organizational culture: identifying, assessing and changing it to

Organizational CultureOrganizational Culture::

Peter B. Rockholz, M.S.S.W.Peter B. Rockholz, M.S.S.W.Deputy CommissionerDeputy Commissioner

Connecticut Department of Mental Health and Addiction ServicesConnecticut Department of Mental Health and Addiction Services

A Healthcare Services Agency

Identifying, assessing and changing it Identifying, assessing and changing it to enhance a culture of recoveryto enhance a culture of recovery

QualityQuality OutcomesOutcomes RecoveryRecovery

Enhancing and Sustaining Enhancing and Sustaining RecoveryRecovery

Organizational Organizational FactorsFactors

Staff Staff FactorsFactors

External External FactorsFactors

Quality/ Quality/ OutcomesOutcomes

Evidence Evidence Based Based

PracticesPracticesXX XX XX ==

Factors Influencing Quality and Factors Influencing Quality and Outcomes in RecoveryOutcomes in Recovery

Source: Dean Source: Dean FixsenFixsen, The National Implementation , The National Implementation Network, University of South FloridaNetwork, University of South Florida



External External FactorsFactors

Quality/ Quality/ OutcomesOutcomes

Evidence Evidence Based Based

PracticesPracticesXX XX XX ==

0.2350.2350.60.60.70.70.70.70.80.8

0.4800.4800.60.61.01.01.01.00.80.8

0.2940.2940.60.60.70.70.70.71.01.0

11..00000011..0011..001.01.01.01.0

Factors Influencing Quality and Factors Influencing Quality and Outcomes in RecoveryOutcomes in Recovery

Recovery Oriented Recovery Oriented Evidence Based PracticeEvidence Based Practice

Adapted from the work of Adapted from the work of Stuart Carney, Oxford UniversityStuart Carney, Oxford University

Scientific Research

Client Choice

Circumstances, Preferences and Cultural Values

Evidence

Clinical Experience

EBIs Outcome

Evaluation & Auditing



Process Process FactorsFactors

Culture Culture FactorsFactors

Enhancing Existing Service DeliveryEnhancing Existing Service Delivery

What is Organizational What is Organizational Culture?Culture?

Culture CharacteristicsCulture Characteristics

•• Natural evolution; taken for grantedNatural evolution; taken for granted•• Common values, beliefs, normsCommon values, beliefs, norms•• How group solves everyday problems How group solves everyday problems

and provides supportand provides support•• Language, history, storiesLanguage, history, stories•• Taught to new membersTaught to new members•• Reflected in symbols, rituals, ritesReflected in symbols, rituals, rites

Aspects of Organizational Aspects of Organizational CultureCulture

FORMALFORMAL: How it: How it’’s supposed to be.s supposed to be.

INFORMALINFORMAL: How things really get done.: How things really get done.

KEY QUESTIONKEY QUESTION: To what extent are the : To what extent are the informal and formal cultures aligned?informal and formal cultures aligned?

How does the culture How does the culture reveal itself?reveal itself?

Common Clues to Common Clues to Informal Organizational CultureInformal Organizational Culture

• House BlindnessHouse Blindness•• Mission DiffusionMission Diffusion•• DissonanceDissonance•• Signs, symbols, stories, mythsSigns, symbols, stories, myths•• LanguageLanguage•• BehaviorBehavior

House BlindnessHouse Blindness

Broken Window Awareness - 1 mo.

0%10%20%30%40%50%60%70%80%90%

100%

1 4 7 10 13 16 19 22 25 28

Days

Leve

l of A

war

enes

s

Key Organizational Objectives Key Organizational Objectives for Service Providersfor Service Providers

•• EngagementEngagement

•• RetentionRetention

•• Recovery Initiation/AcculturationRecovery Initiation/Acculturation

Engagement NeedsEngagement Needs““What am I looking for?What am I looking for?””

•• RespectRespect

•• BelongingBelonging

•• ChoiceChoice

•• Will this help me?Will this help me?

