Bringing it all together

Cathie O’Neill

Health Services Today

• Chronically busy

• Stressful

• Fatigue

• Cynicism

• High turnover

• Little follow through

• Accreditation

• Projects

• Restructures 2

What does effective quality look like??

• The million dollar question

• Easy to establish audits and checklists for components

• Somewhat harder to implement the components and processes

• Much harder to measure

• Much much harder to have an effective quality culture

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Typically find

• An established policy system – voluminous, not current, contradictory

• Immature Risk Management approaches – no linkages, closure, resolution

• Incident and complaint reporting with some management• Indicators collected and some degree of benchmarking –

often silo based• Accreditation processes – ad hoc, reactive, centrally

controlled• Established OHS systems often driven by a need to reduce

workers compensation premiums• A staff development program• A poorly linked and often ineffective committee structure

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Lessons from history

• King Edward Memorial Hospital, Perth (2002)

• Royal Melbourne Hospital (2002)

• Campbelltown and Camden Reports, NSW (2003)

• Bundaberg, Qld (2005)

• Glasgow’s Victoria Infirmary, Scotland (2003)

• Bristol Royal Infirmary, England (1998 & 2001)

• Celje Hospital, Slovenia (2003)

• Southland District Health Board, NZ (2002)

• Winnipeg health Services, Canada (1998)

• Hindle D, Braithwaite J, Travaglia J, Iedema R (2006). Patient Safety: a comparative analysis of eight Inquiries in six countries. Centre for Clinical Governance Research , UNSW: Sydney

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Lessons• Ineffective organisational structures• Poor lines of responsibility• Absent monitoring of patient safety/quality• No effective adverse event reporting / response system• Poor supervision of junior staff• Poor communication skills/processes between health professionals,

departments, facilities and with patients and families• Over emphasis on fiscal matters• Poor clinical audit systems• Non compliance of staff relating to patient safety systems• Poor communication with patients and families when things went wrong• Professional silos with nurses disempowered• Poor documentation in records• Blame culture• Poor credentialing• Fragmented organisational quality structure• Poor recognition of the concept of clinical accountability• Lack of will to tackle difficult issues.

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How does your service rate?

‘Irrespective of the specialty, seven million dollars of careful analysis at any Australian tertiary hospital would have yielded the same conclusions. What lies at the core of the problem are grossly deficient industry standards for quality, safety and efficiency’

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Every system is

designed exactly to

achieve the results it

does

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Relative Performance

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Root CausesBusyness

Large Organisations

Restructures

Politicisation

Lack of Resources

Unrealistic demands

Professional Silos

Lack of

accountability

Managing Up

Micro management

Risk Aversion

Scapegoating

Blame

Cover Ups

Them or They

Not my problem

No decisions

Silly decisions

‘Lost’

Mistakes

Waste

Promotions (Inapp.) Cynacism

Fatigue

Incompetence

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Organisational Components

People Leadership

Workforce Clients

Facilities

Funding

ProcessesPolicy

YOU

Structure

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Culture

Organisational

Professional

Personal

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What is a positive culture?

• Involvement• Engagement• Consensus• Working together• Understanding of the objectives of “the cause”• Engaging others• Being receptive• Networking• Communicating• Not whinging!

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How do you fix it?

• Look at yourself – leaders / managers must be personally effective and promote effective workplaces

• Use appropriate tools – content knowledge alone is not enough

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“ In an increasingly dynamic, interdependent and unpredictable world, it is simply no longer possible for anyone to figure it all out at the top. The old model, ‘the top thinks and the local acts’, must now give way to integrating thinking and acting at all levels. While the challenge is great so is the potential pay off”

Senge ;1990:7

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Leadership

• The content of leadership hasn’t changed –the context has (Kouzes and Posner)

• Change is a constant

• Often primary role of a leader is to drive change

• Difficult, challenging

• Often tests the best EI

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What is leadership

• Many definitions, but the majority agree:

– Is a process

– It involves influence

– It occurs in the group context (leaders and followers)

– It is about goal attainment

– It is about motivating & influencing people to work towards shared goals.

