leading sustainable change

Saskatchewan Institute of Health Leadership 2011

Michelle Schmalenberg, Crystal Hope and Minh Vuong

Team: Ernie How, Elizabeth Rackow,

Leading Sustainable Change: Patient and Family Centered Care

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Table of Contents

Background...................................................................................................................................................................................3

Project Overview ..........................................................................................................................................................................5

Survey and Worksheet Sample.....................................................................................................................................................7

Concluding Remarks .....................................................................................................................................................................8

Our Journey ..................................................................................................................................................................................9

Appendix Materials.....................................................................................................................................................................10

Survey……………………………………………………………………………………………………………………………………………………,……………………. A

Worksheet ........................................................................................................................................................................... B

Supplementary Tools............................................................................................................................................................C

Further Readings ................................................................................................................................................................. D

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Patient Family Centered Care:

Patient and Family Centered Care is working with

patients and families, rather than just doing to or

for them.

BACKGROUND

Patient and Family Centred Care is about providing respectful care that is responsive to the needs, values, and preferences of patients and their family members by working collaboratively with them and is grounded in mutually beneficial partnerships among patients, families and healthcare providers he or she is developmentally mature and competent to make such a decision. In October 2009, independent commissioner, Tony Dagnone released the Patient First Review Report, For Patients’ Sake. The Commissioner made the important point that “Our current health care system has been designed around the people who deliver the care. It is time to realign the values of Saskatchewan’s health system so that the patient is again made the centre of attention… Changes to the health system must serve to meet patients’ needs, and a publicly designed health system must reflect the values of the patients and citizenry, while enabling providers to do

their work in a stable, safe, supportive, and collaborative environment”. The report identified 13 recommendations to improve the patient experience, the first and foremost being, “that the health system make patient and family centred care the foundation and principle aim of the Saskatchewan health system.” (Ministry of Health: Patient and Family Centered Care Framework) Patient and Family Centered Care Core Concepts: Dignity and Respect. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.

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Information Sharing. Ultimately, the final result will be that information will be shared equally between health practitioners and patients/families, and patients/families will be the drivers, receiving and giving the information they require for informed decision making. The scope of the project includes information sharing between all members of the health care system to foster full participation.

Participation. All levels of the health care system will participate in learning and applying Patient and Family Centered Care principles. Specific to the project, managers will engage front line staff to participate in applying these principles during every health care encounter with every individual. The end result is that patients and families will be encouraged to participate in their own health and wellness decisions.

Collaboration. Patient and Family Centered Care is not just “being nice,” it is about partnerships and patient engagement. Ultimately, for Patient and Family Centered Care to become the consistent philosophy of care, it will require collaboration between employees at all levels of the health care system, external partners, and patients/families themselves. For the scope of this project, collaboration is to be fostered between managers, change leaders and the staff that they influence to foster transformational change at the front line. Implementing Patient and Family Centered Care has been proven to improve:

Patient and family experience (e.g. decreased

anxiety and stress)

Patient health outcomes (e.g. increased patient and family adherence to treatment plans)

Patient safety (e.g. decreased medical errors and infection rates)

Efficiency of the health system (e.g. reduced diagnostic tests and referrals, fewer readmissions, reduced length of stays, etc.)

Employee satisfaction (e.g. decreased staff turnover rates)

(Ministry of Health: Patient and Family Centered Care Framework)

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Project Overview: The Transformational Change Tool

Project Challenge Patient and Family Centered Care (PFCC) is a culture change, and is currently not consistently understood nor practiced across Saskatchewan’s health care system.

Hypothesis Effectively led change will result in consistent and sustainable Patient and Family Centered Care within the Saskatchewan health care system. Mission To provide a leadership tool that will support system leaders and engage health care providers in Patient and Family Centered Care resulting in a sustainable culture change.

Assumptions: 1. The health system is currently not patient and family centered. 2. A model for change has not been implemented nor followed consistently across the system resulting in lack of willingness to change. 3. Based on the Patient First Review, we know what the patient wants. 4. That the method we propose can be applied across all parts of the systems and transferrable to other change initiatives.

Constraints:

1. Front line staff believe they provide patient and family centered care 2. Resistance to change 3. Competing priorities

4. Buy‐in from management is lacking 5. Diversity of providers 6. Diversity of types of care 7. Geography

Project Overview: Using the community development principles and the factors of change, a leadership tool was developed. The tool will support system leaders lead the culture change necessary to establish a Patient and Family Centered health care system. Community Development Principles:

Promote active and representative citizen participation so that community members can meaningfully influence decisions that affect their lives;

Ensure that all levels of the work unit both horizontal and lateral are involved in the culture change.

