Download - Utah Association of Local Health Departments Train-the-Trainer Workshop October 19 and 20, 2011
…PHF Mission:
We improve the public’s health by strengthening the quality and performance of public health practice
Innovative Solutions. Measurable Results.
http://www.phf.org
Brainstorming
5 minutes individually, write down:What issues have arisen around implementing or setting up a QI training session?
Volunteer ideas as scribe writes
Build on listed ideas
Add new thoughts as they occur
Debrief to whole group
Coaching QI Teams
The purpose of coaching QI Teams is to:
Build a partnership between the coach, team leader, and team members
Help the team move to a higher level of achievement
Help the team overcome obstacles
Help the team navigate a politically sensitive situation
Provide training or problem solving assistance
Coaching QI Teams
Building a partnership between the coach, team leader, and team members is effective when there are:
Agreed upon ground rules
Clear expectations
Specific time frames
Established goals and measures of success
Some Issues That Could Arise:
Coach groups into teamsClarify objectives and goals Dissolve hidden agendas Move to commitment & accountability Move from hoping to acting Generate efficiency Model success of other high performing teamsShare values & vision of the organizationOvercome frustration & failure Keep them going Give recognition
The Five Dysfunctions of a TeamThe Five Dysfunctions of a Team
Fear of… Conflict
Absence of… Trust
Lack of… Commitment
Avoidance of… Accountability
Inattention to… ResultsThe Role of the Coach
Be Vulnerable
Demand Debate
Force Clarity and Closure
Confront Difficult Issues
Focus on Collective Outcomes
© PHF 2009
P. Lencioni 2005
What is Coaching?
Establish trust
Build rapport and open communication
Clarify key roles and responsibilities
Establish goals and an effective personal development plan
Create and implement a mentoring agreement
Coaching Exercise, #1
Break into teams of five each
List out the elements you would want in a coach
Identify the top three elements you would consider most important for a successful coaching intervention.
Debrief
First Rule of Coaching
Start where your client “is” and not where you think he should be or where you are.
Second Rule of Coaching
Confirm readiness:
Is the client receptive to coaching?
Do they want to be coached?
Have they requested coaching or been told to get it?
What do they expect to get from coaching?
Third Rule of Coaching
Set Expectations:
Establish goals
Intent is to help, not run the team
Build trust – who do you have to report your results to – make it clear
Establish when and where coaching will take place
Fourth Rule of Coaching
Observe The Team:
Identify destructive behaviors
Document specific incidences
Document their strengths and weaknesses
Understand what they think is blocking or hindering their progress
Fifth Rule of CoachingDevelop an Improvement Plan:
Describe observed team behaviors and the impacts; both good and bad
Review causes that lead to bad outcomes for the team
Set realistic change expectations
Build the plan around their strengths
Describe specific corrective actions to overcome weaknesses
Indicate any training that may be required and how they can obtain it.
Sixth Rule of Coaching
Confidentiality:
What you observe, recommend, or help the team with stays in “Vegas”
If you must report your finding to some one higher in the organization let the team know at the outset
Seventh Rule of Coaching
Follow-Up:
Set a time to follow-up with the team to see if progress has been made
Ask them to send you brief updates on a regular basis – what is and is not working
Coaching Exercise #2
Choose a partner for this exercise. You will practice coaching techniques.
Look at the three most important elements for a successful coaching intervention each of you chose during exercise 1.
Choose one element to practice with your partner. You can each choose a different element.
Continued…
Coaching Exercise #2The first “coachee” sets up the situation in which the “coach” will provide support. The coach LISTENS to the “coachee” to understand their coaching need.
The coach then explores different approaches (DO NOT TELL) to that scenario with the “coachee.”
Take no longer than 5 minutes for the exchange.
Take two minutes for the “coachee” to express observations of the helpfulness of the coaching.
Swap roles and repeat with the second partner.
Problem Solving vs. Decision Making
Whenever teams encounter a problem, we are involved in decision making.
We are involved in decision making even when there is NOT a problem.
