edge talk: the key ingredient to organisational transformation

@theEdgeNHS | #EdgeTalks

The Key Ingredient To Organisational Transformation

Dr Irv Rubin and Matt Stone, TemenosDr Maxine Craig

Friday 6 May 2016 at 9.30am BST

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The team today

Chat room monitorDom Cushnan @DomCushnan

Twitter monitorKate Pound@KateSlater2

Session chairOlly Benson@ollybenson

Our presenters

Irv Rubin, Ph.D.CEO, Temenos, Inc.@temenosinc

Matt Stone, J.D.COO, Temenos, Inc.@MattStone048

Dr Maxine Craig@maxine_craig

Key Ingredient to Organisational Transformation

-Edge Talk-

6 May 2016

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Overview1

The Organisation as Patient

2 Key to Better Engagement

3Feedback Technique

4Behavioural Diagnostic Tool

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THE TRUTH HAS BEEN TOLD...AND IT IS OLD

         REVANS' RESEARCH [1964]        SALMOND'S RESEARCH [1972]

•LENGTH OF PATIENT STAY...UNRELATED TO SIZE

•THE RICH WERE NOT GETTING RICHER!

•HIGH-TOUCH NOT HIGH TECH WAS THE EXPLANATION

•NURSING TURNOVER AND LoS HIGHLY CORRELATED

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Houston, we Have A Problem:Healthcare Is In Trouble

Malpractice is destroying health care

Tens of thousands are dying from treatment unrelated to their

admitting condition

Untold numbers of near misses go unreported

Good nurses are hard to find and hard to keep

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Zooming in on the Nurses:The Point of ‘TLC’

Disruptive Behaviors Witnessed orExperienced by Nurses (N=2562)

Condescension 69%Disrespect

80%Abusive anger43%Abusive language69%Berating patients26%Physical abuse 22%

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How Often Does It Happen?

38% up to 10 times per year

29% 1 - 2 times per month

24% weekly

7% daily

2% never

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Who Are The ‘Perpetrators’?

6 - 9 % exhibit over 70% of the disruptive behaviors

Majority of staff exhibit 28% of the disruptive behaviors

2% of the staff were seen as exhibiting 0% of the behaviors

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Not Just An American ‘Dis-ease!”2 District Hospitals; 4 Community Hospitals;

9 Practices; 3 PCT Headquarters

33% = Weekly or More Often

8% = Daily

37% = Once/Twice in Last Month29% = Not Once in Last Month

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BQA: CQI At The Individual Level

TechnicalEffectiveness BQA

ManagerialEfficiency

Three-legged Stool

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Behavioral Quality Assurance (BQA)

1. CURING F (Science of Medicine)Focus of traditional Q.A.

“Having the hard technologies and science of medicine been appropriately and skillfully applied in service of curing?”

2. HEALING F (Art of Medicine)Focus of BQA

“Have ALL the hands laid on patients been appropriately and skillfully applied in the service of healing?”

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A Spiritual Sister in Chiba, Japan:St. Marguerite Hospital

To heal sometimes.To support often.

To comfort always.

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One Example of Failure To Embrace This Truth and The Consequences

QUESTION: Does It Make a Difference Which E.R. You’re Taken to?

[Over 5000 Patients]ANSWER: Only a Matter of Life or

Death! [60% survival versus 58% Deaths

“Differences Appear to relate to the quality of the interaction and communication between physicians and nurses…”

[Knauss, et.al., Annals of Internal Medicine, Vol. 104]

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True or False?__ We have one common Behavioral code of conduct for everyone.

__ Our Behavioral Code of conduct is enforced without ‘favoritism.’

__ Everyone gets a performance review at least yearly.

__ Both technical and interpersonal competencies impact performance rating.

__ Feedback is direct and face-to-face versus anonymous and averaged.

Potential Managerial Malpractice Liability Quiz

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True or False?

__ We have “dead messengers” in some of our closets.

__ We have big “undiscussed elephants” on some of our meeting room tables.

__ We know that ‘staff infections’ are as potentially lethal as ‘staph infections.’

__ We know that the culture in the Boardroom filters into the treatment room.

__ We view our organisation as a human entity, a “Patient in need of care.”

-Cont-

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It Starts With What We Believe

• Identity must be “either or”

• Treatment of people become a “yes and”

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Do We Have the Courageand Integrity?

