BUILDING A CULTURE OF

OWNERSHIP IN HEALTHCARE

with theValue of Specialty Nursing

Certification

Bob Dent DNP, MBA, RN, NEA-BC, CENP, FACHE, FAAN, FAONE

Senior Vice President, Chief Operating and Chief Nursing Officer, Midland Memorial Hospital

Adjunct Faculty, University of Texas of the Permian Basin School of Nursing

& Texas Tech University Health Sciences Center School of Nursing

2019 Immediate Past President, American Organization of Nurse Executives

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Learning Outcomes

1. Describe “the healthcare crisis within” of incivility, bullying, and toxic

emotional negativity in the workplace and the way it contributes to

stress, burnout, and compassion fatigue.

2. Describe the three essential elements needed to move from a culture of

accountability to a culture of ownership.

3. Discuss the value of specialty nursing certification in a culture of

professional ownership.

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Building a Culture of Ownership in Healthcare

The Invisible Architecture of Core Values, Attitude, and Self-Empowerment

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Invisible Architecture?

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Lateral

Violence

Bullying

Intra-staffffffffAggression

Intra-staffffffffHostility

Incivility

Names Used to Describe Phenomenon

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Mahr, 2016

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Incivility can take the form of rude and discourteous actions, of gossiping and spreading rumors, and of refusing to assist a coworker. All of these are an affront to the dignity of the coworker and violate professional standards of respect.

ANA Position Statement on Incivility, Bullying, and Workplace Violence (2015)

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Many Faces of TENTENTENTEN

Name-callingFault-Finding

Criticism

Intimidation

Gossip

Shouting

Blaming

IgnoringRefusing to help

Unfair assignments

Sabotage

Exclusion

Broken Confidences

Failure to respect privacy

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Overt (Done Openly)Covert (Not Openly

Acknowledged)

Mahr, 2016

22,000,000

negative workers in the United States

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$500,000,000,000 wasted in negative energy and

employee disengagement

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Theoretical Model of Horizontal Violence (TEN)(TEN)(TEN)(TEN)

Process

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Oppression

(TEN)

Internalized

Dominant

Values

Horizontal

Violence

Peer

Communication

Patient

Safety

Key:

+ Positive Relationship

− Negative Relationship

Mahr, 2016;

Purpora, 2010

“

”

Danny Meyer, owner of twenty-seven restaurants in New York City, preaches civility and tolerates nothing less. If bad behavior from an employee at any level isn’t corrected quickly, they’re gone. Meyer is convinced that customers can taste

incivility. Even exceptional chefs don’t last in Meyer’s restaurants if they’re disrespectful to other employees.

Christine Porath, Professor, McDonough School of Business, Georgetown University

Mastering Civility: A Manifesto for the Workplace

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Source: Quartz, September 15, 2017. The silent killer of workplace happiness, productivity, and health is a lack of basic civility

CommunicaCommunicaCommunicaCommunicatititition Breakdown: on Breakdown: on Breakdown: on Breakdown:

Leading Cause of SenLeading Cause of SenLeading Cause of SenLeading Cause of Sentitititinel Eventsnel Eventsnel Eventsnel Events ---- 2014201420142014

18The Joint Commission, April 2015 retrieved from

www.jointcomission.org/assets/1/23/jconline_April)_29_15.pdf

1. Human Factors (ex: staff supervision issues)

2. Leadership

3. Communication

Medical Errors: Significant Cause of Death

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Medical Errors: 8th leading cause of death

Negative Impact of HV (TEN)(TEN)(TEN)(TEN) on Organizations

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Work Culture

•Commitment

•Collegiality

•Support

•Satisfaction

•Learned Behavior

Patient Safety

•Late Interventions

•Incomplete Interventions

•Errors

Cost

•Absenteeism

•Workforce Rehires

•Nursing Shortage

Mahr, 2016;

56-78.5%

resign

1 in 3 leave

nursingBurnout

Dissatisfaction

Irritability

Impaired Relationships

Fatigue

Hypertension

PTSD

Depression

Panic Attacks

Diminished

Confidence

Substance Abuse

Negative Effects of HV (TEN)(TEN)(TEN)(TEN) on Nurses

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Vessey, 2009

Townsend, 2012

Longo, 2013

Mahr, 2016

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BUILDING ABUILDING ABUILDING ABUILDING ACULTURECULTURECULTURECULTURE

OF OWNERSHIPOF OWNERSHIPOF OWNERSHIPOF OWNERSHIPIN HEALTHCAREIN HEALTHCAREIN HEALTHCAREIN HEALTHCARE

The Invisible Architecture ofCore Values, Attitude, and

Self-Empowerment

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From Accountability ….

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Accountability Is Not Enough!

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Accountability implies irresponsibility

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Accountability can be exhausting!

