Positive Cultural Change Research Articles

Changing our culture

Today, a great challenge of our profession is to envision how we will deliver exemplary neurosurgical care in the future. To accomplish this requires anticipating how economic, political, and societal influences will affect our ability to provide the highest quality of patient care in an arena that will look increasingly different from today's world of medicine. Already, our profession is battling a relentless assault as numerous sectors implement change that impacts us and our community every day. Surviving this requires an effective strategy that will involve significant cultural change. To accomplish this, neurosurgery must take an honest look inward and then commit to being the agents of positive cultural change. Such a path will not be easy but should reap important benefits for all of neurosurgery and our patients. Several practical and proven strategies can help us to realize the rewards of changing our culture. Vital to this process is understanding that effecting behavioral change will increase the likelihood of achieving sustainable cultural change. Innovation and diversity are crucial to encourage and reward when trying to effect meaningful cultural change, while appreciating the power of a "Tipping Point" strategy will also reap significant benefits. As a profession, if we adopt these strategies and tactics we can lead our profession to proceed in improvement, and as individuals we can use the spirit that drove us into neurosurgery to become the agents of an enduring and meaningful cultural change that will benefit our patients and us.

A Faculty Created Strategic Plan for Excellence in Nursing Education

Strategic planning for nursing education, when seen through a faculty lens creates a deeper, more meaningful critical analysis of effective program development. New strategies are required for academic institutions to transform their curricula to meet the needs of a dynamic healthcare and changing global environment to provide quality education for students. In this article, an evidence-informed process is presented that was progressively co-created by the faculty and facilitators. Seminal business frameworks, leadership development philosophies, and innovative interventions enabled faculty to become engaged and developed as they created a strategic plan for a future-driven nursing program. Phase One presents the process of developing a strategic plan for excellence in nursing education by leveraging faculty potential and preparing for an upcoming accreditation. In Phase Two, four team members from Phase One continue as part of Phase Two team serving as the collective memory for this initial work. This method of strategic planning encouraged faculty engagement and leadership and laid the groundwork for a positive culture change among nursing faculty.

Cooperative oriented learning in inclusive physical education

In this study the implementation of cooperation directed learning of peer tutoring in elementary general inclusive physical education (GPE) setting in three elementary city schools in Sweden was studied. The purpose was to assess the impact of peer tutoring on the interaction behaviours between students with and without disabilities in GPE. A design of multiple case study with elementary school age students with moderate disabilities (n = 4) was used. Peer tutors (n = 37) were students without disabilities who voluntary participated in a peer tutor training programme. The programme included the collaborative learning values, teaching instructions and communication skills served as the independent measure. Dependent measures were multiple interactions between students with and without disabilities. Data to the case studies were collected through a design of mixed methods, containing both quantitative and qualitative data. Totally 43 observation sessions of inclusive GPE settings were collected on videotapes and analysed using the Computerized Evaluation Protocol of Interactions in Physical Education (CEPI-PE). In addition, interviews with school personnel and children served as a complementary study outcome. The percentage of interactions between target students and peer tutors significantly increased (3.2–11.8%, respectively, p < .05) during peer tutor intervention. This study indicated that peer tutor arrangements can contribute the successful cooperation between students with and without disabilities in inclusive GPE in Swedish elementary school. All four students with moderate disabilities maintained high percentage of activities done independently throughout baseline and intervention phase (50.5 and 57.6%, accordingly). Qualitative data throughout field notes and interviews with school personnel and pupils confirmed a positive class climate change and improvement in peer relation culture.

Aligning leadership and organizational culture: The leader–culture fit framework for coaching organizational leaders.

This paper describes the conceptual underpinning and application of a novel framework for coaching organizational leaders. Rooted in person– environment fit theory, the leader– culture fit framework yields a set of inferences about leader– culture fit and leads to several unique perspectives on coaching. The intent of the framework is to organize and augment the coach’s subjective insights about how the organizational culture may support the leader’s development of certain capabilities while potentially constraining the development of others. The proposed model also has the potential to better align leader-development strategies, vis-a `-vis coaching, with the broader organization’s development needs by identifying key ways in which the leader can serve as an agent for positive culture change. From a methodological perspective, we discuss three requirements: the use of parallel attributes, commensurate measures, and evaluative judgments of attributes. We also briefly illustrate the model’s application using a case study that combines data from an organizational culture assessment with data from a parallel 360-degree leader assessment, and finally, discuss several key challenges and limitations to implementing the framework within a coaching engagement.