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How do you do it?

• Use a toolkit

• Be personally effective

• Manage change

• Know where you are and where you need to be – performance monitoring

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Using modelsFrame the Story

Evidence and Analysis

Design delivery

Develop Mindset for Change

Build capacity and capability

Integrate Plans / Projects

Hold to account

Make progress visible

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NHS Model for Large Scale Change CPI Model

Leadership for change

• Know the mechanisms for change

• Understand the psychology of change

• Remain personally effective

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Changing Systems

•Disengagement

•Disidentification

•Disenchantment

Ending Phase

•Disorientation

•Disintegration

•Discovery

Emotional Wilderness

Neural Zone •Redesign

•Planning

•Monitoring

•Skills training

•New Identity

New Beginnings

21Bridges Transitional Change Model

Transitions

• Change is situational: the new site, the new boss, the new team roles, the new policy.

• Transition is the psychological process people go through to come to terms with the new situation.

• Once you understand that transition begins with letting go of something, you have taken the first step in the task of transition management.

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Mobilising for Change

• Each person has to be able to connect with the change message

• The connection has to be deep enough to inspire action

• Much of that motivation will come from emotions

• Negative emotions can often outweigh positive ones

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Identify need

Plan project

Implement solution

Monitor Sustain

Process vs People

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SWTAFlexible

Involve

Support win win

Respond to

feedback

Celebrate success

Culture change solution

Tools

Behaviour

Attitudes

CULTURE!!!

James Bagian 2008

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Personal Effectiveness

• 4 main components– Knowing who you are and where you are heading– Time management– Stress management– Skills base

Getting the results you want in a way thatenables you to get even greater results in the future – sustainable and balanced success

(Covey)

Knowing who you are

• Requires a high level of Emotional Intelligence

When I finally understood that emotions run the show, it was unquestionably the single greatest

breakthrough of my career(James Loehr (1997) Stress for Success)

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Definition

• Emotional intelligence (EI) refers to the ability to perceive, control, and evaluate emotions.

• Salovey & Mayer: “We define emotional intelligence as the subset of social intelligence that involves the ability to monitor one's own and others' feelings and emotions, to discriminate among them and to use this information to guide one's thinking and actions.”

• Some researchers suggest that emotional intelligence can be learned and strengthened, while other claim it is an inborn characteristic.

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What does emotion do?

• We use them as clues as to where we sit in the world

• They enable us to evaluate our needs and desires – feedback mechanisms

• The direct our efforts and interactions

• The can work for us – or against us

• The promote creativity and productivity

• They can adversely affect the workplace culture

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Relevance

• It is EQ that will predict role performance more than IQ

• Depression will soon become the reason for more lost work days than any other

• Burnout is often from the workplace not the work

• 2/3 of all stress related problems result from abusive, unsatisfying, limiting or ill-defined relationships

• Doctors who lack empathy get sued more 32

Why is it important

• “We are being judged by a new yardstick: not just by how smart we are, or by our training and expertise, but also by how well we handle ourselves and each other.” (Goleman, 1998)

• The good thing is - emotional competence is “a learned capability based on emotional intelligence that results in outstanding performance at work” (Goleman, 1998).

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Components of EI

• Knowing your emotions

• Managing your own emotions

• Motivating yourself

• Recognising and understanding other people’s emotions

• Managing relationships, ie. managing the emotions of others

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Assessing EQ

• Exercise

• Complete the following questionnaire

• 1 = almost never, 5 = almost always

• Place your answers to each question in box

• Total each column

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Results

• Scores between 20 and 35 indicate a high EQ for that category

• 14 – 19 indicate average EQ

• 5 – 13 indicate low EQ

• What are your top three strengths?

• What are your three weaknesses?

