QI tools from across the pond

In Patient Safety on November 8, 2015 at 2:30 pm

Great list of simple tools to use to make improvements,com_quality_and_service_improvement_tools/Itemid,5015.html

Culture transformation Thursday : power and deviance

In Patient Safety on October 21, 2015 at 12:11 pm

There are some interesting leadership behaviors that can occur in an unsupportive workplace environment. When a leader gets frustrated with lack of progress on an initiative or overall group day to day performance they can attempt to regain control by exerting power (kind of like parenting?  “because I am your mother thats why!”).

There is a theory of how employees repond to this (Sims, 2010):

  1. Leader Display of Power
  2. Employee becomes frustrated… might product feelings of threats to autonomy/social identity and feelings of injustice
  3. Two options:

1) Employee accepts this

2) Employee rejects the display of power by:

  1. a) displaying exit behaviors which can be physical or emotional (eg. leave the group or physically stay but become disengaged).
  2. b) using the employee voice: which is productive if its internal and listened to and used to find a better solution or non-productive if the voice is ignored or used outside of the group to bad mouth the leader or the group in general

A group who perceives this cycle to be repeating over and over(even if its not true), eventually may adopt a deviant culture where negative organizational behaviors become the norm.  When this happens even internally motivated, self-regulated individuals can conform to socialization.  In general, people need to feel a sense of equity: that the reward they get from work matches the effort they put out (Henle, 2005). Rewards are more than just money. They can be respect, acknowledgement, educational opportunities, a good schedule, gratitude from patients/customers, etc…In times of budget restriction, the rewards for employees are usually reduced and the work demands are increased, thus creating a potentially harmful mismatch.

One of the mediators of workplace deviance is interactional justice.  In a leader this would mean treating all with sensitivity, dignity and respect and giving adequate explanations for decisions made AND taking ownership for decisions made. Staff experience more frustration if they feel their leader does not agree with an organizational decision but is powerless to fix it. Senior leadership has an obligation to give their middle managers adequate explanations and a list of talking points to help disseminate the information. If the decision does not have a valid explanation maybe it is not the right decision!  There are many psychological biases inherent in leadership decision-making that can compromise effective operational strategy.

Another mediator of workplace deviance is to have leader and employee goals that match.  It is important to understand employee workplace goals. A good leader will help the employee discover how their goals can align with the organizational goals or in a case where there might be a poor fit and the goals do not align, coach the employee to seek an alternate environment.

Those employees whose goals do align can be used to create positive deviance within the group.  Involve them in projects that fit with their goals. Eventually the norms of the group will change and become more aligned with the organizational goals creating benefit for the organization and engagement in the employees.

Lessons from a Cat

In culture, Human Factors, Just Culture on June 7, 2015 at 3:52 pm
Good kitty or bad kitty?

Good kitty or bad kitty?

After three years of amazing litter box use (she even went in the litter box to cough up hairballs), my cat Muffin looked me in the eye and pooped right on a rug outside of her litter box. At first I thought she was sick. But then she played and acted normal for the rest of the evening. When I woke up in the morning, I noticed she had peed all over the rug. This was such unusual behavior.

I searched the internet and found many theories of cat behavior. Maybe she didnt like the new litter, maybe her box was too dirty, maybe she was upset. I decided to buy her a totally new litter box and went back to her fav kitty litter. I bought a slightly smaller box than she was used to because the other one had to squeeze into the fake furniture housing that encased it and I didn’t clean it as thoroughly as I should because it was challenging to get in and out.

It seemed to work! Muffin was doing her business back in the box. After a week or so when I took the box out to clean it, I noticed urine all underneath it. UGH! she was peeing outside the box. Maybe this was behavioral after-all. Time to google cat therapists.

Let’s look at this from a just culture lens.

Initially I thought Muffin’s defiant voiding outside of her box was a protest…malicious behavior. Then after searching cat behavior, i thought maybe she was just being reckless. Then one day after cleaning all the urine under the litter box, i noticed that the side of the pan where she usually pees was pretty short. I flipped the pan around and put the taller side in that spot. Like magic problem solved! Muffin never meant to be malicious or reckless nor was she making a mistake! With a little redesign of her environment…problem solved! She just needed new better designed equipment.

Do we support help our healthcare workers in redesigning their environment for safety  or do we just accuse them of making errors and being reckless?


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