Engagement Process Engagement Process FactorsFactors

• PrePre--site visit contact (e.g., phone)site visit contact (e.g., phone)•• Before entering the facilityBefore entering the facility•• The facility entranceThe facility entrance•• Lobby environmentLobby environment•• ReceptionReception•• Next stepsNext steps

Retention NeedsRetention Needs““Is this getting me where I need to go?Is this getting me where I need to go?””

•• Whose goals are these?Whose goals are these?•• Does their approach match my reality?Does their approach match my reality?•• How much do I really trust people here?How much do I really trust people here?•• Am I feeling hopeful?Am I feeling hopeful?•• Do they really understand me?Do they really understand me?•• Am I becoming prepared for a new life?Am I becoming prepared for a new life?

The The ““Oxygen MaskOxygen Mask”” TheoryTheory

Hi Daisy!!Hi Daisy!!

This isn’t an office…

It’s

HELLwith fluorescent

lighting.

Mission DiffusionMission Diffusion

•• Shared mission?Shared mission?•• Formal/informal cultures aligned?Formal/informal cultures aligned?•• Opposing values/beliefs?Opposing values/beliefs?•• Subculture developmentSubculture development

FCI CulturegramFCI Culturegram

FacilityBoundary

Bureau of Prisons

Warden

Exec. Staff

Department Heads

Lts.

Non-CustodyStaff

Custody Staff

The “Me” GroupInmates

Management

Long-TermInmates

Short-TermInmates

OldStaff

Union

NewStaff

Central Office

CommunityGroupsState Legislature

InstitutionalBoundary

Culturegram – Facility #6

DissonanceDissonance

•• Youthful offender exampleYouthful offender example•• CIW poster exampleCIW poster example•• Nicotine dependenceNicotine dependence

Recovery Initiation/Recovery Initiation/Acculturation NeedsAcculturation Needs

•• Exposure to Recovery Role ModelsExposure to Recovery Role Models•• LanguageLanguage•• Instilling Hope and ConfidenceInstilling Hope and Confidence•• Building Individualized SupportsBuilding Individualized Supports•• Develop Healthy LifestyleDevelop Healthy Lifestyle•• Keep it Up FrontKeep it Up Front•• Giving backGiving back

Recovery Oriented Organizational Recovery Oriented Organizational Cultural CharacteristicsCultural Characteristics

Recovery SupportiveRecovery Supportive•• Consumer orientedConsumer oriented•• Multiple pathsMultiple paths•• Recovery PlansRecovery Plans•• Outcome drivenOutcome driven•• Walking the talkWalking the talk•• Role modelingRole modeling•• Strength/goal orientedStrength/goal oriented

Not SupportiveNot Supportive•• Organization orientedOrganization oriented•• One way (our way)One way (our way)•• Treatment PlansTreatment Plans•• Process drivenProcess driven•• HypocrisyHypocrisy•• Double standardDouble standard•• Deficit/problem orientedDeficit/problem oriented

Keys to Culture ChangeKeys to Culture Change• Raise awareness (triangulation) Raise awareness (triangulation) •• Clear leadership vision and commitment Clear leadership vision and commitment •• ‘‘TopTop--downdown’’ + + ‘‘InsideInside--outout’’ approachapproach•• Be open and inclusiveBe open and inclusive•• Ask and listen (actively)Ask and listen (actively)•• Staff come firstStaff come first•• Role modeling (Role modeling (““walk the talkwalk the talk””))•• Inclusion from all levels and disciplinesInclusion from all levels and disciplines•• Sustained effortSustained effort

Peter B. Rockholz, M.S.S.W.Deputy Commissioner

Department of Mental Health and Addiction Services

[email protected]

CONTACT INFORMATIONCONTACT INFORMATION

Connecticut Department of Mental Health and Addiction ServicesA Healthcare Services Agency

organizational culture: identifying, assessing and changing it to

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