Doing Safer Masculinities: Addressing at-Risk Gendered Behaviours on Mine Sites

Doing Safer Masculinities: Addressing at-Risk Gendered Behaviours on Mine Sites

Abstract TP335: Cohorting Patients From Door to Discharge Impact on Improved Patient Outcomes

Background: Evidence-based studies illustrate the effectiveness of specialized stroke services in improving stroke patient outcomes. The American Stroke Association (ASA) has recommended the development of primary (PSC) and comprehensive (CSC) stroke centers to ensure that organizations have the expertise and resources to provide stroke care. Purpose: Cohorting (grouping) stroke and transient ischemic attack (TIA) patients on a dedicated neurological intensive care unit (ICU) and providing continuum of neurological patient care through the stroke unit has shown to improve patient outcomes through 90-100% compliance with stroke core measures and Get With The Guidelines ( GWTG ) quality measures. Methods: The ICU redesigned and selected eight neurological beds; while simultaneously, the medical/surgical stroke unit transitioned to include neuroscience/telemetry. The transition utilized the theoretical framework of Appreciative Inquiry (AI) to promote positive culture change. Through the dedication of nursing leadership, stroke coordinator and neuro educators, a comprehensive education plan was executed for all registered nurses of these units. Through utilization of coordinated NIHSS during change of shift and inter-department report, subjective differences were eliminated and baseline assessment created consistently. A neuroscience task force established and incorporated nurses from emergency room, intensive care unit and neuroscience/telemetry unit to facilitate collegiality and stroke patient care continuum. Results: Examination of the Stroke Core Measures and GWTG quality measures pre and post the transitions confirmed improved compliance with ASA’s stroke core measures and quality indicators. In addition, the patient length of stay decreased well below the national average and 30 day readmission rate decreased as well. Conclusions: The benefit from treatment in a dedicated stroke unit remains a key component of improved outcomes. Therefore, creating a coordinated stroke/TIA continuum of care from door to discharge has exhibited improvement of the core measures and quality indicator compliance thus improving patient outcomes.

Shooting the messenger: Outsiders critical of your group are rejected regardless of argument quality

People are more resistant to criticisms of their group when those criticisms are made by an outgroup rather than an ingroup member, a phenomenon referred to as the intergroup sensitivity effect (ISE). The current study compared four competing models of how argument quality would moderate the ISE, with a view to establishing the complex interrelationships between source and message effects in group-directed criticism. Quality of the argument affected responses to ingroup critics, but not to outgroup critics. For outsiders who wish to promote positive change and reform in a group culture, this leads to a somewhat depressing conclusion: their message is likely to be rejected regardless of whether it is objectively 'right', well-considered, well-justified, or well-argued.

The surgical safety checklist survey: a national perspective on patient safety

In 2008, the World Health Organisation (WHO) recommended practices to ensure the safety of patients worldwide. This led to the development of the Surgical Safety Checklist (SSC). Ireland has endorsed the SSC ( www.hiqa.ie/press-release/2008-06-17-health-information-and-quality-authority-launches-world-health-organization , 10). We aimed to determine (i) whether SSC is being implemented, (ii) whether it promotes a safer surgical environment and (iii) identify problems associated with its introduction and on-going implementation. All hospitals in Ireland with operating departments (n = 61) were invited to participate in an online survey. The response rate was 67 %. The WHO SSC or modified version is in place in 78 % (mean time: 20 months) of operating departments that responded. Partaking in Time Out as a team was reported as occurring in 57 % of cases. Greater than 60 % of respondents reported that the SSC was difficult to introduce and implement and that its introduction was time consuming. Further training in using the SSC was reported as desirable by 84 % of respondents. The introduction of the SSC was reported to be associated with an improvement in team communication (72 %), a positive change in team behaviour (63 %), an increase in the consistency of patient care (82 %) and a positive culture of safety in theatre (81 %). The SSC has not been implemented throughout all operating departments in Ireland. Where it has been introduced there has been a perceived positive change in safety culture. However, overall greater education, endorsement, teamwork, and communication will be required to optimise the potential benefits associated with this safety instrument. In order to properly determine the benefit of the SSC following its implementation, a formal audit of morbidity and mortality is required.

