Weaving it all together

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Weaving it all together

• Creating a person centered organization in a
  program centered system

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For every complex problem there is a simple
solution --- and it is wrong.
Peter Senge quoting Oscar Wilde
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Quality cannot be inspected into a product
Inspection to improve quality is too late, too
costly, and too ineffectiveQuality must be
designed in. Deming, 1991
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Some of this weeks meetings

• PCP committee
• Work force development committee
• Budget committee
• Outcomes review committee
• Strategic planning committee
• Unusual incident review committee

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Doing all the right things but -

• the outcomes dont match the effort

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Success requires

• Changes in thinking about people, planning, and
  how to develop services
• Skills in person centered thinking and planning
  as well as how to develop and organize services
• Commitment to be a change agent

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Success requires -

• Changing the thinking, not just the planning
• Everyone in the organization/system has had
  training in person centered thinking
• Everyone is encouraged to apply what they have
  learned

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Success requires

• That plans are developed in partnerships
• The person and those closest to the person have
  lead roles

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Success requires

• There is active, on-going work to apply the
  principles that go with person centered thinking
  to the whole organization
• Senior managers consistently model the behaviors
  needed to create a person centered culture

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Successful change agents -

• Keep their eyes on the prize know what
  changes they want to see
• Find allies create formal and informal support
  groups
• Recognize and take advantage of opportunities for
  big and little changes
• Dont give up never stop pushing

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External Context
Licensing accreditation
Funding rules amounts
transforming mediating buffering structures
processes
Culture of Support
Community Expectations
Wage hour rules
Workforce issues, wages demographics
Family expectations
O S H A
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Strategy for Change
Incremental ChangeTypical Practice
EstablishBest Practice
Positive Pressure for Change
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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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Each of us want lives where
We are supported by contribute to our
communities
Have our own dreams and our own journeys
Have opportunities to
meet new people try new things change
jobs change who we live with where we live
Have what/who is important to us in
everyday life people to be with
things to do, places to be...
Stay healthy safe (on our own terms)
(with apologies to Abraham Maslow)
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Health and Safety
Dictates Lifestyle
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All Choice, No Responsibility
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Balance
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Stay focused on where you want to go

• The desired outcomes for those using your
  services
• The organizational culture that supports the
  outcomes
• The skills and knowledge needed to achieve the
  outcomes
• The structures, policies, and practices that help
  you to keep moving in the desired direction

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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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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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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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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 then
  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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Begin with what is
Important to _______
Important for________
What else do you need to learn/know?
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Inside a Persons Life
Not Our Paid Responsibility
(Domain of friends)
Use
Judgement/Creativity
Core
Responsibilities
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Ex
Michael Libby
Examples from Inside Libbys Life
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Going from Planning to Action

• Learn/describe-
• what is important to and what is important for
  the person

• Explore what is
• conceivable -
• see what has been done elsewhere
• look for options that best fit how the person
  wants to live

Teach planning, Develop mentors
Whats conceivable coaches

• Make it happen -
• be able to navigate local system
• be able to use available funding to shop
• develop capacity

System navigators
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Partnerships and experts

• All good plans are done in partnership
• Partnerships that work have agreed upon roles
• Think about the roles from the perspective of
  content experts and process experts

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Planning in partnership

• Phases in planning
• Before you plan work
• Gathering information
• Developing a 1st plan
• Using the plan
• Recording on-going learning

• The bias in who has the lead role in each phase
• The persons whose plan it is
• A family member
• Others who have a personal relationship
• The facilitator

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Developing plans Getting started, keeping them
alive

• Talk with theperson about
• the purpose of the plan
• ground rules
• ways to gather information

Choose 1 of 8 ways to gather information
Develop a 1st plan, 2nd plan, etc.
Figure out how to have and record ongoing learning
Reflect, organize, synthesize
Record the learning
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Increasing retention helping people feel
listened to, reducing stupid documentation,
increasing learning, quality of life
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Good paper

• Is 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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What should be absent?The 4 stupids

• Stupid goals which lead to
• Stupid programs which lead to
• Stupid staff training leaving us with
• Stupid stupid paper

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Characteristics of people I like hanging out with
Characteristics of people I like working with
Characteristics of people I dont want to work
with
Characteristics of people I dont like to hang
with
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• Imagine that there is a new disease that is
  spread by mosquitoes and you have been bitten
• The bite 1st causes a rash and then 2 weeks of
  paralysis
• During the paralysis you will need personal care
  for everything
• You are now looking for the person who will
  provide the care and you are going to fax me a
  list of characteristics to look for and to avoid
  
• Look at your list of characteristics
• Circle the ones that must be present and the ones
  that must be absent
• Add any that are missing
• Clarify any that are too general to allow me to
  match you are the person providing the care

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Because there are a lot of people who have been
bitten the demand for personal care services is
high. I tell you that you will just have to
accept whoever I send. The person that comes has
the characteristics that you said needed to be
absent. But except for being able to talk you
are paralyzed. What would you do?
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Matching staff supporting _________________    

 
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Learn more about where you are current reality

• Look at where you are across the same dimensions
  
• Outcomes for those supported
• Organizational culture
• Skills knowledge
• Structure, policies, practices

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Beta summary 2

• There is a strong blame culture operating
  between Smith county case mangers, independent
  support brokers, and Beta Corporation managers
•    This results in strong us versus them
  perceptions
•   Blocks the development of critical
  partnerships in problems solving and areas of
  shared responsibility
•  Helps to maintain the absence of clarity in
  roles and responsibilities
• Has created fear of retribution when giving
  honest feedback (among some of those working for
  Beta Corporation).

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What is working/ not working
Listen/ learn
Organization
Act on what is learned
Individual
Analysis
See what is not working
Act on what is learned