This week, I’m heading north to work with a large in-patient psychiatric facility that’s on quite a road to successful culture change. Over the past five or six years, they’ve been taking small steps toward what will soon be actualized as a whole new way of caring for their patients—a new hospital culture.
This organization provides care for some of society’s most challenging individuals, including those with dual diagnoses, geriatric mental health conditions, and those adjudicated not responsible for their crimes due to their diagnoses.
Fourteen hand-picked staff will begin the initial training roll-out to the veteran staff next week. Fourteen hand-picked staff will become the voices of change within their organization—an organization that’s steeped in tradition and history.
It will not be an easy task. But the hard work will ultimately make staffs’ jobs easier, the hospital’s culture of care stronger, and quality of life better for the facility’s service users.
Changing Your Hospital Culture
According to the National Implementation Research Network
, successful implementation of improved practices results in three outcomes:
- A change in the organizational culture. (When organizations implement CPI’s offerings, they demonstrate a culture that provides Care, Welfare, Safety, and SecuritySM for everyone, even during crisis moments.)
- A change in adult professional behavior. (Staff demonstrate a commitment to safer practices.)
- A change in relationship to consumers and stakeholders. (Staff demonstrate an improved quality of care.)
Five Things to Consider
Here are five things I think all organizations should consider as they prepare for and assess their readiness for change—especially for making changes in order to prevent and manage workplace violence.
- Establish a vision and benchmarks.
Where are you now? Where do you want to be? How much time do you anticipate it will take you to actualize your desired outcomes?
Too often, we implement an evidence-based practice without establishing clear goals and benchmarks, and without measuring outcomes. Then it becomes difficult to gain buy-in and to support the implementation over time because we can’t speak to the return on our investment. But your CFO wants to know about ROI—trust me on that one!
So think about where you want to actualize positive results, both financially and in terms of patient care. Don’t forget about measuring staff confidence and turnover rates. Confidence increases and turnover rates decrease when staff feel safer at work.
Keep in mind that it’s simply not possible to communicate too much. Each and every employee will be affected by the hospital culture change somehow. Be creative in your communication strategies, and know that if you want buy-in from direct care providers, they must understand “what’s in it for me.”
All administrators need to be on board too. If one top administrator is opposed to the idea, he or she will taint the process or even cause it to fail, depending on his or her influence. Too often, organizations experience distrust when veteran staff have seen initiatives come and go—some succeeding; others fading away. Communicate—to all players—not only the goals and objectives, but the benchmarks and outcomes. How will I know I’m successful and making the requested behavior changes as a professional? Tell me what tools you’re giving me so I don’t feel like you’re just taking away the things I’ve known for years. Keep the feedback loop open.
- Be transparent.
Transparency is tough for organizations. It means owning up to what you’re currently doing. Sometimes that’s great and you’re simply trying to move to greater than great, but often it reveals that you have gaps; that you could be doing much better at some things. But being transparent builds trust and buy-in. Employees respond much better to change they feel they are a part of versus change they feel is being imposed on them.
Establish a process for accountability at all levels of the organization for supporting and sustaining the initiative. Who owns it? More importantly, how does each unit within the organization support its success? Write the expectations for the changes in adult professional behavior right into job descriptions, performance appraisals, and policies and procedures. Often, initiatives fail because no one takes the hard job of holding others accountable to the change. Old habits slip back into play and no one calls it out. Training drift occurs because we have taken the “train and hope” approach. Avoid that by establishing accountability.
- Reward positive behavior and successes—even the small ones!
People need to know when they’re doing a good job. As you achieve benchmarks—even small steps toward your ultimate goal—celebrate them. Staff are more likely to keep working at the change when they feel that they’re supported and rewarded for their hard work. True culture change can take years. It’s easy to lose the passion and drive around the vision without continuous attention to the successes you actualize. Be prepared for small steps backward or unanticipated barriers, but work through them and keep moving forward.
I hope these tips give you a few ideas to ground your next initiative to. Don’t hesitate to call us if you’d like to do what so many others are doing in really pushing to reduce, and even eliminate, coercive practices and restraint and seclusion within your organization. For a detailed assessment tool, I recommend this Checklist for Assessing Your Organization’s Readiness for Reducing Seclusion and Restraint
[PDF], created by David Colton, Ph.D.