AndBeHaveItOfTheToWillYou

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BQA: CQI At The Individual Level

TechnicalEffectiveness BQA

ManagerialEfficiency

Three-legged Stool

Awareness = Seek and Provide Feedback on

Consequences of Behavior

Behavior = Strive to Learn and Exhibit Win-Win Behaviors Regularly

Consequences = Monitor Impact of Behavior Regularly so As to Increase Awareness

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Dr. Maxine Craig

2015

PAST - 2003&

The here and now

2003

Some of the biggest challenges

we face are not far far away …

but in my opinion are the ones we encounter in our

every day work

What we worked out :

•People had not known how to give feedback in a way that was impactful and might have stopped things developing•We had no process of assuring the behaviour of our leaders and our staff

Technical CLINICAL Effectiveness

BQA

ManagerialEfficiency

Three-legged Stool

© 2003 Temenos ®, Inc., USA. All rights reserved.

The information needed to prevent

thedisaster was known

PUSH

PULL

Describe Prescribe

Understand Ask

Appreciate Inspire

Empathise Attend

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2 Key to Better Engagement

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Engagement is a quality of a relationship, not a person…

taking place from the inside-out,

not the outside-in.

and…It’s all personal.

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The New Executive Listening Tour“We want your input!”

Summer Picnic/BBQ

Remodeled Breakroom

Christmas/Holiday Party

Retreat

New “Values” Statement

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Connectivity ≠ Connectedness

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Self-Assessment Personality Profiling

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Google Research on Building Great Teams(http://nyti.ms/20Vn3sz)

Good vs. Dysfunctional Teams Hinged on: “how teammates treated one another.”

Putting the “best people” or similar people into groups does not correlate to good team performance.

MOST IMPORTANT FACOR:PSYCHOLOGICAL SAFETY

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Feedback

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BEHAVIORAL FEEDBACK

The key to all Learning and Development

In a Relationship

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We need to rehabilitate this word.

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Anonymous 360s

The Cure that Worsens the Illness.

Annual Performance Reviews

A Compliance Task“Whew, glad we could check that box!”

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Relationships

are

Relational Infrastructure

“Culture is built through shared learning and mutual experience.”

–Ed Schein, Ph.D.

Feedback Organisational Transformation???

Feedback is the key to developing and sustaining a

shared experience.

4 Keys to Successful Feedback

RegularitySkill

HonestyCompassion

–Dr. Rose N. Franzblau

“Honesty without compassion and understanding is not

honesty, but subtle hostility.”

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Beware the shortcut answers.

“Empower your People”“Support Enthusiasm”“Encourage Learning”

“Invite Input”“Create Fun Environment”

“Be Flexible”

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3Feedback Technique

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“DAP”Feedback Technique

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[D] The report was due at 2:00 and it’s 3:30.

[A] It’s hard to trust your word when you don’t keep a commitment.

[P] In the future I need you to call me before-the-fact if you need to re-negotiate a change in the schedule.

Describe: The FactsAppreciate: Your Feelings

Prescribe: Your Suggestion/Need

Be Specific D A P

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[D] "My kids are still sick and you’ve bailed me out twice now."

[A] "I really value your support."

[P] "Let me know if you ever need any help from me."

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4Behavioural Diagnostic Tool

Relationships Thrive on Behavioral Feedback

Easy to Use

Fast

Non-Judgmental

Proven Model

Specific, ActionableBehaviors

Inviter(Richard)

Invitee(Kim)

“Please give me feedback.”

Invitee

“Kim”

Desire for More/Less/Same

Five Priority Behaviors

Frequency Perception

Inviter“Richard”

Inviter’s Survey Limited to His/Her Frequency Perception

For Comparison with Invitee’s Perception

1

See how another person sees you behaving when you are dealing

with them—their impression of you.

The Behavior Minder® Enables you to do three things:

2

Compare this with how you see yourself behaving with this person—your impression of yourself.

3

Identify specific actions to further strengthen the relationship—to extend its

win-win range and potential.

MoreTrust

Mutual UnderstandingInfluence

CollaborationConstructive Conversations

Cooperation

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www.temenosinc.com

Thank You!

We are witnessing the emergence of a new

phenomenon in healthcare: self-organising, online

communities, all focused on a particular disease area. We

know from other digital platforms just how quickly

these platforms can evolve, disrupt old business models

and create entirely new businesses.

Paul Hodgkin and Ben Metz interviewed more than 50 actors working with online health communities to map and explore this emerging

field, to begin to build an on-going community of experts and practitioners who look to understand this new field and

accelerate its successful interaction with the NHS and

policy makers. 

JUNE EDGE TALK: EXPLORING ONLINE HEALTH COMMUNITIES, WITH PAUL HODGKIN AND BEN METZ

FRIDAY 3 JUNE, 09.30 – 11.00 (GMT +1)

Find out more at http://

theedge.nhsiq.nhs.uk/june-edge-talk-exploring-online-health-communities

.

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