Redesigning the Organization: Tools for Growing Self-Directed Teams

1. Redesigning the Organization: Tools for Growing Self-Directed Teams Nancy Fox Vivage Chris Perna Eden Alternative

2. Defining the Need • 16,000+ nursing homes and 5,800+ hospitals in the U.S. • Most of them structured alike - similar to military brigades with top-down hierarchies, robust chains of command, and a departmental approach to care. • Organizational designs are “purposeful interventions that are designed to shape and influence human behavior in a particular direction.” (Organizational Psychology: a Scientist-Practitioner Approach, Steve M. Jex)

3. The Oddest of Ethos • Ethos = The disposition, character, or fundamental values peculiar to a group or team. • The institutional model ethos has been largely shaped by the very organizational structures we have used to “shape and influence the behaviors” of our employees. • We know that human behavior is a result of context more than character.

4. The CULPRIT!What behaviors has this design shaped?

5. The Institutional Context • Top down hierarchy – “You’ll have to ask the nurse” • Departmental approach to care – “It’s not my job” • Hands-on staff rotated – “That’s not my resident” • Division into shifts– “Night shift left it” • Punitive culture – Excuses – “We’re short today.” & “I didn’t do it.”

6. Constituencies • The current organizational structure has created a series of constituencies that pit us against each other. • Management vs. staff • Department vs. department • Shift vs. shift • Staff vs. families • Facility staff vs. corporate staff • Facility staff vs. regulators

7. Constituency vs. Community • Constituency = a group of people who work to promote their own agenda and fulfill their own needs, often to the detriment of people outside their constituency • Community = a group of unrelated people living and working together in shared fellowship toward a common noble aim

8. Leadership “Leaders must go beyond behaviors and address the contextual issues at the heart of departmental separation and politics….There is perhaps no greater cause of professional anxiety and exasperation- not to mention turnover – than employees having to fight with people in their own organization.” – Patrick Lencioni (Silos, Politics and Turf Wars, Patrick Lencioni)

9. Coming out of Constituencies and into Community • It begins with leadership… • Recognize the very way we have organized our work has created these constituencies and behaviors we don’t like • Stop clinging to an outdated management theory – Scientific Management and the division of labor • Frederick Taylor, the father of Scientific Management

10. Meet Taylorasaurus Rex • Looks menacing due to its size, but it takes a long time to decide to do anything. • Spinal cord: a pyramidal hierarchy for passing information up and down. A lot gets lost in transit. • Taylorism in its extreme form: employees leave their brains & hearts at the door. There are only a few responsible people here! • Status: extinct (except in healthcare organizations)

11. We know Taylorism does not work • Separates workers from the results of their work • Strips them of the opportunity to understand the whole process, participate in a variety of tasks, do the planning, evaluating & improving of work processes – all normal aspects of working in community • Prevents them from knowing and understanding the residents and families – our customers. • Strips the meaning out of their work & denies the organization the benefit of their creativity, passion and energy

12. Daniel Pink – Drive: The Surprising Truth About What Motivates Us • “The course of human freedom has always moved in the direction of more freedom. And there is a reason for that – because it is in our nature to push for it.” • “The secret to high performance and satisfaction - at work, at school, and at home – is the deeply human need to direct our own lives.” • “We are born to be Players, not Pawns.”

13. Engage & Empower • Old Culture Thinking: • “I need to get buy-in of my staff.” • New Culture Thinking: • “ I need my staff to take ownership.” Ownership only comes from having a part in shaping the plan. You can not separate Authority and Accountability If you want people to be accountable, you must give them the authority that comes with it. Empowerment = ARIA

14. Is this what we have done? “There is nothing more dangerous than to build a society with a large segment of people in that society who feel that they have no stake in it, who feel that they have nothing to lose. People who have a stake in their society protect that society, but when they don’t have it, they unconsciously want to destroy it.” — Martin Luther King, Jr. By putting all of the decision-making authority into the hands of a few courageous people?

15. A question we asked ourselves: • Is the current organizational design serving our highest purpose of creating a caring community?

16. We understood… • That we would never be able to achieve deep, sustainable person-directed/person-centered care in the current organizational design. • But even more than that, we understood if we are going to be successful in the future, we must unleash the creative energy and passion of each person in our organization.

17. We began with a Vision Organizational Redesign using these principles: • Push resources and decision-making closer to the residents. • Flatten the hierarchy – Engage in empowerment • Smaller is warmer and easier to change • Consistent assignment of staff • Grow team instead of department and shift/ management and staff • Cross-training & blending of roles • Create a sense of belonging & ownership “Make the job as big as their hearts.” — Dr. William Thomas

18. Self-Directed Work Teams • Definition: A group of employees who have day-to-day responsibility for managing themselves and the work they do with a minimum of direct supervision. Members of the SDWT make service–related decisions and take action on problems. • People, not programs or systems are the answer to increased competition in the work environment. • Changes caused by customer demands, employee expectations, competition, government intervention, and public pressure are creating an environment where empowered work teams make more sense. • Many corporations have used them since the early 1960’s

19. Growing Capacity • We are going to need Guides • Managers who facilitate the team’s growth & development • “The worst thing you can do to a team is leave it alone in the dark. I guarantee that if you come across someone who says that teams did not work in his company, it’s because management did not take an interest in them.” — James Watson, VP of Texas Instruments

20. Grant Project • Colorado Culture Change Accountability Board • To develop and mentor Neighborhood Guides in 5 different Piñon managed communities • These NGs would then use the same curriculum to develop at least one Neighborhood Team in each of their communities. • The grant project was for a one year period from July 2010 to July 2011. • Our project continues

21. Project definitions • Neighborhood – a small section of a long-term care community where people live and work together. • Neighborhood Guide – a person, usually in a management position (but there are exceptions) within the long-term care community, who has education and skills in developing and mentoring high-functioning self-directed work teams.

