Building a Culture of Ownership in Healthcare:
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1 Building a Culture of Ownership in Healthcare: The Invisible Architecture of Core Values, Attitude, and Self-Empowerment Dr. Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE Senior Vice President, Chief Operating and Chief Nursing Officer, Midland Memorial Hospital Adjunct Faculty, University of Texas of the Permian Basin Adjunct Faculty, Texas Tech University Health Sciences Center School of Nursing President-Elect, American Organization of Nurse Executives
2 Learning Outcomes 1. Describe the healthcare crisis within of incivility, bullying, and toxic emotional negativity in the workplace and the way it contributes to stress, burnout, and compassion fatigue. 2. Describe the elements of the Invisible Architecture of core values, organizational culture and workplace attitude. 3. Practical values-based leadership applications to foster and sustain a culture of ownership. 2
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11 What was the effect of this new building on outcomes? 11
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13 Invisible Architecture? 13
14 Toxic Emotional Negativity 14
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16 Names Used to Describe Phenomenon Incivility Intra-staff Aggression Intra-staff Hostility Lateral Violence Bullying Mahr,
17 Incivility can take the form of rude and discourteous actions, of gossiping and spreading rumors, and of refusing to assist a coworker. All of these are an affront to the dignity of the coworker and violate professional standards of respect. ANA Position Statement on Incivility, Bullying, and Workplace Violence (2015) 17
18 Many Faces of TEN Overt (Done Openly) Name-calling Fault-Finding Criticism Intimidation Gossip Shouting Blaming Covert (Not Openly Acknowledged) Ignoring Refusing to help Unfair assignments Sabotage Exclusion Broken Confidences Failure to respect privacy 19 Mahr, 2016
19 22,000,000 negative workers in the United States 20
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22 $500,000,000,000 wasted in negative energy and employee disengagement 23
23 Theoretical Model of Horizontal Violence (TEN) Oppression (TEN) Process Key: + Positive Relationship Negative Relationship Internalized Dominant Values Horizontal Violence Peer Communication Patient Safety 24 Mahr, 2016; Purpora, 2010
24 Communication Breakdown: Leading Cause of Sentinel Events Human Factors (ex: staff supervision issues) 2. Leadership 3. Communication 25 The Joint Commission, April 2015 retrieved from
25 Medical Errors: Significant Cause of Death Medical Errors: 8 th leading cause of death 26
26 Negative Impact of HV (TEN) on Organizations Work Culture Patient Safety Cost Commitment Collegiality Support Satisfaction Learned Behavior Late Interventions Incomplete Interventions Errors Absenteeism Workforce Rehires Nursing Shortage Mahr, 2016; 27
27 Negative Effects of HV (TEN) on Nurses Impaired Relationships Hypertension Depression Fatigue PTSD Irritability Panic Attacks Dissatisfaction Burnout % resign 1 in 3 leave nursing Diminished Confidence Substance Abuse Mahr, 2016 Vessey, 2009 Townsend, 2012 Longo,
28 This is The Healthcare Crisis Within! 29
29 Determinants of Best Places to Work Pride Connection Trust 30
30 31
31 From Accountability. 32
32 Accountability Is Not Enough! 33
33 Accountability implies irresponsibility 34
34 Accountability can be exhausting! 35
35 Accountability focuses on rules, not on values 36
36 Accountability is always after the fact and often demotivating 37
37 Accountability provides an incentive to cheat 38
38 Accountability never takes an organization from good to great 39
39 40
40 to Ownership! 41
41 Ownership IS the secret sauce! 42
42 43
43 Mission, Vision, and Core Values 44
44 CORE VALUES Who you are What you stand for What you won t stand for 45
45 Be yourself unless you re a jerk. Integrated DNA Technologies,
46 Give a damn. Southlake Regional Health Centre,
47 Our culture is based on the Christian faith and that staff and physicians are encouraged to pray with patients Craig Lindsey, Chief Nursing Officer Park Ridge Health, North Carolina Interaction of Personal and Organizational Values 48
48 49
49 50
