HealthCert

 by Gillian Robinson

Understanding the Change Process

When undertaking a change management process in care facilities, I’ve identified 5 distinct phases of reaction from managers and staff.  These have often occurred after I’ve been appointed to perform the role of statutory (temporary) manager by a DHB. This is generally after risk to residents has been identified following an audit or a serious complaint.

As a temporary manager, often there is a facility manager in place however for a range of reasons doesn’t have the resources or knowledge to meet the needs of the residents to a standard that satisfies audit outcomes.

Phase 1 is on first arriving and there is relief on the part of the staff and manager (if there is one) on the basis they have the view that I’m there to ‘save the day’, make things right and then they can get on with running things.  Comments such as “you should have been called in a long time ago” are common.

Phase 2 is where the staff and in place management start to realise that I’m not going to do all the work for them and my role is that of mentor and coach. Further to that the role includes assistance with obtaining necessary resources to support clinical and operational practices. This is where push-back and resistance starts to show as people resist change and try to hold stead-fast to those practices that have got them to the point they’re at.  As pressure increases for change to occur, resistance increases and at times sabotage of the new way of doing things starts to appear.  As one provider put it recently “they’re ever so nice to your face and will stab you in the back”. The denial phase plays out and the anger phase starts.

Phase 3 is a time when divisions start between those who want to embrace change knowing it’s intended to improve and make the workplace safer for staff and more so, safer for residents; and those who don’t have insight to recognise the need for change.  The need for people to remain in their comfort circle doing what’s known and predictable is incredibly strong for a large number of people. This slows momentum and the temporary manager starts to get the blame for things being wrong.  Such comments as ‘it was all fine before the DHB stepped in, they just need to back off and let us get on with it’ are also commonplace in this phase. Sometimes senior staff at the facility will contact their DHB and say the temporary manager is unreasonable, not doing anything and needs to be removed. All as an attempt to get rid of the person they see as pushing them outside their comfort circle and affecting maintaining of the status quot. The bargaining phase can continue for quite some time but this often depends on how direct and steadfast the response is to the bargaining strategies.

Phase 4 occurs when there is the start of the depression phase and realising that solid work, participation by all and a willingness to take on new ideas and learn new ways of doing things needs to occur. The real work has started by the willing few in the early phase and continues and now the collective change can start to be evident.

Phase 5 is acceptance that the temporary management or change management process was necessary. Staff start to commend the new way and embrace new ideas recognising that things are actually better now than they’ve been before.  As people always have choice about coming on board with change or leaving, invariably there are some staff and sometimes managers or even members of Governance who continue to resist seeing a new way is needed and those few will leave the organisation or continue to resist.

I’m able to observe which phase an organisation is operating in by the response of those working there and was intrigued to read of exactly this same set of steps in a book titled ‘Expert Secrets’ written by Russell Brunson. Some of you who are familiar with the work of Elisabeth Kübler-Ross will also recognise these phases as reflecting her stages of grief.

Acceptance is hard as people take the need for change as a criticism when in my view, people don’t fail; systems do!!

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 by Gillian Robinson

Testimonial from Tainui Village – New Plymouth

Upon reading one policy everything fell neatly into place. I found her documentation to be outstanding.  It is very reassuring to know that every policy and procedure is the most up to date and designed to meet audit requirements.  All her forms are easily accessible and very user friendly.   We can instantly benchmark against others.  At the click of a button we can analyse falls, infections and adverse events.   Creating graphs and other information for Board reports takes minutes rather than hours.

Having come from a background of many years in QA, HSE and Electronic Document Management in the Oil and Gas Industry, when I entered the aged care sector, it was a huge “eye opener”.  After sitting through several handovers and meetings and listening to discussions on medications etc I felt as if I was listening to a foreign language.  Oh my goodness I thought and then Gillian’s documentation arrived together with a visit from her shortly after.

Gillian’s enthusiasm and commitment for both the aged care sector and her documentation is contagious.  I feel I can now discuss, with the knowledge I have acquired in a few short months, aspects of aged care I never knew existed.  Gillian is only a phone call or email away and all queries are always answered promptly, no matter how minor.

 

Thank you very much Gillian.

Lois Lash – Quality Assurance

Tainui Village –  October 2017

 

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 by Gillian Robinson

Success Leaves Clues

Success leaves clues but often these aren’t being picked up so you miss the learning and miss the opportunity to recognise growth or gain continuous improvement in your audits.

In residential care, HealthCert (MoH) Certification processes appear solely to promote a goal of verifying compliance with requirements. Looking deeper however, the goal of meeting requirements ensures the protection and support of those in your care. This can then be evidenced in a way that’s reflective of service received as meaningful, safe and appropriate by individual residents.

It’s no longer an expectation that you’ll have a number of partial attainments as a result of an external audit. The expectation is full compliance and showing evidence of continuous improvement, going over and above the base ‘pass-mark’ brings you into line with your high performing peers. I’ve heard managers say “but it’s the Auditors job to find things wrong so we expect to get partial attainments.”  That is out-dated thinking and doesn’t fit the current audit and compliance environment or continuous improvement philosophy.

Systems can’t be implemented to show compliance, if staff are not looking at policies and procedures, or using them to guide services and care of residents. If individual staff or managers do what they think best, based on previous experience, without verifying whether that practice is still appropriate or best practice, they do themselves and residents a disservice.

Success leaves clues.  It’s apparent when quality systems are implemented, outcomes are checked in a measurable way, recorded, examined, analysed and greater gains identified for future implementation.  This is a cycle and if you have the right tools to record your continuous improvement projects on, you too will be in the elite who are out-performing those who continue to have multiple partial attainments (deficits) in audit.   Don’t be a provider that looks at others saying it’s ok for them; they have this or that or the other reason for their success but we don’t have those things so we can’t achieve.  Don’t make others extraordinary to let yourself off the hook.  You can have, and deserve to have, all the recognition for the amazing work you perform just like others who are achieving four years.

The lack of a robust up to date quality system, along with deficits in implementation, will lead you down an expensive compliance track. Expensive in loss of reputation as audits are published and accessed online by the public, expensive in loss of time trying to figure things out yourself, increased risk to residents, loss of financial resources as you end up being audited more often than would have otherwise been necessary. The better you achieve at audit, the longer your period of certification, the less often you are audited and therefore less often you’re paying auditors fees!

A common failing in the care facilities under Temporary Management has been from the lack of a proven quality system and application of that system into service provision. I’ve been contracted into a number of sites as a Temporary Manager over the years and this has consistently been the case.

If you would like a free Continuous Improvement Project template to help you identify and record your success, contact us and we’ll email it to you.

Go here to read testimonials from a few of our clients.

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