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@theEdgeNHS | #EdgeTalks
The Key Ingredient To Organisational Transformation
Dr Irv Rubin and Matt Stone, TemenosDr Maxine Craig
Friday 6 May 2016 at 9.30am BST
Joining in today and beyond• Please use the chat box to contribute
continuously during the web seminar
• Please tweet using hashtag #EdgeTalks and the handle @School4Radicals @theEdgeNHS
• Send a request to join our Facebook group School for Health and Care Radicals and The Edge NHS
The team today
Chat room monitorDom Cushnan @DomCushnan
Twitter monitorKate Pound@KateSlater2
Session chairOlly Benson@ollybenson
Our presenters
Irv Rubin, Ph.D.CEO, Temenos, Inc.@temenosinc
Matt Stone, J.D.COO, Temenos, Inc.@MattStone048
Dr Maxine Craig@maxine_craig
Key Ingredient to Organisational Transformation
-Edge Talk-
6 May 2016
Copyright © 2016
Overview1
The Organisation as Patient
2 Key to Better Engagement
3Feedback Technique
4Behavioural Diagnostic Tool
Copyright © 2016
THE TRUTH HAS BEEN TOLD...AND IT IS OLD
REVANS' RESEARCH [1964] SALMOND'S RESEARCH [1972]
•LENGTH OF PATIENT STAY...UNRELATED TO SIZE
•THE RICH WERE NOT GETTING RICHER!
•HIGH-TOUCH NOT HIGH TECH WAS THE EXPLANATION
•NURSING TURNOVER AND LoS HIGHLY CORRELATED
Copyright © 2016
Houston, we Have A Problem:Healthcare Is In Trouble
Malpractice is destroying health care
Tens of thousands are dying from treatment unrelated to their
admitting condition
Untold numbers of near misses go unreported
Good nurses are hard to find and hard to keep
Copyright © 2016
Zooming in on the Nurses:The Point of ‘TLC’
Disruptive Behaviors Witnessed orExperienced by Nurses (N=2562)
Condescension 69%Disrespect
80%Abusive anger43%Abusive language69%Berating patients26%Physical abuse 22%
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How Often Does It Happen?
38% up to 10 times per year
29% 1 - 2 times per month
24% weekly
7% daily
2% never
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Who Are The ‘Perpetrators’?
6 - 9 % exhibit over 70% of the disruptive behaviors
Majority of staff exhibit 28% of the disruptive behaviors
2% of the staff were seen as exhibiting 0% of the behaviors
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Not Just An American ‘Dis-ease!”2 District Hospitals; 4 Community Hospitals;
9 Practices; 3 PCT Headquarters
33% = Weekly or More Often
8% = Daily
37% = Once/Twice in Last Month29% = Not Once in Last Month
Copyright © 2016
BQA: CQI At The Individual Level
TechnicalEffectiveness BQA
ManagerialEfficiency
Three-legged Stool
Copyright © 2016
Behavioral Quality Assurance (BQA)
1. CURING F (Science of Medicine)Focus of traditional Q.A.
“Having the hard technologies and science of medicine been appropriately and skillfully applied in service of curing?”
2. HEALING F (Art of Medicine)Focus of BQA
“Have ALL the hands laid on patients been appropriately and skillfully applied in the service of healing?”
Copyright © 2016
A Spiritual Sister in Chiba, Japan:St. Marguerite Hospital
To heal sometimes.To support often.
To comfort always.
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One Example of Failure To Embrace This Truth and The Consequences
QUESTION: Does It Make a Difference Which E.R. You’re Taken to?
[Over 5000 Patients]ANSWER: Only a Matter of Life or
Death! [60% survival versus 58% Deaths
“Differences Appear to relate to the quality of the interaction and communication between physicians and nurses…”
[Knauss, et.al., Annals of Internal Medicine, Vol. 104]
Copyright © 2016
True or False?__ We have one common Behavioral code of conduct for everyone.
__ Our Behavioral Code of conduct is enforced without ‘favoritism.’
__ Everyone gets a performance review at least yearly.
__ Both technical and interpersonal competencies impact performance rating.
__ Feedback is direct and face-to-face versus anonymous and averaged.
Potential Managerial Malpractice Liability Quiz
Copyright © 2016
True or False?
__ We have “dead messengers” in some of our closets.
__ We have big “undiscussed elephants” on some of our meeting room tables.
__ We know that ‘staff infections’ are as potentially lethal as ‘staph infections.’
__ We know that the culture in the Boardroom filters into the treatment room.
__ We view our organisation as a human entity, a “Patient in need of care.”
-Cont-
Copyright © 2016
It Starts With What We Believe
• Identity must be “either or”
• Treatment of people become a “yes and”
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Do We Have the Courageand Integrity?