Engage community members in problem diagnosis so that those affected may adequately understand the cause of their situations;

Involve all levels of the work unit in identifying what is Patient and Family Centered and what is not.

Help community leaders understand the economies, social, political, environmental, and psychological impact associated with alternative solutions to the problem;

Involve all levels of the work unit in understanding patient and family centered care and the impact it will have on the patient, the workplace and individual healthcare providers.

Assist community members in designing and implementing a plan to solve agreed‐upon problems by emphasizing shared leadership and active citizen participation in that process;

Involve all levels of the work unit in deciding the HOWs – how will we move our work unit from the present to the future state (see worksheet)

Disengage from any effort that is likely to adversely affect the disadvantaged segments of a community; and

Collaborate across the organization.

Actively work to increase leadership capacity (skills, confidence, and aspiration) in the community.

Provide support, education opportunities, skills development, empowerment, etc. to the team.

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Factors of change:

focus on the patient; Patient First

strong leadership; Top down leadership is crucial when the going gets tough. Build bottom‐up leadership by empowering others to succeed.

flatten the hierarchy; Allow others to take a leadership role, eliminate red‐tape, etc.

create a learning environment; and Mentorship

establish measurement Understand your current state and evaluate the future state and determine next course of action.

Transformational Change Readiness Survey Tool and Worksheet: In order to implement change that is sustainable, it is recommended that system leaders understand the current state within their organization as it relates to:

Vision for Change

Business Case for Change

Leadership

Communication

Individual and Team Capacity

Internal/External Events

Organizational Design

HR Practices

Culture By identifying the current state, system leaders can see where they are achieving engagement/success and where they are lacking. From there, it is recommended that system leaders engage health care providers and front line staff in identifying the future state – where the organization wants to go. By involving staff in the creation of a desired future state and enabling them to determine the HOWs, it is more likely they will feel

ownership, be committed, and feel included in the process thus increasing the potential for success. The Transformational Survey Tool and Worksheets will enable departments/work units to determine the capacity they have within their staff to effectively transform the system to one that is Patient and Family Centered. The survey has a range of questions pertaining to important areas that are necessary for transformational change. Each category of questions is paired with two worksheets, one for a low level of engagement and one for a mid level of engagement. The worksheets will help system leaders engage in meaningful discussion on the current state of the work unit, the desired future state, and facilitate a discussion on the HOWs. The HOWs being actionable items that will move the unit from the current to the future state. Moreover, this tool acts as a base line measurement. By being repeated throughout the course of the transformation, it can be utilized to determine progress. Likewise, the purpose of the worksheet is to involve staff in the change process. By gaining staff input on what the future state could be and what needs to be done, staff can work towards Patient Family Centered Care. Also, Included in the appendix is compilation of Patient and Family Centered related tools. These tools can be used as reference for staff as they work through the worksheet.

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Survey and Worksheet Samples:

Below is a sample of the survey and worksheet. The questions relate to the organizations understanding of Patient and Family Centered Care and its potential impact on the system. Based on how the work unit ranks after answering these questions, the current state is outlined in the worksheet and provides a basis for determining the desired future state and the HOWs.

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Concluding Remarks

By using the transformational change survey tool and working with staff through the worksheet, system leaders will gain staff buy‐in, create excitement and embark on a journey that will improve patient care and experience. By enabling staff to determine the desired future state and the HOWs, a dialogue is created and a balance between top down leadership and bottom‐up leadership begins to form. Staff want to be included in the decision making, it is even more important when it comes to Patient and Family Centered Care – as it is the frontline staff who will ultimately determine the success of this culture change, therefore it is crucial they are involved and empowered to transform the system. This transformational change tool will create ownership that will drive the culture change that is needed within the system. The survey can be re‐administered in order to gage success, and the guide is a simple, yet constant reminder that can be referred to and used again when projects stall, or when the team is ready to take on more.

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Our Journey

Learning #1: Team charter and project summaries are very important in seeing expectations and having a clear vision. As a team we felt that the team charter and the project summary were helpful steps in getting started. However, we abandoned those documents for a period of time during which we had troubles defining our project: how to lead transformational change. In the end, when we revisited them, we were surprised to learn that what we first set out to do, we unknowingly achieved by project end.

