Organizational Culture and Change Management

Transcription

1 Organizational Culture and Change Management TeamSTEPPS Master Trainer Workshop Master Trainers 1. Know the team strategies and tools 2. Role model, teach, coach, team strategies and tools 3. Implement action plans to use the team strategies and tools to solve clinical problems 4. Manage culture change as you implement action plans Objectives: Managing Culture Change 1. Explain the concept of safety culture (what are you trying to change?) 2. Use an explicit strategy to manage culture change 1

2 8/16/2018 Objective 1. Explain the concept of safety culture Definition 4 Categories of Culture 3 Levels of Culture 4 Components of Culture Role of Organizational Culture Role of Leadership in Organizational Culture 4 What is a Safety Culture? LEARNED, 1 enduring, shared, beliefs and behaviors that reflect an organization s willingness to learn from errors 2 Patient safety has a high relative importance to other organizational goals (i.e. productivity) 3 Four beliefs present in a safe, informed culture 4 1. Our processes are designed to prevent failure 2. We are committed to detect and learn from error 3. We have a just culture that disciplines based on risk 4. People who work in teams make fewer errors 5 Four Categories of Culture 1 Macroculture Organizational Culture 14 clinics each have their own culture Nurse-taking-blood-sample-from-patient-at-the-doctors-office-Stock-Photo.jpg Subcultures within Positions Microculture within each Clinic 6 2

3 7 Three Levels of Organizational Culture 1 values reflect desired behavior but are not reflected in observed behavior. (Schein, 2010, pp. 24, 27) Behaviors Beliefs & Values Underlying Assumptions Observed Communication Behavior: 29% agree, Staff feel free to question decisions or actions of those with more authority. Belief: Belief about Communication: 60% agree, Staff will speak up if they see something that will negatively affect patient care. Assumption: Safety is a system property but I will be attached if I speak up. Staff and providers should work together as a team to achieve results (patient safety and clinical outcomes) 8 Four Components of Safety Culture 5 1. Reporting Culture 2. Just Culture 3. Flexible (Teamwork) Culture 4. Learning Culture Effective reporting and just cultures create atmosphere of trust 5 Sensemaking 6 of patient safety events and high reliability result from an explicit plan to engineer behaviors from each component of safety culture S E N S E M A K I N G HRO INFORMED and SAFE LEARNING FLEXIBLE JUST REPORTING T R U S T Crosswalk Reason s Components Reason s Components 4 Reporting Culture - a safe organization is dependent on the willingness of front-line workers to report their errors and near-misses Just Culture - management will support and reward reporting; discipline occurs based on risk-taking HSOPS Dimension or Outcome Measure Frequency of Events Reported (U) Number of Events Reported (O) O=Outcome Measure, U=Unit, H=Hospital Nonpunitive Response to Error (U) 9 3

4 Crosswalk Reason s Components Reason s Components 4 Flexible Culture - authority patterns relax when safety information is exchanged because those with authority respect the knowledge of front-line workers Learning Culture - organization will analyze reported information and then implement appropriate change HSOPS Dimension or Outcome Measure Teamwork w/in Units (U) Staffing (U) Communication Openness (U) Teamwork ax Units (H) Hospital Handoffs (H) Hospital Mgt Support (H) Manager Actions (U) Feedback & Communication (U) Organizational Learning (U) Overall Perceptions (U) Patient Safety Grade (O) 10 The Role of Organizational Culture Organizational Culture 1 Allows us to make sense of environment Reflects common language is heard and observed Leaders create/teach culture Share information Reward, provide feedback Hold people accountable Safety Culture 7 A cross cutting contextual factor Moderates effectiveness of patient safety interventions Associated with adverse events and patient satisfaction 11 Leaders Engineer Culture 1 it is the unique function of leadership to perceive the functional and dysfunctional elements and to manage cultural evolution and change. Schein, E.H. Organizational Leadership and Culture 4 th ed. San Francisco: John Wiley & Sons;

5 The Bottom Line Improving safety culture increases likelihood of success of all other patient safety interventions 13 Objective 2. Use an explicit strategy to manage culture change 1. Kotter s Eight Steps of Change Comprehensive Unit Based Safety Program (CUSP) Diffusion of Innovations 12 Why Does Change Fail? Why isn t the US on the metric system?

