OSH Task Report 1 - Cultural Excellence

8/8/2019 OSH Task Report 1 - Cultural Excellence

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Task 1 Defining Cultural Excellence(As-is Cultural Norms and Instilling the Changes)

Deliverable 1a: Cultural Assessment

Deliverable 1b: Change Strategy

Prepared for the

Oregon Health Authority / Oregon State Hospital

Salem, Oregon

in satisfaction of Contract #133459,

Oregon State Hospital Excellence Project

Prepared by:

14 January 2011


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Table of Contents

A. Executive Summary....B. Background and Purpose...................C. Situational Assessment.

Introduction to Tools and Techniques.....

1. Organizational Alignment and Effectiveness Survey (OAES).2. Focus Interviews....3. Functional Mapping..4. Online Surveys....5. Workplace Interviews.

Current Cultural Norms......

D. Cultural Changes to be Instilled..E. Strategy for Bringing About Cultural Change......

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A. Executive SummaryIntroduction: This document is comprised of two merged Task 1 deliverables, 1a and 1b, satisfying the

State of Oregons Professional Services Contract Number 133549 for the Oregon State Hospital (OSH)

Excellence Project as follows:

Deliverable 1a is a written report on current cultural norms, cultural changes needed andidentification of cultural norms necessary to be instilled in management, staff and patients, and

Deliverable 1b is a written strategy for bringing about the recommended cultural changeThe findings and recommendations cited in this document are employed to develop a practical approach

to instill behaviors that serve to improve organizational culture at all levels throughout OSH operations.

Overview: Mindful of the modern new facility that hospital patients and staff would soon occupy, and,

following sober consideration of the Quality and Compliance External Review Report, Oregon State

Hospitals (OSH) top administration directed sweeping efforts to improve hospital performance through

the Oregon State Hospital Excellence Project. In its nine tasks conveyed in twelve deliverables over

seven months (Figure 1), the project focuses on making OSH a first class psychiatric facility where

effective patient treatment and recovery is the anticipated norm.

Figure 1 OSH Excellence Project Tasks. Early deliverables include Task 1s Cultural Assessment and

Change Strategy. Task 1 work was designed to unambiguously profile OSHs current-state cultural norms

and then define an effective strategy to improve upon them in order to best focus resources to achieve

rapid and sustainable performance transformation. This document summarizes Task 1s first two

deliverables (dark shading above). The companion deliverable, 1c, completes in June 2011. It focuses on

technical implementation support for adopted changes as supported and led by the OSH Cabinet.

Cultural Assessment: Task 1 used select data discovery and analysis techniques sourced from Kaufman

Globals proven Culture and Climate Tool Suite. These included Organizational Alignment and

Effectiveness Survey (OAES), Focus Interview, Functional Mapping, Online Opinion Surveys, and

Workplace Interviews. These methods were chosen as they could be applied with speed, the needed


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breadth and depth, and, yield accurate strategy recommendations. While any individual tool might have

proved revealing on its own, such techniques applied in composite helped to boost fidelity of the

findings. Moreover, with these tools we could touch many hundreds of stakeholders, broadly

validating the hospitals overall cultural norms.

Not surprisingly, such discovery techniques demand a great deal of stakeholder involvement from the

entire hospital ecosphere patients, families, front-line staff, management and leadership brought

into focus through the lens of their daily experiences. Such involvement isnt only essential to ensure

accurate assessment findings, but, it also serves to build broad organizational buy-in for the cultural

change strategy.

Change Strategy: From an informed foundation of the completed cultural assessment, defining a change

strategy with practical recommendations was both simplified and put on track. Recommendations boil

down to two principal factors: (a) those cultural elements that should be recognized and enhanced; and,

(b) those cultural elements which must be overcome in order to foster an ongoing atmosphere of

excellence to deliver first class patient care and to manage hospital operations. Thus, from this

comprehensively informed platform subsequent culture change recommendations and urgently needed

follow-on implementation actions tend to be broadly supported, successful and sustainable.

Conclusions: This work was in part intended to build upon the Quality and Compliance External Review

Reporttaking awareness many levels deeper to clearly get at thorny problems, catalyze a path to lasting

solutions, and, build upon positive developments already underway. Such progress to-date includes: a

potent transition to treatment malls with a recovery model, hiring proven new leadership and qualified

staff at all levels, sweeping facility upgrades that promote safety and patient care, and scores of ongoing

improvement projects such as the Behavioral Health Integration Project (BHIP) all aimed at top

performance, securing beneficial changes, and, helping the cultural transformation endure.

