DISCOVERY & ACTION DIALOGUESA TOOL FOR GETTING STARTED

OCTOBER 22, 2013

What is a Discovery & Action Dialogue? • Discover what people are already doing that works

Positive Deviants

What is a Discovery & Action Dialogue?

• Discover what people are already doing that works Positive Deviants

• These deviants face the same restrictions as everyone else but find their own solutionsHidden and untapped solutions

What is a Discovery & Action Dialogue?

• Discover what people are already doing that works Positive Deviants

• These deviants face the same restrictions as everyone else but find their own solutionsHidden and untapped solutions

• They gain support as colleagues see the solutions working and then adapt the new thinking/behavingMomentum spreads

1. What do you know about (the problem) / how do you know when it’s present?

2. What do YOU do about it?

3. What are the BARRIERS that prevent you from doing (the right thing/process) 100% of the time?

4. Who are the Positive Deviants that are overcoming these barriers?

5. WHO ELSE needs to be part of this conversation? (“Don’t decide about me without me.”) How do we invite them to join the action?

6. What other ideas do you have? Any volunteers?

The “DAD”: 6 Questions

Q1:

How do you know when a resident is on inappropriate antipsychotics? (the problem is present)

• Affirm that we all have existing knowledge of the problem

• Provide opportunities to get questions on the table

The Details …

Q2:

How do YOU contribute to reducing inappropriate antipsychotic use? (solving the problem)

• Focus on personal practices, NOT on what other people don’t do

• Amplify / confirm the participant’s knowledge of effective practices

The Details …

Q3:

What prevents you from doing this or taking these actions all the time?

• Identify real barriers and constraints

• Ask: What prevents you?

vs Why don’t you?

The Details …

Q4:

Is there anyone you know who is able to frequently address BPSD without inappropriate medications?

(solve the problem, overcome barriers)

• Establish that getting around barriers is possible

• Identify the existing-but-uncommon successful strategies

The Details …

Q5:

Do you have any ideas? • Identify the supports that make the desired behaviour more likely

• Provide an opportunity for participants to generate and share new ideas for enabling the desired behavior

The Details …

Q6:

What needs to be done to make it happen? Any volunteers?

• Identify action steps, target dates & feedback loops for metrics

• Invite volunteers for each action step (capture ideas that don’t yet have an identified action plan or volunteer)

The Details …

Q7:

Who else needs to be involved?

• Who else can we bring in?

• Widen the circle of people involved in discovering solutions, drawing in unusual suspects

The Details …

Demonstration of a DAD

• What is the problem you are going to talk about? – Inappropriate antipsychotics?– BPSD?– Culture? – Care Planning?

• How will you get people to come?

• When will you hold the meeting or meetings?

• How will you follow-up with the information you learn?

Getting Started with a DAD

• Where? When? With Whom?

Arranging Space & Materials for the Conversation

• Where? When? With Whom?

• Have someone else record the responses so you can facilitate

Arranging Space & Materials for the Conversation

• Where? When? With Whom?

• Have someone else record the responses so you can facilitate

• Room set-up:– Chairs in a circle OR standing around a flip chart

Arranging Space & Materials for the Conversation

• Where? When? With Whom?

• Have someone else record the responses so you can facilitate

• Room set-up:– Chairs in a circle OR standing around a flip chart

• 5 – 15 people with diverse roles and experience is an asset, although one-on-one can be powerful too!

Arranging Space & Materials for the Conversation

• Everyone interested in solving the problem

Everyone Who Touches the Resident Can Participate

• Everyone interested in solving the problem• Look to your process map!

Everyone Who Touches the Resident Can Participate

• Everyone interested in solving the problem• Look to your process map! • Multiple disciplines and different roles

Everyone Who Touches the Resident Can Participate

• Everyone interested in solving the problem• Look to your process map! • Multiple disciplines and different roles• Who else?

– Residents– Families– Volunteers

Everyone Who Touches the Resident Can Participate

• Everyone interested in solving the problem• Look to your process map! • Multiple disciplines and different roles• Who else?

– Residents– Families– Volunteers

• Make sure everyone has an equal opportunity to participate

Everyone Who Touches the Resident Can Participate

• Start with the purpose “We are here to _______________!”

• “Give” the questions to the group, then wait at least 20 seconds for a response Sing Happy Birthday to yourself

• Encourage quiet people to talk

Facilitator “Do” Guidelines

How do you handle cynical responses?

“If I understand you correctly, no one has ever done this successfully or well.”

“What would you do if there was an opportunity for change?”

“Can you please re-frame what you just said with a question beginning with ‘what’ or ‘how’? Include some kind of action.

Facilitator “Do” Guidelines

• Work through all or some of the questions without worrying about the order

AND/OR • Follow the conversation with other questions

More “Do’s”

• Work through all or some of the questions without worrying about the order

AND/OR • Follow the conversation with other questions• Keep respect at the forefront of the conversation

More “Do’s”

• Work through all or some of the questions without worrying about the order

AND/OR • Follow the conversation with other questions• Keep respect at the forefront of the conversation • Have someone record responses on flip charts

More “Do’s”

• Don’t answer questions that haven’t been asked directly to youEven then, ask the group members to provide an answer (they are the wise ones who will have the answers)

• Don’t miss opportunities to “catch butterflies” Record ideas that got missed in the conversation

Facilitator “Don’t” Guidelines

• Don’t continue the conversation when others need to be present -“Nothing about me without me!”Invite them to the next dialogue

More “Don’ts”

• Don’t continue the conversation when others need to be present -“Nothing about me without me!”Invite them to the next dialogue

• Avoid responding positively or negatively to contributionsYou might ask, “How/What do others think or feel about this suggestion?”

More “Don’ts”

• Hold the dialogue out in the open

• Make impromptu invitations as you enter the area

• Create an “informal climate”, starting with introductions and a story if appropriate

• Maintain eye contact and sit with the group (not higher or far away)

General Tips & Traps

General Tips & Traps

• Talk less than participants, and encourage everyone to share stories and “sift” for action opportunities

• Draw out stories that help people make a leap of understanding from a small example of behavior change to a larger shift in values and/or resource sharing

• Demonstrate genuine curiosity in everyone’s offerings without answering the questions yourself

Reminders!

• Monthly Reports

• Team Charter

• Measures

• Next Webinar:

Experiences from the NHS on Reduction of Anti-Psychotic MedicationsNovember 12, 1100 – 1200Dr. Karim SaadConsultant Psychiatrist, Coventry & Warwickshire Partnership TrustAlzheimer Cooperative Valuation in Europe (ALCOVE)Lead for Dementia, NHS West Midlands

rescare@bcpsqc.ca

Questions?