Building a Culture of Respect and Safety: How can you make a difference in your workplace? PeriAnesthesia Nurses Association of British Columbia October 26, 2013 Rebecca Brooke & Marlene Weeks

What is culture? The way we work together Teamwork, communication, leadership, and more It’s the people side of healthcare 2

Why does it matter? It’s the foundation of what we do. We must work together and communicate in order to deliver optimal care. We don’t always see it, but we know when it’s not working. We all mean to do well. Actually the healthcare work force is educated and dedicated, and sometimes we do amazing things. Sometimes you put a bunch of highly skilled individuals together, and it doesn’t add up. So we throw more smart people at the problem. It’s not about any one person – it’s about how we work together. 3

[data showing effects of culture on clinical outcomes] From Pascal metrics Culture has effects on clinical outcomes for patients and the providers working in the system 4

If we had a mirror… If we had a mirror to look at our own culture, what would we see? What about…    Jewellery and makeup (the difference between policies on paper and our lived practice) o   Food and drink o   supporting new staff? o   Bullying o   Talking over the patient or forgetting the patient is there 5

The first thing we have to do in order to change is to be able to talk about it. Often it’s the elephant in the room. Turn to your neighbour and discuss the “elephant in the room” that you might see in your unit or work area 6

How do we change culture? It seems impossible! We want to pull at loose threads. Little actions have a ripple effect. 7

Individuals can… Be Situational Leaders Situational awareness means knowing what is going on around you Or having the information we need to do our job Often this means communicating with other team members Any individual can help the team build situation awareness by helping to understand what’s going on around us. 8

Individuals can… Be Situational Leaders Briefing: Who is on the team? Goals? Roles and Responsibilities? Plan of care? Staff? Resources? Debriefing: Process Improvement; Informal after event; Improve teamwork, improve outcomes “What should we do differently next time?” Here are some specific times and questions to ask Before the shift starts clarify the goals and plan of care. After tasks are complete review how it went. 9

Individuals can… Be Situational Leaders Huddle: “touch-base”; Emerging events. Concerns! Outcomes/Contingencies? Resources? Sometimes it might be an unexpected event – call a huddle at any time! There was an example shared by an anesthesiologist about when a nurse did this really well A patient had come out of the OR into the PACU with a bite block still in place. It was a nurse who called the team together to discuss why it happened and how it could be prevented in the future 10

Groups can… You don’t need everyone on board – that is daunting All you need is a critical mass, to tip the scales People will follow and it will grow – peer pressure and curiosity Find your allies! 11

The Victoria General Journey March 2010 – New Manager Fall 2010 - Rotations December 2010 – New Manager Ready to Quit January 2011 – Stop the Bus March 2011 – 5 Dysfunctions May 2011 – MBTI Formal and Informal Leaders June 2011 – Vision, Mission, and Values – Start July 2011 – Motivation Survey - RN September 2011 – Motivation & Efficiency Survey – All Disciplines October 2011 – Gallup November 2011 – SQAN/Morale Fall 2011 – DOBA Issues Explore what truly motivates different groups of professionals (nurses, anesthesiologists, respiratory therapists, surgeons, etc.) under very different funding models to be efficient/effective in our environment. In doing this we need to figure out what the common shared values are amongst all members and how team members will be held accountable to those values (consequences). The ultimate goal is to work towards the development of a Team Charter. 12

The Victoria General Journey Jan-May 2012 DOBA and New Rotations March to June 2012 – Teamwork and Culture Survey October 2012 – Halloween Vision and Values Work November 2012 – Communication and Efficiency Survey November 2012 – TLC Board November 2012 to September 2013 Short Staffed February to May 2013 Values Exercises June 2013 - Gallup Vision: Caring Together: Patients First Courage: Supporting accountability and responsibility Aspire: Striving for personal and professional excellence to realize our goal of providing the gold standard of patient care Respect: Communicating with truth, integrity and kindness Empathy: Acknowledging individuality in ourselves, our patients and each other 13

J & C Dear Marlene, I was involved in an incident with a co- worker Friday afternoon. It was personal in nature and did not involve a patient but it is a serious matter and I felt I should bring it to your attention. The co-worker involved is C and the fault in this incident lies completely with me. C and I spoke at length on Saturday about what transpired and I think we have come to an understanding but I am heartbroken about what I have done and would really appreciate a meeting with you and hopefully L to discuss the matter. I start work at 14:45 Monday but can come in at any time during the day to meet with you. I look forward to hearing back from you.   J A prime example of how values were lost and found More work to be done - W 14

Your turn How can we connect with our shared values? How can you create a ripple effect in your organization?

Geoff Schierbeck, Quality Leader at BCPSQC Contact us Rebecca Brooke Quality Improvement Coordinator, The Ottawa Hospital Previously Quality Leader, BC Patient Safety and Quality Council RBrooke@toh.on.ca Marlene Weeks OR Manager, Victoria General Hospital Marlene.Weeks@viha.ca Resources Geoff Schierbeck, Quality Leader at BCPSQC Gschierbeck@bcpsqc.ca http://bcpsqc.ca/clinical-improvement/teamwork/resources/