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Lighting the Way to Culture Change

Lighting the Way to Culture Change. Presented by Renee Beniak, RN, LNHA, CPHQ Interim Executive Director, BEAM Sheila Atwood, RN, BSN, MSA, Assistant Administrator, Kalkaska Memorial Health Center. Today’s Objectives. Describe the process of organizational culture development

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Lighting the Way to Culture Change

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  1. Lighting the Way to Culture Change Presented by Renee Beniak, RN, LNHA, CPHQ Interim Executive Director, BEAM Sheila Atwood, RN, BSN, MSA, Assistant Administrator, Kalkaska Memorial Health Center

  2. Today’s Objectives • Describe the process of organizational culture development • Compare the development of long term care organizations to hospital cultures • Describe how long term care cultures are transforming and developing • Identify how transformation and culture development can expand beyond long term care to acute care settings

  3. The Process of Organizational Culture Development

  4. Organizational CultureWhat Is It? • Set of shared attitudes, values, goals, and practices that characterizes a company or corporation • Combination of institutional history, leadership, budget reality, and staff experience • Underlying sense of appropriate behavior and practice that prevails throughout the workplace

  5. Organizational CultureWhat Is It? Formally: A pattern of basic assumptions invented, discovered, or developed by a group as it learns to cope with the problems, which have evolved over time and are handed down from one generation to the next. (Schein) Informally: “How we do things here” • What experienced staff know • What new employees and clinicians learn • What outsiders sense

  6. Organizational Culture • A code of conduct, for example: • Org. Culture #1: “That’s not my job,” [go away]. • Org. Culture #2: “Sorry, that’s not my job, go see [someone else].” • Org. Culture #3: “Let me see how I can help you.”

  7. Clarifying Cultures • Role/Task Driven Cultures • Are highly formalized, bound with regulations and paperwork • Authority and hierarchy dominate relations • Innovative/Relationship Rich Cultures • Preserve a strong sense of the basic mission of the organization • Teamwork is the basis for work design

  8. Levels or Layers of Culture • On the surface what is: • Seen • Heard • Felt • Visible products such as: • Language used • Technology (complicated therapy, acuity) • Style of clothing, manners of dress, myths, and stories • Easy to observe • Hard to decipher

  9. Central Aspects of Culture • Evaluative Element • Involves social expectations and standards; the values and beliefs that people hold central and that bind the organization • Material Elements or Artifacts • Signs and symbols that the organization is recognized by • Events, behaviors and people that embody the culture

  10. Bonding Agent: Social Interaction • Social Interaction • Medium or bonding agent of culture • Web of communications that constitute an organization • Shared language is especially important in expressing and signifying a distinctive culture

  11. Changing Organizational Culture • Changing the corporate ethos: • Images and values • New way of understanding organizational life • Must be brought into the management, leadership, and personal transformation process

  12. Why Should We Change the Culture? • The challenge: • If real change is to occur within organizations, as opposed to short-lived change, it has to happen at the cultural level. • Organizational culture has many powerful attributes as a lever for change. • The problem is how to get a hand on the lever.

  13. Keeping Patients Safe: Transforming the Work Environment (IOM 11/2003) Sources of Threats to Patient Safety in Health Care Safety Defenses Adopt evidence-based management and leadership practices Management Maximize the capability of the workforce Workforce Work Processes Design work and workspace to reduce error Create and sustain a culture of safety Organizational Culture

  14. Organizational Culture that Continuously Strengthens Patient Safety • Regularly reviews organizational success in achieving formally specified safety objectives • Fosters a fair and just error-reporting, analysis, and feedback system • Trains and rewards workers for safety IOM Keeping Patients Safe 11/03

  15. Managing Culture Change • The ability of organizations to be culturally innovative is related to leadership. • Top management must be responsible for building strong cultures. • Leaders construct the social realities of the organization. • They shape the values and attend to the drama and vision of the organization.

  16. Challenges in Organizational Culture Development • Culture spans the range of management thinking or styles. • Organizational culture has been one of the most enduring buzz words of popular management. • Culture of an organization, like the personality of a person, is difficult to change.

  17. The Development of Long Term Care Organizations Compared to Hospitals

  18. Long Term Care FacilitiesHow Did They Develop? • Early 1900s • Federal assistance programs did not exist to help pay for the care of the elderly and disabled. • Most states sent their impoverished citizens to "poor farms" or "almshouses"

  19. Long Term Care FacilitiesHow Did They Develop? • 1930s • The New Deal • Promotes benefits based on need • Social Security • Universal • Only tangentially needs-based

  20. Long Term Care FacilitiesHow Did They Develop? • 1930s • Social Security Act • Matching grants to each state for Old Age Assistance (OAA) to retired workers • Public institutions residents not eligible for the payments • Private old-age homes created to enable collection of OAA payments