• What do you need to do?

• Complete running sheet 36

Personalities

• Personality refers to the emotion, thought, and behaviour patterns unique to an individual.

• Personality influences one's tendencies, such as a preference for introversion or extroversion.

• EQ influences how personalities are displayed

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4Ps of Personalities

Playful

PrecisePeaceful

Powerful

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Exercise

• Circles the words that most reflect who you are most of the time

• Use second page to determine quadrants

• Count the number of words selected in each quadrant

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Results

• The highest score in one quadrant shows your dominant personality trait

• If you have two scores the same you are a blend of those two types

• If you have three equal scores the middle quadrant of those scores is likely to be your dominant personality

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So what

• Coupled with improved EI:

– Can help improve your understanding of self

– Can help you interpret conflict

– Can help determine what others need

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Playful

• Fun, lively, enthusiastic, motivating

• Love to talk, Can go off on tangents

• Very confident, healthy egos

• Glass half full

• Work well under pressure, rise to any challenge

• Stylish dressers, newsy emails

• Avoid conflict

• Overcommit 42

Precise

• Thoughtful, logical, well-mannered, fact-based

• Like planning and detail, want to know the risks of everything, Rational decisions

• Get the job done

• Like fine arts, music, environment, latest gadgets

• Caring and loving – but not always obvious

• Sigh, tsk or shake their heads when frustrated with others Don’t tend to praise others, Don’t suffer fools well

• Pedantic, nit-picking, perfectionists43

Peaceful

• Reliable, versatile, supportive, loyal, sincere

• Great listeners, nurturing

• Bring clarity, Systematic, efficient

• Very balanced, don’t tend to experience the highs and lows

• Internally strong

• Seek mediation positions, avoid conflict, keep everyone happy

• Don’t like change but are adaptable

• Need time to think, contemplate, Hesitant decision makers

• When forced or pushed can become passive, procrastinating

• Poor time managers

• Can be selfish

• Supress conflict rather than resolve it44

Powerful

• Achievers, visionaries, ambitious

• Doing is their oxygen, Accomplish more in a day than most

• Appreciate honesty and candour – can speak their mind

• Love to take charge

• Competitive

• Move fast, hands on hips, finger point

• Commanding tone of voice

• Can work in a mess – piles

• Like to display trophies

• Work harder under stress

• Under plan and wing it

• Drive meetings – quick meeting is a good one45

Type Drivers / Needs

Playful Need relationshipsLike positive praiseLoves an audienceacceptance

AttentionAffectionApproval

Precise SpaceSilenceTo get it right

SensitivitySupport

Peaceful Need to be appreciatedSpecific thanksLack of stress

Loyalty To be valued – respectedPeace and quiet

Powerful CreditAppreciation

Loyalty To be in controlNew challenges

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How do they relate

Playful Precise

Peaceful Powerful

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Key conclusions

• Powerfuls can be exasperated by the Peacefuls indecisiveness

• Precises can drive Playfuls away with the intense need to get things right

• Peacefuls can become passive-aggressive as they get annoyed

• Playfuls will start to do anything to get attention

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Time Mgt Quadrants (Covey)

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Stress Management

• Change is constant

• Stimulus is constant

• Both result in release of adrenaline

• This creates stress

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Stress Management

• Cannot control the stimulus

• Can control the response

• Emotional Intelligence

• Be Proactive

• Fill the jug

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Fill the jug

• Look after yourself

• If you keep giving without replenishing you will fall over

• Factor this into your goals / daily strivings

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Circle of Influence

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Control

Influence

No controlWork on these

Don’t let these worry you

Finally

• It is incumbent on all those who work in health to recognise the inherent riskyness of what they do and live up to their duty of care to ensure the safest and highest quality of care at all times (O’Neill, C 2009)

• Clinical governance is a shared responsibility –it is core business – it is health service management

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Brave, courageous, tenacious and innovative

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