Quality Improvement is about process, not only the outcome of our processes (W. Edwards Deming)
Align Quality Improvement Measures
Three steps for generating data for analysis and decision making:
Assessing: Identifying, defining, prioritizing – Plan
Analyzing: Examining and investigating – Do and Check
Answering: Finding solutions - Act
Act
DoCheck/Study
Plan
In Reality; There Are Two Qualities
1. A product or service – Attribute QualityWhat you deliver to the client
2. A management tool – Method Quality
What do you do internally to deliver the product or service to the client?
How does the service you provide support the critical goals of your Department?
We all work in Quality. We all work to improve the department. Quality isn’t about titles or departments, It’s about methods and their impact on individuals,
our communities and how well we use our resources.
Analyzing Goals and Measures of Success
Activity preparation:
What organizational goals do you have in common with others in this session?
Focus on the most operational goals possible for this activity
Group in teams of 4 or 5 who have at least 3 common goals.
RTR Analysis and Decision Making
15 Minutes: Using the RTR matrix handout, identify:
Which of the identified goals are the right or wrong priorities based on your most critical stakeholder needs?
Which actions taken to meet the identified goals are either the right or wrong ones to successfully meet those goals?
Share your RTR observations
Listening and Communications
Communications is a two-way process
Speaker has to accurately convey their thoughts to the listener
The listener must make sure they understand the message
This seems simple enough
Listening and CommunicationsWhen the message understood by the listener matches the message intended by the speaker we have successful communications
Whenever we communicate there are two basic factors at work:
Ideas
Feelings
Listening and Communications
Ideas – thought process which contains the concept we are attempting to communicate
Feelings – emotions associated with the concepts we are communicating
Listening and Communications
An Idea-feeling relationship is in balance most of the time
During stressful situations the feel factor will take over and distort the message
Stressful situations require an emphasis on effective listening
Class Exercise
Break into teams of two each and sit back to back
One person faces the screen; the other makes sure you cannot see the screen
The person facing the screen must instruct the person sitting behind them to draw the figure to be shown
You have 3 minutes
Quick debrief – what happened and why
Class ExerciseNow turn and face each other
One person faces the screen; the other makes sure you cannot see the screen
The person facing the screen must instruct the person sitting in front of them to draw the figure to be shown
You have 3 minutes
Quick debrief – what happened and why
Cues of Communications:
Verbal:
What we say and our choice of wordsBig versus little words
no slang
Speak from our experience which may not be your listener’s experience - disconnect
Cues of Communications:
Vocal – how we say it – tone, pitch, volume, inflection
Volume – too soft suggests uncertainty
Pitch – high pitch suggests excitement or nervousness
Tone – may suggest skepticism or disagreement
Inflection – upward pitch at the end of a sentence may make a statement sound like a question
Listening and Communication
Research indicates that:
50% of our communications comes from body language
43% from tone of voice
7% from the actual words we speak
Every Body’s Talking
A way to read emotions not put into words
Nonverbal speak loudly – sometimes louder than words
Watch your intended message recipient or audience for these clues
Washington Post, Section F 1, June 24, 2008
Listening and Communications
Three types of listening:
Passive listening
Acknowledgement response
Active listening
Three types of listening
1. Passive listening:
Listener may or may not be paying attention
No response to spoken words – silence
Limited or no body movement
Voice can whine
Three types of listening
2. Acknowledgement response:
Listener hears and understands
Response acknowledges message
Direct eye contact
Body movement – gestures of acknowledgement
Three types of listening
3. Active Listening:
Listener uses feedback
Listener tries to gain additional information
Eye contact
Positive body gestures
Remember
The busy employee spends
50% of their time listening to people and still does not remember half of what is said
We forget 1/3 to 1/2 of what we hear within one to eight hours
We forget an additional 25% in the next 48 hours
We forget more in the first eight hours than in the next six months
Listening Is A SkillFind areas of interest – worth of the message – match your experiences
Judge the content not the delivery