Policy implications of gay men's workplace experiences: public service employees in Australia's capital, Canberra

In 2008, changes in Australian federal legislation commenced the removal of workplace policies that historically discriminated against non-heterosexual employees. Academic research, however, reveals that much workplace discrimination is covert. To examine perceptions of covert workplace discrimination, experiences of gay men employed in the public service in the Australian Capital Territory in Canberra were investigated using semi-structured, in-depth interviews. Qualitative thematic analysis revealed a range of workplace experiences by gay male employees including perceived positive cultural change and continued sexuality-based discrimination. Participants’ workplace experiences included perceived general acceptance of homosexuality as well as workplace cliques and discrimination in specific instances. These perceptions occurred despite official changes in workplace legislation and the unanimous existence of employment opportunity, anti-discrimination and/or anti-bullying or harassment policies. This research advocates the need to prioritise identifying, managing and reviewing existing workplace policies and practices that fail to include covert sexuality-based discrimination as a means to improve workplace dynamics for all employees, thereby reducing social inequality.

Queensland Health – a leadership development journey

PurposeThis paper is a descriptive case study which seeks to outline how leadership development is being utilised across Queensland Health (Queensland Department of Health, Australia) to achieve improvements in workplace culture and ultimately improvements in clinical care and patient outcomes.Design/methodology/approachQueensland Health has been implementing a comprehensive organisation‐wide suite of leadership development programs since 2006. This includes a range of specific leadership development programs conducted over a period of time for clinical and non‐clinical staff. It also includes specialist leadership development workshops of shorter duration, online leadership modules, web‐based support, executive coaching and 360‐degree feedback. The programs are based upon experiential learning which engages participants in critical thinking and self‐reflection based upon in‐context experiences relevant to themselves. Ongoing leadership program development has been evidence‐based and identified through 360‐degree feedback outcomes, staff opinion survey outcomes and program evaluation outcomes.FindingsThe 360‐degree feedback survey results of participants have improved. This demonstrates that the leadership development programs have impacted positively on participants' workplace behaviour. The culture and climate survey results have improved which demonstrates positive cultural change has taken place. The programs have been evaluated very highly by participants.Originality/valueThis is one of the most comprehensive and innovative leadership development initiatives ever undertaken within the Australian health sector, with over 10,000 participants to date.

Drama for Schools: teacher change in an applied theatre professional development model

Applied theatre often draws upon critical pedagogy and constructivist methodology as a way to bring participants into direct engagement with their own learning experiences. As learners, adults bring a wealth of perspectives that further affect how they interact with an applied theatre experience. Drama for Schools (DFS) is a professional development programme that partners graduate students and academics with teachers in elementary and secondary education. DFS hopes to shift the learning culture of classrooms through the use of drama-based instructional methods (e.g. interactive games, improvisation, and role playing). This article investigates how DFS facilitated change in (1) teacher identity; (2) pedagogy; and (3) teacher perceptions of their students. Data sources in this study included monthly written reflections and focus groups by DFS participants. Results varied across the research. Teacher's did not appear to change their views substantively over the course of the year. However, instructional strategies shifted in distinct ways, often reflecting the critical pedagogical nature of the drama-based strategies. Furthermore, teachers reported that DFS strategies facilitated risk-taking by all members of the classroom. As a result, the roles of teacher and learner in the classroom became more fluid during drama-based instruction. Implications for this work include a discussion of how DFS, as an applied theatre professional development model, is a vehicle for potential positive change in the learning culture of classrooms.

The Locative, the Ambient, and the Hallucinatory in the Internet of Things

ABSTRACTThis paper outlines three modes in mobile digital media in the contemporary cityscape: the locative, the ambient, and the hallucinatory. All of these tendencies appear in contemporary artistic and commercial strategies for “intertwingling” our cities and our data, yet each bears its own distinct freight. Rhetoric around locative media projects, which frequently draws on Situationist texts, tends to make broad claims about the potential for positive cultural change. Ambient media's rhetoric is entwined with neo-liberal desires for a closed, frictionless circuit of consumption, where mobile technologies directly connect consumers to brands via virally circulating digital advertising codes. The hallucinatory is a moment of the unexpected irruption of the Real, and, as such, offers the possibility of conceiving of a relationship between data and objects that escapes the fantasy of frictionless global digital capital. Drawing on international urban art projects such as “[murmur]” and recent urban ad campaigns from marketing firms such as Dentsu Canada and Sony Pictures. This article argues for the growing need to map the stakes of these emergent modes in the Internet of Things.

