Practical Steps

Toward Culture Change

Agree to take this issue on as a priority

Create a Team/Work Group to develop a Restraint/Seclusion Action Plan

Formulate a plan to coincide with the six core evidence-based strategies

Hospital/RTF

Leadership Towards Organizational Change Use of Data to Inform Practice Workforce Development Use of Restraint and Seclusion Prevention Tools Full Inclusion of Consumers and Families Rigorous Debriefing

Six Core Evidence-Based Strategies

4

Barriers to Establishing EBP

It’s difficult to overcome “inertia” You may have too much on your plateTraining staff on new practices requires

time and expertiseClinicians and staff may disagree with

new approaches

5

Become a Champion/Leader

Leadership is critical in the success of your Project!! You are the leaders Create a positive vision◦Better outcomes for consumers◦Latest and best evidence◦“Let’s do it!” message

Communicate importance and commitment Engage hospital leadership and Board

6

Eight Steps for Leading Change John Kotter of Harvard Business School studied why transformation

efforts fail and suggested Eight Steps for “Leading Change”

John P. Kotter, Leading Change: Why Transformation Efforts Fail, Harvard Business School Press, 1995

Focus: Communicating the VisionSimplicity

Multiple formsRepetition

Leadership by exampleExplanation of seeming inconsistencies

Give and take

1. Establishing a Sense of Urgency2. Forming a Powerful Guiding Coalition3. Creating a Vision4. Communicating the Vision5. Empowering Others to Act on the Vision6. Planning for and Creating Short-term wins7. Consolidating Improvements and Producing Still More Change8. Institutionalizing New Approaches

7

Project Team Work as a Team rather than as individuals Establish standing (regular) meetings and

reporting mechanisms◦Standing agenda item for meetings of Team and

Executive Leadership Develop a plan Identify barriers to implementation and

address or mitigate problems Encourage thinking “outside the box” Have a kick-off date

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Project Team (continued) Implementation of plan ◦Not too fast – don’t have kick off until ready

to implement initial series of steps ◦Not too slow – avoid long lags between

implementation of steps Start with Small Successes Monitor process and outcome data ◦Is the plan being carried out?◦Is the plan having intended effects?

Review and respond to data

Assure review of data by leadership and team Make processes and outcomes transparent Educate and engage staff (clinical, medical and

support staff) about the project Share WHAT WORKED and WHAT DID NOT◦Compare results across wards in a hospital◦Call your colleagues/network

Project Team (continued)

With both staff and individuals in careAs Management does unto Staff… So shall Staff do unto Consumers

Strength-based supervision for staff Use three buckets or red rules/green rules

with individuals in care◦Offer choices◦Respectful interactions

Moving from Control to Collaboration

Promote calm, nurturing, healing environments◦signage

Model caring, compassionate behavior Demonstrate active listening Interview and observe for triggers Adjust environment to prevent triggers Use full range of prevention tools Model, teach, model, teach - i.e., shape the behavior

you want to see

Stress Primary Prevention

Persistence and sustained attention

Don’t get discouraged

Jayne Van BramerDirector, Office of Quality ManagementNew York State Office of Mental Health44 Holland AvenueAlbany, New York 12229

(518) 474-4447 Jayne.VanBramer@omh.ny.gov

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