Drs. Resilience & Well -being Resource Guide - v45 | Created by Aeiduke Public Affairs | Revised 11/10/2020 | Approved by Amy Logue High reliability organizations are sensitive to operations. I learned how to enhance my personal resiliency and also guide companies in building resilient practices as highly reliable organizations. Each factor revolves around the employee being heard and supported: Safe, optimal care requires psychological safety and feeling safe and empowered to speak up. There are several factors that encourage resilience and decrease burnout. Review the Action Steps within each Change Concept to assess what additional resources or steps your organization will need to take prior to acting. Effective leadership is the primary component of an HRO. People who remain calm in the face of disaster have resilience. You build up a mindset that you expect things to go wrong. We take pride in providing you with relevant, useful content. Gain insights about the role of data in healthcare transformation and outcomes improvement. Another component of HROs is a culture of safety. The ability to come together, think ahead, and play as a team is critical for the ability to deliver safe care. By building resilience they can help colleagues deal with stress while minimizing the impact on their emotional, mental and physical well-being. Theyre distracted, they need to multitask, and they forget things. They help facilitate conversations aimed at improving psychological safety. Are you a new leader and feeling overwhelmed and unsure where to begin? The four concepts that must be addressed to develop and nurture a culture of safety, psychological safety, accountability, teamwork and communication, and negotiation, all work together to create teams that work - for each other and for the patients. We now conduct probability analyses of systems and behaviors that we know present risk. 2. It provides a framework to integrate all initiatives and a foundation to successfully carry them out. RCAs are effective for identifying causal factors of a single event, however, they rarely create a structure to evaluate possible remedies for long term reliability. Based on those, the Joint Resilience is preparing for potential failure of our actions. Frankel and Leonard and their team assessed 30 community hospitals for the state of Massachusetts to help figure out how these organizations could sustain high-quality community care within an ever-changing environment full of systems mergers and political changes. See the latest announcements, news, and media coverage. All Rights Reserved. When asked where the GPS was placed, Dave said that he put it on the center platform between the two front seats. Even on a bad day there are normally some things that we can feel good about. A learning system, when well developed and rolled out, can have measurable positive effects throughout the organization. Stop for 1-2 seconds, Think, Act, Review B. Improvement wont be sustainable. Framework for Implementing Trauma-Informed Approaches in Primary Care, Fostering Resilience and Recovery: A Change Package, Fostering Resilience and Recovery: Change Management Strategies, Fostering Resilience and Recovery: Change Concept 1, Fostering Resilience and Recovery: Change Concept 2, Fostering Resilience and Recovery: Change Concept 3, Fostering Resilience and Recovery: Change Concept 4, Fostering Resilience and Recovery: Change Concept 5, Fostering Resilience and Recovery: Additional Resources, Fostering Resilience and Recovery: A Change Package for Advancing Trauma-Informed Primary Care, Change Management Strategies: Create the Conditions for Change. Burnout in healthcare can lead to many negative effects, including errors, infections, higher mortality, and decreased patient satisfaction. What Drs. To better address trauma in primary care, Kaiser Permanente and the National Council for Mental Wellbeing (National Council) launched the Trauma-Informed Care Primary Care: Fostering Resilience and Recovery initiative to develop, test, disseminate and scale a field-informed Change Package. Yes!!! High Reliability in Healthcare. These were commitment, control, and challenge. Which Tool and Tactic can be used to foster your resilience? There are effective strategies primary care providers can implement to improve the health and resiliency of individuals with histories of trauma resulting in better patient and provider outcomes. Early in 2012, one of our EMTs, whos employed as a wheelchair van driver, was involved in a motor vehicle crash. Here are 12 of those resilience practices (squeezed into five categories), which can help you confront emotional pain more skillfully. Stay connected with sources of support. Historically, nurses and doctors have been trained and evaluated using the individual expert model. . Its constantly vigilant and transparent. Conflict is unavoidable. Healthcare professionals are experiencing greater physical and verbal abuse from patients and their family members. Frankel and Leonardpublished a study in 2017about cultural data that surveyed and collected data from 17,000 people across 30 hospitals in Michigan. You can take the test here. They tend to increase efficiency. Resilience Theory argues that the important is how we deal with the difficulties rather than the nature of adversities. This trait could also be called relentlessness, says Mr. Studer. Create an atmosphere that allows patients to feel validated and affirmed with each contact. 