creating a positive chain of leadership david farrell, msw, nha
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High Performing Nursing HomesThree Common Elements - Culture – person-centered care Workforce commitment Leadership practices
All three are interdependent
Grant, L. 2008
Results are Interrelated Implement principles of culture change
Enhanced leadership practices Employee satisfaction Workforce stability
Low turnover, high retention, low absenteeism Consumer satisfaction Clinical outcomes Regulatory compliance Occupancy rate and mix
Grant, L. 2008
Kind Caring Staff
Know me as an individual
Quality Care
A Consumer Perspective on Quality Care: The Residents’ Point of View
NCCNHR 1985
Drivers of Consumer Satisfaction Caring staff Competent staff Choices and preferences Nursing care Responsive management Respectfulness of staff
MyInnerView, Inc. 2010
Better Census and Resources for More
Improvement
Improved Quality and Satisfaction
Staff Stability and Engagement
Path to Improvement
© B&F Consulting Inc. 2011 www.BandFConsultingInc.com
People and Systems Development
Drivers of Staff Engagement
Management cares about employees Management listens to employees Help with job stress
MyInnerView, Inc. 2010
Building Trust and Making a Statement Presence
“You go into the rooms?” Asking and delivering Listening Speaking with conviction Painting the graffiti
Adapted from Albert Einstein Health Foundation, Philadelphia,
PA., 1990
Leadership Practices Matter Most
Leadership Practices
Process Improvement
Performance Improvement
Person-Centered
The Impact of Leaders
Healthcare organizations Fragile ecosystems Leader’s actions influence:
Culture Relationships
Staff engagement Clinical outcomes Quality of life
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People ParadigmW. Edwards Deming: Quality, the result, is a function of quality, the
process Essential ingredients of the process:
Leaders and their people Cannot improve interdependent systems and
processes of care until you progressively improve interdependent, interpersonal relationships
Theory of Relational Coordination
The effectiveness of care and service is determined by the quality of communication among staff
Which depends on the quality of the underlying relationships
The quality of the relationships reinforce the quality of the communication
Gittell, et al, 2008
Food Service
Physicians
NursesCNAs
Therapists
Healthcare Organizations
Nurses
CNAs
Therapists
Food service Physicians
Within functions Across functions
Gittell
Trigger Relational Coordination
Leadership actions Increase Communication
Frequency, timeliness Accurate, transparent, frequent Model problem solving
Enhance Staff Relationships Shared goals Enhance shared knowledge Model mutual respect
Relational Coordination Works Significantly associated with –
Enhanced resident quality of life Higher nursing assistant job satisfaction
Evident in SNFs implementing person-centered care
Gittell, et al, 2008
20
Quality is All About Relationships Between co-workers Across departments Between supervisors Frontline and supervisors Staff and residents Between residents Staff and resident’s family members
Eaton, S. 2001
Thank You Cards Cards are powerful
Send them to staff members’ homes Birthday cards Anniversary cards Excellent attendance “I appreciate you” “I am glad you work for us. On behalf of the
residents, their families and your co-workers – Thank you.”
Relationship Facilitation Strategies Ample supplies at hand Resident transfer equipment at hand Report between shifts Staffing configurations Staff composition
Relational Coordination in OaklandKey changes – New name badges Created efficiencies Mitigate conflict “Just in time” compassion
Tragedies in their lives
Enhancing Staff Relations
Karaoke Kids Day Heritage Days Senior Prom Weight Loss Challenge Safety Huddles
Manage Relational Coordination
Our systems and structures of communication create our relationships and our culture
Relational Coordination Applied to Staff Assignments
LOW:Rotating
Assignments
HIGH:Consistent
Assignments
Communication and Relationship Factors
© B & F Consulting, Inc. www.BandFConsultingInc.com
Relational Coordination Applied to Shift Hand-off
LOW:Tape
recorded
HIGH:Structured Person to
person discussion
with checklist
Communication and Relationship Factors
© B&F Consulting Inc. 2011 www.BandFConsultingInc.com
Relational Coordination Applied to Interdisciplinary Problem-solving
LOW:Conducted by 2 managers and solution rolled out via
in-service
HIGH:Root-cause
analysis conducted by PIP team led to successful pilot test and then facility-
wide adoption
Communication and Relationship Factors
© B & F Consulting, Inc.
Enhancing Relational CoordinationFollow QAPI systematic process - Charter Performance Improvement Projects Learn, teach and utilize
Ice breakers Root-cause analysis Brainstorming Flow chart Learning circle
Empowerment
Humility Listen to others perspectives Stakeholders –
Who is effected? Who can help us understand this better?
Involvement = success of changes Spread Sustainability
Leadership Visibility
Rounds to trigger engagement Engage the heart and minds of staff What you do and say matters
Meet and greet, linger Observe – processes of care, handoffs Praise, build self-esteem Build trust Foster teamwork
Invisibility
“The problem is not motivation. It is theways in which we unintentionally de-motivate employees.”
Quint Studer
Community Meetings Performance data
Human resource Clinical outcomes Business results
Benchmark and compare Celebrate positives
Employee and rookie of the month Raffles Patient safety chain
The “Golden Rule” Christianity
Do unto others, as you would have them do unto you Islam
No one of you is a believer, until he loves for his brother what he loves for himself
Judaism What you hate, do not do to anyone
Hinduism Do nothing to thy neighbor, which thou would not have them do to thee
Buddhism Hurt not others with that which pains thyself
Confucianism What you do not want done to thyself, do not do to others
Assume the Best
To bring out the best - Self-fulfilling prophecy Express confidence Spark optimism “I’m proud of all of you.”
Sutton, R., 2010
Bad is Stronger Than Good
Eliminate the negative Interdependent work = larger negative effect Grumpiness is contagious
Felps, W. 2001
Human Beings are FlawedWhat exposes the flaws?
Workload, fatigue Broken systems Lighting, noise, distractions Personal issues Coworkers behaviors Equipment, supplies
41
Who are the CNAs?
Total 1.47 million Deliver 80% of hands-on care 90% are women 51% are non-white Average age is 38 50% are near or below the poverty line 41% rely on public benefits
GAO, 2001National Clearinghouse on the Direct care Workforce, 2006BLS 2006, FHCEF 2010
Common Forms of Feedback Silence Negative Positive Deliver feedback to individuals and teams:
Timely Be specific Be sincere End on a positive
CompassionPerformance
Person-Centered Care Leadership
“We missed you yesterday…and the residents did too. I hope your son is feeling better. We are a better place when you are here.”
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