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Accountability focuses on rules, not on values

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Accountability is always after the fact and often demotivating

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Accountability provides an incentive to cheat

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Accountability never takes an organization from good to

great

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… to Ownership!

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OwnershipOwnershipOwnershipOwnership ISISISIS the secret sauce!

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Mission, Vision, and

Core ValuesCore ValuesCore ValuesCore Values

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CORE VALUES

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Be yourself…

Integrated DNA Technologies, 201639

unless you’re a jerk.

Give a damn.Southlake Regional Health Centre, 2012

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Our culture is based on the Christian faith and that staff and physicians are

encouraged to pray with patients …

Craig Lindsey, Chief Nursing Officer

Park Ridge Health, North Carolina

Interaction of Personal and Organizational Values

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“Culture is a peoples adaptation to an

environment”

Dr. Jean-Jacques Decoster

Cultural Anthropologist

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Workplace culture is important to the job satisfaction of all employees. For all generations, the highest indicator of the highest indicator of the highest indicator of the highest indicator of

satisfaction is to feel valued satisfaction is to feel valued satisfaction is to feel valued satisfaction is to feel valued on the job.

AARP: Leading a Multigenerational Workforce

Young People: They’re People, Too

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How would you describe your culture in just 6 words?

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““Cursed with Cancer,Cursed with Cancer,

Blessed with FriendsBlessed with Friends””

9 year old Hannah Davies 9 year old Hannah Davies

Southwest Airlines Motto

Servant’s Heart, Warrior Spirit, Fun-Loving Attitude

The Real Marine CorpsThe Real Marine CorpsThe Few, the Proud, The Few, the Proud, the Brave*the Brave** And you* And you’’re not one of themre not one of them

So, what is your 6-Word Culture Story?

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No Opting Out

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One toxically negative person can drag down morale

and productivity of an entire work unit.

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Attitude is a choice!

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Bring your whole self to work; not only your knowledge and expertise, but also your values. Stay true to who you are and have the courage of your convictions. If you do, you will become an If you do, you will become an If you do, you will become an If you do, you will become an authentic and courageous leaderauthentic and courageous leaderauthentic and courageous leaderauthentic and courageous leader — something intensely needed at this time in healthcare. And you will have the power to change your workplace and the community around you.

Mary Brainerd, President and CEO, HealthPartners

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The call to end this silent epidemic in our profession has been heard loud and clear. It is time we turn our

caring behaviors more fully toward our colleagues and those we work with and demand a stop to any

form of violence that occurs in any setting

Dr. Cole Edmonson, Chief Nursing Officer

Texas Health Presbyterian Hospital, Dallas, Texas

www.stopbullyingtoolkit.org

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How do we create healthier and more

positive work environments?

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Blueprinting a Culture of Ownership

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People will be and do their best with the tools they

have.

As a leader, we need to make sure they have the

tools!

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Three Essential Elements of a Culture of Ownership

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1. Be Positive …

2. Be Self-Empowered …Taking Initiative

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3. Stay Fully Engaged …

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… in our profession!

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… Fully Engaged

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A Leadership A Leadership A Leadership A Leadership PhilosophyPhilosophyPhilosophyPhilosophy

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Text BOB to 66866 For my Leadership

Philosophy and continuing

the conversation!

Leadership Job #1

Shifting the shape of your Attitude & Ownership Bell Curve

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What is the Value of Nursing Specialty Certification?

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Source: AMN Healthcare, 2013 (n = 3,413)

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Nursing Specialty Certification and Patient Outcomes: What

We Know in Acute Care Hospitals and Future Directions

by Diane K. Boyle, PhD, RN, FAAN, September 2017

Findings:

Studies have found relationships between higher rates of

nursing specialty certification and lower rates of total patient

falls, pressure injuries, selected hospital-acquired infections,

failure to rescue, and death.

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Core Action Value 4: Core Action Value 4: Core Action Value 4: Core Action Value 4: Core Action Value 4: Core Action Value 4: Core Action Value 4: Core Action Value 4: CourageCourageCourageCourageCourageCourageCourageCourage

Core Action Value 5: Core Action Value 5: Core Action Value 5: Core Action Value 5: Core Action Value 5: Core Action Value 5: Core Action Value 5: Core Action Value 5: PerseverancePerseverancePerseverancePerseverancePerseverancePerseverancePerseverancePerseverance

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TBSSSNDQ

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Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE, FAAN, FAONE

Senior Vice President, Chief Operating & Chief Nursing Officer

Midland Memorial Hospital

400 Rosalind Redfern Grover Parkway

Midland, Texas 79701

432.221.4566 (office)

432.559.2911 (mobile)

bob.dent@midlandhealth.org

Twitter: @bobdent

LinkedIn: bobdent

Facebook Page: rldent1

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Text BOB to 66866 For my Leadership Philosophy and

continuing the conversation!

References