Learning #2: Collaborate! Collaboration as well as patience is vital to working effectively as a team. We had individual interpretations of the same vision and had to work together to develop a common team vision that we all understood. This involved listening, teaching one another, and coaching each other. There were calls that were frustrating, but we worked through the kinks and eventually had our A‐HA moment.

Learning #3: Using technology to communicate isn’t the same as having conversations. Working remotely had its challenges, the majority of our meetings were done via conference call, it was the face‐to‐face that really helped us bring the project together. Technology is not always the solution, but a tool to keep projects

Learning #4: When working on a project, make sure you have the right people around the table. Differing perspectives ensures you are covering all aspects of the project. It was also helpful to have team members with different backgrounds:

Student RHA managers who work with frontline staff Ministry representation

Make sure your team has the right people on it – ask yourself: how does the project I am working on affect people laterally and vertically within my organization.

SIHL 2011

APPENDIX

APPENDIX A

Survey Tool

Patient and Family Centered-Care Readiness Survey For each question, two responses are given with a range of responses between them. Please choose the value in accordance with how strong you feel about the answer. For each section, follow the formula in the bottom right corner to tally your scores. A. Vision for Change A1 Do you understand the contribution Patient

and Family Centered Care will make to the vision:(insert HR vision)?

Not at All 1 2 3 4 5

Very Much So

A2 Do you understand the change that implementing Patient and Family Centered Care will make on how Health Region Departments carry out their work?

Not at All

1 2 3 4 5

Very Much So

Formula: Total Score/2=_________ If score is less than 3 record W1 in box. If score is 3 or more record W2 in box.

B. Business Case for Change B1 Are you aware of Patient and Family

Centered Care?

Not at all aware

1 2 3 4 5

Very Aware

B2 Do you understand the goals and objectives of Patient and Family Centered Care?

Not at all well

1 2 3 4 5

Very Well

B3 How important is Patient and Family Centered Care in achieving your goal of meeting the mission and vision of the Health Region?

Of no importance

1 2 3 4 5

Essential

B4 How achievable are the goals of the Patient and Family Centered Care?

Not at all achievable

1 2 3 4 5

Entirely achievable


C. Leadership C1 Do you think your Leadership Team is

committed to the success of the Patient and Family Centered Care?

Not all committed

1 2 3 4 5

Very Committed

C2 Do you think that your Leadership Team has the right people involved to make this change happen?

Not at all 1 2 3 4 5

Very much so

C3 Do you believe your direct supervisor is committed to the success of Patient and Family Centered Care?

Not at all committed

1 2 3 4 5

Very committed

C4 Do you believe that your manager will help you to understand how you can support and adapt to changes needed to implement Patient and Family Centered Care?


Very much so

C5 Will you be able to support your manager through this change process?

Not at all 1 2 3 4 5 Very much so


D. Communication D1 How effective is communication from the

Leadership Team to frontline staff?

Very ineffective

1 2 3 4 5

Very Effective

D2 Are changes that directly affect your work communicated to you regularly?

Hardly Ever 1 2 3 4 5

All the time

D3 Do the messages you have heard on Patient and Family Centered Care make you feel that you will be comfortable with implementation?

Less Comfortable

1 2 3 4 5

More comfortable


E. Individual and Team Capacity E1 Is your job role clearly defined? Not at all

Unclear

1 2 3 4 5 Very clear

E2 Do you receive the necessary training and support to enable you to do your job more effectively?

Not a all 1 2 3 4 5

Very much so

E3 Do you understand how Patient and Family Centered Care will affect you?


Very much so

E4 Are you confident that you would receive the relevant training and support to enable you to fulfill any new activities/roles effectively within Patient and Family Centered Care?

Not at all confident

1 2 3 4 5

Very Confident

E5 As an individual, how quickly do you adapt to change?

Never 1 2 3 4 5

Almost immediately

E6 How quickly do you think that your organization adapts to changes?

Never 1 2 3 4 5

Almost immediately


F. Organizational Design F1 Are your reporting relationships clear (others

reporting to you and you reporting to others)?

Not at all clear

1 2 3 4 5 Very clear

F2 Do you think the decision making is effective?

Very ineffective

1 2 3 4 5 Very effective


G. Human Resources Practices G1 How often do you have reviews with your

manager to discuss objectives and priorities (i.e. personal, program, organizational)?

Never 1 2 3 4 5 Very Often

G2 Are the relationships between you and your leadership team effective to implement change?

Very Ineffective

1 2 3 4 5 Very Effective


H. Internal/External Events H1 Have previous change initiatives within the

health system achieved their objectives?