Hold your fire – listen to the content, not the hot button words – do not jump in right away – over stimulated
Listen for ideas or facts that are interesting
Be flexible and open minded
Listening Is A Skill
Work at listening – be prepared physically
Resist distractions
Exercise your mind
Keep your mind open – do not go to the deaf spot
Capitalize on thought speed
Summary
We need to make sure we keep our listener(s) fully engaged or they will drift off
Use visuals, exercises, handouts, etc. to fill in the voids that words cannot possible do
Summary
Research indicates that we can:
Speak at 100 words per minute
Hear at 200 words per minute
Think at 600 words per minute
Being an Effective Team
QI Team Building
The following material is from the text “Growing Teams” by G. Fetteroll, G. Hoffherr, and J. Moran, Goal/QPC, 1993
16 Guidelines For Teams To Work Effectively
1. Establish goals and objectives all team members accept
2. Let each team define its own standards of performance
3. Allow members to disagree in a constructive way to resolve problems
4. Review past actions when making plans for the future
5. Make decisions by consensus
6. Remain cohesive and maintain a sense of unity
7. Strive for synergy
8. Develop a comfortable working atmosphere
9. Use physical space that is conducive to the team process
16 Guidelines For Teams To Work Effectively
10. Listen to each other and provide useful feedback
11. Use constructive criticism to facilitate group interaction
12. Allow members to express their ideas fully and frankly
13. Recognize individuals for the contribution they make within the team
14. Assist members when it ensures successful completion of team goals
15. Highly value creative approaches to problems
16. Incorporate flexibility in the team’s thoughts and action
Roles and Responsibilities
Sponsor:Set improvement project goalSelect the team leaderParticipate with the team leader to select team membersRemove barriersEmpowerMonitorReview progressHelp implement final improvement
Roles and Responsibilities
Facilitator:
Keep the team on track
Train if needed
Assist the team leader
Help overcome negative behaviors
Impartial observer – give the team constructive feedback
Roles and Responsibilities
Team Leader:
Conducts the meetings
Prepares agendas
Participates actively in the team meetings
Represents the team to management
Follows up on action items between meetings
Secures needed resources for the team
Roles and Responsibilities
Team Members:
Give your undivided attention
Take responsibility for comprehending
Listen to understand rather than to refute
Control your emotions
Listen for the main ideas, not the details
Put your mind to work
Selecting Team Members
“Hire for attitude, train for skills
Skunk works
Softball at recess
Conscripted
Volunteer
….
Maintaining Teams
Agree on the improvement model to use.
Use proven methods based on data and knowledge.
Manage team dynamics.
Team Roles & Responsibilities
The Public Health Quality Improvement Handbook
Table 21.1 (Handout)
15 minutes: Review the Team Roles and Responsibilities
Discuss:
• Why so many different “positions?”
• Which are hard? Which are easy?
• Why?
Be prepared to share your observations with the group
© PHF 2009
• Reserve judgment• Concentrate on the act not the
person • Get their perspective • Maintain your own self worth• React only to the current
situation
Dealing with “Difficult” People
© PHF 2009
• Be direct • Ban blaming• Stay focused• Negotiate • Realign priorities• Say less• Let it go
Don’t Nag
© PHF 2009
88
• Put your shields up
• Act like a coffee filter
• Pretend you’re Sherlock Holmes
• Say “you’re right”
Receiving Criticism
© PHF 2009
89
Hearing is not listening
•Acknowledging is not agreeing
•Acknowledging is not yielding
When You Disagree
© PHF 2009
Leading Effective Meetings
Preparation.
Use an agenda, distribute early.
Fill key meeting roles.Facilitator
Timekeeper
Scribe
Involve participants actively.
Take and distribute minutes.
• Hear• Clarify• Dialogue• Gain agreement• Summarize• Act/follow-up• Hand off
Build a Loyalty Action Plan
© PHF 2009
Topics We Will Cover
What is Responsibility Charting
When do you use Responsibility Charting
Key Definitions
The Four-Step Process for Responsibility Charting
Tips for Analyzing a Responsibility Chart
Objectives
Describe the need for and benefits of having clearly defined roles and responsibilities within teams
Analyze and develop an effective RACI chart
So What is RACI Charting?
A systematic and participative technique to:
Identify all functions (activities, tasks, and decisions) that have to be accomplished for effective operation
Clarify roles and individual levels of participation in relation to each function
Develop best methods for individuals to fill these roles
Therefore, with clear roles and responsibilities we should expect to see...