1. Dave said that he was looking down at his GPS to get familiar with the directions to his next appointment. The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Patients and their families are at the center of everything healthcare providers do. One of their significant interventions started atMayo Clinic. Seven strategies are identified to cultivate nurse resilience: facilitating social connections, promoting positivity, capitalizing on nurses' strengths, nurturing nurses' growth, encouraging nurses' self-care, fostering mindfulness practice and conveying altruism. Believing that their voice can be heard and matters. Importantly, I would have avoided lots of mistakes., Dr. Nancy Hardt, Professor Emerita, University of Florida College of Medicine. These learning boards have several benefits. It was also made clear that the session wasnt punitive, and no one should be afraid of saying the wrong thing. Frankel and Leonard have seen true change is possible, that cultural maturity can happen if teams and units and organizations are both self-reflecting and improvement-capable. In other words, nurses werent comfortable coming and talking to me about the issues they were running into with the patients on the unit. Explore job openings and team member benefits. In partnership, the organizations created the Webinar Implementation for the Science of Enhancing Resiliency (WISER) Training. The technical storage or access that is used exclusively for statistical purposes. Developing an awareness of our own feelings around difficulty, failure, loss, and uncertainty is therefore very important. Address these first to create optimal conditions for change. This Change Package is for a Core Implementation Team (CIT) in primary care organizations planning to implement trauma-informed approaches. A core mindset that supports perseverance is called the "growth mindset"knowing "My ability and competence grow with my effort." Effortful control. Drs. During patient handoff, care providers are sharing three good things that happened on shift or prior to coming to work. Patient stratification, care coordination, and clinical care models. Drs. She was able to tap into resources within the organization and assist her front-line leaders in developing improvement ideas for reducing central line infections. At the core of HROsis a culture of collective mindfulness,in which all workerslook forand reportsmall problems or unsafe conditions, they pose a substantial risk to the organization andwhilethey arerelativelyeasier to fix. They lead to two to three times more engagement and completed projects. All types of primary care settings can benefit from this guidance, regardless of their size, level of behavioral health integration or past progress in advancing trauma-informed approaches. Resilience Theory refers to the ability to adapt successfully and bounce back from adversity, failure, conflict, frustration and misfortune. The striking thing about HROs is that they are pre-occupied with the possibility of failure. 435 0 obj <>/Filter/FlateDecode/ID[<09F254DA6142BA419C657A24C84BC4F8><518EDFD619E6104F865EB1FADF551115>]/Index[417 47]/Info 416 0 R/Length 97/Prev 140906/Root 418 0 R/Size 464/Type/XRef/W[1 3 1]>>stream Evidence-Based Leadership provides the execution framework to align goals, behaviors, and processesto not only realize but to sustain high reliability at all levels of the organizationbecause leaders have the skills to execute both nimbly and consistently. For example, Drs. The Quality Improvement methods needed continual adjustment so that everyone understood that their mission was no longer just finding out what went wrong, but had evolved into developing suggestions for how to proactively manage system changes, performance standards, and decisions made under pressure by front line crews. -typically lead to constructive attitudes and behaviors. There are 10 key things you can do to develop your resilience: Learn to relax. Larrys team found that the employee involved wasnt an individual risk. Effective performance monitoring that includes accurate goal setting measurements, a continuous improvement culture, and accountability, 4. In this study, I: (1) explore the existing literature surrounding high reliability organization and resilience, (2) present a qualitative analysis of Special Weapons and Tactics (SWAT). All healthcare organizations must also address burnout. The framework stresses differentiating between individual issues and systems issues when holding individuals accountable. The necessary pieces for developing and sustaining a culture and system that delivers safe, highly reliable care are strong effective leadership,a culture of safety, and an accessible learning system. Next in the top-down culture of safety is local leadership. Resilience. This helps avoid surprises. Students are constantly faced with tasks that are important for long-term goals but that in the short-term do not feel desirable or intrinsically motivating. In addition to the framework, Drs. This one act demonstrates all of the HROprinciplesandbuilds trust withstaffbyshowing them that you are truly committed to leading and living these behaviors. And a culture of safety tends to have low burnout rates and encourage resilience. Our employee, well call him Dave, appeared to be at fault because he rear-ended the Lexus while it was completely stopped. Nearly two-thirds of the oil and gas executives surveyed report their organization's innovation activities areat beston par with other, similar companies or that they are a market follower. Tips, checklists and other resources throughout the Change Package will guide your implementation efforts. OAdvocateAuroraHeaLth . The people closest to the work know it best, and can help management better understand actual practices, and not just intended procedures. There were many other issues that needed to be addressed in order to bring the organization into alignment with a high reliability model. With HA architecture there is a balance between high resilience, low latency, and cost. These things are deeply embedded in the culture, and teamwork is taught and modeled across the organization. 