are pieces of your puzzle missing? considering the culture of your worksite
TRANSCRIPT
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 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.
What is a Discovery & Action Dialogue?
• Discover what people are already doing that works Positive Deviants
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
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
• 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?
• Have someone else record the responses so you can facilitate
Arranging Space & Materials for the Conversation
• Where? When? With Whom?
• Have someone else record the responses so you can facilitate
• Room set-up:
– Chairs in a circle OR standing around a flip chart
Arranging Space & Materials for the Conversation
• Where? When? With Whom?
• Have someone else record the responses so you can facilitate
• 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!
Arranging Space & Materials for the Conversation
• Everyone interested in solving the problem
• Look to your process map!
Everyone Who Touches the Resident Can Participate
• Everyone interested in solving the problem
• Look to your process map!
• Multiple disciplines and different roles
Everyone Who Touches the Resident Can Participate
• Everyone interested in solving the problem
• Look to your process map!
• Multiple disciplines and different roles
• Who else? – Residents
– Families
– Volunteers
Everyone Who Touches the Resident Can Participate
• Everyone interested in solving the problem
• Look to your process map!
• Multiple disciplines and different roles
• Who else? – Residents
– Families
– Volunteers
• Make sure everyone has an equal opportunity to participate
Everyone Who Touches the Resident Can 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”
• Work through all or some of the questions without worrying about the order
AND/OR
• Follow the conversation with other questions
• Keep respect at the forefront of the conversation
More “Do’s”
• Work through all or some of the questions without worrying about the order
AND/OR
• Follow the conversation with other questions
• 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