Institute on Healthcare Systems

RAD Improvement Process

Session 5: Develop Awareness of Differences on Work Teams (Oct 6)

Objectives

Using the Relational Coordination framework, become aware of the relational core of a work process, the conversations needed for systemness and why differences matter. Deepen awareness of one’s own and others personal identities and how they influence one’s frame of reference; get more familiar/comfortable with talking about identities and frames of reference. Explore dynamics and experiences of inclusion and exclusion. Learn communication skills for fostering inclusion and psychological safety.

Participants

QI Coaches and RAD Coaches

Pre-work

Optional Readings

Videos

Activity

  • Create a pie chart to represent your own social identities - for example race, gender identity, disability, profession, education, income, parent education - not to be shared with others but as a basis for self-reflection. Develop a 2-minute personal story about one of the identities in your pie chart.

Modes of delivery

Personal assessment tools, personal stories, response to videos, facilitated conversations.

Content

Welcome, the Coaching Team introduces themselves.  Brief introduction to the frameworks for the change process. Review constructive and destructive listening behaviors. Co-create ground rules for our learning community, and how we will all deal with inevitable breaches.  

Facilitate conversation about “Dangers of a Single Story,” “The Power of a Simple Idea” and “Building Psychological Safety.”

Share your personal story with one other participant.  Practice mindful listening with each other.  Introduce your partner to the whole group.  Invite 2 or 3 participants to share their personal story with the whole group. Facilitate debrief with attention to professional and social identities.  Did others' stories seem to overlap with your own?  How did your identities shape your own story?  

 

Session 7: Explore and Harness Differences on Work Teams (Dec 1)

Description

The quality of relationships and communication on a work team powerfully determine all the important outcomes of the work – quality, safety, cost, patient experience, staff well-being, and ability to innovate. Three kinds of conversations are needed for individuals to work together as a system: conversations to foster alignment, to cultivate a systems perspective and to manage the interdependence of everyone’s tasks.

In these systemness conversations, each person can make unique observations that are valuable to the whole system. But everyone must be willing to both speak up about and be receptive to hearing all these unique perspectives to gain the benefit of their differences. Patterns of power, inclusion and exclusion associated with professional and social differences often make people more reluctant to share their perspectives, to the detriment of the whole system. Therefore, an important component of quality improvement is improving the quality of communication and the ability of a work team to harness the value of its own differences.

In this session, we will be exploring a powerful, practical tool called Relational Mapping that helps you see the quality of relationships and communication on a work team, and we’ll be using this tool to observe the impact of social and professional differences.

Learning Objectives

  1. Using the Relational Coordination framework, become aware of the relational core of a work process, the conversations needed for systemness and why differences matter.
  2. Use Relational Mapping to investigate the influences of differences in a work process.
  3. Deepen awareness of one’s own and others personal identities and how they influence. Become familiar and gain experience with communication skills for exploring differences.

Pre-work

To get the most out of this session we ask you to do the following:

  • Journaling: Keep a journal for 1-2 weeks recording your observations about professional and social identity differences in the work process you are seeking to improve, noting ways that those differences are (i) helpful and (ii) challenging in some way.  Consider the impact of power differences due to professional and social identities, as well as seniority.
  • Relational Mapping: Using the provided instructions/worksheet, create a relational map for the work process you are working to improve. It would help us prepare for the session if you would send us a photo or doc/pdf of your map by November 28th (please send to oolaleye@brandeis.edu).
  • Optional Reading: We’ve attached a brief reading about conversations of interdependence that suggests a format for having one of the three kinds of systemness conversations. After reading the article, try out this approach with a colleague.
  • Optional Reading: Self, System and Society (please do not distribute)

Participants

QI Coaches and RAD Coaches

Modes of delivery

Develop a relational map of roles on our clinical unit.  Learn how to develop relationships of shared goals, shared knowledge, mutual respect - and how to create psychological safety - among diverse colleagues.  Simulations or role plays to understand the perspectives of others and respond appropriately.  As participants observe simulations or role plays, they will use protocols to help identify the seven dimensions of relational coordination.  Which are relevant in a given situation? Which are present? Which are lacking?  From whose perspective?  

Content

Welcome, invite participants to reflect on what they’ve learned since we last met.

