Transforming Health Care: Partnership-Based Health Education Teddie Potter PhD, RN, FAAN

Objectives Participants will be able to: Give three (four) rationales for shifting the paradigm from domination to partnership in health education. Analyze the culture of an organization for its place on the domination/partnership continuum. Demonstrate partnership-based health care education.

Transformative Leadership: Envisioning a Better Future Patient satisfaction IMPROVED: Patient experience Population health Cost effectiveness Improved clinician experience

What is wrong with what we are doing ?

“Insanity: Doing the same thing over and over again and expecting different results.” -Albert Einstein

If more money and more resources are not the answer, what is?

Culture

Culture eats strategy for breakfast -Peter Drucker

We often do not perceive that we have a unique worldview or culture. It’s just the way things are.

For example: The world as we (and Google) know it

Another way of knowing the world

Our “world view” or paradigm impacts our knowledge and behaviors

The culture in the United States includes the tendency to rank or categorize into rigid hierarchies

This rigid ranking shapes our behavior

Ranking in Universities

Ranking is a VERY old story in health care…

And the story of ranking in health care is alive and well today

Cultural Transformation Theory

Where does your organization fall on the partnership/domination continuum?

Domination runs Deep therefore we need to take a systems approach

Employees in Domination-Based Health Care: Fear being shamed so they may skip steps or cut corners in procedures to be able to finish work on time Worry about being blamed so do not tell management if a policy, procedure, or product is not working May not call to report changes in patient’s status until they are extreme due to fear of being bullied Do not participate in innovation or creative problem-solving Employees in Partnership-Based Health Care: Know that quality is valued and feel supported to give their best Feel safe communicating opinions and observa- tions to management. Know that their observa- tions are respected and early detection of status changes is valued Have energy to innovate solutions and create process improvements for quality and safety.

Employees in Domination- Based Health Care: May feel disengaged from work and have more ill calls May treat their patients with decreased caring and attention. When patients are dominated, they become disengaged. They do not share status changes or indicate when something is not working. Treat one another with disrespect. Lateral violence and incivility increase. Employees in Partnership- Based Health Care: Are eager to come to work and be part of a team. Treat their patients with respect, inviting them to be full partners in their own care. Treat each other with respect and value one another’s unique contributions to health care. Resolve conflict in a healthy way that encourages dialog and ongoing relationships.

Patients in Domination- Based Health Care: Are treated like “cases” rather than people Feel afraid to disagree with their provider Are patronized when they raise a concern Are dismissed when they tell their story Are not offered clear choices When they are offered choices they often come with words like “Of course you know…” Patients in Partnership- Based Health Care: Are invited to be full partners in their health care Feel free to voice their opinions and views even when they are different from their provider’s Are encouraged to raise concerns Their story is valued as the foundation of care Are offered clear choices Receive information at whatever depth is needed for full health literacy

What is it like when health care workers experience DOMINATION? “Domination paradigms feel very unhealthy because the staff are afraid to speak to their superiors for fear they will get punished or blamed.” “There is ineffective communication and work flows are stymied due to lack of working as a team.” “Staff are not trusted to be equal partners in the organization. They are held accountable for performing tasks, instead of bringing ideas forward to change the organization.”

Safety, quality, and patient outcomes are NEGATIVELY impacted in organizational cultures where there is fear, shame, and blame.

“Partnership makes me feel energized and excited about the future. It makes me feel as if there is nothing in the world that can stop innovation.” “Partnership makes me feel energized and excited about the future. It makes me feel as if there is nothing in the world that can stop innovation.” “All workers are respected for being important members of the team. Diversity of input invites ideas which will only make the end product better.” What is it like when health care workers experience PARTNERSHIP?

Safety, quality, outcomes, and patient satisfaction IMPROVE in organizational cultures based on respect and empowerment.

LEADING in Partnership-Based Health Care Hierarchies of Actualization: Power with rather than power over.

Partnership-based Education Students are seen as partners in the learning process Faculty model facilitation rather than control Every student’s unique abilities are fostered Students are treated with empathy and caring Diverse learning styles are honored Students’ voices are heard and their ideas are respected Emotional needs are understood and addressed Cooperative learning and individual responsibility are combined Learning is a reciprocal activity between teacher and student Students learn through experiential opportunities Students think for themselves and trust their observations and experiences Students learn to value all contributions to the healing process

Partnership opens the door for transformation of health care

Your Turn! One-Two-Four-All How can we educate health care workers to partner with: Colleagues (intra- professional), Other health professionals (inter- professional), and Patients, families, and communities?

Our seeds for partnership- based health care education

References Eisler, R. (1987). The chalice and the blade: Our history, our future. San Francisco: Harper & Row. Eisler, R., & Montuori, A. (2001). The partnership organization a systems approach. OD Practitioner, 33(2), Eisler, R., & Potter, T. M. (2014). Transforming interprofessional partnerships: A new framework for nursing and partnership-based health care. Indianapolis, IN: Sigma Theta Tau International. Whitman, W. (2010). Leaves of grass. (L. Ross, Ed.). New York: Sterling Innovation. (Original work published in 1855). World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. WHO Department of Human Resources for Health. Geneva, Switzerland: WHO Press.