Patientensicherheit in der Orthopädie: Implementierung und erste Erfahrungen mit CIRS und Team Time-out

The critical incident reporting system (CIRS)and a surgical safety checklist (SSC) are considered to be the most powerful and important means for patient safety and for avoiding surgical errors. Nevertheless, these tools are not yet standard in orthopaedic surgery. We have implemented CIRS and a surgical checklist adapted to the specific conditions in orthopaedic surgery. In this article, we provide a guideline to put CIRS and SSC into practice and report on preliminary results one year after implementation in our department. A comprehensive statistical analysis of the reduction in surgical errors cannot yet be given. As a first effect after one year, an improvement in interdisciplinary team building, an increased sense of responsibility of each employee and a positive change in failure culture can be observed. SSC and reporting near mistakes enables a comprehensive failure analysis helping to avoid future complications and improve medical quality.

Supportive care of rural women with breast cancer in Tasmania, Australia: changing needs over time

Providing for patients' psychosocial needs is a potential means of minimising cancer morbidity. Needs assessments can guide responsive patient-centred care. A longitudinal survey of women with early breast cancer consulting a breast nurse in a primarily rural state of Australia was undertaken to measure unmet supportive care needs, identify changes in unmet needs across time and compare results with previous studies. Needs assessments were completed with the Supportive Care Needs Survey (SCNS) at 1 month (n = 74) and 3 months (n = 83) post-diagnosis. Access to services was also examined. High levels of psychological and health system and information needs were identified at 1 month post-diagnosis, but these decreased significantly at 3 months post-diagnosis. Sexuality domain needs increased significantly during the same time. Compared to a previous SCNS study of rural women with breast cancer, unmet supportive care needs in this study were significantly lower than previously reported, although assistance with energy levels (i.e. fatigue) continues to be an unmet need for women with breast cancer. Results suggest there have been positive cultural changes within healthcare systems, specifically in better informing patients and providing support. Although services appear to be more responsive to breast cancer patients, significant unmet needs still exist.

Sustaining the Wait Time Strategy

Significant early positive cultural changes have been made in the Ontario healthcare system to address the province's Wait Time Strategy. Improving efficiency in parallel with the introduction of accountability agreements will provide early successes. However, there are fundamental system weaknesses that must be addressed in the long term to sustain the program. These include a wait list information system that addresses all patients waiting for care, additional healthcare providers with wider scopes of practice, improving hospital capacity, accountability agreements with agreed-upon performance indicators, new payment systems for physicians and a fundamental change in referral and care processes. Innovative approaches such as gain-sharing should be considered. Though resources are scarce, there is a need for significant early additional investments to achieve long-term success.

Context dependent learning: its value and impact for workplace education

Purpose – The purpose of this paper is to describe how a management development programme based on situated learning theory resulted in change for individuals, organisational culture and performance. The case study illustrates how new understandings about learning in the workplace and in higher education points towards the need to take account of the context in which learners utilise their knowledge and skills. Design/methodology/approach – Quantitative and qualitative strategies were used to provide an evaluation of the impact of a management development programme in a group of companies. A questionnaire, focus groups and semi-structured interviews were used to collect data on three cohorts of supervisors and middle managers at different stages of the programme. A triangulated approach was adopted towards data analysis that illuminated a broad and deep change process. Findings – Positive cultural change was a significant benefit to the host organisation from the training programme. It was apparent that training can move beyond individual development to bring about organisational gains. Research limitations/implications – Future research might adopt a longitudinal design and facilitate a co-researcher approach using students’ learning logs of workplace experiences. Practical implications – Situated approaches to learning in higher education and the workplace need to be developed further to enhance workplace performance. A proposal is made for “learning consultants” to move between the two environments and facilitate knowledge exchange and improve understanding of the variety of learning contexts in business and educational settings.