AndBeHaveItOfTheToWillYou
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BQA: CQI At The Individual Level
TechnicalEffectiveness BQA
ManagerialEfficiency
Three-legged Stool
Awareness = Seek and Provide Feedback on
Consequences of Behavior
Behavior = Strive to Learn and Exhibit Win-Win Behaviors Regularly
Consequences = Monitor Impact of Behavior Regularly so As to Increase Awareness
Copyright © 2016
Dr. Maxine Craig
2015
PAST - 2003&
The here and now
2003
Some of the biggest challenges
we face are not far far away …
but in my opinion are the ones we encounter in our
every day work
What we worked out :
•People had not known how to give feedback in a way that was impactful and might have stopped things developing•We had no process of assuring the behaviour of our leaders and our staff
Technical CLINICAL Effectiveness
BQA
ManagerialEfficiency
Three-legged Stool
© 2003 Temenos ®, Inc., USA. All rights reserved.
The information needed to prevent
thedisaster was known
PUSH
PULL
Describe Prescribe
Understand Ask
Appreciate Inspire
Empathise Attend
Copyright © 2016
2 Key to Better Engagement
Copyright © 2016
Engagement is a quality of a relationship, not a person…
taking place from the inside-out,
not the outside-in.
and…It’s all personal.
Copyright © 2016
The New Executive Listening Tour“We want your input!”
Summer Picnic/BBQ
Remodeled Breakroom
Christmas/Holiday Party
Retreat
New “Values” Statement
Copyright © 2016
Connectivity ≠ Connectedness
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Self-Assessment Personality Profiling
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Google Research on Building Great Teams(http://nyti.ms/20Vn3sz)
Good vs. Dysfunctional Teams Hinged on: “how teammates treated one another.”
Putting the “best people” or similar people into groups does not correlate to good team performance.
MOST IMPORTANT FACOR:PSYCHOLOGICAL SAFETY
Copyright © 2016
Feedback
Copyright © 2016
BEHAVIORAL FEEDBACK
The key to all Learning and Development
In a Relationship
Copyright © 2016
We need to rehabilitate this word.
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Anonymous 360s
The Cure that Worsens the Illness.
Annual Performance Reviews
A Compliance Task“Whew, glad we could check that box!”
Copyright © 2016
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Relationships
are
Relational Infrastructure
“Culture is built through shared learning and mutual experience.”
–Ed Schein, Ph.D.
Feedback Organisational Transformation???
Feedback is the key to developing and sustaining a
shared experience.
4 Keys to Successful Feedback
RegularitySkill
HonestyCompassion
–Dr. Rose N. Franzblau
“Honesty without compassion and understanding is not
honesty, but subtle hostility.”
Copyright © 2016
Beware the shortcut answers.
“Empower your People”“Support Enthusiasm”“Encourage Learning”
“Invite Input”“Create Fun Environment”
“Be Flexible”
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3Feedback Technique
Copyright © 2016
“DAP”Feedback Technique
Copyright © 2016
[D] The report was due at 2:00 and it’s 3:30.
[A] It’s hard to trust your word when you don’t keep a commitment.
[P] In the future I need you to call me before-the-fact if you need to re-negotiate a change in the schedule.
Describe: The FactsAppreciate: Your Feelings
Prescribe: Your Suggestion/Need
Be Specific D A P
Copyright © 2016
[D] "My kids are still sick and you’ve bailed me out twice now."
[A] "I really value your support."
[P] "Let me know if you ever need any help from me."
Copyright © 2016
4Behavioural Diagnostic Tool
Relationships Thrive on Behavioral Feedback
Easy to Use
Fast
Non-Judgmental
Proven Model
Specific, ActionableBehaviors
Inviter(Richard)
Invitee(Kim)
“Please give me feedback.”
Invitee
“Kim”
Desire for More/Less/Same
Five Priority Behaviors
Frequency Perception
Inviter“Richard”
Inviter’s Survey Limited to His/Her Frequency Perception
For Comparison with Invitee’s Perception
1
See how another person sees you behaving when you are dealing
with them—their impression of you.
The Behavior Minder® Enables you to do three things:
2
Compare this with how you see yourself behaving with this person—your impression of yourself.
3
Identify specific actions to further strengthen the relationship—to extend its
win-win range and potential.
MoreTrust
Mutual UnderstandingInfluence
CollaborationConstructive Conversations
Cooperation
Join us Facebook.com/temenosinc
Follow usTwitter.com/temenosinc
Visit us
www.temenosinc.com
Thank You!
We are witnessing the emergence of a new
phenomenon in healthcare: self-organising, online
communities, all focused on a particular disease area. We
know from other digital platforms just how quickly
these platforms can evolve, disrupt old business models
and create entirely new businesses.
Paul Hodgkin and Ben Metz interviewed more than 50 actors working with online health communities to map and explore this emerging
field, to begin to build an on-going community of experts and practitioners who look to understand this new field and
accelerate its successful interaction with the NHS and
policy makers.
JUNE EDGE TALK: EXPLORING ONLINE HEALTH COMMUNITIES, WITH PAUL HODGKIN AND BEN METZ
FRIDAY 3 JUNE, 09.30 – 11.00 (GMT +1)
Find out more at http://
theedge.nhsiq.nhs.uk/june-edge-talk-exploring-online-health-communities
.
#EdgeTalks