OR Manager - January 2018 - 23

Success Stories
Culture change
Continued from page 19
The Five Dysfunctions of a Team: A Leadership
Fable. These smaller groups,
which included staff members, were
able to successfully make changes
(sidebar below).
One example of an issue was that
staff felt there was a lot of blame, but
also a lack of consequences. To ensure
accountability, leaders now set
expectations and use just culture algorithms
to evaluate behavior. These
algorithms help determine if it is a process
issue, a personnel issue, or a
combination of the two.
Planting for change
The original steering committee no longer
meets, but former committee members
are part of the surgical governance
board. They still discuss engagement
and changes that are needed.
Geisinger's focus on staff was key
Involving staff was
key to sustaining
change.
to creating sustainable change. " This
isn't something that can be driven from
the top down, " Gorgone says. " This is
something that needs to be organic,
planted, and then grown. " ✥
Cynthia Saver, MS, RN, is president of
CLS Development, Inc, Columbia, Maryland,
which provides editorial services to
healthcare publications.
References
Lenconi P. The Five Dysfunctions of
a Team: A Leadership Fable. San
Francisco: Jossey-Bass. 2002.
Lenconi P. Overcoming the Five Dysfunctions
of a Team: A Field Guide for
Leaders, Managers, and Facilitators.
San Francisco: Jossey-Bass. 2005.
Next steps
The PEER initiative resulted in this
initial list of next steps. Examples of
actions taken are included.
➤ Establish a common purpose
for the surgical suite (focus
on patient outcome rather than
process)-accomplished through
the work of focus groups.
➤ Emphasize a culture of empathy
and respect-operationalized
through briefings and debriefings and
use of a just culture algorithm.
➤ Establish appropriate structure
to execute plan-clarified dotted-line
relationships.
➤ Engage employees to drive solutions/process
change-staff worked
on process improvements.
➤ Implement an " air traffic controller "
(a single person who oversees all
of the ORs)-this is still in process.
➤ Establish reliable and closed-loop
grievance process-established a set
time frame for the process.
➤ Simplify, consolidate, and enforce
policies-working through each
department to streamline policies so
there aren't so many.
➤ Investigate changes to isolation
patient policy/process-simplified
the policy.
➤ Evaluate resources, and establish
appropriate resources-including use
of staffing calculators.
➤ Explore teaming concept (so that
there is more consistency with which
staff, surgeons, and anesthesia providers
work together)-set an 80-20
goal: people work within their service
80% of the time.
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OR Manager - January 2018

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