RROHC™ NEWSLETTER
SPRING 2010


IN THIS ISSUE
May RROHC Revisited Free Introductory Webinar
Shared Mental Models: Swarming to a Cultural Change
New RROHC Specialist Guided Self-Study Class Begins June 21
The Nurse Executive's Coaching Manual


"Teams in combat can't afford to be out of sync any more than healthcare professionals can, because in either situation, death or disability can result."

"It takes a lot more time to communicate without a plan or shared mental model."

"I often observe the graceful, beautiful 'dance' of teams in which interdisciplinary team members work in a coordinated and seamless manner with patients and families."


RROHC Revisited Free Introductory Webinar

We continue to offer the RROHC Revisited Free Introductory Webinar on a periodic basis for those who need a refresher and those who are new to the RROHC program.  Following is information on the next session.

RROHC REVISITED

Date:  Thursday, May 13, 2010
Time:  9:00am to 10:30am PACIFIC
Cost:  Free

To join the RROHC Revisited Webinar, click on the following link:

https://www2.gotomeeting.com/join/698098666


To Join the Conference Call, Dial 712-338-7101
Access Code: 698-098-666
Audio PIN: Shown after joining the meeting
Meeting ID: 698-098-666


If you are interested in scheduling a complimentary RROHC Revisited Webinar specifically for your facility, contact Hansten Healthcare PLLC or Kathy Watkins.

Shared Mental Models:  Swarming to a Cultural Change

Ruth Hansten
Ruth Hansten
Healthcare organizations must provide better health outcomes.  To accomplish that long-term goal, attitudes and behaviors at the point of care, as well as teamwork, must be transformed.   As your RROHC faculty, we hear from leaders overburdened with economic challenges, the tempo of techno-change, and resistance or negativity from coworkers.  Even the most engaged and enthusiastic leader experiences moments of drooped shoulders and crossed eyes.

Catherine the Great said: "You philosophers are lucky men. You write on paper, and paper is patient.  Unfortunately, Empress that I am, I write on the susceptible skin of human beings."   Team members may be impatient with us or with the pace of change, and we are not Empresses who can rule by fiat. 

Question: How can we help people transform THEMSELVES through their behavioral choices?  Answer: By developing and implementing a clear, shared mental model, offering education on the concepts and skills, along with coaching culture, and by allowing positive behaviors to develop into "swarms."

Shared Mental Models

We can learn so much from the field of neurobiology, teamwork studies from the military and symbolic systems or the information systems world.  Teams in combat can't afford to be out of sync any more than healthcare professionals can, because in either situation, death or disability can result.  As we developed the RROHC 10 steps or best practices, we knew from empirical application of education at 160+ hospitals or healthcare organizations, that all must possess a mental model before they can apply the ideas in their work.  We also combined critical thinking theories that prescribed application of concepts and models to create productive memory and the templates for clinical judgment.  From Case Western and the College of William and Mary (Druskat, Pescosolido), shared mental models are "theories in use" or "shared cognition" that can be used with complex adaptive systems to aid with both explicit and implicit messaging among team members.  The psychological ownership, continuous learning and "heedful interrelating" allow business and psychology to aid us, as well as the military, in moving toward better teamwork.

Now to the world of Info systems:  If we have shared goals, we then have "joint intention," which works well in environments where teams must "filter and fuse an overwhelming amount of information and make critical decisions under time constraints."  The "shared understanding of team structure" [different roles] enable a team member to develop a higher level of abstraction about capabilities, expertise, and responsibilities." (Yen, Fan, Sun, Chen et al, Penn State, Volz, R, Texas A and M).  

Sounds like RROHC to me!




What Does This Mean for Us?

It is time to evaluate whether or not your coworkers have been educated.  What do they think RROHC is? Can they name any of the steps?  What kind of education was offered to them?  An hour at orientation is helpful (better than no training), but will not suffice when we look at actually changing practice for each individual.   Does the RN have an idea in mind about how s/he sets up checkpoints or huddles for each shift?  If not, then how can the RN adequately supervise the NA?  The result: no psychological ownership and shared understanding.  It takes a lot more time to communicate without a plan or shared mental model. 