6 Why Does Change Fail? Share examples from your setting 16 Multiple Strategies for Change 1. Kotter s Eight Steps of Change 10 CUSP ENDURE EXPAND EVALUATE EXECUTE EDUCATE /TRAIN ENGAGE Peter Pronovost 1. Create a Sense of Urgency 10 Get people s attention (with stories and data)! MOS results, harmful events, issues with waste of time/resources, patient satisfaction, core Measures Sell the need for change and the consequences of not changing to administrators, clinic leaders and managers, clinic providers and staff Immerse clinic staff in information about the change Empower people to solve problems associated with the change 6

7 2. Build the Guiding (Change) Team 10 Include proven leaders who can drive the change process Formal power with high credibility Informal opinion leaders Interprofessional Set expectations for follow through Need management and leadership skills Management skills control the process and details Leadership skills drive the change with a vision TeamSTEPPS initiative should have a designated executive/leadership sponsor 3. Develop the Change Vision and Strategy 10 Work with leaders to define and communicate your vision for change Defining a culture of safety aligned with expectations, core values, shared beliefs Informing the clinic of these values and evaluating the culture Leading the process of: Translating values into expected behaviors Establishing trust and accountability Share how this change is consistent with mission and core values 4. Communicate for Understanding & Buy-In 10 Includes education and training Encourage discussion, dissent, disagreement, debate keep people talking Tell people what you know and what you don t know Value resisters (NO NO) 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 7

8 4. Communicate Using Talking Points (Data & Stories) It is important to improve teamwork in our organization because: 1/4 of our nursing staff believe that shift changes are problematic for patients 2/3 of our clinical staff do not feel psychologically safe speaking up to those with more authority when patient safety is at stake Only ½ of the staff in the ED agree that there is good cooperation among hospital departments that need to work together. RCA identified poor communication during a handoff of a patient from floor to radiology that led to a fall Lack of using check-back in a code situation may have contributed to a patient death 5. Empower Others to Act 10 Train employees so they have the desired skills and attitudes Identify personnel with the vision and skills to COACH others Manage high-level resisters how does professor manage NO NO? An organization cannot be improved from the top only 6. Produce Short-Term Wins 10 Provide positive feedback (shirts, pins) Further builds morale and motivation Results from debriefs Provide feedback to plan next goal Create greater difficulty for resisters to block further change Provide leadership with evidence of success 8

9 7. Don t Let Up 10 Evaluate your training sessions and learn from the evaluations (form on website) Reaffirm the vision Celebrate successes and accomplishments Orient new employees to the tools Include in annual training to reinforce behaviors (Overview on website) Communicate, communicate, communicate Stay connected to TeamSTEPPS communities (your 14 clinics, UNMC, National Implementation) 8. Create a New Culture Hard wire the change Job descriptions Performance evaluations Policies/procedures Use language and tools in clinical and nonclinical settings Managers use the tools Leaders call for briefs, huddles, and debriefs All monitor the situation to establish situation awareness All seek and offer task assistance All structure communication with SBAR, Call-out, Check-back and I PASS the BATON All structure communication, document reviews, requests for maintenance with SBAR TeamSTEPPS Innovation to Address Need 2. Comprehensive Unit Based Safety Program (CUSP) 11 Innovation: An idea or practice that is perceived as new Diffusion process: Innovation is communicated through Strategies and Tools channels over time to Enhance Performance among members of a and Patient Safety social system

10 TeamSTEPPS as an Innovation Getting a new idea adopted, even when it has obvious advantages, is difficult. Many innovations require a lengthy period of many years from the time when they become available to the time when they are widely adopted. 12 Rogers EM. Diffusion of Innovations (5 th ed.). New York, NY: Simon & Schuster; pp. 1, Attributes of Innovations 12 General Attributes Relative advantage Compatibility Complexity Trialability Observability Rogers EM. Diffusion of Innovations (5 th ed.). New York, NY: Simon & Schuster; TeamSTEPPS Train-the-Trainer Fundamentals Essentials Coaching Culture Assessment Implementation/ Action Planning Teamstepps.ahrq.gov 29 Characteristics of Innovative Organizations/Individuals Organizations 12,13 Management supportive Resources available Implementation practices hard wired Champions Fit between innovation & values Effective innovation improves culture/climate Individuals 12 Greater contact with change agents Actively seek information Greater knowledge of innovation Greater social participation 30 10

