Transcript Creating a Positive Chain of Leadership

Creating a Positive Chain
of Leadership
David Farrell, MSW, NHA
What Matters the Most?
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Systems
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Equipment
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People
High Performing Nursing Homes
Three Common Elements  Culture – person-centered care
 Workforce commitment
 Leadership practices
All three are interdependent
Grant, L. 2008
Results are Interrelated
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Implement principles of culture change
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Enhanced leadership practices
Employee satisfaction
 Workforce stability
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Low turnover, high retention, low absenteeism
Consumer satisfaction
 Clinical outcomes
 Regulatory compliance
 Occupancy rate and mix
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Grant, L. 2008
A Consumer Perspective on Quality Care:
The Residents’ Point of View
NCCNHR 1985
Kind
Caring
Staff
Know me as
an individual
Qualit
y Care
Drivers of Consumer Satisfaction
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Caring staff
Competent staff
Choices and preferences
Nursing care
Responsive management
Respectfulness of staff
MyInnerView, Inc. 2010
Path to Improvement
Staff
Stability and
Engagement
Improved
Quality and
Satisfaction
© B&F Consulting Inc. 2011
www.BandFConsultingInc.com
Better
Census and
Resources
for More
Improvement
Drivers of Staff Engagement
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Management cares about employees
Management listens to employees
Help with job stress
MyInnerView, Inc. 2010
Building Trust and Making a Statement
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Presence
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“You go into the rooms?”
Asking and delivering
Listening
Speaking with conviction
Painting the graffiti
Leadership Practices Matter Most
PersonCentered
Performance
Improvement
Process Improvement
Leadership Practices
Adapted from Albert Einstein Health
Foundation, Philadelphia, PA., 1990
The Impact of Leaders
Healthcare organizations
 Fragile ecosystems
 Leader’s actions influence:
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Culture
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Relationships
Staff engagement
Clinical outcomes
Quality of life
Person-Centered Care Leadership
Performance
Compassion
Relationships and Quality
People Paradigm
W. 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
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Theory of Relational Coordination
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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
Relational Coordination in Healthcare
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Task interdependence
Uncertainty
Time constraints
Gittell
Healthcare Organizations
CNAs
Nurses
CNAs
Therapists
Nurses
Therapists
Physicians
Food Service
Food service
Within functions
Physicians
Across functions
Gittell
Trigger Relational Coordination
Leadership actions
 Increase Communication
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Frequency, timeliness
Accurate, transparent, frequent
Model problem solving
Enhance Staff Relationships
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Shared goals
Enhance shared knowledge
Model mutual respect
Relational Coordination Works
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Significantly associated with –
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Enhanced resident quality of life
Higher nursing assistant job satisfaction
Evident in SNFs implementing personcentered care
Gittell, et al, 2008
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
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Eaton, S. 2001
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Thank You Cards
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Cards are powerful
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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
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Ample supplies at hand
Resident transfer equipment at hand
Report between shifts
Staffing configurations
Staff composition
Relational Coordination in Oakland
Key changes –
 New name badges
 Created efficiencies
 Mitigate conflict
 “Just in time” compassion
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Tragedies in their lives
Enhancing Staff Relations
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Karaoke
Kids Day
Heritage Days
Senior Prom
Weight Loss Challenge
Safety Huddles
Manage Relational Coordination
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Our systems and structures of
communication create our
relationships and our culture
Relational Coordination
Applied to Staff Assignments
HIGH:
Consistent
Assignments
LOW:
Rotating
Assignments
Communication and Relationship Factors
© B & F Consulting, Inc. www.BandFConsultingInc.com
Relational Coordination
Applied to Shift Hand-off
HIGH:
Structured
Person to
person
discussion
with checklist
LOW:
Tape
recorded
Communication and Relationship Factors
© B&F Consulting Inc. 2011
www.BandFConsultingInc.com
Relational Coordination Applied to
Interdisciplinary Problem-solving
HIGH:
Root-cause
analysis
conducted by
PIP team led
to successful
pilot test and
then facilitywide adoption
LOW:
Conducted by
2 managers
and solution
rolled out via
in-service
Communication and Relationship Factors
© B & F Consulting, Inc.
Enhancing Relational Coordination
Follow QAPI systematic process  Charter Performance Improvement Projects
 Learn, teach and utilize
 Ice breakers
 Root-cause analysis
 Brainstorming
 Flow chart
 Learning circle
Cause and Effect Diagram
Systems
Environment
People
Equipment/Supplies
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First 2 Hours Checklist
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People support what they help create
Empowerment
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Humility
Listen to others perspectives
Stakeholders –
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Who is effected?
Who can help us understand this better?
Involvement = success of changes
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Spread
Sustainability
Communication Builds Trust
Leadership Visibility
Rounds to trigger engagement
 Engage the heart and minds of staff
 What you do and say matters
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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 the
ways in which we unintentionally demotivate employees.”
Quint Studer
Community Meetings
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Performance data
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Human resource
Clinical outcomes
Business results
Benchmark and compare
Celebrate positives
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Employee and rookie of the month
Raffles
Patient safety chain
Communicate
Why?
How?
What?
The “Golden Rule”
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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
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Eliminate the negative
Interdependent work = larger negative effect
Grumpiness is contagious
Felps, W. 2001
Human Beings are Flawed
What exposes the flaws?
 Workload, fatigue
 Broken systems
 Lighting, noise, distractions
 Personal issues
 Coworkers behaviors
 Equipment, supplies
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Who are the CNAs?
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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, 2001
National Clearinghouse on the Direct care Workforce, 2006
BLS 2006, FHCEF 2010
Common Forms of Feedback
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Silence
Negative
Positive
Deliver feedback to individuals and teams:
 Timely
 Be specific
 Be sincere
 End on a positive
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.”
Performance
Compassion
Small Wins are the Path
Steps forward
Visible results
People Energized
Contact Information
David J. Farrell, MSW, LNHA
Director of Organizational Development
Regional Director of Operations
SnF Management
[email protected]
(510) 725-7409