Emotional Intelligence Can Create A Culture of Safety and Leadership Sylvia del Castillo, MD Clinical Associate Professor of Pediatrics USC Keck School of Medicine February 11, 2019

Objectives Understand what “culture” is Discuss what makes our unit have its own culture Understand the components of Emotional Intelligence Understand the 5 components of a dysfunctional team

WHAT IS CULTURE? Culture is the world you live in Culture is the air we breathe Culture is what you grew up with

WHAT IS CULTURE? A pattern of shared basic assumptions…. To be taught to new members as the CORRECT way to perceive, think, and feel in relation to problems Its power is derived by the fact that if or when the assumptions are discussed, we do not examine them, but defend them.

COMPONENTS OF CULTURE It is shared It is learned It is symbolic It is transmitted cross-generationally It is adaptive and integrated Mental processes, beliefs, knowledge, and values are all part of culture

Culture eats strategy for breakfast

THREE TYPES OF CULTURES Constructive Members are encouraged to interact with others and approach tasks in ways that will help them meet their higher-order satisfaction needs. Norms support: Achievement Self-actualizing Humanistic-encouraging Affiliate behavioral styles to eliminate any possibility of interference from the bladder and to span the greatest surface area of the small intestine.

THREE TYPES OF CULTURES Passive/Defensive Members believe they must interact with people in ways that will not threaten their own security. Norms promote or implicitly require: Approval Conventional Dependent and Avoidance styles

THREE TYPES OF CULTURES Aggressive/Defensive Members are expected to approach tasks in forceful ways to protect their status and security. Norms support: Oppositional Power Competitive and Perfectionist behavioral styles

HOW DOES CULTURE CONNECT TO CLINICAL CARE? 98,000 deaths in the US from preventable medical errors Sentinel events: 70% related to a failure in communication 1 of 3 verbal interactions between MD and RN are miscommunications that result in an error in care Most quality improvement projects result in no or temporary improvements Almost all of these facts are related to behaviors observed daily in healthcare Pulsatility index is a measurement of downstream resistance to flow. HR, SPO2, IrSO2 measured continuously over a 2 hour period, before, during and after a bolus feed.

Adapted from TR Krause et al., 2005 Delta for controls 32-34% Delta for CHD 37-42% Data listed as median (interquartile ranges) Adapted from TR Krause et al., 2005

LEADERSHIP AND CULTURE * LEADERSHIP AND CULTURE ACCOUNTABILITY Leaders get the behaviors they exhibit and tolerate. You change the culture of a workplace by changing the behavior of its leaders. Larry Bossidy, Execution-the discipline of getting things done

PHILOSOPHICAL CHANGES SELECTION AND DEVELOPMENT Demonstrating behaviors consistent with our values Leadership training and development Redefining what success looks like in senior nurses and physicians (technical skills and knowledge are not enough) Servant leadership principles.

ENGAGE THE ENTIRE TEAM Multidisciplinary input to patient care Nurse facilitated daily rounds Family Centered Care Committee Nurse and RCP led quality improvement projects Acknowledging and addressing moral distress (tea for the soul) Our study population was stable on bolus feeds with no signs or symptoms of NEC

HOW DO YOU READ CULTURE? The way people interact Expressed values Rules of the game Guiding principals Special competencies Thought and language Shared meanings Group norms of behavior Climate Emotional and aesthetic responses

https://youtu.be/8uSyvw5RR28

WHAT MAKES A TEAM COMPETENT AND EFFECTIVE? Self awareness Self control Commitment Collaboration Emphasis on teamwork

Do you See what I See?

SEVEN KEYS TO EFFECTIVE TEAMS Clear sense of direction Talented members Clear and enticing responsibilities Reasonable and efficient operating procedures Constructive interpersonal relationships Active reinforcement systems Constructive external relationships

HAND HYGEINE PROJECT

CONCLUSIONS The change in culture, increased availability of Sterillium dispensers and the transparency of our audit results have contributed to our success of maintaining a 90% hand hygiene compliance rate since Q4 of 2011.   We continue to monitor our hand hygiene and discuss on a monthly basis at our PI meetings.

Thank you for all you do for our patients and each other every day!  This starts with YOU!! Thank you for all you do for our patients and each other every day! 