11 Agenda Setting: Identify need for innovation (performance gap as a trigger) Summary Pulling it All Together Organization Innovation Process Initiation Matching: Find an innovation to meet need and bridge performance gap Decision Redefining/ Restructuring: Re-invent innovation to match context, restructure organization to fit innovation Implementation Clarifying: Make roles and tasks associated with innovation clear Routinizing: Innovation is hard-wired into organization s policies/ procedures Rogers EM. Diffusion of Innovations. 5th ed. New York: Free Press; Mod Page 31 TEAMSTEPPS Individual Innovation Process Summary Pulling it All Together Pre-Contemplation and Contemplation Preparation Action Maintenance Knowledge: Recall information, knowledge & skill for effective adoption Persuasion: Like the innovation, discuss with others, form positive perception Decision: Intent to seek additional information and to try innovation Implementation: Acquire additional information and use innovation on regular basis Confirmation: Recognize benefits of using innovation, integrate into routine, promote to others Prochaska et al. In search of how people change. American Psychologist. 47: Rogers EM. Diffusion of Innovations. 5th ed. New York: Free Press; Mod Page 32 TEAMSTEPPS Change Management: Putting it All Together 8 Stages (Kotter) Change Model (Pronovost) Create Sense of Urgency Organizational Stages (Rogers) Individual Stages (Rogers) Engage Agenda Setting Knowledge Persuasion Build Guiding Team Engage Agenda Setting Matching Develop Change Vision & Strategy Communicate for Understanding Empower Others COACH Knowledge Persuasion Engage Educate Matching Redefining Knowledge Persuasion Decision Educate Clarifying Persuasion Decision Execute Clarifying Decision Short-Term Wins Execute Evaluate Clarifying - Routinizing Implement Don t Let Up Evaluate Expand Clarifying - Routinizing Implement Create a New Culture Expand Endure Routinizing Confirmation 33 11

12 Putting it All Together: The Checklist Clearly define the change Management is supportive Implementation Champion Employees recognize change is a priority Resources are available Policy/Procedure changed Job descriptions/performance appraisals changed Change is evaluated Results of evaluation guide improvement Download Checklist for Implementing Change from 34 Culture Change Comes Last, Not First! 10 Changes in values come at the end of the transformation process New behaviors adopted by the laggards after success has been proven by the early adopters Feedback and reinforcement are crucial to using the behaviors adopting Sometimes the only way to change culture is to change key people Individuals in leadership positions need to walk the walk and talk the talk Reculturing takes time and it really never ends Role of Leaders in Transformational Change Create a compelling positive vision Concretely define the goal as a performance problem not changing culture Ensure new behaviors are formally taught in groups Ensure new behaviors are reinforced Provide opportunities for practice, coaching, feedback Be a positive role model Create structures consistent with new way of thinking/working/behaving 36 Schein, E.H. Organizational Leadership and Culture 4 th ed. San Francisco: John Wiley & Sons;

13 Summary Safety culture is the learned, shared beliefs and behaviors that reflect organization s willingness to learn and whether safety is a priority There are multiple strategies to use an innovation such as TeamSTEPPS to change your culture; they all have common elements Urgency/Engagement/Agenda Setting the reason to change Develop the right team to guide the change; make sure they have the time and resources to do the work Match a specific problem to a solution and communicate the vision! (targeted or transformational change) Empower, clarify, make it routine don t give up! Expect barriers and manage them! 37 References 1. Schein, E.H. Organizational Leadership and Culture 4 th ed. San Francisco: John Wiley & Sons; Wiegmann. A synthesis of safety culture and safety climate research; Report/02-03.pdf 3. Zohar D, Livne Y, Tenne-Gazit O, Admi H, Donchin Y. Healthcare climate: a framework for measuring and improving patient safety. Crit Care Med. 2007;35: Institute of Medicine. Patient safety: Achieving a new standard of care. Washington, DC: The National Academies Press; Reason, J. (1997). Managing the Risks of Organizational Accidents. Hampshire, England: Ashgate Publishing Limited. 6. Battles et al. (2006). Sensemaking of patient safety risks and hazards. HSR, 41(4 Pt 2), Weaver SJ, Lubomski LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM. Promoting a culture of safety as a patient safety strategy: A systematic review. Ann Int Med. 2013;158: References 8. Mardon RE, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf 2010;6: Sorra J, Khanna K, Dyer N, Mardon R, Famolaro T. Exploring relationships between patient safety culture and patients assessments of hospital care. J Patient Saf 2012;8: Kotter JP. Our Iceberg is Melting. New York: St. Martin s Press; Pronovost et al. Creating high reliability in health care organizations. Health Services Research. 2006; 1(4, Part II): Rogers EM. Diffusion of Innovations (5th ed.). New York, NY: Simon & Schuster; Helfrich et al, (2007). Determinants of implementation effectiveness: Adapting a framework for complex innovations. Med Care Res Rev 64(3), p