Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
Shannon Duncan, RN, MN, Patient Care Manager, Pediatric Intensive Care Unit, Stollery Children’s Hospital
Doreen Perschon, MAL, Principal, En-Gauge Consulting Inc.
The Journey of a PICU Care Team to Improved Work
Culture
AH
S
Sto
llery
Ped
s C
ritic
al C
are
Organizational Context
CCL Study, The Effort Dividend, 2004.
Engagement
Thinking
Effort
Feeling Thinking
Effort
The Iceberg Analogy Of Undiscussables
This work is licensed under a Creative Commons Attribution © Copyright Showeet.com
•WHAT’S WORKED IN THE PAST
•BUSINESS AS “USUAL” •AUTHORITATIVE EXPERTISE
•REQUIRES SHIFTS IN THINKING AND BEHAVIOURS
•REQUIRES MOBILIZING DISCOVERY, SHEDDING ENTRENCHED WAYS, TOLERATING LOSSES AND GENERATING NEW CAPACITIES
ABOVE GROUND • RATIONAL • TECHNICAL
UNDERGROUND • EMOTIONAL • ADAPTIVE
strategic planning restructuring
budgets role clarity
negative emotions
watercooler talk
meeting after the meeting
work arounds
• Experimental mindset/
solutions unknown • Group problem solving
• Systems focused
• Productive disequilibrium
as goal • Risky
• Known solutions
• Leader as problem solver
• Issue focused
• Equilibrium as goal
• Generally safe
Presencing Institute – Otto Scharmer – www.presencing.com/permissions
TECHNICAL ADAPTIVE
“The practice of mobilizing people to tackle tough challenges and thrive.” (Heifitz, Grashow, Linsky)
Who is my Self? What is my Work?
suspending
redirecting
letting go
embodying
enacting
letting come
Step 1: Interviews
•Listen •Look for themes •Surface undiscussables
Step 2: Survey
• Validate interview themes
• Culture specific questions
Step 3: Focus Groups
•Share data •Group prioritization of issues
•Develop proposed solutions
Step 4: Action Plans
•Collaborative plans show leadership support
•Clear ownership & timelines
•Grassroots buy-in
Step 5: Re-Survey
•Within 1 year •Qualitative / quantitative trending
•Set new goals
I am at my wits end with work these days. I feel under valued, taken for granted and demoralized. We are expected to keep going until we break. I think that breaking point is coming. Critical incident debriefs are pretty much non-existent. It is a well-known fact that nurses eat their young. It is disheartening to see bullying in the unit. I feel at times family centered care is not embraced. Parents have expressed at times they don’t feel they can speak up on their children’s behalf.
Resources Accountability Management Engagement
Transparency Team support Orientation Leadership
Identified Priorities
1. Management team
2. Change management
3. Culture
4. Day-to-day improvements
1. Leadership
2. Processes
3. Education
4. Culture
Status to Date 2011 2012 2013 2014 2015 2016
Total Hired 33 28 43 44 30 12 Employed in a
position 3 15 22 25 18 11
% in a Position/year
9% 54% 51% 57% 60% 92%
Employed Casual 0 1 5 3 1 0 % casual/year 0% 4% 12% 7% 3% 0%
Resigned 30 12 16 16 11 1 % Resigned/Year 91% 43% 37% 36% 37% 8%
Retention
There has been a BIG change; now coming to work is like coming to my second family.
Satisfied because I have noted great improvement over the last year between staff and management.
We are evolving and expanding; this is an exciting time of the PICU history. We have the ability to become the best PICU in Canada and perhaps even North America. We may still have some issues but we have begun a steady upward trend!!
LESSONS LEARNED
Measurement and outcomes driven • Specificity is key • Results focused
LESSONS LEARNED
Responsiveness • Immediate action/incident reviews • Educational supports