling Frontline Accountability: Best Practices for Enhancing Individual Investment in Organizational Goals 18

19 Contact Information Kate FitzPatrick 19