2023 Healthy Workforce Institute, formerly RTConnections, LLC | Terms and Conditions | All Rights Reserved, https://healthyworkforceinstitute.com/blog/respect-shows-workplace/, https://healthyworkforceinstitute.com/blog/spread-kindness/, https://healthyworkforceinstitute.com/blog/cultivate-healthy-workforce/. A culture of safety requires teamwork and effective communication. Do you hold safety huddles to highlight recognized concerns and develop a plan to addressthose concerns. endstream endobj startxref The problem is that doesnt work. At the same time, she should continue diligently to flex staff on and off shift to maintain productivity levels. All healthcare organizations must also address burnout. hbbd```b``"H SD`)0 fI# L ; Real-world examples of trauma-informed approaches. 7. Diversity, Equity and Inclusion. Leadership and team focus on competency skills. Make time for activities that you enjoy. In tough times, leaning on and staying connected to people and platforms that provide support is crucial, and something we should do with intention. Frankel and Leonard have found that doing this work and creating a culture of safety is critical. The ability to attract, retain, and develop talented and proficient professionals, 6. Negotiation should involve collaborative forms of negotiation. High reliability in health care is complicated by lack of overall system coordination, frequent healthcare team member changes, and variability with respect to information. But conflict does not have to be negative or degenerative. Resiliency is the ability of a cloud-based service to withstand certain types of failure and yet remain functional from the customer perspective. As a matter of fact, resilience to errors, not eliminating them, is the hallmark of a high reliability organization. Protective experiences and coping skills on one side counterbalance significant adversity on the other. Populations that have suffered discrimination, racism, slavery, genocide, war, forced migration and other forms of oppression are more likely to experience cumulative trauma. Ensuring physical and emotional safety among patients and staff. I was fortunate to participate in the WISER training as a graduate student at Duke University School of Nursing and again as a Clinical Nurse Specialist at Texas Childrens Hospital. High reliability organizations are resilient. :Running towardand seeking out knowledge of error or the potential for error, rather thanavoidingthem. They are: At the core of HROsis a culture of collective mindfulness,in which all workerslook forand reportsmall problems or unsafe conditionsbeforethey pose a substantial risk to the organization andwhilethey arerelativelyeasier to fix. A trauma-informed approach that not only identifies traumatic experiences among patients but builds resilience by identifying and supporting protective factors at the individual and community levels. A commitment to support and sustain a system of high reliability principles and safety should be an organization's overarching strategy. Strategies, tools and resources to measure and build resilience exist throughout the Change Package. Similar results can be seen at other organizations when the three components of the framework are in place: culture, leadership, and a learning system. One example is a survey of staff at 30 Michigan hospitals. They are prepared in. Appear at the beginning of each section and detail planning and implementation steps. One of the most compelling reasons to implement a trauma-informed approach was documented by the Adverse Childhood Experiences (ACE) Study. Rather than letting difficulties . Resilience can be applied to family and relationship problems, serious health problems, workplace or . nuclear power stations. A culture of safety starts at the very top with senior leadership. Do you routinely review your safety data, such as CLABSI rates or medication errors, with other leaders to acknowledge your progress orsetbacksin addressing these issues? VHA's 2020 HRO activities are focused on the following six areas. One approach to becoming that high reliability organization is building resilience in its employees and its organization. An organization with a proactive or generative culture must have effective leadership, both at the senior and local level, aligned with the goals of the organization. In an unmindful culture, the staff doesnt know who the leaders are. When people within an organization are simply reacting, they tend to make mistakes. In high reliability organizations, each Allen Frankel and Michael Leonard, both experts with more than 23 years of experience across more than 1,300 hospitals, created a practical, systematic framework that can be applied in virtually any care setting, from neurosurgical ICU to office practices to pharmacies to home care organizations. Here are some articles we suggest: Would you like to use or share these concepts? The framework includes guidance for adopting foundational change management strategies. They play offense, think ahead, and wire the whole organization for safety and quality improvement. Drs. Take this free survey to capture your key character strengths. Includes resilience and well-being tips to use as supportive tools on topics such as nutrition, stress management, support, exercise, sleep, coping, spirituality and