Are Pieces of your Puzzle Missing? Considering the Culture of your Worksite

Considering the culture of your worksite

Innovative approaches for engaging your colleagues and generating ideas for improving care.

Are Pieces of your puzzle missing?

TRIZ

• теория решения изобретательских задач, teoriya resheniya izobretatelskikh zadatch

• it is a problem-solving, analysis and forecasting tool heavily researched from 1946 - 1985

• It was developed by the Soviet inventor and science fiction author Genrich Altschuller and his colleagues, from initial work with the Soviet Navy.

• In English the name is typically rendered as "the theory of inventive problem solving" and occasionally goes by the English acronym TIPS.

Step One

• How can we ensure that 100% of the time, we NEVER provide optimal medication care?

Step Two • Take each crazy or not so crazy idea and see if there is an

element of truth within it OR is it something you currently practice.

• Lift out that truth and write it in note form on your flip chart.

• This is where you dive deeply into each statement made on the flip chart.

• Be brutally honest with yourself.

• Example – give all the staff a frontal lobotomy. This is pretty silly, HOWEVER, what are all the ways that we numb down/ dumb down the creativity in our staff?

Step Three

• Go through your list of identified truths – start to separate the truths into themes;

• Begin to prioritize how you might begin tackling the list to stop the practices that may be contributing to the care planning issue.

DISCOVERY & ACTION DIALOGUES A TOOL FOR GETTING STARTED WITH

CONVERSATIONS

What is a Discovery & Action Dialogue?

• Discover what people are already doing that works Positive Deviants



• These deviants face the same restrictions as everyone else but find their own solutions Hidden and untapped solutions



• These deviants face the same restrictions as everyone else but find their own solutions Hidden and untapped solutions

• They gain support as colleagues see the solutions working and then adapt the new thinking/behaving Momentum spreads

1. What do you know about (the problem) / how do you know when it’s present?

2. What do YOU do about it?

3. What are the BARRIERS that prevent you from doing (the right thing/process) 100% of the time?

4. Who are the Positive Deviants that are overcoming these barriers?

5. WHO ELSE needs to be part of this conversation? (“Don’t decide about me without me.”) How do we invite them to join the action?

6. What other ideas do you have? Any volunteers?

The “DAD”: 6 Questions

Q1:

How do you know when a

resident is on inappropriate

antipsychotics?

(the problem is present)

• Affirm that we all have

existing knowledge of the

problem

• Provide opportunities to get

questions on the table

The Details …

Q2:

How do YOU contribute to

reducing inappropriate

antipsychotic use?

(solving the problem)

• Focus on personal practices,

NOT on what other people

don’t do

• Amplify / confirm the

participant’s knowledge of

effective practices

The Details …

Q3:

What prevents you from

doing this or taking these

actions all the time?

• Identify real barriers and

constraints

• Ask: What prevents you?

vs

Why don’t you?

The Details …

Q4:

Is there anyone you know who

is able to frequently address

BPSD without inappropriate

medications?

(solve the problem,

overcome barriers)

• Establish that getting around

barriers is possible

• Identify the existing-but-

uncommon successful

strategies

The Details …

Q5:

Do you have any ideas?

• Identify the supports that make

the desired behaviour more

likely

• Provide an opportunity for

participants to generate and

share new ideas for enabling

the desired behavior

The Details …

Q6:

What needs to be done to

make it happen? Any

volunteers?

• Identify action steps, target

dates & feedback loops for

metrics

• Invite volunteers for each

action step (capture ideas that

don’t yet have an identified

action plan or volunteer)

The Details …

Q7:

Who else needs to be

involved?

• Who else can we bring in?

• Widen the circle of people

involved in discovering

solutions, drawing in unusual

suspects

The Details …

http://bcpsqc.ca/blog/knowledge/discovery-and-action-dialogue/








• What is the problem you are going to talk about?

– Inappropriate antipsychotics?

– BPSD?

– Culture?

– Care Planning?

• How will you get people to come?

• When will you hold the meeting or meetings?

• How will you follow-up with the information you learn?

Getting Started with a DAD

• Where? When? With Whom?

Arranging Space & Materials for the Conversation


• Have someone else record the responses so you can facilitate




• Room set-up:

– Chairs in a circle OR standing around a flip chart




• Room set-up:

– Chairs in a circle OR standing around a flip chart

• 5 – 15 people with diverse roles and experience is an asset, although one-on-one can be powerful too!


• Everyone interested in solving the problem

Everyone Who Touches the Resident Can Participate


• Look to your process map!




• Multiple disciplines and different roles





• Who else? – Residents

– Families

– Volunteers





• Who else? – Residents

– Families

– Volunteers

• Make sure everyone has an equal opportunity to participate


• Start with the purpose “We are here to _______________!”

• “Give” the questions to the group, then wait at least 20 seconds for a response Sing Happy Birthday to yourself

• Encourage quiet people to talk

Facilitator “Do” Guidelines

How do you handle cynical responses?

“If I understand you correctly, no one has ever done this successfully or well.”

“What would you do if there was an opportunity for change?”

“Can you please re-frame what you just said with a question beginning with ‘what’ or ‘how’? Include some kind of action.

Facilitator “Do” Guidelines

• Work through all or some of the questions without worrying about the order

AND/OR

• Follow the conversation with other questions

More “Do’s”


AND/OR


• Keep respect at the forefront of the conversation

More “Do’s”


AND/OR


• Keep respect at the forefront of the conversation

• Have someone record responses on flip charts

More “Do’s”

• Don’t answer questions that haven’t been asked directly to you Even then, ask the group members to provide an answer (they are the wise ones who will have the answers)

• Don’t miss opportunities to “catch butterflies” Record ideas that got missed in the conversation

Facilitator “Don’t” Guidelines

• Don’t continue the conversation when others need to be present -“Nothing about me without me!” Invite them to the next dialogue

More “Don’ts”

• Don’t continue the conversation when others need to be present -“Nothing about me without me!” Invite them to the next dialogue

• Avoid responding positively or negatively to contributions You might ask, “How/What do others think or feel about this suggestion?”

More “Don’ts”

• Hold the dialogue out in the open

• Make impromptu invitations as you enter the area

• Create an “informal climate”, starting with introductions and a story if appropriate

• Maintain eye contact and sit with the group (not higher or far away)

General Tips & Traps

General Tips & Traps

• Talk less than participants, and encourage everyone to share stories and “sift” for action opportunities

• Draw out stories that help people make a leap of understanding from a small example of behavior change to a larger shift in values and/or resource sharing

• Demonstrate genuine curiosity in everyone’s offerings without answering the questions yourself

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Questions?

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Are Pieces of your Puzzle Missing? Considering the Culture of your Worksite

Health & Medicine