participative leadership: what is it, and why does it … leadership: what is it, and why does it...

Participative

Leadership: What is it,

and why does it

matter?

Adrian Norbash, Ashley Collette, Beth Gallant-Loggie &

Heath Robson

2017 BC Health Leaders Conference –

13 October 2017

Canadian Forces Health Services Group

AGENDAAddiction and Substance Use Disorder (SUD) in the Canadian Armed Forces

Introduction

Why social connection, support and meaning/purpose matter?

What does the current addiction and SUD situation look like in the CAF (why

are we different)?

What does the prevailing culture and our relationship with the Chain of

Command look like and why?

What does our current Base Addictions and Aftercare program look like today?

What are we doing to improve the care we deliver, and how does participative

leadership factor into our design – Aftercare Improvement Initiative

Open discussion and Q&A


Still today…the common understanding of

addiction is wrong…and it’s hurting us all

What gets us into trouble is not what we don't know. It's what we know for

sure that just ain't so - Mark Twain

The story of Rat Park, the Vietnam War, and what it should mean for us today

Addiction must be viewed as a community and public health illness, as

opposed to a disease of individuals alone. Only when we understand this issue

properly can we expect to address it properly.

Reference: Everything you think you know about addiction is wrong - Johann

Hari. TED Talk, July 2015


Substances of AbuseMyths, Facts, and Implications for the CAF


Drugs/Drug Classes

Opioids (Narcotics)

Alcohol Cocaine/Crack/Methamphetamine

Hallucinogenics/Dissociative Drugs

Gamma Hydroxybutyrate (GHB)

Nicotine

Marijuana/ Synthetic cannabinoids

Other Synthetics


Risk of Mental Health Disorders in CAF

Higher incidence of adverse childhood events

Higher incidence of psychological trauma (e.g.

deployments)

Military factors (frequent moves, acculturation,

separation from family)

In SUDs, the military culture may play a role


Selected 12- month disorders by Regular Force

members (2013) & Canadian population (2012), aged

17 to 60


Canadian population


CAF data (Stats Can 2013)

full-time regular force

members

%

Any selected mental or

alcohol disorder116.5

Major depressive episode 8.0

Post traumatic stress disorder 5.3

Generalized anxiety disorder 4.7

Panic disorder 3.4

Alcohol abuse or

dependence24.5

http://www.statcan.gc.ca/daily-quotidien/140811/t140811a001-eng.htm#fn01

http://www.statcan.gc.ca/daily-quotidien/140811/t140811a001-eng.htm#fn02


Treatment for alcohol – DAOD 5019-7

The Chain of command is responsible for ensuring that a CAF member who is believed to be displaying unacceptable alcohol-related conduct or performance is referred to a CAF medical care provider for assessment. A DAOD 5019-7A: Medical Referral and Certification

Only a CAF medical care provider or a CF addictions counsellor may assess, recommend treatment for, and treat alcohol abuse or alcohol dependence.

A CAF medical care provider shall fully describe and explain to the CO, by appropriate means, any medical employment limitations (MELs) assigned to the CAF member and any time required away from the workplace for medical reasons.


Considerations in Safety-Sensitive

occupations

Drug use likely and foreseeably impairs cognitive

function

Intoxication is consistently associated with an

increased vehicle crash risk

Most pronounced in high cognitive demand positions

Medical Employment Limitations (MELs)

No flying (pilot)

No operating commercial transport

No driving in line of duties, incl. emergency driving

No training in, or use of firearms (handguns and/or long guns)

No operational duties

No shift work

No night work

No task where incapacitation is a danger to self or others

No situation where the employee may be involved in confrontation

No duties where employee is expected to respond to emergencies

In summary: No decision-critical duties & No safety sensitive

duties


Criteria for retention…for now

The involvement constitutes a first time established involvement with drugs

Limited to personal use or possession for personal use

Did not take place on duty and did not create an immediate danger to operational readiness, security or safety

Unlikely repeat unauthorized use

Conduct and performance otherwise satisfactory and capacity for leadership has not been compromised


Ecological model of SUDs


Ecological factors

CAF culture related to addiction

Stigma of mental health treatment – where we were and

where we are now

Influence of chain of command in recovery

Closing the circle of care - where we are going


Aftercare group

Mandated program for members who complete a

residential treatment program

Attendance: 6 months – 1 year

2 hour sessions, 2x/week

Considered a medical appointment

Not 12 step, but aligned with principles

Uses CBT, MI, strengths based and psycho-education

approach


Changes to Aftercare

Increased attendance – up to 20 members

Counsellors facilitate, members participate

Emphasis on peer support approach


So what are we doing?

Focus of our Aftercare Improvement Initiative

Engage, Educate, Enable (Patient, CoC, Family, Ourselves)

Change the culture through respectful two way dialogue

(ambitious, we know…but so necessary)

Strengthen social support & connection (Circle of Care) and

grow/influence recovery capital for our patients

Define and commit to purpose for each participant -

together

Study outcomes and share knowledge to improve

Aftercare programs CAF-wide


How is the project designed, and why?