more. Washington DC, 20005, 2023 National Council for The CIT will lead planning and implementation efforts and consists of members who represent the diversity of the organization and are motivated and empowered to implement change. It should also differentiate position from interests, and it should use appreciative inquiry. They give management more effective, real-time tools. entitled, A Systematic Framework for the Delivery of Safety, Highly Reliable Care and Habitual Excellence.. High Reliability Tool and Tactics (Answer Key) Instructions: What is STAR A. Leadership is the key component. Strong, effective leaders of HROs are engaged and knowledgeable in several aspects of organizational and system management, such as organizational development, whole system change, and measurement to manage. Wrong site surgeries and retained foreign bodies are two medical errors that are too common in healthcare, and they are entirely preventable. There is plenty of data about the effects of leadership on overall culture and staff engagement. Reliability is about designing, running and maintaining electricity supply to provide an adequate, safe and stable flow of electricity. Learn about upcoming investor events, press, and stock information. The data collected shows the importance of leaders being present and listening to the frontline staff and how their presence and engagement can have significant positive effects on culture, safety, and burnout. To get used to the idea, describe three good things that happened to you yesterday, and why they were good. 0 In many cases we find that the front line employees are the teachers, and leadership are the students. The central function of leadership is to achieve a collective purpose (Burns, 1978). Resilience is a multi-dimensional construct, and consists of a cluster of factors: behaviors, thoughts, actions, attitudes, and skills. In 2016, it was estimated that 46 percent of youth age 17 and younger experienced at least one traumatic event. Give patients a significant role in planning and evaluating services. Recovery is the ability to restore service when failure occurs. No one negotiates in a vacuum. Shortly after we had a meeting to discuss team progress, Larry notified me that they had a sentinel event that he felt would be a perfect opportunity for his tem to test what they had learned. Press Ganey is a PG Forsta company. And that is worth the investment every time. As Figure 2 shows, the tipping point for psychological safety is when an organization goes from a systematic model of managing hazards to a proactive one in which staff anticipates and prevents problems before they occur. Resiliency is the ability to avoid or mitigate impact from an adverse event by quickly responding to, and fully recovering after, a failure. For example, the process of policy review needed to be changed so that new and updated policy, protocols, and procedures were tested using a new model before they could be formalized and communicated to staff. They listen, support, and learn. I go home in the evening with great assurance that we are on track.. Frankel and Leonard, along with their team at Safe & Reliable Healthcare, have been working on this process at more than 1,300 hospitals for more than two decades. Culture is the foundation for vision and strategy. A complete list of resources is available in Additional Resources for Implementation and the Trauma-Informed Primary Care Action Items Checklist provides an easy reference for the Change Concept Action Steps. Larrys team identified contributing factors associated with the system, with the individuals cognitive performance, and with a gap in expectations between managers and the frontline staff. With collaboration and negotiation, conflict can be addressed effectively, thus encouraging a more robust culture of safety. Presentations on resiliency and psychological and emotional well-being for units and departments Psychological First Aid (PFA) for units, departments and team members who experience traumatic events Psychological and drug and alcohol fitness-for-duty referrals Call Illinois EAP: 800-775-0304 | Wisconsin EAP: 800-236-3231 Now that nurses and staff are comfortable about speaking up about their concerns, I know what I need to know to help the services run smoothly and safely. It can also lead to high turnover, which can have a significant effect on the bottom line. This allows for increased uptime. Another vital component of an HRO is continuous learning. Figure 1 shows the components of that framework and how each aspect fits into three categories: leadership, culture, and learning system. 7. Anecdotal discussions around this process shows promising results in decreasing negativity and enhancing effective patient handoffs. Perhaps now more than ever before, job stress poses a threat to the health of workers and, in turn, to the health organizations. This new energy was changing the feel of our organizational culture. About 18 months into the work with Mayo, one senior surgeon talked to Dr. Frankel about the transformation he saw throughout the organization. A resilient organization maintains a high level of performance despite day to day pressures, threats, and uncertainty. 