Becoming a Person Centered Organization

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Becoming a Person CenteredOrganization

• Michael Smull
• October 2005

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CommunityLife
Service Life
A Good But Paid Life
Important to recognized
Focus on connecting, building relationships
Important to present
To and for present Closest people paid or
family Few real connections
Important for addressed No organized effort about
important to
To and for present Active circle of
support Included in community life
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MISSION STATEMENT The Arc of the United States
advocates for the rights and full participation
of all children and adults with intellectual
disabilities. Together with our network of
members and affiliated chapters, we improve
systems of supports and services connect
families inspire communities and influence
public policy.
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When you compare the mission with reality

• Change is happening
• But it is too slow
• We have known how to meet the mission for more
  than a decade
• Yet there is still more typical practice than
  best practice

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We have learned what doesnt work for system
change -

• Best practice models dont infect all of typical
  practice and cause change
• Pilot efforts work but become another program
• Only requiring person centered plans improves the
  quality of the paper more than the quality of
  lives
• Change by memo has no effect

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What we are learning about things that work -

• You have to change how people think
• It has to be everyone - top to bottom and side to
  side
• New ways of thinking have to become habits
• Organizational culture has to reflect the values
  and support the skills
• All of the efforts have to be integrated
• Changing structures and policies has to arise
  from and reflect the learning

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Local change strategy

• Desired
• Outcomes for those supported
• Organizational culture
• Knowledge and skills
• Policies, practices, and structures

• Current
• Outcomes for those supported
• Organizational culture
• Knowledge and skills
• Policies, practices, and structures

Organizational
Change
Efforts
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Introduce and apply person centered thinking
skills

• Formal training for
• All managers senior, middle, front line
• Selected direct support staff
• Key players, the opinion molders among the
• self-advocates, family members, board members,
  funders, inspectors, service coordinators, etc.

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Help the skills become habits

• Support the pervasive and routine use of the
  skills
• In day to day work
• In problem solving
• Use the skills to develop living descriptions
  of how people want to live through partnerships
  with
• Those who use the services
• Family members
• Those closest to the person
• Make and celebrate level 1 changes
• Create optimistic discontent

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Build Person Centered Teams
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Increase organizational efficiency Positive and
Productive Meetings
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Active, integrated use of quality improvement
techniques

• Measure progress
• Aggressive efforts to reinforce person centered
  practices and improve organizational efficiency
• Review of processes and structures
• Ruthless review of all paper requirements
• Integrate learning
• Change policies, structures, practices

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Skills needed to support people
Supporting Dreams
Supporting Relationships/ Community Connecting

• Working/Not Working
• The 4 Questions
• Learning Log

Being Mindful and Recording Learning
Matching Staff and Those Using Services
Learning, Using and Recording Communication
Recognizing/Sorting Important To and Important
For Finding the Balance Between
Defining Staff Roles and Responsibilities
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• Important to
• What is important to a person includes only what
  people are saying
• with their words
• with their behavior
• Where what people say is different from what they
  do the bias is to rely on behavior.

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• Important for
• What is important for people includes only those
  things that we need to keep in mind for people
  regarding
• Issues of health or safety
• What others see as important to help the person
• Be valued members of their communities

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What is -
Important for .
Important to ..
What else do you need to learn/know?
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Important to/important for

• For the person
• Helps people get more of what is important to
  them without ignoring important for
• Identifying what still needs to be learned
• Helps people make critical decisions only when
  the relevant information is present

• For the organization
• Teaches critical thinking
• Reinforces think before you act
• Helps people feel listened to
• Supports an active learning culture

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Ex
Michael Libby
Examples from Inside Libbys Life
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Defining roles and responsibilities using the
donut

• For the person -
• Makes it more likely that those things that are
  most important (to or for) will happen
• People will be creative in support
• Those paid will keep their noses out of those
  things that are not their paid responsibility

• For the organization -
• Builds a culture of accountability
• Clearly delineates who is responsible for what
• Supports being creative without fear

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Person centered thinking skills - 3
For each person what are
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Matching staff with those who use services

• For the person -
• Because staff find more pleasure in their work
  they stay longer (more stability)
• Where there is a good match
• People who use services are more likely to have
  what is important to them
• New learning about what is important to people is
  more likely to happen

• For the organization -
• Reduces turnover
• Makes those who use and provide services feel
  valued/respected
• Helps support real relationships
• Decreases likelihood of incidents

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Person centered thinking skill 4 Where people
communicate more clearly with their behavior
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Communication chart

• For the person -
• Use of the communication chart in day to day
  support insures that -
• There is an increase in the presence of what is
  important to the person
• People using services feel listened to
• There is a decrease in frustration and the
  behaviors that go with it

• For the organization -
• Recognizes learning done by those who support
• Reinforces learning culture
• Provides new/relief staff with a quick way to get
  off to a good start
• Decrease in challenging behaviors and therefore a
  decrease in incidents
• Increases/reinforces observational skills

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Given the medication that someone is taking
What makes sense, is working, the up side, right
now
What doesnt make sense, is not working, the
downside, right now
Your guess about the persons perspective
your /staff perspective
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Mindful learningWorking/not working

• For the person -
• Results in greater clarity about what needs to
  stay the same and what needs to change in each
  persons life
• Helps in determining goals/outcomes that help the
  person move toward a desired life

• For the organization -
• Teaches critical thinking
• Promotes better problem solving
• Leads to clarity about what needs to change and
  what needs to stay the same
• Supports a learning culture

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Learning Log
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Mindful learninglearning log

• For the person -
• Because people are recording what is working and
  not working in support
• More of what is working and
• Less of what is not working will occur

• For the organization -
• Those doing the work feel listened to
• Learning done by those doing the work is recorded
• Provides a vehicle for learning to be synthesized
  and recorded
• Helps with problem solving/hypothesis testing
• Creates good paper
• Reinforces a learning culture and teaches
  critical thinking

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5 Mindful learning 4 1 questions

• Using the 4 questions to focus on learning and
  acting on that learning
• What have we tried?
• What have we learned?
• What are we pleased about?
• What are we concerned about?
• And then
• What should we try/do based on what we have
  learned?