Not at all

1 2 3 4 5 Very much so

H2 Do you think that the health system is undertaking too much change at the moment

Not enough change

1 2 3 4 5 Too much change

H3 Do you think that the health system is undertaking too little change at the moment?

Too little

1 2 3 4 5 Too much

H4 Do you value change initiatives?

Not much

1 2 3 4 5 Very much


J. Culture Backward Looking

1 2 3 4 5 Forward looking

Unresponsive 1 2 3 4 5 Responsive

J1 How do you feel about the culture within your organization relating to change?

Directive 1 2 3 4 5 Involving

Formula: Total Score/3=_________

If score is less than 4 record W1 in box. If score is 4 or more record W2 in box.

K. Additional Questions K1 In your experience, what has helped change

projects to be successful within your organization?

K2 In your experience, what has limited the success of change projects within your organization?

K3 What do you think will be critical to the success of Patient Family Centered Care?

K4 What do you think could limit the success of Patient Family Centered Care?

APPENDIX B

Woorksheet

Patient Family Centered Care Transformational Change Survey and Worksheets

A. Vision for Change: Do you understand the contribution Patient and Family Centered Care will make to the vision:(insert HR vision)? Do you understand the change that implementing Patient and Family Centered Care will make on how Health Region Departments carry out their work? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section.

Adapted from OPIF Technical Change Readiness Questionnaire 1


Worksheet #1 Use the driver diagram to start an engaging discussion with staff about PFCC and work together to determine next steps in achieving your desired future state as a team. Refer to Appendix A for tools. Current State HOW Future State

Employees do not have a clear understanding of the health region’s vision. Employees do not have a clear understanding of the contribution Patient and Family Centered Care has on the region’s ability to deliver quality patient care.



Worksheet #2 Use the driver diagram to start an engaging discussion with staff about PFCC and work together to determine next steps in achieving your desired future state as a team. Refer to Appendix A for tools. Current State HOW Future State


Employees may have a good understanding of PFCC and HR vision but may have a fear of change and how it will impact heir work life. t


B. Business Case for Change: Are you aware of Patient and Family Centered Care? Do you understand the goals and objectives of Patient and Family Centered Care? How important is Patient and Family Centered Care in achieving your goal of meeting the mission and vision of the Health Region? How achievable are the goals of the Patient and Family Centered Care? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section.



Work Sheet #1 Use the driver diagram to start an engaging discussion with staff about PFCC and work together to determine next steps in achieving your desired future state as a team. Refer to Appendix A for tools. Current State HOW Future State


The goals and objectives of Patient and Family Centered Care are not well understood. The employees do not have a clear understanding of how Patient and Family Centered Care will improve the quality of patient care. The employees do not have a clear understanding of how Patient and Family Centered Care will improve workplace morale.



The goals and objectives of Patient and Family Centered Care are understood. The employees do not have a clear understanding of how Patient and Family Centered Care will improve the quality of patient care. The employees do not have a clear understanding of how Patient and Family Centered Care will improve workplace morale.



C. Leadership Do you think your Leadership Team is committed to the success of the Patient and Family Centered Care? Do you think that your Leadership Team has the right people involved to make this change happen? Do you believe your direct supervisor is committed to the success of Patient and Family Centered Care? Do you believe that your manager will help you to understand how you can support and adapt to changes needed to implement Patient and Family Centered Care? Will you be able to support your manager through this change process? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section.



Work Sheet # 1 Use the driver diagram to start an engaging discussion with staff about PFCC and work together to determine next steps in achieving your desired future state as a team. Refer to Appendix A for tools. Current State HOW Future State


Staff do not believe that Patient and Family Centered Care is a priority of the leadership team. Staff do not have confidence in their leadership team, and do not believe they are supported to make the changes necessary for Patient and Family Centered Care.




Staff believe the leadership team is committed to Patient and Family Centered Care. They have confidence in those involved in leading Patient and Family Centered Care. They feel supported by their direct supervisor and are willing to support Patient and Family Centered Care.


D. Communication How effective is communication from the Leadership Team to frontline staff? Are changes that directly affect your work communicated to you regularly? Do the messages you have heard on Patient and Family Centered Care make you feel that you will be comfortable with implementation? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section.





Staff do not believe they receive adequate communication about Patient and Family Centered Care from the leadership team. Communication is not consistent, clear, nor timely. Messaging received by staff about Patient and Family Centered Care is not adequate and does not help staff understand Patient and Family Centered Care.