Hive Minds

Len Fisher wrote The Perfect Swarm: the Science of Complexity in Everyday Life (Basic Books 2009) about how intricate patterns grow out of simple rules.  We can learn from other beings:  ants or fish, and how they use swarm intelligence to behave in a way that their individual actions become "intelligent."  The fastest route to the honey quickly becomes the dominant one.  UPS used this idea when they asked drivers to learn from each other and they discovered that the fastest route included the most right turns.  Applying this knowledge saved UPS 3 million gallons of fuel in 2006.  The TCAB projects (Transforming Care at the Bedside) allow for one point of care discovery to quickly disseminate into practice at other facilities.  The RROHC program allows simple rules to be used and adapted at many healthcare organizations.  We swarm and learn from each other's successes.  I often observe the graceful, beautiful "dance" of teams in which interdisciplinary team members work in a coordinated and seamless manner with patients and families.  It looks simple, but took months of developing shared mental models, clear roles and "rules of the road" regarding teamwork, and requires ongoing reciprocal feedback.  Time is saved because the positive patterns or swarms have been developed and are nourished.

For all RROHC leaders attempting to transform culture, the Perfect Swarm would encourage us to be sure that the simple rules are clear for all members of the team.  Then leaders are free to coach each individual to discover what best patterns have emerged from experiential application of the RROHC principles and practices.  Skillful coaching allows the individual to recognize his/her own strengths and challenges, to identify barriers, successes, and to build on what s/he has identified, always making the choice to care and engage in the transformation at hand.  Measurement of individual skill growth will soon build, as staff members behave in the same manner, and their collective actions together form a new culture. 

New RROHC Level 1 Specialist Certification Guided Self-Study Program Begins Monday,
June 21, 2010


It's time to start identifying key staff at your facility to join the RROHC Level 1 Specialist Program that begins Monday, June 21, 2010.  Up to 37% improvement has been evaluated as a result of participation in this program, and countless on-site problems have been avoided or solved through the six-step critical thinking problem-solving process taught in the program.

Take a look at the improvement in delegation skills pre- and post-RROHC Level 1 certification, as shown on the following graph:

Delegation Skills Graph


Fees for the RROHC Specialist Level 1 training program, including instructor-guided self-study, is $475/person group rate for 3 or more from your facility (or $495/person single registration), plus textbooks and internal copying of portfolio.


Contact Hansten Healthcare PLLC or Kathy Watkins for more information, or to register members of your team for the RROHC Specialist Level 1 Class that begins on Monday, June 21, 2010. 

New Publication: The Nurse Executive's Coaching Manual

For leaders embarking on the journey to elevate professional practice to world class levels, the comprehensive travel guide has arrived!  

 

The Nurse Executive's Coaching Manual is a must read for honing the most important tools for healing: ourselves and our conversations with each other and those we serve. This handbook's encouraging narrative and conversational tone inspires belief in the reader's abilities to ask the difficult questions that will lead to growth.  

 

Kimberly McNally
Authors Kimberly McNally and Liz Cunningham incorporate the theories and themes of great thinkers into step by step, simple approaches and tools for coaching.  Emerging with new skills and sample questions, we can learn from the field experiences of these expert coaches and even begin to reconnect with ourselves.
Kimberly Cunningham


We predict that this manual and the I-COACH Model will become the key encyclopedia and guide for nurses whose passion is improving health care for our communities!

 

You can purchase your copy of The Nurse Executive's Coaching Manual at www.nursingknowledge.org/STTIbooks (Sigma Theta Tau).


About Hansten Healthcare

As a healthcare provider, you strive for optimal, individualized, relationship-based care, along with satisfying working conditions, and teamwork. As a citizen, you desire superior technical care delivered with the same compassionate focus and respect, in order to achieve your intended results.

Hansten Healthcare PLLC provides practical, exemplary service in consulting, based on decades of rich experience in clinical practice, leadership, and administration. We focus on the common building blocks of healthcare services and the systems that support them.

Our mission is to promote healing and wholeness, transforming organizations through relationship enhancement and skill development.

The RROHCTM Program is a protected copyrighted and registered trademarked program of Hansten Healthcare PLLC (HHC).  If you wish to use our ideas and/or materials, we would be pleased to provide licensing and/or to register your organization in our programs in accordance with our fees and pricing schedules. You may not use our intellectual property or materials unless you are a client of HHC and/or have obtained express written permission from us.