Q&amp;A with Tom Theriot and Ali Rashid Al-Jarwan

As program committee chairpersons for the Eighth International Conference on Health, Safety, and the Environment, can you offer some highlights of this year's event? Al-Jarwan: This conference will be one of the biggest events in the global oil and gas industry focusing on the current challenges and opportunities associated with HSE. The main objective of the conference is to share all best practices in our industry to support sustain-ability of HSE performance. Theriot: Certainly the location in Abu Dhabi is a highlight in itself, as is the outstanding technical program, which has a global reach. What were your objectives in putting together the technical program? Theriot: One objective in putting together the technical program is to provide a high-quality program that will inform and motivate while covering a range of relevant and practical HSE-related topics. A second objective is to promote networking and interaction among the participants. This is the eighth such conference. What is the most significant difference in how the oil and gas industry views HSE issues now compared to how it viewed them at the time of the first conference? Al-Jarwan: During the last 10 years, the HSE performance of the oil and gas industry has been generally good, showing continuous improvement mainly because of the application of management systems, compliance with rules and regulations, and by implementing audits to find gaps for further improvements. To sustain HSE performance further, the drive should come from the entire workforce. A truly positive cultural change in behavior will be needed to sustain performance. Theriot: One significant difference is the increased awareness by industry that strong HSE performance is essential to overall business success. Said differently, sustained business success starts with success in HSE, and it is this realization that has led to improved HSE management approaches across the industry. This realization also emphasizes the value to industry of sharing and collaboration, and the importance of global conferences such as this one. How is this event different from other HSE events? Theriot: The worldwide scope and participation, including a strong senior leadership presence from many companies and organizations, and the breadth of the technical program make this conference unique. Al-Jarwan: This conference will capitalize on the central location of Abu Dhabi and the rich diversity of the oil and gas industry in the Middle East. The various technical and panel sessions will be diverse and cover the latest HSE success stories and challenges. What is the next great stride the industry must make regarding HSE issues? Theriot: The next great stride must be in improving execution. Numerous tools, practices, and systems are in place, and it is essential that all employees and contractors effectively exe-cute in all phases of their activities to promote continuous HSE improvement industry wide. Al-Jarwan: The oil and gas industry is truly on a long journey in both HSE and business improvement while meeting increasing challenges in E&amp;P developments. But this journey is generating a wealth of experience. For example, during the last 10 years, quantified risk assessment and safety installation have improved to prevent major accidents.

The World Alliance for Patient Safety

Despite enormous strides in our knowledge about quality health services, and the continuously growing interest in the safety of patients among policy makers and clinical leaders, much remains to be done to avoid unintentionally harm occurring in health care. In May 2004, the Fifty-seventh World Health Assembly supported the creation of the World Alliance for Patient Safety which aims to coordinate, spread and accelerate improvements in patient safety worldwide. The Forward Programme 2005 of the World Alliance for Patient safety sets out an important and comprehensive programme of international work in areas such as reporting and learning, patient involvement and safety solutions. The experience of other high risk industries, suggests that patient safety problems are primarily a function of deficiencies in system design, organization and operation. Understanding and improving the design of processes, structures and culture of health care delivery is therefore central to making care safer. A number of core challenges emerge across many European countries including the need to continue to build strong political will and commitment to address patient safety problems, stronger engagement and leadership from health care professionals, and promoting positive cultural changes with health care.

Empowered teams effecting positive corporate culture change

Many manufacturers have implemented a participative, team‐based approach to remain competitive in this global arena. Numerous studies have extolled the competitive advantages of implementing this approach. Few studies, however, have examined employees’ perceptions of participative management. Therefore, the purpose of this study is to examine issues of culture change from the employees’ point of view by investigating the transition from piece rate to team‐based production in a sewn‐products plant. Using the case study approach, 16 in‐depth interviews were conducted, observations were made, and written documents were analyzed. Employees’ perceptions of their work environment prior to the transition, the transition itself, and the resulting new corporate culture are discussed. The new corporate culture is described as an open, participative environment built on trust where employees feel empowered to make decisions for the betterment of their team and the plant as a whole. Negative outcomes of the participative approach are also addressed.

Reducing medication errors.

This article describes initiatives one institution developed to improve systems for detecting and preventing adverse medication events. Our discussion focuses on issues regarding the frequency and incidence of medication errors, the trials of traditional versus anonymous incident reporting, and the efforts to improve systems rather than placing blame and punishment on individuals. Initiatives such as improved documentation of pediatric patient weights and hepatic and renal function, increase of direct physician order entry into our Medical Information System (MIS), elimination of nonemergent verbal orders, and new and improved MIS ordering matrices (incorporating medical protocols and pathways) have led to more rational and efficient practices. Improved error prevention and critical incident review have identified on-going opportunities for improvement. Although the direct impact on patient outcomes is not yet measurable, numerous positive results have allowed for improved clinical decision making, streamlining of processes, increased regulatory compliance, and a positive culture change.