Ask participants to develop a relational map of their clinical unit, with attention to professional roles as well as social identities within those roles. Where is relational coordination currently strong?  Where is it less strong? What are the consequences for outcomes? What are the root causes?  How might social identities be affecting the relational map? How might social identities be affecting the seven dimensions of relational coordination - frequent, timely, accurate, problem-solving communication, shared goals, shared knowledge, mutual respect? What important information might you be missing? How can you learn more about that?

Engage in simulation or role play. Invite participants to serve as actors and observers.  Observation protocol includes attention to interactions around teamwork in general, then noting the influence of professional and social identities.  Coaches lead a reflective debrief among actors - what did they think? How did they feel? - then invites observers to speak.

Process reflection: How are we doing as we learn how to learn about differences? What can we learn from what happened today about how to build shared knowledge, shared goals, mutual respect?  About how to create a safe space through listening and power-sharing?  Which conversations about social identities would you like to have that you don’t feel you can have now? What would help make that more possible?

Baseline Assessment (Jan 4-18)

Objectives

Invite your colleagues to participate in the baseline RAD Survey to assess shared goals, shared knowledge, mutual respect, the quality of communication, psychological safety, and comfort with talking about differences.  Possible langugage for inviting your colleagues:

Happy new year! As part of our quality improvement project, we want to improve how we work together across differences.  Please share your experiences with working together on this unit so we can make 2023 an even better year.  To have your voice included in this baseline assessment, you must respond by Wednesday January 18.  We look forward to sharing the high-level results with you!

Participants

All members of each participating clinical unit are invited to respond to the baseline assessment, as well as QI Coaches and RAD Coaches.

Session 8:  Review Data and Prepare to Co-Design Interventions (Jan 19)

Objectives

Review baseline data. Prepare to share the data with all members of each participating clinical unit, and to engage them in co-designing interventions based on the data.

Participants

QI Coaches and RAD Coaches

Content

Review results of the baseline RAD Survey.  Brainstorm how to share data with your colleagues on the unit, practice doing it.  Brainstorm possible interventions.  Develop and practice methods for co-creating interventions with your colleagues.

Co-Design and Implement Interventions (Feb-April)

Objectives

Share data with all members of each clinical unit, co-design and implement interventions with them using rapid cycle improvement.

Participants

QI Coaches and RAD Coaches

Follow-Up Assessment (April)

Objectives

Invite your colleagues to participate in the follow-up assessment to assess changes in shared goals, shared knowledge, mutual respect, the quality of communication, psychological safety, and comfort with talking about differences.

Participants

All members of each clinical unit - and QI Coaches and RAD Coaches - are invited to respond to the follow-up assessment.

Session 10: Reflect on Progress, Celebrate and Plan (April 6)

Objectives

Reflect on and learn from your experiences thus far. Review follow-up data and assess progress.  Celebrate!  Identify areas for continued improvement.

Participants

QI Coaches and RAD Coaches

Pre-work

Reflect on what you’ve learned thus far from your implementation efforts.  What have you learned about yourself, about others, and about your workplace?

Modes of delivery

Conversational, reflecting on participant experiences using qualitative and quantitative assessments.

Content

QI Team assesses progress building relational coordination across professional and social identities, and assesses progress toward other desired outcomes.  Assess enablers and hurdles for speaking up, helping others, showing respect for differences, etc. and how you might address those. Help participants to navigate specific professional and social identity differences.  Develop an updated action plan for continued progress.

RAD Learning Lab (starting in June)

Objectives

To share, sustain and spread our learning over time rather than allowing the learning to degrade over time, inviting other clinical units and other health systems to engage in this improvement process. 

Participants

QI Coaches, RAD Coaches and other participants from all three health systems join this Learning Lab as they complete their first year of work.

Modes of delivery

Conversational, reflecting on participant experiences, and making structured group presentations with updates on a periodic basis.

Content

Support participants in continuing to use the tools and concepts they learned, in their current clinical unit and other units that they will join over time.  Create an environment for sharing the learning across clinical units and across health systems.

Post-Assessment (June)

Objectives

Invite all members of the clinical units to participate in the post-assessment to identify changes in shared goals, shared knowledge, mutual respect, the quality of communication, psychological safety, and comfort with talking about differences.

Participants

All members of each participating clinical unit - and QI and RAD Coaches - are invited to participate in the final assessment.