Johnson, Hope L, MSN, RN, CNOR

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingBudging CultureHope L. Johnson MSN, RN, CNORLehigh Valley Health Network, Hope_L.Johnson@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtResearch Day 2012: Transforming Culture Through Evidence-Based Practice, October 29,2012, Lehigh Valley Health Network,Allentown, PA. Budging Culture   Hope Johnson RN, MSN, CNOR, NEA-BC Director of Operative Services Objectives ■ At the conclusion of the presentation, the learner will be able to: – Describe degrees of change within the OR and SPD environment – Modify systems to change behavior – Measure implemented methods to shift culture Disclaimer ■ Culture shifting is an ongoing journey ■ You will find changing culture is a gradual change What is Culture? ■ Organizational culture is the collective behavior of humans that are part of an organization. ■ It is formed by the organization values, visions, norms, working language, systems, it includes beliefs and habits. ■ It includes patterns of accepted behavior.  OR Culture ■ Teamwork ■ Language ■ Customs ■ Personality ■ Roles and hierarchy   SPD Culture ■ Teamwork ■ Production line mentality ■ Location of department ■ Lack of attention  Work System Model The Work System Model supports that changing fundamental work behavior requires modifying the system within which employees work. This is accomplished by altering influences of behavior/scene in combination.  Workplace Design: Arrangement of the physical & virtual work area  Organizational Structure: lines and boxes (org chart)  Decision Allocation: Who participates in what manner in which decisions  Information Distribution: Who gets to know what and when  Measurement/scorecard: What is tabulated, the scorecard  Rewards/Punishments: What the system truly recognizes, ignores, rewards and punishment  Task or Work Processes: Job content (processes, descriptions, protocols)  People/Skills : Orientation, history, culture, skills of organization members, education           Gregory P. Shea, PhD and associates Barriers to Change ■ Cognitive ■ Limited Resources ■ Motivation ■ Politics What is our story? ■ In the OR – Start to build a culture of safety – Focus on the teamwork and communication ■ In SPD – Create recognition surrounding the department – Support self-worth and promotion OPERATING ROOM Periop Team Training ■ Mandatory Course ■ Joint interest for Departments of Surgery, Anesthesiology and Perioperative Services ■ Held over 18 months across 2009-2011 ■ Use data to build the course  Course Outline ■ Introduction/Background ■ Crew Resource Management ■ Team Communication Retrospectively ■ Talked about what is important for a culture of safety ■ Failed to nail down the expectations for all involved ■ Began the conversation ■ Had people talking Tasks/Work Process ■ Surgical Technician certification ■ Perioperative Technical Partner reorganization ■ OR Efficiency ■ Regulatory requirements   Surgical Technician Certification ■ Altered job description ■ Support through certification requirement ■ Staff champions ■ 100% certification across the network Perioperative Technical Partner Reorganization ■ One massive team divided into 3 based on work task ■ Continual meetings leading up to change ■ Implemented change ■ Re-evaluation of change with continued actions (PDCA)  SPPI ■ Not only a departmental culture shift – but organization wide ■ Forces a change in thought pattern  – Do more with less – Evaluate your processes to capture most efficient – Use tools to help the journey Tools Helping Culture Shift ■ Transparency – Visibility Boards – Daily Metric Board ■ 6S ■ Value Stream Mapping ■ A3 thinking   OR Efficiency Work ■ On Time First Case Start ■ Turnover Time ■ Immediate Use Sterilization Regulatory Changes ■ Joint Commission represents an ideological shift ■ Pre-procedural assessment ■ Time Out (regulations) ■ Health Care Reform Location, Location, Location ■ Movement of a manager’s office to increase visibility  Location of Supplies ■ North Storage movement ■ Move the supplies closer to the work Addition of Management ■ Key organizational additions – Manager of Operative Services – Manager of Support Services Getting Staff Involved ■ Employee Satisfaction Committee ■ Process Mapping Exercises Additional Communication ■ Increased team meetings within weekly inservice schedule ■ Daily Metric Boards – OR Efficiencies ■ Visibility Walls ■ Days of Safety Data Collection and Report ■ Daily Metric Boards Recognitions ■ Expectations on PRIDE behaviors ■ Celebrations of our success  – OTFCS carnival – Robotics success ■ Kudos awards STERILE PROCESSING People/Skills ■ Organizational Development Work Sessions Tasks/Work Processes ■ Reorganization of SP Techs and addition of Surgical Technologists ■ Sterile Processing Technician Certification ■ SPPI -  Value Stream 2  Construction ■ Construction Project – SPPI was the catalyst – Value Stream #2 – chosen based on approved construction for the department – Form follows function ■ Major Changes – Movement of dry goods and instruments – New equipment – New process flow Organizational Structure ■ Managerial changes Decisions ■ Process Mapping ■ Construction Plans ■ Organizational Development Meetings Who Gets To Know What ■ Information is transparent ■ Several visibility walls ■ Daily Metric Board ■ Increased staff meetings Measurements ■ Daily Metric Board ■ Immediate Use Sterilization ■ Incomplete trays Rewards ■ Working towards revamping R&R ■ Accountability within the department  So How Do You Do It? ■ Win hearts and minds of those that will change – make them trust you ■ Come with clear vision – hit more than this is what we have to do and why – hit the heart ■ Experience harsh realities ■ Focus on what uses limited resources but will help with large change   ■ ID stakeholders and be systematically responsive to them ■ Draw on full capability of staff ■ Put in place new systems and process that support the change/vision ■ Reinforce by transparency Leadership Expectations ■ Ensure leadership buy in – this is a mistake to only look at front line ■ Lead by example ■ On going and never ending process QUESTIONS  

Breakout Session #2: Budging Culture

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Breakout Session #2: Budging Culture

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