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Mindful learning4 plus 1 questions

• For the person -
• Provides a record of those things that have been
  tried and their efficacy
• Those who support are less likely to continue to
  do those things that are not working in support
• Figuring out better ways to support people are
  likely to happen faster

• For the organization -
• Everyone has a voice and feels listened to
• Collective learning/knowledge is gathered
  efficiently
• More effective use of meeting time
• Facilitates effective problem solving

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Use the tools to create living descriptions of
how people want to live and what we need to do to
support them
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Person centered thinking coaches are

• Champions
• advocate for the use and utility of person
  centered thinking skills
• Actively reinforce the use of the skills
• Informal teachers
• Demonstrate the skills
• Give those who are using the skills feedback in
  how they are doing

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Difference between a coach and a trainer

• Trainers teach skills in formal settings using a
  fixed curriculum
• Coaches
• Teach informally, using teaching moments
• Demonstrate skills thru modeling
• Give people immediate feedback as they are
  using the skills and help them improve

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Effective Coaches

• Recognize teaching moments
• Understand how people learn
• Know the goal is to help others learn to do for
  themselves, not make the coach look smart
• Talk the talk and walk the walk

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Good paper versus good lives

• In a culture in which good paper takes precedence
  over a good life -
• The mission/vision is about helping people get
  good lives
• BUT
• Efforts to get good lives are not noticed
• WHILE
• The behavior of senior managers tells front line
  managers that good paper is rewarded and bad
  paper is punished
• AND
• The people who use the services often have good
  plans but lives where what is really important to
  them is absent

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Crisis Culture

• In a crisis culture -
• You only have time for the quick fix
• All temporary solutions are permanent
  (until they create a new crisis)
• Time to think things through is seen as a luxury
  
• Those good at crisis management find it addictive

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Blame culture

• You have blame culture when -
• Real responsibility is avoided
• Thinking outside the box results
• in psychic decapitation
• Advice from others focuses on risks more than
  rewards and the importance of CYA activities
• A strong blame culture kills creativity, distorts
  learning, and eventually drives out many of those
  you want to retain.

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Accountability versus BlameCulture

• In an accountability culture you know what the
  boundaries are before you meet them
• In a blame culture you discover the boundaries by
  crossing them

Smull Allen 2001
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Passive (only professionals learn) Culture

• In planning meetings the less time you spend with
  the person the more
• you get to talk
• The closer you are to the person the less you
  are expected to think
• The learning done by the person and those closest
  to them is not recorded
• Much of the data generated is fabricated

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Partnership

• Partnership is built on a foundation of
• Respect and
• Trust
• Partnership requires that everyone
• is clear about their roles, responsibilities
  while being flexible
• Partnership is about sharing power and
• about following the rules of trust

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Creating the ground rules for partnership

• How do you know if
• Respect is present in the workplace
• Trust is present in the workplace
• Partnership is present in the workplace
• Vote for the top 5 and then, with discussion,
  pick no more than 10

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Learning culture

• A learning culture requires
• That everyone is heard feels their voice
  matters
• Learning is continuous not just during review
  or planning meetings
• What is learned is recorded as it is learned
• People are supported in acquiring the skills they
  need and opportunities to enhance skills are
  routine

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In a learning culture there isGood paper

• Our memory, a place to record what we have
  learned
• What helps new people to meet the person
• It serves to focus our efforts, our learning
• Helps with problem solving
• Is useful in day to day support

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Accountability

• Everyone knows what the expectations are for
  their job what the boundaries are
• They can be creative without fear
• Those who do not meet the expectations, who cross
  established boundaries, are held accountable

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Discontent is the engine of change

• Good plans create a kind of mirror they reflect
  how people want to live
• Discontent comes from comparing what is with what
  could be
• There are 2 kinds of discontent
• Optimistic, and
• Cynical

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Optimistic discontent requires trust based on

• A history of acting on those things that can be
  changed immediately
• Honesty about those things that take time
• Signs of progress in acting on the things that
  take time
• Where change is new trust must be created

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Cynical discontent

• One of the things that good plans do is hold a
  mirror up to the system and create discontent
  with what is.
• Without hope for change this level of discomfort
  becomes intolerable.
• Without hope for change you get denial,
  distortion, or departure
• People say this is no different from what we have
  always been doing
• Plans are distorted to suggest that what people
  want is what is already offered
• The people who have the most passion for change
  leave (depart) when they see no hope for change

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Learning new ways of seeing/looking/evaluating
causes discontent when what could be/should be is
not present
Discontent creates pressure for change
Change happens at 2 levels
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2 levels of change

• Level 1 change
• those changes that can be made without becoming a
  change target
• without changing core structures,
  responsibilities, etc.
• E.G. helping people with their morning rituals,
  honoring what is important that doesnt require
  that people move or major changes in staff
  responsibilities

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2 levels of change

• Level 2 changes
• Changes that make you a change target
• New responsibilities, practices, structures