Increased productivity through well defined accountability
Increased capacity by eliminating overlaps and redundancies
Less confusion/misunderstandings by encouraging teamwork
Streamlined work process by eliminating unnecessary interfaces and assigning ‘accountability’ where it belongs
Improved team effectiveness by allowing disciplines to cooperate and share responsibility
Unclear roles and responsibilities result in comments like these…
“My team leader always overrules my recommendations whenever he/she wants”
“The approval process for even the simplest item takes so long today”
“It seems every department has someone putting together a spreadsheet on the same data”
“Things are always slipping through the cracks”
“I have the responsibility, but not the authority, to get the job done”
Clear roles and responsibilities can be identified
through RACI charting
R: Responsible
A: Accountable
C: Consult
I: Inform
RESPONSIBLE: Do The Job. Execute.
These are the individuals who actually complete the task or activity and are responsible for action and/or implementation.
Responsibility is often shared, with each individual’s degree of responsibility determined by the individual with the “A”.
R: Responsible
A: Accountable
C: Consult
I: Inform
ACCOUNTABLE: Make the decision. Take ultimate ownership.
This is the individual who carries the “yes” or “no” authority and has full veto power for an activity.
It is important to clarify the levels of accountability and to distinguish between management accountability and operational accountability.
Only one “A” can be assigned to a task or activity and authority must accompany accountability.
R: Responsible
A: Accountable
C: Consult
I: Inform
CONSULT: Communication before. In the loop.
These are the individuals who must be consulted prior to a final decision or action.
“Consult” implies two-way communication.
R: Responsible A: Accountable
C: Consult
I: Inform
INFORM: Need to know. Do not change the decision.
These are the individuals who need to be informed after a decision or action is taken because they, in turn, may take action or make a decision based on the output.
“Inform” is FYI and implies only one-way communication.
The output RACI Matrix can initially look quite complex
RACI’s provide lots of information in a very simple format
R CA I
R CA
I
C
CI
R A
IR CA
R CA I
RCA I
I
R
C
A
Roles of Participants
Decisions or
Activities
Validating Open
Position Activities Line
Mgm
t
Dep
artm
ent M
gr
(Dir/
VP)
HR
Rep
rese
ntat
ive
Dep
artm
ent M
gr
HR
Hea
d of
C&B
*
HR
A
dmin
istra
tion
1 Review Position AR C2 Creat draft job description AR C3 Complete Staff requisition form AR C4 Approve Staff requisition form AR5 Inform HR Representative AR I I6 Organise Open Position Review meeting A R I IA Decide unchanged/ changed/new I I R A7 Update final Documentation C C R A8 Elevate Final Documentation for approval I I R A9 Approve Request for Staff form I R A
10a Accept Request formt: Inform Line Mgr. I R A
10b Adjust Request form: Send back in process I R A I
10c Reject Request form: Inform Line Mgr. I I R A
R = Responsible (execute)A = Accountable (Yes or No)C = Consulted beforeI = Informed After
RACI Chart for Validating Open Position
See for the Grading sub process next page
Regrading Activities1 Prepare/ revise job description AR C2 Validate request and decide to continue I AR
Grading3 Check for similar roles I A R4 Evaluate new / changed role I A R5 Schedule review for gtading Committee I A R6 Decision by Grading Committee R A I R7 Add decision and description to matrix an database I I A R8 Inform stakeholders I I A R
Grading 7 Aproved grade by BoM I I C A R8 Add decision and description to matrix an database I I A R9 Inform stakeholders I I A R
28-and above
R = Responsible (execute)A = Accountable (Yes or No)C = Consulted beforeI = Informed After
RACI Chart for the grading/regrading
The 4–Step Process
1. Determine the activities
2. Prepare a list of functional roles
3. Develop the RACI chart
4. Get feedback and buy-in (validate)
Guidelines for developing a RACI Chart (to-be)
Remember new ‘culture’ philosophy when defining roles and responsibilities:
Eliminate “checkers checking checkers” Encourage teamwork 100% accuracy is not always required
Place ‘accountability’ (A) and ‘responsibility’ (R) at the lowest feasible level
There can be only one accountability per activity
Authority must accompany accountability
Minimize the number of ‘consults’ (C) and ‘informs’ (I)
All roles and responsibilities must be documented and communicated (use team charter)
Obtain Feedback and “Buy–In”
The RACI chart is shown to people that represent the functional roles on the chart
These individuals are asked for their input, and the RACI chart is revised as appropriate
The RACI chart may be validated in conjunction with the other products generated by the QI teams
Common Errors
‘RACI’ everything (instead of thinking about what is value-added)
Do not take into account that people are trying to justify their jobs
Do not eliminate the "coordinators & consolidators"