50 Workplace culture is important to the job satisfaction of all employees. For all generations, the highest indicator of satisfaction is to feel valued on the job. AARP: Leading a Multigenerational Workforce Young People: They re People, Too 51
51 No Opting Out One toxically negative person can drag down morale and productivity of an entire work unit. 52
52 53
53 54
54 Attitude is a choice! 55
55 56
56 Bring your whole self to work; not only your knowledge and expertise, but also your values. Stay true to who you are and have the courage of your convictions. If you do, you will become an authentic and courageous leader something intensely needed at this time in healthcare. And you will have the power to change your workplace and the community around you. Mary Brainerd, President and CEO, HealthPartners 57
57 The call to end this silent epidemic in our profession has been heard loud and clear. It is time we turn our caring behaviors more fully toward our colleagues and those we work with and demand a stop to any form of violence that occurs in any setting Dr. Cole Edmonson, Chief Nursing Officer Texas Health Presbyterian Hospital, Dallas, Texas 58
58 A silent epidemic A great threat to patient safety An ugly secret in the most caring of professions These are just a few of the ways that incivility and bullying have been referred to in the literature over the last 10 years. Edmonson, Bolick and Lee: A Moral Imperative for Nurse Leaders: Addressing Incivility and Bullying in Health Care, Nurse Leader, February 2017
59 Eight Essential Characteristics of a Culture of Ownership Joe Tye, The Florence Prescription 60
60 Commitment To the mission, vision, and core values of the organization 61
61 Engagement With patients, coworkers, and with the work itself 62
62 Passion Enthusiasm, positive attitude, and joy reflected in everyday actions 63
63 Initiative A Proceed Until Apprehended mindset 64
64 Stewardship Caring for yourself, your organization, and your world 65
65 Belonging Making everyone feel like a partner and not just a hired hand 66
66 Fellowship Fostering a support group culture of respect and caring 67
67 Pride In the organization, in the profession, in the work, and in yourself 68
68 Be Emotionally Positive 69
69 Be Fully Engaged 70
70 Be Self Empowered 71
71 People will be and do their best with the tools they have. As a leader, we need to make sure they have the tools! Leadership 72
72 73
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74 Daily Leadership Huddle 75
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78 Sacred 60: Leadership Rounds
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83 96
84 Leadership Job #1 Shifting the shape of your Attitude Bell Curve 97
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87 And now for the results at MMH 100
88 Patient Satisfaction: 90 th percentile in Emergency Department All other departments continue improvement But that s not all! 101
89 22% reduction in CLABSI 64% reduction in CAUTI 38% reduction in ventilator related events 32% reduction overall nursing turnover 43% reduction in first two year s Nurse Satisfaction Improvements w/ Emergency Department: Top 10 th percentile 102
90 The transformation I have witnessed the last few years has been inspirational for me. Dr. Sari Nabulsi, MD Private Practice Pediatrician and Past Chief of Staff 103
91 104
92 Midland s Year of Values Robert Wood Johnson Foundation s: Culture of Health Study 3 rd ANCC Pathway to Excellence Submission & ANCC Magnet Submission 105
93 106
94 TBSSSNDQ 107
95 To be published by Sigma Theta Tau International on March 14,
96 Professional Organization Engagement 109
97 110
98 Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE Midland Memorial Hospital 400 Rosalind Redfern Grover Parkway Midland, Texas (office) (mobile) LinkedIn: bobdent Facebook Page: DrBobDent Blog: 111
99 References Gordon, J (2007). The Energy Bus. John Wiley & Sons, Inc. Hoboken, New Jersey. Tye, J. & Dent, B (2017) Building a Culture of Ownership in Healthcare. The Invisible Architecture of Attitudes, Values, and Self-Empowerment. Sigma Theta Tau International. Tye, J. & Dent, B (2016). The Pickle Pledge Tye, J. The Florence Prescription. Mahr, Nicole (2016). Identifying Factors Associated with Horizontal Violence. ANCC Magnet Presentation
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