Staff believe they receive helpful communication from their leadership team. Communication about Patient and Family Centered Care is consistent, clear and timely. Staff have an understanding of Patient and Family Centered Care and their role in advancing Patient and Family Centered Care.


E. Individual and Team Capacity Is your job role clearly defined? Do you receive the necessary training and support to enable you to do your job more effectively? Do you understand how Patient and Family Centered Care will affect you? Are you confident that you would receive the relevant training and support to enable you to fulfill any new activities/roles effectively within Patient and Family Centered Care? As an individual, how quickly do you adapt to change? How quickly do you think that your organization adapts to changes? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section.





Staff do not understand their role or how Patient and Family Centered Care will affect their practice. Staff do not feel they will be equipped to make necessary changes for Patient and Family Centered Care.




Staff understand their role and how Patient and Family Centered Care will affect their practice. Staff feel they will be equipped to make necessary changes for Patient and Family Centered Care.


F. Organizational Design Are your reporting relationships clear (others reporting to you and you reporting to others)? Do you think the decision making is effective? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section.





Staff do not understand what their leadership responsibilities are or those above them. Staff do not perceive that productive decisions are made.




Staff understand what their leadership responsibilities are or those above them. Staff feel that productive decisions are made.


G. Human Resources Practices How often do you have reviews with your manager to discuss objectives and priorities? Are the relationships between you and your leadership team effective to implement change? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section..





Objectives and priorities are not regularly discussed. Employees do not feel the relationship between themselves and their leadership team is ffective in implementing change. e




Objectives and priorities are regularly discussed. Employees feel the relationship between themselves and their leadership team is effective in implementing change. However, in both factors, communication and relationships, there may be still be some room for mprovement. i


H. External/Internal Events Have previous change initiatives within the health system achieved their objectives? Do you think that the health system is undertaking too much change at the moment? (Too much….Just Enough) Do you think that the health system is undertaking too little change at the moment? (Too Little….Just Enough) Do you value change initiatives? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section.





Employees perceive that change initiatives in the past have not been effective and do not achieve their objectives. Staff feel there are too many change initiatives taking place. If there have been no change initiatives implemented recently, employees feel there should be more initiatives introduced.




Employees believe that some change initiatives within the organization have achieved their objectives. Employees feel change initiatives are balanced.


J. Culture How do you feel about the culture within your organization relating to change? Go to Worksheet #1 if the majority of your team scored “W1” in this section. Go to Worksheet #2 if the majority of your team scored “W2” in this section.





Staff feel the culture within the organization is backward looking and unresponsive to change. Rather than involving employees in the organization’s decisions, management takes a directive approach.




Staff feel the organization is forward looking and response to change. Staff feel that management involves them in the decision making process.

APPENDIX C

Supplementary Tool

Supplementary Tools

A. Vision for Change Patient first Review: http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=79bf4a96‐ff32‐486d‐b4ab‐c0d2d4d42922&MediaID=3332&Filename=patient‐first‐recommendations.pdf&l=English Institute for Patient and Family Centered Care http://www.ipfcc.org/faq.html B. Business Case for Change

Institute for Patient and Family Centered Care http://www.ipfcc.org/pdf/PartneringwithPatientsandFamilies.pdf

Strategies for Patient Centered Care

http://www.aha.org/aha/issues/Quality‐and‐Patient‐Safety/strategies‐patientcentered.html

Patient Experiences in Acute Care Saskatchewan

http://www.hqc.sk.ca/portal.jsp?X3JzcRKTCGAvRhvh6/qyPDBIzBf0QfLQkUwK4QBZaJt0x+ZUqF3/ZFVvI5thiwzu

C. Leadership Institute for patient and family centered care workshop http://www.ipfcc.org/resources/other/hospital_self_assessment.pdf

Strategies for Leadership: http://www.aha.org/aha/content/2005/pdf/assessment.pdf

D. Communication http://www.mindtools.com/CommSkll/CommunicationIntro.htm

E. Individual and Team Capacity http://www.ipfcc.org/faq.html

F. Organizational Design Four stages of transformational leadership http://psychology.about.com/od/leadership/a/transformational.htm

