Shannon Duncan, RN, MN, Patient Care Manager, Pediatric Intensive Care Unit, Stollery Children’s Hospital

Doreen Perschon, MAL, Principal, En-Gauge Consulting Inc.

The Journey of a PICU Care Team to Improved Work

Culture

AH

S

Sto

llery

Ped

s C

ritic

al C

are

Organizational Context

CCL Study, The Effort Dividend, 2004.

Engagement

Thinking

Effort

Feeling Thinking

Effort

The Iceberg Analogy Of Undiscussables

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•WHAT’S WORKED IN THE PAST

•BUSINESS AS “USUAL” •AUTHORITATIVE EXPERTISE

•REQUIRES SHIFTS IN THINKING AND BEHAVIOURS

•REQUIRES MOBILIZING DISCOVERY, SHEDDING ENTRENCHED WAYS, TOLERATING LOSSES AND GENERATING NEW CAPACITIES

ABOVE GROUND • RATIONAL • TECHNICAL

UNDERGROUND • EMOTIONAL • ADAPTIVE

strategic planning restructuring

budgets role clarity

negative emotions

watercooler talk

meeting after the meeting

work arounds

• Experimental mindset/

solutions unknown • Group problem solving

• Systems focused

• Productive disequilibrium

as goal • Risky

• Known solutions

• Leader as problem solver

• Issue focused

• Equilibrium as goal

• Generally safe

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TECHNICAL ADAPTIVE

“The practice of mobilizing people to tackle tough challenges and thrive.” (Heifitz, Grashow, Linsky)

Who is my Self? What is my Work?

suspending

redirecting

letting go

embodying

enacting

letting come

Step 1: Interviews

•Listen •Look for themes •Surface undiscussables

Step 2: Survey

• Validate interview themes

• Culture specific questions

Step 3: Focus Groups

•Share data •Group prioritization of issues

•Develop proposed solutions

Step 4: Action Plans

•Collaborative plans show leadership support

•Clear ownership & timelines

•Grassroots buy-in

Step 5: Re-Survey

•Within 1 year •Qualitative / quantitative trending

•Set new goals

I am at my wits end with work these days. I feel under valued, taken for granted and demoralized. We are expected to keep going until we break. I think that breaking point is coming. Critical incident debriefs are pretty much non-existent. It is a well-known fact that nurses eat their young. It is disheartening to see bullying in the unit. I feel at times family centered care is not embraced. Parents have expressed at times they don’t feel they can speak up on their children’s behalf.

Resources Accountability Management Engagement

Transparency Team support Orientation Leadership

Identified Priorities

1. Management team

2. Change management

3. Culture

4. Day-to-day improvements

1. Leadership

2. Processes

3. Education

4. Culture

Status to Date 2011 2012 2013 2014 2015 2016

Total Hired 33 28 43 44 30 12 Employed in a

position 3 15 22 25 18 11

% in a Position/year

9% 54% 51% 57% 60% 92%

Employed Casual 0 1 5 3 1 0 % casual/year 0% 4% 12% 7% 3% 0%

Resigned 30 12 16 16 11 1 % Resigned/Year 91% 43% 37% 36% 37% 8%

Retention

There has been a BIG change; now coming to work is like coming to my second family.

Satisfied because I have noted great improvement over the last year between staff and management.

We are evolving and expanding; this is an exciting time of the PICU history. We have the ability to become the best PICU in Canada and perhaps even North America. We may still have some issues but we have begun a steady upward trend!!

LESSONS LEARNED

Measurement and outcomes driven • Specificity is key • Results focused

LESSONS LEARNED

Responsiveness • Immediate action/incident reviews • Educational supports