Patient Flow Collaborative

1. Patient Flow Collaborative Belinda Moyes Principal Nurse Advisor/Director Nurse Policy Branch Chair National Nursing and Education Taskforce 1 April 2004

2. Welcome

3. Patient Flow Collaborative Aims • To tackle key constraints in the patient process identified by each health service • To promote and facilitate the development of service improvement skills within each health service

4. Patient Flow Collaborative The challenge is to revolutionise our expectations of health care: to design a continuous flow of work for clinicians and a seamless experience of care for patients. Donald.M.Berwick President and CEO Institute for Healthcare Improvement

5. Issues • Excellent innovation in pockets • Long waits in ED • Elective surgery waiting times • Inpatient delays

6. House keeping • Mobile phones and pagers • Rest rooms • Fire Alarm • Informal – ask questions

7. Nurse Leaders Master Class Agenda 9.15 – 10.00 Ancient myths and modern magic, Kate Harmond 10.00 –10.30 Morning tea 10.30 – 12.30 Innovation case study – leadership, Lee Martin 12.30 – 1.30 Lunch 1.30 – 3.00 Leadership for improvement, Kate Harmond 3.00 – 3.30 Afternoon tea 3.30 – 4.30 Polarity management, Kate Harmond

8. Questions

9. Kate Harmond Nurse leaders masterclass, Melbourne, April 2004 Ancient myths and modern magic

10. The case for change “I believe that public servants are working flat out but in a system that shrieks out for fundamental change… If we don’t get the systems and structures right we will never get to the roots of the problem, only prune its visible branches… The key to reform is redesigning the system around the user.” Tony Blair, 2001

11. Public opinion Service failures Workforce pressures Access improvement Clinical governance Investment Policy context

12. Decisions based on training or experience “Do no harm” is up to each individual The system reacts to needs Professional roles shape the system Decisions are based on evidence Safety relates to the system Needs are anticipated and met Co-operation is an explicit priority Changing culture

13. Lessons from top companies • Constant improvement • Culture for innovation • Team development • Community involvement • Client centred • Open and blame-free environment

14. Know your strengths If there had been three wise nurses instead of three wise men, they would have asked for directions, arrived on time, helped deliver the baby, cleaned up the stable, and brought something practical, like a nice casserole. Barbara Bush (adapted)

15. Morning tea

16. Patient Flow Collaborative Lee Martin Collaborative Director Rochelle Condon Improvement lead

17. Leadership and behaviour styles case study on leadership

18. What is your style

19. Expressive • Verbal • Motivating • Enthusiastic • Gregarious • Convincing • Generous • Influential • Dramatic • Animated

20. Amiable • Patient • Loyal • Sympathetic • Relaxed • Mature • Considerate • Stable • Trusting • Team person

21. Direct Driver • Action oriented • Decisive • Problem solver • Direct • Assertive • Risk taker • Competitive • Independent • Determined

22. Analyst • Controlled • Orderly • Precise • Disciplined • Deliberate • Cautious • Diplomatic • Accurate • Fact finder • Systematic

23. Exercise • Corners of the room are sign posted • Move to the corner of the room that reflects your style

24. Verbal inspiring Ambitious Energetic Enthusiastic Confident Friendly Talkers Overly dramatic Impulsive Undisciplined Excitable manipulative Positive and Negative perceptions of Expressive

25. How to work with expressive people better • Tell who first • Be enthusiastic • Allow for fun • Support their creativity • Talk about people and goals • Handle the details for them • Value feelings • Keep fast paced

26. Patient Respectful Willing Agreeable Dependable Concerned relaxed Hesitant Wishy washy Pliant Conforming Dependant Unsure Laid back Positive and Negative perceptions of Amiable

27. How to work with amiable people better • Tell why and who first • Ask instead of telling • Draw out their opinions • Explore personal life • Define expectations • Strive for harmony

28. Decisive Independent Practical Determined Efficient Assertive Risk takers direct Pushy One man/woman show Tough Demanding Dominating Insensitive Cuts corners Positive and Negative perceptions of Direct Driver

29. How to work with direct driver people better • Tell what and when first • Keep fast paced • Don’t waste time • Be business like • Give some freedom • Talk results • Find shortcuts

