ABOUT THE AUTHOR

Cathy Parsons is a nursing practice consultant at St. Joseph’s Health Care London, and a Master of Applied Positive Psychology graduate, University of Pennsylvania, Philadelphia.

Practice changes are an everyday reality in the life of a healthcare provider. Clients, patients, and residents are more knowledgeable and expect care that is evidence-informed. All change creates some kind of emotional response. If the recommended change challenges staff members’ long-held assumptions and cherished beliefs, it may create frustration and moral distress. It may feel like the research negates years of tradition. For example, one of our units recently reflected on best practices for reducing patient falls and use of restraints, and practice changes have required a significant shift in staff behaviors and attitudes.

Don Ewert, Coordinator, Veterans Care, and I recently collaborated on ways to enhance the success of practice change by using an approach grounded in principles from VitalSmarts’ training. We used the skills from Crucial Conversations to achieve the organization’s vital behaviors of speaking up, holding each other accountable, and asking for help whenever concerned about safety, quality of care or service, and/or quality of work life.

Getting unstuck begins with our awareness of discomfort with the practice change. Our emotional response helps us to gauge whether we have a difference of opinion about the desired change, or whether we fear the stakes are high (maybe I won’t be able to do it). Starting with Heart reminds us that those promoting the practice change and those who put the change into practice usually have good intentions. By suspending judgment, admitting our biases, being open to new possibilities, and recognizing the role of Villain, Victim, or Helpless behavior, we Master Our Stories so that we can be fully engaged in the change process.

Stating Our Path requires us to share our views while also staying open to hear and consider others’ stories. During this step, Learning to Look for behaviors of Silence or Violence ensures that everyone continues to contribute to the Pool of Shared Meaning which is key to successful change. As we discover the Mutual Purpose of the change, we are more likely to show Mutual Respect when there are differences of opinion. This, in turn, makes it safe for dialogue to continue.

The term evidence-informed practice requires us to Explore Others’ Paths—including research on the subject, experience of the healthcare provider, and especially patient, client, and resident preference—this does not have to be an either/or choice! It also means that we prepare care providers with the skills and tools to successfully adopt the change. This is how we strengthen a person-centered approach to care in body, mind, and spirit.

Our Move to Action includes implementing and evaluating the change. The success of the change is assessed from the perspective of the patient, the care provider, and the care environment processes. Our vital behaviors help us to evolve the implementation process as we speak up about problematic aspects of the change, hold each other accountable when we see members of the team not modeling new behaviors, and ask for help when we feel unable to support the new practice. Ultimately, the way to enhance quality of patient care, build positive team relationships, and foster a shared and inclusive approach to practice change is grounded in the outcomes of these conversations.

ABOUT THE AUTHOR

Adrian Gostick is the New York Times bestselling author of All In: How the Best Managers Create a Culture of Belief and Drive Big Results.

 I’ve been newly appointed to manage a team that’s previous management was very controlling and not very trusting. I am having trouble getting my employees to buy in to our goals, responsibilities, and camaraderie. What are some ways to get them motivated and to start looking to the future rather than dwelling on the past?

 When leaders set out to establish a new more positive culture, they face an equal chance of one of two eventualities: adoption or oblivion. Adoption requires an extensive process of employee input, management accountability, and continuing communication and recognition. Adoption is a lot of work for a leader and thus, it is rare.

Honestly, in our work with organizations, the more common result we see is oblivion. The majority of culture shifts are never integrated into the day-to-day actions. Instead, they fade away—becoming victims of sub-par or inconsistent communication and reinforcement. Where many managers slip up is trying to focus their employees as if this process were something to check off a to-do list rather than a commitment that runs DNA-deep. Superficiality in this process is deadly because employees mirror it. They view the mission, vision, and goals with continued suspicion, rather than as core values to embrace.

A wise leader can begin to create a new culture of openness and trust by starting with inclusion—bringing employees together to draft the team’s mission, values, and goals. The leader must then commit to open communication (we call this a Share Everything culture) and then publicly recognize even small steps toward the desired culture.

In our new book, All In: How the Best Managers Create a Culture of Belief and Drive Big Results, we defined the seven steps managers can use to influence corporate culture. These steps were built from the results of a 300,000-person research study conducted by Towers Watson. They also include solid direction for turning around the cynicism and doubt your leaders are facing:

1. Define your burning platform. Instill a sense of urgency about threats on the horizon and define mission and values with great clarity.
2. Create a customer focus. Help employees focus like lasers on specific customer needs and salesmanship—motivating employees to take initiative.
3. Develop agility. Learn how to capitalize on new opportunities.
4. Share everything. Become a place of truth, constant communication, and marked transparency.
5. Partner with your talent. Have a sincere desire to create opportunities for employees to grow and develop—retaining the best.
6. Root for each other. Provide much greater levels of peer-to-peer and top-down recognition and camaraderie.
7. Establish clear accountability. Turn accountability from a negative into a positive in developing a performance-driven culture.

Right now, your particular situation may seem inexorable. It is not. There is a path to a hidden reservoir of drive and dedication in your people. There is a process by which seeds of a strong culture can begin to grow. Good luck.