Maggie Bennington-Davis, MD Chief Medical and Operating Officer Cascadia BHC May 25, 2011.

Maggie Bennington-Davis , MDChief Medical and Operating Officer

Cascadia BHC

May 25, 2011

LEADING FOR GOOD

Doing the Right Things Right

1. Live with integrity; Lead by example

2. Develop a winning strategy

3.Build a great team

4. Inspire employees to achieve greatness

5. Create a flexible, responsive organization

6. Tie it

together, reinforced

by systems






6. Tie it


by systems


Vision Statement

To create and provide mental health and addiction services that:

• Are trauma informed• Facilitate state-of-the-art treatment provided

by highly qualified doctors, nurses, and therapists who are attracted to work with us

• Value those we serve in every respect• Occur in compassionate and non-coercive

environments in which people find their own paths to healing

Level 5 leadership

• Paradoxical combination of personal humility plus professional will

• Stimulates others to high performance

• Trust through vision and modeling• Gratification through organizational

and succession success






6. Tie it


by systems


Clarify the Vision

• Portray the destination• Translate the picture into an experience• Create a plan• Give everyone a part to play• Be consistent• Ensure early wins; celebrate every

success• Embody the new identity

Clarify the purpose:Cultural Revolution

Listening to those we seek to serve• How can STAFF change what WE do• Increased emphasis on respect/dignity• Increased attention to recovery• Increased awareness of trauma and its

effects• Focus on decrease of power/control• Focus on increase in client participation

and satisfaction

PLAN, and then PLAN againFocus on the process

PLAN

ACT DO

STUDY

MeasureChangeCount

orTally

Improvethe

Process

Why should we

change… what

should we

accomplish?

How will we

know it worked?

What changes can we make in our work?






6. Tie it


by systems


Critical Mass• The square root of the number of people

affected are required for a successful major change

• Watch for the “early adopters” (5-15% of the group)

Planning Team

• Stakeholders’ design team• “Top down” when necessary• Participant vs. recipient of information• Clients and families• Different phases: different members

Some Stayed, Some MovedSome Left, Some Came

• False: “People are your most important asset”

• True: “The RIGHT people are your most important asset”

• Who should be on the bus? INCLUDE the consumer…

• Is each person sitting in the right seat?• Leaders must facilitate some leaving the bus• Make sure the “right” people are leaving

Focus on Staff Members

• Respect• Education• Assumption we’ll treat each other well• Involvement• Celebration






6. Tie it


by systems


Stages of Change

Pre-contemplationPre-contemplation

ContemplationContemplation

PreparationPreparation

ActionAction

MaintenanceMaintenance

Relapse-L

apse-Change

Relapse-L

apse-Change

Hawthorne Effect

• Hawthorne was hired to study the effects of lighting on work productivity

• The lighting didn’t matter… but the study did!

• You change what you measure

Staff Education

• Internal trainers• Training program• Cultural immersion• Teaching the language• Informal and formal approaches






6. Tie it


by systems


Transition fundamentals

• Letting the old ways go (and keeping some)

• Transition begins with an ending

• “Neutral zone” – neither old nor new

• New beginning• Transition ends with a

beginning

Do’s and Don’tsAlways:

– Be aware of who must change– Be aware of who will be affected– Market the vision aggressively– Talk to individuals and talk to

groups– Describe the process of transition;

predict reactions– Listen intently and obviously; seek

input

As much as you’re able:– Align new behaviors with reward– Design stop-gap between new and

old – Make your mentors visible to staff– Change incentives to reward

teamwork

Do’s and Don’tsSometimes:

– Rearrange which staff work with which staff– Reorganize your management team– Include outside partners– Appeal to a higher authority

Avoid:– Turn the project over to the group and ask them to

come up with a plan– Shrink the vision; separate the components from

the vision– Give up and find a less disruptive plan– Become a disciplinarian regarding the change

The New Beginning

• Beginnings reactivate old anxiety• New way represents a gamble – some

people are more gambler than others• New beginnings disrupt the water-treading

of the neutral zone






6. Tie it


by systems


Data Driven

• Map and study process of care• Map and study environment of care• Identify what it is you’ll measure• Share the data with staff, families, and

patients• Set new expectations

Using root cause analysis and aggregated data for system change

If you want deeply rooted change, you need to apply deeply rooted methods.

J. Goldstein, 1994

The Unshackled Organization

Eliminating seclusion and restraint

WHY, WHY, WHY, WHY…

Seclusion Restraint

Threw a chair

Angry couldn’t

use phone

Restricted Phone hours

Staff convenien

ce

SYSTEM INTERVENTIONS ARE ESSENTIAL

PERFECTLY DESIGNED SYSTEM

“EVERY SYSTEM IS PERFECTLY DESIGNED TO ACHIEVE EXACTLY THE RESULTS IT ACHIEVES” (DON BERWICK)

Environments that rely on coercion,

power, and control will result in

• Seclusion • Restraint• Power struggles

Seclusion and

restraint

MaterialsMethods

People Environment Equipment / technology

Trauma education (not done)

Medical record (not avail)

Peer specialists (not used)

Seclusion & Restraint

No trauma history elicited

No family members (or other support people) involved

No alternatives offered beyond “time out”

Staffing “short” today

Float nurse

Physician not in yet

Rob has best rapport – on break

Quiet milieu

Involuntary

Shared room

Community (here)Substance use +

Database

Activities (not engaged)

Seclusion room

Young man with psychosis

Admitted midnight

Did not go into room

Hit staff when approached

Wouldn’t leave common area

Secluded then restrained

No safety plan completed

Comfort room

System navigation (not offered)

Medications

Admitted midnight

Food

Rule to be in room

The Power of Aggregate DataIndividual considerationsImportant, but isolated information

Conclusion is often “did the best we could”

Critical Incident Review

TrendsContextual information

Conclusions give clues about the system

Aggregated Data

Aggregate analysis in S&R

Shift changes, near meal times

Within 36 hours of admission

Younger men

One occurrence predicted another

Everything changed

Perception changed

Admission process changed

Staff empowered

Language changed

People served have a voice

Hiring practices changedStaff to staff

behavior changed

Shift times changed

Rules and policies changed

Charts and Graphs

• Count it• Evaluate yourself• Make a picture out of it

Ch-ch-ch-ch-changes

• When you change the way you look at things…. The things you look at change

• Use the power inherent in continued improvement and delivery of results

• Build momentum: celebrate incremental success

• People must decide among themselves to turn the fact of potential into the fact of results… then the goal sets itself

• Long term goals meet short term pressures• Too much too soon• Urban legends• Splitting of leadership• Fatigue• Changing course• Bad outcome

Potholes and detours

Culture Pushes BACK• Culture of the

“parent” organization• Culture of staff who

have “homesteaded” their jobs

• Training of staff and patients… “we’ve always done it that way”

• STIGMA

Five Squirrels

• Donald Geisler 2005. “Meaning from Media: the Power of Organizational Culture”. Organization Development Journal 23 (1): 81-83.

System Change Takes Time• Persistence• Calm• Focus• Repetition• Using the same

language repeatedly• Keeping your eye on

the ball

How to Move Forward

• Leadership is key• Start with the truth; lead with

questions; navigate with data• Education• Inclusion• Perseverance

The Greatest Successes occur...

When preparation meets opportunity

Maggie Bennington-Davis, MD Chief Medical and Operating Officer Cascadia BHC May 25, 2011.

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Transcript of Maggie Bennington-Davis, MD Chief Medical and Operating Officer Cascadia BHC May 25, 2011.