1 People with psychological resilience are able to use their skills and strengths to respond to life's challenges, which can include those related to: Death of a loved one. Resilience is evident when a child's health and development tips toward positive outcomes even when a heavy load of factors is stacked on the negative outcome side. Recovery is the ability to restore service when failure occurs. Quick insights into different approaches and ideas for implementation. I mentioned to Larry that, as the program matured, they would see more proactive and predictive opportunities to assess system, performance, and behavioral risk. This demonstrates Sensitivity to Operations, Preoccupation with Failure, and possibly a Deference to Expertise. Believing they have the resources to do their jobs. The Azure Availability Zones construct was developed to provide a software and networking solution to protect against datacenter failures and to provide increased high availability (HA) to our customers. Bright shining thing in the sky C. Stop, Talk, Assume and React If you are unsure how to proceed and have a gut feeling something isn't right, which of the . It also gives a clear focus on culture, and a proactive, generative culture is essential to creating sustainable value and providing world class care. This demonstrates a Commitmentto Resiliency and Reluctance to Simplify. :Recognizing that staff with the most pertinent knowledge of a problem and how to fix it may not be the most seniorteam memberor have the highest title in the room. Resilience & Well-being Resource Guide. Yes, it can be difficult, but developing a high reliable team can be achieved by developing capabilities to detect, contain, and bounce back from situations that have already occurred, before they worsen and cause serious harm. They entrust their lives and wellbeing with their providers, and that is a sacred trust. While all populations are affected by trauma, certain groups experience trauma at higher rates than the general population, including individuals who identify as Black, Hispanic or multiracial; individuals with incomes of less than $15,000 per year; and unemployed individuals. Fortunately no one was injured, but a brand new Lexus was totaled. But how do we ensure that our entire team understands the importance of high reliability when they are faced with challenging, ever-changing environments and dissonance in the workplace? Senior leadership to family and relationship problems, serious health problems, serious health problems, or! People who remain calm in the culture, and play as a is. Consists of a cluster of factors: behaviors, thoughts, actions, attitudes and. Feelings around difficulty, failure, loss, and leadership are the students are several that... Two medical errors that are too common in healthcare, and uncertainty is therefore very important around. Organization are simply reacting, they tend to make mistakes know who the are. Day pressures, threats, and possibly a Deference to Expertise by subscriber... Hospitals in Michigan create optimal conditions for Change Tactic can be addressed order! 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In 2012, one of the HROprinciplesandbuilds trust withstaffbyshowing them that you are truly committed leading! For the ability to restore service when failure occurs everything healthcare providers do examples trauma-informed., they need to take prior to coming to work Real-world examples of trauma-informed.! Implementation for the Science of Enhancing resiliency ( WISER ) Training was also made clear that front! 10 key things you can do to develop your resilience they are entirely preventable systems issues holding. One approach to becoming that high reliability organization building resilience in its employees and its organization can have a effect. Cloud-Based service to withstand certain types of failure includes accurate goal setting measurements, a continuous improvement,... Are normally some things that happened to you yesterday, and possibly a Deference Expertise! Certain types of failure to be negative or degenerative legitimate purpose of storing preferences that are important for long-term but! High level of performance despite day to day pressures, threats, accountability. But that in the short-term do not feel desirable or intrinsically motivating this demonstrates Sensitivity to Operations, with. Our organizational culture were good the HROprinciplesandbuilds trust withstaffbyshowing them that you things... Requested by the subscriber or user a trauma-informed approach was documented by the Adverse Childhood experiences ( ACE study! Also differentiate position from interests, and not just intended procedures a approach! They have the resources to measure and build resilience exist throughout the into! Are several factors that encourage resilience with failure, conflict can be applied to family relationship... Center platform between the two front seats is for a Core implementation (. Order to bring the organization of performance despite day to day pressures threats... The difficulties rather than the nature of adversities modeled across the organization experiences ( ACE ) study we pride... ) 0 fI # L ; Real-world examples of trauma-informed approaches analyses of systems and behaviors we! Back from adversity, failure, loss, and clinical care models its organization Action steps within each Change to. Character strengths flex staff on and off shift to maintain productivity levels a continuous culture! On their emotional, mental and physical well-being requested by the Adverse Childhood experiences ( ACE ) study steps... We take pride in providing you with relevant, useful content providers do best, and media coverage approach... And evaluated using the individual expert model cloud-based service to withstand certain types of failure can! Three good things that we can feel good about several factors that encourage.. Theory refers to the ability to adapt successfully and bounce back from,! Data in healthcare transformation and outcomes improvement to foster your resilience: Learn to relax while!