Do not use enough ‘action’ verbs in constructing the “Activities” list
Do not understand it will change
Do not consider "interface" issues
Learn about it in training and think they can do it without practice
1. If you have an "R“ (to someone else's "A") it becomes your "A“ in most cases.
2. If you have the "A" that means you have no constraints or limits in your decisions…for that task.
3. To ensure good communication in an organization, we should encourage many "consults" and "informs" on a task.
4. It is quite common to see the VP in an area have the "Accountability" for a task, and an Operator to have the "R," so we should be okay with that.
5. The structure of RACI allows even the most recent of Core / Process team members to successfully complete it.
6. RACI is interesting as an exercise, but it doesn't help to eliminate the "non value-added" work/functions.
7. When in doubt, give the "A" to the highest ranking individual in the room.
True False
True False
True False
True False
True False
True False
True False
Let’s see what we know
Before the first team meeting, the Team Leader should:
Review the team charter and direction with the Team Sponsor*
Clarify roles
Draft a plan
Identify pertinent existing data
Set meeting logistics
Draft an agenda
* Some organizations and Sponsors develop the team charter before the team comes together. Others see value in having team members define their own charter for greater empowerment.
Process Improvement Case Study Worksheet 3 1. TEAM CHARTER 2. Team Name: 3. Version: 4. Subject:
5. Problem / Opportunity Statement:
6. Team Sponsor: 7. Team Leader: 8. Team Members: Area of Expertise:
1. 2. 3. 4. 5. 9. Process Improvement aim (Mission): 10. Scope (Boundaries): 11. Customers (primary and other): Customer Needs Addressed:
12. Objectives: 13. Success Metrics (Measures):. 14. Considerations (Assumptions / Constraints / Obstacles / Risks): . 15. Available Resources: 16. Additional Resources Required:
17. Key Milestones: Date: 18. Communication Plan (Who, How, and When): 19. Key Stakeholders: Area of Concern (as it relates to the Charter):
A Team Charter provides the initial focus for a quality improvement project.
This is an example of a simple team charter. This document should be drafted as one of the first activities when a team is created.
The Team Charter is a living document and should be reviewed and modified to reflect the progress of the team through the different phases of the project.
Create and Maintain a Team
Charter
114
Goals for the first few meetings:
Build relationships:Get to know each other
Learn to work as a team
Work out decision making issues
Set ground rules
Understand the project:Review the charter
Develop a work plan
Identify stakeholders
Learn new tools and skills:The scientific approach (PDCA)
Team behavioral skills
Basic quality tools
The Team Meeting CycleDesign
the Meeting
Develop the agenda
Design the format
Conduct the
MeetingAgenda review
Discuss items
ID follow-up actions
Evaluate the meeting
Carry out between meeting assignm
ents
Collect informati
on needed
to design the next meeting
Follow the Communication Plan in your Team Charter
Internal team communications according to ground rules (informal)
Tollgate reviews with Sponsor, process owner and Senior Management (formal)
Involvement of key stakeholders (formal and informal)
Effective project management tools: (formal)Project deadlines, action items and tracker
Gantt chart
Meeting minutes
What is a Tollgate ReviewA Tollgate Review, as the name indicates, is like a checkpoint in an improvement project where the various team members meet with the Team Sponsor to determine whether the work has been performed as indicated in the project plan and whether the objectives planned have been achieved.
