Toward Culture Change

 Agree to take this issue on as a priority  Create a Team/Work Group to develop a Restraint/Seclusion Action Plan  Formulate a plan to coincide with the six core evidence-based strategies

 Leadership Towards Organizational Change  Use of Data to Inform Practice  Workforce Development  Use of Restraint and Seclusion Prevention Tools  Full Inclusion of Consumers and Families  Rigorous Debriefing

4  It’s difficult to overcome “inertia”  You may have too much on your plate  Training staff on new practices requires time and expertise  Clinicians and staff may disagree with new approaches

5  Leadership is critical in the success of your Project!!  You are the leaders  Create a positive vision ◦ Better outcomes for consumers ◦ Latest and best evidence ◦ “Let’s do it!” message  Communicate importance and commitment  Engage hospital leadership and Board

6  John Kotter of Harvard Business School studied why transformation efforts fail and suggested Eight Steps for “Leading Change” John P. Kotter, Leading Change: Why Transformation Efforts Fail, Harvard Business School Press, 1995 Focus: Communicating the Vision Simplicity Multiple forms Repetition Leadership by example Explanation of seeming inconsistencies Give and take 1. Establishing a Sense of Urgency 2. Forming a Powerful Guiding Coalition 3. Creating a Vision 4. Communicating the Vision 5. Empowering Others to Act on the Vision 6. Planning for and Creating Short-term wins 7. Consolidating Improvements and Producing Still More Change 8. Institutionalizing New Approaches

7  Work as a Team rather than as individuals  Establish standing (regular) meetings and reporting mechanisms ◦ Standing agenda item for meetings of Team and Executive Leadership  Develop a plan  Identify barriers to implementation and address or mitigate problems  Encourage thinking “outside the box”  Have a kick-off date

8  Implementation of plan ◦ Not too fast – don’t have kick off until ready to implement initial series of steps ◦ Not too slow – avoid long lags between implementation of steps  Start with Small Successes  Monitor process and outcome data ◦ Is the plan being carried out? ◦ Is the plan having intended effects?  Review and respond to data

 Assure review of data by leadership and team  Make processes and outcomes transparent  Educate and engage staff (clinical, medical and support staff) about the project  Share WHAT WORKED and WHAT DID NOT ◦ Compare results across wards in a hospital ◦ Call your colleagues/network

 With both staff and individuals in care As Management does unto Staff… So shall Staff do unto Consumers  Strength-based supervision for staff  Use three buckets or red rules/green rules with individuals in care ◦ Offer choices ◦ Respectful interactions

 Promote calm, nurturing, healing environments ◦ signage  Model caring, compassionate behavior  Demonstrate active listening  Interview and observe for triggers  Adjust environment to prevent triggers  Use full range of prevention tools  Model, teach, model, teach - i.e., shape the behavior you want to see

Persistence and sustained attention Don’t get discouraged

Jayne Van Bramer Director, Office of Quality Management New York State Office of Mental Health 44 Holland Avenue Albany, New York (518)