Collaborative safety and MDT July 2019 conference · Screening Assessment Placement Case opening Child Safety and Permanency Division|mn.gov/dhs Reunification Case closing 14 Each

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Collaborative Safety and Multi-Disciplinary Team Decision Making

Kelly Knutson | CQI Supervisor

Rebecca Wilcox | Safety & Prevention Manager

Child Safety and Permanency Division | mn.gov/dhs

Today

• Minnesota’s Journey away from a Culture of Blame and towards a Culture of Safety and Accountability

• Collaborative Safety Model

• Scientific Underpinnings of Safety Science

• Integration of Safety Science Strategies into Everyday Work

Child Safety and Permanency Division | mn.gov/dhs 2

How we got here


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Collaborative Safety - Who they are


2014-2015High Profile Child Death-Governor's Task Force

Impact for Minnesota


93 Recommendations

Culture of Blame/Fear

Defensive Practice

Impact for Minnesota


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Collaborative Safety Model

• Moves away from blame and toward a system of accountability that focuses on

identifying underlying systemic issues to improve Child Welfare Systems

• Used by other Safety Critical Industries such as Aviation and Healthcare

• Based in Human Factors and Systems Safety (Safety Science)

• Integrates Behavioral Analysis, Forensic Interviewing, and Trauma Informed Science

• Includes a robust, scientific, trauma-informed review process

• Review process is embedded within a larger framework to support and advance a

safety culture. It is key artifact.

• Other key artifact is language and perspectives.


Today’s main focus

Larger framework and culture of safety science

Language and Biases


Transitioning to a Safety Culture


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7 Transitions to a Safety Culture

1. Blame to Accountability

2. Applying quick fixes to

understanding underlying

features

3. Fallible Humans in

Perfect Systems to Fallible Humans in Imperfect Systems4. First Stories

to Second Stories

5. Employees are a Problem to Control to

Employees are a Solution to

Harness

6. Accountability up to

Responsibility Down

7.Simple to Systemic Accident Models

Scientific Underpinnings 10

Safety Culture Practices

• Way of thinking and behaving that supports continued organizational and systems change - ultimately leading to an improvement in outcomes for clients served

• The science and framework allows for engagement and change at every level (top to bottom alignment) so more people are impacted in meaningful ways


“Child Welfare is the most complex social system that exists.”

~ Safety Science Leaders

As a result, incredibly complex and difficult decisions are made in Child Welfare everyday!


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Complexity of Decision Making In Child Welfare

We need to understand together how individuals operate and make decisions in our

system and how our system influences decisions and those operating our child welfare system.


Child Protection Key Safety Decision Making Points

Screening Assessment Placement Case opening


Reunification Case closing

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Each Decision Point Relates to a Key Question

First phone

call

Safety,permanency,

well-being

Screenin?

Should ongoing case be opened?

What should be on the case plan?

Is the child safe?

Reunify this child?

Close case?

Safetyassessm ent

Riskassessm ent

Fam ilystrengths and

needs assessm ent

Reunificationassessm ent

Risk reassessm ent

Screening andresponse

priorityassessm ent

Work with families


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In a healthy system, there is no blame.- Michael J. Schmoker -


Transition 1. Blame to AccountabilityTo understand how to learn and improve as an organization.

Blame Actually Decreases Accountability

• Hold ourselves and our system less accountable

• Inverse relationship between blame and accountability

• Shuts down the learning process

• Need to hear from those that experience the event



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Integrating Safety Science into Teaming

• Understand from those that experienced the event/outcome

• Look for barriers/challenges/ways to improve

• Individual and system accountability

• Not about shifting blame

• My role – vulnerability

• Example



Transition 2. Applying quick fixes to understanding underlying featuresTo make meaningful change and address the real problems.

Impacts the daily work and decision making of staff

Goal Conflicts

Limited Time &

Resources

Multiple Tasks

ETTO

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• Pause, gain perspectives, and learn

• Move away from adding more and “try harder” recommendations

• Move towards features of our system that support or don’t support work – including coordinating activities

• Give attention to the underlying systemic features that make it difficult for staff in any part of our system achieve success

• Example



Transition 3. Fallible Humans in Perfect Systems to Fallible Humans in Imperfect SystemsTo learn the role of the system on organizational outcomes.

ECONOMIC CONSTRAINTS

WORKLOAD CONSTRAINTS

Budget Cuts

Limited

Resources/Service Array

Accessible Training

Multiple Tasks

Understaffed Paperwork

Work as Prescribed

SAFE WORKBOUNDARY

Erro

r M

arg

in

Failure Point

Safety Culture

Competing Contingencies


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• Our system is not designed perfectly• Understand systems role/pressures on staff’s ability to carry

out work• Need to be systemic versus mechanistic • Need to understand the connections and complex interplay

between staff and the system • Most complex social system that exists• Example



Transition 4. First Stories to Second StoriesTo dive beneath surface level descriptions of events and understand the true sources of failure and success.


