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Quality , Safety culture & Change Management

approaches It is time for a revolution

Prof Dr Nagwa El Hosseiny Quality Consultant

March 2013

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What Is Organizational Culture?

Organizational culture is used to describe the shared beliefs, perceptions, and expectations of individuals in organizations.

Organizational culture has been variously described as institutional excellence, climate, empowerment, and total quality and human resource management.

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Surface CultureAbove the Surface

Emotional Load: Relatively Low

Unspoken RulesJust Below the Surface

Behavior-Based

Emotional Load: High

Unconscious RulesFar Below Surface

Value-Based

Emotional Load: INTENSE

Deep Culture

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Surface CultureAbove the Surface

Emotional Load: Relatively Low

Food * Dress * Music * Visual Arts * Drama * Crafts * Dance * Literature * Language *

Celebrations * Games

The kind of VISUAL elements of culture that are easily identifiable, easily shared, and easily

accessed.

“Everybody does it differently”

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Unspoken RulesJust Below the Surface

Emotional Load: High

Deep Culture

Courtesy * Contextual Conversational Patterns * Concept of Time * Personal Space * Rules of Conduct * Facial

Expressions * Non-Verbal Communication * Body Language * Touching * Eye-Contact * Patterns of Handling

Emotions

“What are you DOING?”

Elements of culture that are perhaps not as easily pointed out, more ingrained into society.

Behavior-based.

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Unconscious RulesFar Below Surface

Emotional Load: INTENSE

Deep Culture

Notions of Modesty * Concept of Beauty * Courtship Practices * Relationships to Animals * Notions of Leadership * Tempo of Work *

Concepts of Food * Ideals of Childrearing * Theory of Disease * Social Interaction Rate * Nature of Friendships * Tone of Voice *

Attitudes Towards Elders * Concept of Cleanliness * Notions of Adolescence * Patterns of Group Decision-Making * Definition of

Insanity * Preference for Competition or Cooperation * Tolerance of Physical Pain * Concept of “self” * Concept of Past and Future * Definition of Obscenity * Attitudes toward Dependents * Problem-

Solving Roles in Relation to Age, Sex, Class, Occupation, Kinship, and so forthThe things that don’t get talked about, and often times aren’t even realized.

Value-Based.

“You just don’t DO that!”

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What Is Organizational Culture?

Organizational culture does not automatically occur when an organization is created. A group must have stability, shared experience, and history to form a culture.

Over time, especially if the organization competes successfully, the staff learns how to cope with external demands and maintain internal stability.

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Why is Culture Important in Healthcare ?

Cultural forces are powerful determinants of health-related behavior

A lack of knowledge about or sensitivity to health beliefs and practices of different cultures can limit one’s ability to provide quality healthcare

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What Is Safety Culture?

An effective safety culture Sees errors as learning opportunities. Motivates individuals to talk about their own

experiences by encouraging such experiences to be shared.

Responds to problems that are identified. Does not unfairly penalize those who have

made errors. Has a reporting system that is seen to

uncover the underling causes of incidents.

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Measures of Success of safety culture survey and leader walk rounds

Number of errors reported per month from voluntary reporting systems

Number of safety-based changes made by managers per year

Percent of changes in overall surveillance data (for example, infection rates)

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Organizational culture is clearly related to Quality and Safety

In general and quality healthcare in particular.

Organizational culture affects several organizational dimensions, including :

job satisfaction, attention to error, learning, and overall quality of performance.

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Change Management

Definition Has been defined by Prosci (2006) as “a set of processes, tools and practices that

are used to manage the people side of change”

Change Management becomes a bridge between “implementing a solution” and an organization ultimately realizing the benefits associated with the change”

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The Eight Step Process of Successful Change

(John Kotter)

Make it Happen

Communicate for Understanding

and Buy In

Empower Others to Act

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Make It Stick

Create a New Culture

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Decide what to do

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Set the Stage

Pull Together the

Guiding Team

Create a Sense of Urgency

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Develop the Change

Vision and Strategy

Produce Short-Term

Wins

Don’t Let Up

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Culture ChangeA successful Example

“When cases of VAP were more frequent, eachnew case was seen as ‘something that happens.’

Today, if a VAP occurs, we ask ‘What did we dowrong? What can we do better?’ It’s anobsession with failure.

Our goal is to have zero.”

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To summarize……………

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Quality and safety cultures are two related important topics that need to be changed (improved) in order to achieve excellence of healthcare services

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Health care Leaders

They need different ways of thinking , learning and working to meet the three challenges of Today:

1-Provide safe, effective and efficient care

2-Attract and retain talented professionals and staff

3-Thrive in the new reform systems that rewards the higher quality

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Role of Leaders in improving the culture of Quality

There are a number of methods for promoting a quality culture, but they all start with leadership embracing the promotion of quality through :

The articulation of the organization’s mission and vision,

Engagement of people throughout the organization in quality and safety ,

and attention to learning.

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Ten safety culture dimensions

1. Supervisor/manager expectations and actions promoting patient safety

2. Organizational learning—Continuous improvement

3. Teamwork within units4. Communication openness5. Feedback and communication about error6. Non punitive response to error 7. Staffing8. Hospital management support for patient safety9. Teamwork across hospital units10. Hospital handoffs and transitions

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Change Agenda Carries Risk

To transform care, hospital leaders must be willing to take prudent risks

Board and CEO can’t demand improved performance without being willing to invest institutional resources, knowing that not every idea will be successful

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Send a Clear Message

Transformation is a high priority We’re in it for the long term Everyone is responsible for quality and safety Engagement is not up for debate

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Send a Clear Message

Change the conversation Champions of improvement teams Link compensation to achieving improvement

goals

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Improving Quality of care is a Win-Win Process

In the best interest of patients and families

In the best interest of the organization

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Conclusion

• Do the right thing for patients• Financial results will follow• Large-scale transformation is the

right thing to do— and the smart thing

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Tell me and I’ll forget; Show me and I may remember; Involve me and I’ll understand

Chinese Proverb

Thank You