30. Accurate Conscientious Serious Persistent organised Critical Picky Moralistic Stuffy stubborn Positive and Negative perceptions of Analyst

31. How to work with analyst people better • Tell how first • List pros and cons • Be accurate and logical • Provide evidence • Provide deadlines • Give them time, don’t rush or surprise

32. driver • will become • autocratic • analytical • will withdraw • amiable • will submit • expressive • will become • offensive • or sarcastic Under stress

33. Fears about change • analytical • not enough information • making a wrong decision • being forced to decide • driver • loss of control • failure • lack of purpose • amiable • damaged relationships • confrontations • not being recognised • for efforts • expressive • being ignored • being asked for detail • being linked with failure

34. Change and learning • Panic • Zone • people • close up • they • freeze • they don’t • learn • Comfort Zone • people stay here • they don’t learn • they don’t change

35. Discomfort Zone Change and learning Panic Zone Comfort Zone • uncertainty • learning

36. Change learning and comfort: people respond differently • some feel it’s an adventure and are excited and stimulated • some feel it is a mission or a duty • some feel it is a forced march and are fearful and cautious • some feel overwhelmed, depressed and demotivated

37. Noer’s Response factor model high Learners Entrenched Capacity for change (ability to learn) BSers Overwhelmed low Comfort with change (learning readiness) low high

38. Noer’s Response factor model high Learners Entrenched Clings to narrow learnings Learns and grows Capacity for change (ability to learn) BSers Overwhelmed ‘Makes it up’ high drive but low substance Withdraws and avoids low Comfort with change (learning readiness) low high

39. Can apply to individuals, groups, departments, directorates or organisations high Learners Entrenched Clings to narrow learnings Learns and grows Capacity for change (ability to learn) BSers Overwhelmed ‘Makes it up’ high drive but low substance Withdraws and avoids low comfort with change (learning readiness) low high

40. Overwhelmed - low comfort with change, low capacity for change Withdraws and avoids • avoids confronting real issues • retreats into old patterns that are perceived as safe • hopes that things get better • engages in passive / aggressive behaviour • avoids thinking about or planning for the future

41. Overwhelmed: low comfort with change, low capacity for change How overwhelmed feel • unhappy or depressed • frustrated, anxious, powerless • bruised self esteem • fearful of mistakes and failure • needs approval, reassurance and stability What is needed • help in coping with stress, fear and frustration • phased transition and success loaded challenges

42. Entrenched - low comfort with change, high capacity for change Clings to narrow learning • blames and complains • acknowledges need for change but resists changing • works harder than ever at previously successful behaviour • tries to ride it out until things return to normal

43. Entrenched: low comfort with change, high capacity for change How entrenched feel • frustrated, anxious, angry • unrealistically confident that past skills are valid • reluctant to take risks What is needed • understanding and help in coping with anger and frustration • phased transition with a bridge from old to new

44. BSer - high comfort with change, low capacity for change ‘Makes it up’ - high drive but no substance • jockeys for positions of influence • presses for quick solutions and actions • may initially come across as a beacon in the darkness - ultimately becomes transparent • often fools superiors

45. BSers: high comfort with change, low capacity for change How BSers feel • comfortable with need for change • compelled to do something - anything! • frustrated with the ‘confused’ and ‘whining’ • confident in ability to function in any situation What is needed • close supervision and close monitoring • assignments which are safe for the organisation and push the employee

46. Learner -high comfort with change, high capacity for change Learns and grows • finds silver linings behind dark clouds • finds humour in difficult situations • is very aware of both strengths and weaknesses • expands boundaries of their comfort zone

47. Learners:high comfort with change, high capacity for change How learners feel • comfortable with need for change • challenged, stretched, optimistic • in control of own destiny / positive thinker • not afraid of short term mistakes and setbacks What is needed • protection, latitude, air time • developmental roles and assignments with impact • rewards and reinforcements

48. How leaders can help Entrenched - find ways to let go of old and comfortable and learn skills Learners - create an organisation to develop, select and preserve learners Overwhelmed - provide help and support during neutral zone of their transition BSers - identification (uninformed optimist and the true hard core) and development

49. Leading your team • Remember to consider your teams behavioural styles: • Analytical/processing • Amiable/supporting • Expressive/enthusiastic • Driver/controlling

50. Questions