Success in the IC Setting: Strategies for Team‐Based Wellness Jennifer L. Hodgson, PhD, LMFT...
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Success in the IC Setting: Strategies for Team‐Based Wellness Jennifer L. Hodgson, PhD, LMFT Professor, East Carolina University Angela L. Lamson, PhD,
Success in the IC Setting: Strategies for TeamBased Wellness
Jennifer L. Hodgson, PhD, LMFT Professor, East Carolina University
Angela L. Lamson, PhD, LMFT Professor, East Carolina University
Doug Smith, MBA CEO, Greene County Health Care, Inc. Affiliate
Assistant Professor, East Carolina University Collaborative Family
Healthcare Association 14 th Annual Conference October 4-6, 2012
Austin, Texas U.S.A. Session # D5A October 6, 2012
1:30PM-2:10PM
Slide 2
Faculty Disclosure We have not had any relevant financial
relationships during the past 12 months.
Slide 3
Objectives At the conclusion of this workshop, participants
will be able to: 1.Discuss the long term challenges of providing
care for a complex patient panel in a FQHC setting. 2.Describe a
theory of relational leadership and systemic dynamics. 3.Describe
common workplace dynamics that can lead to a decrease in
productivity and provider well-being. 4.Gain knowledge about the
use of intentional relational strategies to help build sustainable
integrated care teams
Slide 4
Need/Practice Gap Working in an integrated care setting, while
enriched by the sharing of complex patients, assumes that teams
function well automatically and methodologically without relational
challenges. *When teams struggle with interpersonal challenges they
are vulnerable to the same loss in productivity and increase in
presenteeism and absenteeism as their patients *Team members under
stress are at risk for developing the same health issues as their
patients *In order to reduce staff turnover and administrative time
managing employee disputes, curriculum is needed to help teams
maintain relational well-being between the staff and
providers.
Slide 5
Greene County Health Care, INC. Quick Facts 30, 822 patients
Rural setting 10 sites 6% Medicaid 87% are uninsured 100% of
patients are below 200% of the FPL Community Health Center (FQHC,
PCMH)
Slide 6
Theory of Relational Leadership Leadership is a relational and
ethical process of people together attempting to accomplish
positive change. Five primary components... This approach to
leadership is purposeful and builds commitment, inclusive of people
and diverse points of view, empowers those involved, is ethical,
and Recognizes that all four of these elements are accomplished by
being process-oriented. Uhl-Bien, 2003
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Process is just as important as outcome Know yourself and
others; engage yourself in learning new information as you develop
the competencies required in your role (knowledge) Be open to
difference and value other perspectives (attitudes) Practice
listening skills, coalition building, interpersonal skills, and
effective civil discourse (skills) Komives, Lucas, & McMahon
(2006)
Slide 8
Systemic Dynamics that Impact the Workplace Environment
Appreciate that each member manages anxiety differently
Non-summativity-the whole is greater than the sum of its parts
Boundaries are the interface between a system and its subsystems or
a system and its environment Systems are goal seeking A closed
system receives no inputs Systems tend toward homeostasis Synergy
is when the system outputs exceed the subsystem outputs
Slide 9
Sources of Power French and Raven (1959) identify five primary
sources of power that individuals bring to their relationships with
others expert power referent power legitimate power coercive power,
and reward power. French & Raven, 1960
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The key gift that leaders can offer is power Bolman & Deal,
2003, p. 341.
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Sources of Stress 1 Insufficient Resources at My Organization
Time Constraints Insufficient Referral Network
Family/Responsibility Work-life Balance Staff Turnover
Organizational Structure Sufficient Team Support Culturallly
Appropriate Resources Insufficient Resources for my Patients Work
Load 1 Hayashi, Selia, McDonnell, Stress and Provider Retention in
Underserved Communities, J of Health Care for the Underserved
20(2009): 597-604.