  21. Long Term Care FacilitiesHow Did They Develop? • 1940s • Hospitals seen as “Houses of Hope” • Hospital Survey and Construction Act funds construction of state-of-the-art hospitals • The Depression and World War II • Limits those able to meet expectations • Backlog in every community for modern facilities

  22. Long Term Care FacilitiesHow Did They Develop? • 1950s • Amendments to Social Security Act • Licensed nursing homes • Lifted ban on providing benefits to residents of public facilities • Channeled federal moneys to health service providers

  23. Long Term Care FacilitiesHow Did They Develop? • 1950s • Federal law changes • Construction grants for nursing homes in conjunction with a hospitals • Worked to raise the quality of care • Nursing homes modeled after hospitals • Transformed nursing homes from being part of the welfare system

  24. Long Term Care FacilitiesThe Result • After the development of long term care facilities, several legislative efforts have increased regulatory requirements. • The result: An institutional model with: • Low morale • Little autonomy • Emotional demands • Inadequate orientation • Lack of flexibility • Increased stress • Staff conflicts • Inadequate leadership • Task oriented care delivery systems

  25. The Transformation of Nursing Homes

  26. How Are Nursing Homes Changing? • Recent culture development efforts focused on the challenges brought about by the institutional model • Culture development philosophies: • Live Oak Regenerative Communities • Eden Alternative • Person Centered Care • Etc. • The story of Kalkaska Memorial Hospital Long Term Care Unit

  27. How Culture Development Efforts Can Impact Hospital & Acute Care Settings

  28. Creating a Culture of Patient Safety at Kalkaska Memorial Health Center

  29. Kalkaska Memorial Health Center • Munson Healthcare Affiliate • Critical Access Hospital with 8 bed acute care and 8 bed ED (11,000 visit/year) • Rural Health Clinic • LTC – 88 beds • Majority of business is Outpatient (40,000/yr)

  30. Thoughts… • Safety must be a value not a priority. • There is no “Quality” without “Safety.” Patient safety is an ethical imperative. • The only thing you can’t afford to do is nothing.

  31. KMHC Safety Journey • Patient safety is part of our Strategic Plan and Strategic Imperatives. • Leadership assigned/all managers part of team • Develop goals and action steps with annual update using the Baldridge framework • Develop KMHC goals based on National Patient Goals

  32. Culture Survey • Conduct yearly surveys since 2003 • Administer to all departments • Changed IHI survey questions to fit KMHC • Share results with managers • Managers share results with their staff • Take action based on results

  33. Culture Survey Results • Gradual improvement in scores • Used 5 point Likert scale LTC Score • 2003 – 3.68 • 2005 - 4.41 • More to it than just the score Acute/ED Score • 2003 – 4.04 • 2005 – 4.45

  34. Culture Survey Strengths • Strengths are: • “Personnel in this area take responsibility for patient safety.” • “I know the proper channels to direct questions regarding patient safety.” • “I am encouraged by my colleagues to report any patient safety concerns I have.”

  35. KMHC Safety Action Steps

  36. Medication Safety • Removed “unsafe meds” • “Tall man” letter labels for look-alike/sound-alike meds • Unacceptable/discouraged abbreviations • Medication reconciliation

  37. Medication Safety Outcomes • No adverse patient outcomes from a medication error • No patient harm incidents from unacceptable/discouraged abbreviations • Increase near miss reporting

  38. Leadership Walk Rounds • All directors & managers • 7 teams round 5 times per year • Have script and guidelines • Base questions on Culture Survey results • Share success stories in employee newsletter

  39. Safety Idea Fair • Unique to KMHC • Fun atmosphere to gather employee input • Games/prizes/food • Calculated by number of ideas, types of ideas and actions taken on ideas

  40. Idea Fair Examples • Added more lift equipment, lower beds, fall alert equipment, IV poles • Developed no-lift policy • Education on lifting, teamwork • New medication competency • Cross trained staff • Added more heated sidewalks

  41. Improve CommunicationAmong Caregivers • SBAR for patient hand-offs • Read back all telephone and verbal orders • Process to report all critical values • Shift to shift safety briefings

  42. MMC and KMHC • We transfer the most patients of any hospital in Munson Healthcare • Received GAE for QI of transfers • Electronic Medical Record • Attend IHI as a team

  43. Other Safety Actions • Clinical alarms • Two patient identifiers • On-line incident reporting • Increase near miss reporting • MHC video / storytelling

  44. New Actions for 2006 • Root cause analysis within 72 hours of any event causing harm or potential harm • Comply with the CDC on hand hygiene guidelines • Fully operationalize medication reconciliation • Reduce harm resulting from falls in LTC

  45. Challenges • Many areas don’t have adequate data to be meaningful • Applying big hospital ideas to a small hospital • Electronic Medical Records and EMAR in LTC

  46. Closing Thought KMHC may not perform many of the high risk procedures that lead to the big mistakes/negative outcomes, but one injury or death is too many if it is my mother.

  47. Thank You

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