22. Project definitions • Self-Directed Neighborhood Team – A multi-functional, cross-discipline, cross departmental group of consistently assigned staff working across a 24-hour/day-7-day/week time period, both management and non-management, who work together to meet the individual needs and desires of the residents in their neighborhood. • Empowerment – The moving of both authority and accountability along with resources and information out of the traditional departmental structure and into the neighborhood team.

23. Neighborhood Guides • Started with 21 people from 5 different communities • 18 managers, 1 weekend nurse, & 2 CNAs • Committed to: • 4 training sessions over the course of the project • To use the curriculum as developed to grow at least one Neighborhood Team • Developed their own Mission, Vision and Code of Ethics • Went to work growing themselves

24. Growing Guides • From Sheepherders to Shepherds • Focused on Self-Awareness and Group Facilitation and Coaching Skills • Guides have to learn how to stop giving answers and start asking questions

25. Guide Core Beliefs • The distinctions between Theory X and Theory Y refers not to management styles or behavior, but to assumptions that we have about people. • Theory X assumptions handicap a leaders ability in creating an empowered workforce. • Theory Y assumptions enables a leader’s ability to support SDWTs.

26. Guides must play many roles • We identified 9 different roles into which a Neighborhood Guide must grow and become. • As the Teams mature in their own growth, these roles may shift in importance and frequency, but they are all necessary and vital to a team’s success. • SDWT will always need Guides. • Even the highest functioning teams will tend to take short-cuts.

27. Guide Roles

28. Our Challenge • Taking an organic process and making it as linear as possible. • We created a road map for the Guides • The Road Map is divided into 30 one-hour Modules. • The “art” of guiding a SDWT is found in the ability to respond to the needs of the moment. • Other than the final 5 Modules, the Guides can reach down and “pull up” a Module if they need it to address a current issue.

29. The Road Map • Modules 1-3 – Setting the Stage • Modules 4-6 – Creating a Team Identity • Modules 7-9 – Building Team Skills • Modules 10-13 – Acting Like a Team • Modules 14-16 – Performance Improvement • Modules 17-19 - Becoming Customer-Focused • Modules 20-22 – Growing as Leaders • Modules 23-25 – Growing as a Team • Modules 26-29 – Team Self-Management

30. Giving them Tools • The Guide’s Log • A scripted curriculum guide was developed for each of the 30 one-hour Modules. • Each Module has a Follow-up from the previous meeting, a Soil Warmer, a Main Topic, a Learning Circle Topic and a Teamwork Growth Assignment • The Log also includes all the handouts needed for each individual Module. • We also included a section on Facilitation Tools and Team Building exercises in the Log

31. The Guide Kit • Each community was given a suitcase with the supplies necessary to facilitate the Modules • A DVD that includes everything in the Guide’s Log along with any videos used in the curriculum • And a Video Camera to record each of their Neighborhood Team Sessions • Each Guide is also charged with journaling their own journey

32. Continued Support • Quarterly, one of the project leaders visited each home to observe a team meeting and provide feedback to the Guides • The project leaders also watch a video of a team meeting and offer feedback to the guides • Quarterly 2-day sessions where the Guides report their successes and challenges and learn from each other, and also receive more Modules.

33. Lessons Learned • Size Matters • Don’t go it alone – train many Guides • Consistency w/flexibility • Not something extra – but how we work now • Anyone can be a Guide – but have a person of formal authority with you • Don’t be afraid to start over or repeat a module

34. Lessons Learned • Administrator and DON involvement • Let the teams decide on meeting times and hold each other accountable for attendance • Come prepared • Meet as a team of Guides often • Guiding a team is not just being at Team Meetings

35. Project Evaluation • Well-Being of Residents & Staff – Baseline and at month 12 • Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) – Baseline and at month 12 • Guide self-assessment based on the 9 Guide Roles • Training Evaluations – after each session with project leaders

36. Results to date • Elders Well-Being

37. Results to Date • Staff Well-Being

38. Empowerment • CWEQ-II • Structural empowerment scores prior to initiation of the curriculum ranged from 18.4 to 20.8. At the conclusion of the project scores ranged from19.7 to 22. • Scores that fall between 14 and 22 are considered to be moderate levels of structural empowerment.

39. Neighborhood Guide • Training Curriculum is coming your way… • Licensed to the Eden Alternative for national distribution through their team of educators. • www.edenalt.org