Slide 12
Workplace Dynamics Organizational Changes Staff Turnover
Communication Styles/Emotional Intelligence Management Team
Involvement Retention Strategies Training New Staff Healthy
Workspace Training/Four Colors Stress/Frustration Technology
Family/Behavioral Issues Generational Difference in Work Ethic Turf
Issues Sexual Harassment Training ???????????? Access to MFTs
Policies Team Meetings
Slide 13
A Team-Based Relational Curriculum Individual, colleague, and
group consultation services Provider and staff workshops on Anger
Management Compassion Fatigue Stress Management Healthy Workplace
Communication Working with the difficult patient Setting Boundaries
and Finding Balance between work and family True Colors
(http://www.true-colors.com/content.php?id=18)
Slide 14
Can you recognize relational stress before it hits you?
Anything that poses a challenge or a threat to our well- being is a
stress. Stresses can be positive or negative. It is also the way
that we respond to a challenge Belmonte, J. (2001-2008).
Understanding stress. Retrieved from
http://www.helpguide.org/mental/stress_signs.htm#what
Slide 15
The situations and pressures that cause stress are known as
stressors. We usually think of stressors as being negative, such as
an exhausting work schedule or a rocky relationship. Anything that
puts high demands on you or forces you to adjust can be stressful.
Top Ten Stressful Life Events 1. Spouses death 2. Divorce 3.
Marriage separation 4. Jail term 5. Death of a close relative 6.
Injury or illness 7. Marriage 8. Fired from job 9. Marriage
reconciliation 10. Retirement Belmonte, J. (2001-2008).
Understanding stress. Retrieved from
http://www.helpguide.org/mental/stress_signs.htm#what
Slide 16
There is a difference between Stress and Burnout Burnout is the
loss of meaning in one's work Stages include: Honeymoon Balancing
Act Chronic Symptoms Crisis Enmeshment Veninga and Spradley's
(1981)
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Exercises to De-Stress Creating Clear Goals for Self and Team
Diaphragmatic Breathing Guided Imagery Progressive Muscle
Relaxation Speaker-Listener Technique
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A Plan of Action to Reduce Stress! 1) small rather than large
goals 2) be specific 3) the goal should be achievable/assignable 4)
the plan should be realistic 5) understand the goal as the start of
something not as the end of something 6) when reducing stress
involve a new behavior rather than just stopping old behavior or
habit
Slide 19
Goal Setting to Minimize Stress! Urgent and Important Urgent
and Not Important Not Urgent and Important Not Urgent and Not
Important *Prioritize *Set yourself up for success Covey, 1990
Slide 20
1.) Find a calm quiet space 2.) Visualize walking down a long
hall leaving where you are fading in the distance behind you 3.)
Open the door at the end of the hall to your idea of a peaceful and
safe place 4.) Experience that place with all of your senses:
sight, taste, smell, touch, and hearing Guided Imagery
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5.) When you feel ready turn around and walk slowly toward the
door feeling refreshed and prepared to face what is on the other
side 6.) Turn around once more to drink in that place knowing that
you will be back again 7.) Open the door and slowly walk down the
hall with the light becoming brighter and the hallway wider as you
re-enter the place where you are now. 8.) Open your eyes Guided
Imagery (continued)
Slide 22
Speaker Listener Technique The Speaker-Listener Technique
offers you an alternative way of communicating when issues are hot
or sensitive, or likely to get that way. Markman, H., Stanley, S.,
& Blumberg, S. L. (1994). Fighting for your marriage: Positive
steps for preventing a lasting love. California: Jossey-Bass Inc.
Slides adopted from
http://www.marriagemissions.com/the-speaker-listener-
technique/
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RULES FOR THE SPEAKER: 1. Speak for yourself. Dont mind read.
Try to use I statements, and talk about your own point of view. 2.
Talk in small chunks. You will have plenty of opportunity to say
all you need to say, so you dont have to say it all at once. It is
very important to keep what you say in manageable pieces to help
the Listener actively listen. A good rule is to keep your
statements to just a sentence or two, especially when first
learning the technique. 3. Stop and let the Listener paraphrase.