Purposeful lack of control in the process and the precision of hypotheses

Redesigning and reimagining the care team. Who cares, cares.

Series of group facilitation exercises, focus groups, individual goal-setting, two-way sharing (two-eyed seeing)

Three proxy measures of success

Does level of participation increase, and incidence of withdrawal decrease (discussed adverse events/relapse, but decided to leave out of definition of success due to empowerment model)?

Do the CoC and unit support staff have the knowledge and tools to be proactive and positive actors in their member’s recovery?

Have the participants defined success from their perspective, and are they making meaningful steps in that direction?


How is the project designed, and why?

Designed around three central themes

Engage, Educate and Enable all stakeholders, including

ourselves

Empower the patients and those in their Circle of Care

employing two way sharing

Create a climate where those suffering from addiction

are encouraged and supported in accessing care, and

once there, makes keeping them enrolled in (and

attending) Aftercare a priority - for the patient, the

CoC, and the family alike.


How are we fostering participative

leadership?

Clarity of expectations and effort (Mission, Vision, Values)

Finding a spark – why should anybody care?

Drawing on the principles of Relationship Based Care and Team

Based Leadership (next slides)

Diluting power, diluting control (Mission Command)

Slow and simple wins the race

Timing is everything…and our Stars are presently aligned

Sharing responsibility and accountability for success

Being curious…and comfortable with discomfort


Relationship Based Care

What is Relationship Based Care in our context?

Clear focus on the strengthening of relationships

Role modelling the behaviour we want to see in our patients, our

colleagues (also our patient’s CoC), and our communities at large

Transforming our practice by returning us to what we see as our

basic purpose: caring for and connecting with other human beings


Relationship-based Care: A Model for Transforming Practice - Mary

Koloroutis, 2004


What does Helen think?

https://scienceforwork.com/blog/psychological-safety/

https://scienceforwork.com/blog/psychological-safety/


Team based leadership principles

What are our conditions for success?

A clear, achievable and laudable vision to link with team

objectives

A focus from management on building, helping and

supporting teams to do what they can do themselves

An effort to align team member’s needs with the

organization’s mission and vision

A staunch commitment to empowering and engaging team

members through trust and support (psychological safety)

Clarity of roles and expectations with clear and respectful

communication…always (R+A+A)


The Unhealthy Workplace

Problem

Person

Union

Supervisor

Co-worker

Doctor Family

Friends

Covering Up

Excuses

Ignore

Ineffectiveness

Denial

Justify

Avoidance Mistrust

Unfairness

Low Morale

Sabotaging

Health Problems

Stress

Mistakes

High Absenteeism

Low Trust

PoorAttitudes

Accidents

The Healthy Workplace

Supervisor

Union

Family

Friends

Doctors

Co-workers

Shared

Values

Respect

Enthusiasm

Kindness

Compassion

Loyalty

Honesty

Safe

Motivated

Effective

Supportive

Sense of FairnessVitality

Accountability

Low Absenteeism

Good Morale

PositiveAttitudes


Care Quality Commission– State of Care

http://www.cqc.org.uk/publications/major-report/state-care

http://www.cqc.org.uk/publications/major-report/state-care


Work done to date

Logic Model and Value Stream Mapping with all parties

Mental Health Forum focused on addiction & recovery

Baseline data collected for last 24 months

Level of participation and withdrawal rate

Baseline survey for patients

Baseline survey for the CoC and Unit support staff prior to

the MH Forum to measure impact


Mental Health Forum – 28 September 2017


What’s next?

Project will end October, 2018

Present findings to colleagues at CIMVHR 2018 in Regina,

SK

Share design and lessons learned with national Addictions

cell

Create an agreed upon design framework in conjunction

with the CoC/Army for successful Aftercare programs and

implement CAF-wide.


So then, what is participative leadership

exactly?

Never underestimate the power of ideas – Robert Evans. An

Undisciplined Economist. 2016.

The Journey of a thousand miles….


References

Everything you think you know about addiction is wrong - Johann Hari. TED Talk, July 2015

Creative Healthcare Management. 2003. Leading an Empowered Organization: Participant Manual. Minneapolis, Minnesota.

Relationship-based Care: A Model for Transforming Practice - Mary Koloroutis, 2004

Guarding Minds @ Work. 2012 Centre for Applied Research in Mental Health and Addiction (CARMHA)

On the way home: Family centered academic aftercare services. University of Nebraska – Lincoln Center for Child and family well-being

State of Care 2016/2017. Care Quality Commission. UK

Five questions about psychological safety answered. Science for work, October 2017


Open Discussion and Q&A

participative leadership: what is it, and why does it … leadership: what is it, and why does it...

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