Tollgate Review Tools
• Tollgate Review
Plan
• Tollgate Review
Do • Tollgate Review
Standardize
The diagram below indicates how a tollgate review is carried out at the end of each stage. When the goals have not been met, activities within the stage need to be re-visited. For example, Check Sheets, Project Deliverables Document and List of Milestones.
Read more: http://www.brighthub.com/office/project-management/articles/52721.aspx#ixzz1YyDJ0hK5
Tollgate Preparation
To ensure successful tollgate review outcome, it is important to conduct pre-review groundwork. This may involve the following:
Ensuring all required attendees are informed of the review.
Blocking time in everyone’s work-day for the duration of the review.
Preparing a suitable presentation consisting of check sheets, milestone lists, etc. for review.
Creating a structured agenda for the presentation.
Read more: http://www.brighthub.com/office/project-management/articles/52721.aspx#ixzz1YyE4QSSs
Build individual task lists
Milestones
Assignments
Measures
Accountability
Final outcomes
127
Set project deadlines
A Gantt chart is a matrix diagram
The vertical axis lists all the tasks to be performed for a project
Each row contains a single task identification
The horizontal axis is headed by columns indicating estimated task duration in hours, days, weeks, months, etc.
Gantt Charts
Henry L. Gantt – WWI
Franklin Arsenal 1910
Progress Chart
Work planned and accomplished are shown in the same space
Emphasizes work movement through time
Deals with plans and progress
Helps identify and eliminate obstacles
Gantt Chart
Establish order of tasks:Sequential and Parallel
Identify resources requirements
Timing of resource needs
Identify the critical path
Monitor the project “On-Time” Schedule
Alerts where remedial action is required
Use Of Gantt Charts
Task: City of XYZ HD 29-Feb 7-Mar 14-Mar 21-Mar 28-Mar
Finalize assessment analysis X
Gain consensus on priorities X
Identify comm. with elected off. X
Plan PHF consultant visit X
Set agenda and travel schedule X
City HD/PHF PI meeting X
On Schedule
Watch
Late or at Risk
Traffic Light Gantt Chart
Communication Activity
Time allotted: 20 minutes
In your QI teams, identify:Team Sponsor
Process Owner
Key Stakeholders
Core team members
Draft a timeline for communicating team progress with each of the above individuals.
Identify the communication subject and choose either formal or informal format.
Be prepared to share your thoughts with others.
Audience Analysis
Definition: Study that describes the nature of the worker or students.
Who are they?
What do they already know?
Are they confident?
Have they volunteered to participate?
How many are in the target population?
Are they local or remote?
What kinds of technology support are available to them?
Are their managers interested in this topic?
Are their managers supportive of their career growth?
Analyzing the training needs
Definition: Study to design and develop instructional and informational programs and materials.
After the performance analysis has determined that training or informational materials are indeed appropriate
Needs assessments involve:Subject matter study
Audience analysis
Determination of prerequisite skills and attitudes
Error and work product examination
Resolution of disagreements among experts
Definition of the details that drive training approaches
Activity: Describe your audience
Time allotted: 15 minutes
Assume that you have been asked to facilitate an improvement project in your own local HD
Answer as best you can the questions on the audience analysis slide using your HD colleagues as the “target population.”
How would you estimate the skill and attitude level of your LHD colleagues in QI tools and techniques? Entry, Working Knowledge, Advanced?
Be prepared to share your assumptions with the class.
Building the agenda and materials exercise
• Time allotted: 40 minutes
• Using all the materials and activity output from the last session and this session:• Draft an agenda for training your Health Department on QI tools
and techniques.• List the materials you will use to introduce and reinforce the
lessons you share with the students.• Be prepared to share your agenda items and material
suggestions with your class mates.
Project Presentations 1-81. AIM statement
2. SIPOC + CM
3. Flowchart
4. Cause & Effect
5. Measures of Current State
6. Areas for Improvement
7. Timeline
8. Next steps: Current Activities
9. If done: Outcomes
10.Lessons Learned
Contact Information
Jack [email protected]
T: 207- 439 – 0560
Grace [email protected]
T: 352-406-8262 cell