After saying a bit, perhaps a sentence or two, stop and allow the
Listener to paraphrase what you just said. If the paraphrase was
not quite accurate, you should politely restate what was not heard
in the way it was intended to be heard. Your goal is to help the
Listener hear and understand your point of view. Markman et
al.
Slide 24
RULES FOR THE LISTENER: 1. Paraphrase what you hear. To
paraphrase the Speaker, briefly repeat back what you heard the
Speaker say. The key is that you show your partner that you are
listening as you restate what you heard, without any
interpretations. If the paraphrase is not quite right (which
happens often), the Speaker should gently clarify the point being
made. If you truly dont understand some phrase or example, you may
ask the Speaker to clarify or repeat, but you may not ask questions
on any other aspect of the issue unless you have the floor. Markman
et al.
Slide 25
2. Dont rebut. Focus on the Speakers message. While in the
Listener role, you may not offer your opinion or thoughts. If you
are upset by what your partner says, you need to edit out any
response you may want to make, so you can continue to pay attention
to what your partner is saying. Wait until you get the floor to
state your response. As Listener, your job is to speak only in the
service of understanding your partner. Your task is to understand.
Good listening does not equal agreement. You can express any
disagreement when you have the floor.
Slide 26
RULES FOR BOTH OF YOU: 1. The speaker has the floor. Use a real
object to designate the floor. When giving seminars, we hand out
small cards or pieces of linoleum or carpet for couples to use. You
can use anything, thoughthe TV remote, a piece of paper, a
paperback book, anything at all. If you do not have the floor, you
are the Listener. As Speaker and Listener you follow the rules for
each role. Note that the Speaker keeps the floor while the Listener
paraphrases, keeping it clear who is in which role all the time. 2.
Share the floor. You share the floor over the course of a
conversation. One has it to start and may say a number of things.
At some point, you switch roles and continue back and forth as the
floor changes hands. 3. No problem solving. When using this
technique you are going to focus on having good discussions. You
must consciously avoid coming to solutions prematurely. Markman et
al.
Slide 27
Additional Helpful Thoughts for Using this Method: When using
the Speaker-Listener Technique, the Speaker is always the one who
determines if the Listeners paraphrase was on target. Only the
Speaker knows what the intended message was. If the paraphrase was
not quite on target, it is very important that the Speaker gently
clarify or restate the point and not respond angrily or
critically.
Slide 28
The heart of the matter At the heart of the matter, the real
changes are in how you think about yourself. By discovering your
limitations and then overcoming them, you learn to be your own
hero. And that, for most of us, is the biggest change of all. John
Bingham
Slide 29
Discussion / Q & A
Slide 30
References Bolman, L. G., & Deal, T. E. (2003). Reframing
organizations: Artistry, choice, and leadership. San Francisco, CA:
Jossey-Bass. French, J. P. R., & Raven, B. (1960). The bases of
social power. In D. Cartwright and A. Zander (eds.), Group dynamics
(pp. 607-623). New York: Harper and Row. Komives, S., Lucas, N.,
& McMahon, T. (2006). The relational leadership model. In
Exploring leadership: For college students who want to make a
difference (2nd ed., Chap.3, pp. 73-114). California: Jossey-Bass.
Retrieved from http://www.nclp.umd.edu/include/pdfs/Exploring%20
Leadership%20II%20- %20Chapter%203.pdf.
http://www.nclp.umd.edu/include/pdfs/Exploring%20 Uhl-Bien, M.
(2003). Relationship development as a key ingredient for leadership
development. In: S. Murphy and R. Riggio, Editors, The future of
leadership development, Lawrence Erlbaum Associates, New Jersey,
pp. 129147.
Slide 31
Contact Information Jennifer L. Hodgson, PhD, LMFT East
Carolina University [email protected] Angela L. Lamson, PhD, LMFT
East Carolina University [email protected] Doug Smith CEO, Greene
County Healthcare Inc. [email protected]
Slide 32
Session Evaluation Please complete and return the evaluation
form to the classroom monitor before leaving this session. Thank
you!