Institute for Patient and Family Centered Care –getting started http://www.ipfcc.org/pdf/getting_started.pdf

http://www.health.gov.sk.ca/adx/aspx/adxGetMedia.aspx?DocID=79bf4a96-ff32-486d-b4ab-c0d2d4d42922&MediaID=3332&Filename=patient-first-recommendations.pdf&l=English



http://www.ipfcc.org/faq.html

http://www.ipfcc.org/pdf/PartneringwithPatientsandFamilies.pdf

http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategies-patientcentered.html

http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategies-patientcentered.html



http://www.ipfcc.org/resources/other/hospital_self_assessment.pdf

http://www.aha.org/aha/content/2005/pdf/assessment.pdf

http://www.mindtools.com/CommSkll/CommunicationIntro.htm

http://www.ipfcc.org/faq.html

http://psychology.about.com/od/leadership/a/transformational.htm

http://www.ipfcc.org/pdf/getting_started.pdf

G. Human Resources Practices Saskatchewan Institute for Health Leadership http://www.uregina.ca/cce/business/SIHL/SIHL%202010%20Brochure.pdf

SAHO Management competencies http://www.saho.org/portal.jsp?y3uQUnbK9L2RmSZs02CjVy0w7ZkI/ks641giY6LWDo597O3uWdv+zQ H. External/Internal Events Health Quality Council – shared decision model http://www.hqc.sk.ca/portal.jsp?X3JzcRKTCGAvRhvh6/qyPDBIzBf0QfLQkUwK4QBZaJv/Zt+uhrdKqlVvI5thiwzu

J. Tools for Specialized Areas

Institute for Patient and Family Centered Care – mini tool kit (safety) http://www.ipfcc.org/tools/Patient‐Safety‐Toolkit‐04.pdf

PDSA cycles. Health Quality Council http://www.hqc.sk.ca/portal.jsp?X3JzcRKTCGAvRhvh6/qyPDBIzBf0QfLQkUwK4QBZaJtcgd48p7IQX4zOVcA+lmY4

http://www.uregina.ca/cce/business/SIHL/SIHL%202010%20Brochure.pdf

http://www.saho.org/portal.jsp?y3uQUnbK9L2RmSZs02CjVy0w7ZkI/ks641giY6LWDo597O3uWdv+zQ

http://www.saho.org/portal.jsp?y3uQUnbK9L2RmSZs02CjVy0w7ZkI/ks641giY6LWDo597O3uWdv+zQ

http://www.hqc.sk.ca/portal.jsp?X3JzcRKTCGAvRhvh6/qyPDBIzBf0QfLQkUwK4QBZaJv/Zt+uhrdKqlVvI5thiwzu

http://www.hqc.sk.ca/portal.jsp?X3JzcRKTCGAvRhvh6/qyPDBIzBf0QfLQkUwK4QBZaJv/Zt+uhrdKqlVvI5thiwzu

http://www.ipfcc.org/tools/Patient-Safety-Toolkit-04.pdf

http://www.hqc.sk.ca/portal.jsp?X3JzcRKTCGAvRhvh6/qyPDBIzBf0QfLQkUwK4QBZaJtcgd48p7IQX4zOVcA+lmY4

http://www.hqc.sk.ca/portal.jsp?X3JzcRKTCGAvRhvh6/qyPDBIzBf0QfLQkUwK4QBZaJtcgd48p7IQX4zOVcA+lmY4

APPENDIX D

Further Readings

Additional Reading/Resources

The Practise of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World, Ronald Heifetz, Alexander Grashow and Marty Linsky. Harvard Business Press Leadership: 50 Points of Wisdom for Today’s Leaders, General Rick Hillier. Harper Collins Publishers Ltd. Effective Implementation Strategies and Tactics for Leading Change on Maternity Units, Debra Bingham, DrPH, RN: Elliot K. Main, MD. (2010) J. Perinat Neonat Nurs: Vol. 24, (1) pp. 32‐42. Models of Change: Carol Reineck, PHD, CNAA‐BC, COI. Journal of Nursing Administration. Volume 37, (9) pp. 388‐391

Transformational Leadership: Characteristics and Criticisms; Iain Hay, School of Geography, Population and Environmental Management Flinders University A Conceptual Model of Transformational Clinical Leadership Within Primary Care Group Practice; Harry A. Taylor, MD MPH; Barry R. Greene, PHD; Gary L. Filerman, PHD. Journal of Ambulatory Care Management, Volume 33, (2) pp. 97‐107. Embracing Transformational Leadership: Team Values and the Impact of Leader Behavior on Team Performance; John Schaubroeck; Simon S. K. Lam; Sandra E. Cha. Journal of Applied Psychology, Volume 92, (4) pp. 1020‐1030.

leading sustainable change

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