Local Rationality -Understanding

Decision Making in Context

Rational Choice Theory

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ExternalFactors

Decision Maker Factors

Organizational Factors

DecisionMaking

Outcomes

Influences Decisions Outcomes

Case Factors

Decision Making Ecology(Baumann, Dalgleish, Fluke & Kern, 2011)


Decision Making Factors

Case factors: Information related to the maltreatment incident and family circumstances

Organizational factors: Agency structure and functioning, management practices, staffing

External factors: Laws and policies informing appropriate decisions and subsequent responses, societal attitudes toward child safety and family preservation

Decision making factors: Attitudes, knowledge, skill, and other characteristics of the worker making a decision


-

1) Attentional dynamics wants to know:

• How we know where to focus attention/risks or issues most relevant?

• What pressures and demands influenced the focus of attention?


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-

2) Possession of knowledge isn’t enough:

• Knowledge factors studies the activation and application of that knowledge in dynamic

situations

• Managing complex and often incomplete information

• Sources of Knowledge - how does this guide the work:

• Laws

• Polices

• Guidance

• Training

• Histories


3) Strategic factors:

• Focus is on goal conflicts

• Goal conflicts are the rule

• Not the exception

Competing Contingencies are always present

• ETTO


Common trade offs in child welfare

• Remove child or leave with family

• Sacrificing time with family to complete other administrative tasks

• Allocating time to higher priority cases

• Efficiency of working case and the thoroughness of assessment/investigation

• Addressing all issues with family or stay strict to referral


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Trade offs are constant in child welfare systems• Frontline staff are constantly:• Shifting between goals• Choosing one goal over another•Weighing benefits between goals• Abandoning some goals• Embracing other goals



• There is always a second story

• Trauma Informed approach - what happened?

• First Stories should not exist without the second story - both are important

• Staff are making trade off decisions everyday to best accomplish the work

• Support staff in seeking the second story from families



Transition 5. Employees are a Problem to Control to Employees are a Solution to HarnessTo make use of the most powerful resource an organization has, its people.

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• Typical responses of checklists/procedures can be a means to control staff

• Bumper pads

• It is our staff that keeps our system afloat

• Listen to staff and defer to frontline expertise

• The solution to us becoming better comes from those that operate it

• They give us the best ideas on how to improve • Example



Transition 6. Accountability Up to Responsibility DownShift from a focus on compliance to support


• Typical approach – “good performer” = meets agency metrics

• Monthly face to face visits = face to face contact within timeframes

• Not achieved = remind again

• Safety Science approach

• Responsibility to create an environment around you that supports success in meeting agency goals/metrics

• Team’s role and the organization's role

• Example


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Transition 7. Simple to Systemic Accident ModelsTo use accident models that are compatible with the complex world we work in.


Accounts for Complexity

Incorporates Multiple PerspectivesChild Safety and Permanency Division | mn.gov/dhs 41


• Supportive and safe environment to have conversations

• Means we have more conversations not less - we put more on the table

• Giving credit to everyone’s perspective

• Remember: decisions make sense to people at the time - it is not helpful to indicate what “should or could” have been done but rather to understand why the decision made sense at the time and what influenced that decision

• Forward looking versus backward looking

• How do we learn and improve as a Team and Organization?

• Example


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Language and Biases


Importance of Language in a Safety Culture

• Remove Cause• Simplistic

• Incompatible with complexity

• Instead Use• Influences



• Remove Error/Mistake• Attributed “after the fact”

• Retrospective attribution

• Focus on negatives

• Instead Use• Explain decision making

• Provide explanation and context


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• Remove Failure• Retrospective attribution

• Focus on negative

• Instead Use• Provide explanation and context

• Adverse event



• Remove Blame• Retrospective judgment

• Simplistic

• Instead Use• Accountability

• Forward Looking


Importance of Language

• Remove should have/could have/if he or she would have• Counterfactual - don’t actually know if they would have, etc.

• Inhibits learning and not helpful

• Instead Use• Provide explanation and context

“Don’t should on yourself and others!”


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Bias

• Awareness of Bias

• Hindsight Bias - outcome knowledge and not in real time

• 3 Reasons why the decision may have made sense

• Severity Bias - same decisions different outcome

• Proximity Bias - close to the outcome


Captain Hindsight

• Captain Hindsight Video


Systemic Factors

• Teamwork/Coordinating Activities (CP and LE, CP and CA, Agency and Courts)

• Procedural Drift

• Prescribed Practices/Policies (Local Agency, State, and Federal)

• Service Availability

• Knowledge Gap

• Supervisory Support

• Tools/Technology/Equipment


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Important Takeaways

• We work in complex systems

• Systems are inherently imperfect

• It is people who hold the system together at all levels

• Safety cultures support all levels of the system enhancing system resilience

• Staff come to work to do a good job everyday - they care deeply about the work they do


Collaborative Change

Through understanding:

• Decision making in context

• Systemic influences

• Seeking and understanding multiple perspectives

We can then targets resources and interventions for meaningful change


Thank you for your work!

Kelly Knutson: [email protected] Wilcox: [email protected]


mailto:[email protected]

mailto:[email protected]

Documents

Collaborative safety and MDT July 2019 conference · Screening Assessment Placement Case opening Child Safety and Permanency Division|mn.gov/dhs Reunification Case closing 14 Each