That said, at a summary-level there remain many concerns that hamstring operations today. Throughout

the hospital there is pervasively:

A general lack of accountability No shared vision for the future or what

good looks like

A lack of trust and fear of retribution forones actions

Ambiguity with respect to roles andresponsibilities

Inconsistent adherence to applicablepolicies and procedures

Gaps in robust policies, procedures andtraining

Weak and / or unpredictable internalcommunication protocols with many

conflicting agendas

Little understanding of why to measurethings, what to measure, how to make it

a routine part of the work and how to go

about establishing meaningful metrics at

the workgroup level

While the hospitals cultural challenges to-date have been serious and have gone on a long time, with a

clear understanding about the problems, and, a thoughtful, resourced and fact-based plan to improve

upon them, none of these problems are infinite, insurmountable nor irreversible. With an investment in


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the progress initiatives noted above, developing employees and leadership, a commitment to

continuous improvement, and, reconfiguring the way daily work is performed so that measurable

engagement, involvement and communications are the only outcome possible, theres in fact little

doubt that a lasting cultural improvement is just upon the horizon.

B. Background and PurposeOrganizational culture is best described as the collective personality of an organization. Its a complex

tapestry woven from the underlying assumptions, attitudes, values, beliefs, shared memories and

customs of the workforce. Some of its elements are readily visible while some may be so tightly

interleaved that they are both difficult to both see and differentiate. Its upon these learned and shared

assumptions that individuals base their daily behaviors that become habitual, patterned and integrated

into work performance and service delivery.

The ongoing transition to recovery-focused treatment programs affects every aspect of OSHs daily

work. OSH recognizes that such a significant transformation from the past approach to patient care must

align not only systems and processes, but also the underlying organizational culture in order to become

a first class state psychiatric hospital. Kaufman Global believes the three core elements that sustain such

a beneficial cultural shift are:

I. Leadership commitment with visible, measurable supportII. A shared vision, mission and values

III. Staff involvement and ownership at all levelsThis cultural analysis was conducted in order to determine which factors and forces currently at work

are most apt to oppose these core elements. Its upon this basis that ensuing recommendations for a

culture change strategy are made.

C. Situational AssessmentIntroduction to Tools and Techniques: Theres no single perfect tool for measuring cultural norms in anorganization as large and diverse as OSH. Yet, a suite of culture and climate tools in their composite yield

an effective organizational profile upon which decisions can be made and actions catalyzed.

Within that tool box private focus interviews can provide a safe environment for honest and candid

feedback. Yet, they are labor intensive and time consuming thereby limiting the amount of interviews

and feedback available. But, in the end they offer rich, narrative context and information as well as data

so must be performed in some way.

When reaching out to a larger and diverse audience such as OSH stakeholders, other analysis methods

are often employed. For example, online and written surveys allow for rapid data collection and

characterizations. Yet, for best results these must pose the right questions in the right ways, i.e. with akeen awareness of the history, language and cultural nuances that influence an entire organization. Even

with those consideration addressed, it isnt always possible or practical to get to everyone, everywhere

this way. As well, survey-fatigue sometimes sets in where participants suspect or have experienced a

lack of results and follow-through with prior discovery efforts. Worse yet, they may anticipate

retribution concerning their views. This can check-out of the process and must be managed.


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Finally, its natural for many mem

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Figure 2 - OSHs Cultural

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creating the architecture

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and sustainable cultural

change, all part of

becoming a first class state

psychiatric facility.

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norms in play at OSH. Those we

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ately 25% of the workforce completed the OAES

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involvement, peer cohesion, supervisor support, worker autonomy, task orientation levels, work

pressure, task clarity, worker control, factors that foster innovation, and, overall organizational change

readiness. Figure 3 - OSH OAES Analysis on the following page displays the summary results of those

surveys. The areas in green are favorable. The areas in white indicate some concerns. The pink areas

indicate greater concerns. The areas in red are undesirable. There seems to be relative alignment

between the largest groups sampled: Administration, Clinical, Nursing and Support Services. Groups that

didnt participate in significant numbers were combined with the closest match for their identified

group.

0

1020

30

40

50

60

70

80

NV PC SS AU TO WP CL CT NN CR

PercentileRank

Scale

Oregon State HospitalOAES - All Groups

Administration Clinical Nursing Support Services

Figure 3 - OSH OAES Analysis. Table 1 - OAES Interpretation, below, describes the general rules to apply

in reading the portrayed graphic.

Table 1 - OAES Interpretation

Factor DiscussionInvolvement (NV) High scores are better

Peer Cohesion (PC) High scores are better

Supervisor Support (SS) High scores are better

Autonomy (AU) High scores are better if TO and CL are at least average

Task Orientation (TO) High scores are better

Work Pressure (WP)Moderate level of 35

thto 60

thpercentile rank is desirable. If

WP score is high, usually the CL and TO scores are low

Clarity (CL) High scores are better

Control (CT)Moderate level of 35

thto 60

thpercentile rank is healthy.

Over 60th

percentile shows too much management control.

Innovation (NN) High scores are better

Change Readiness (CR) High scores are better

Further OAES Analysis: Generally, if most scores are low (as these are), employees believe they have

very little structure, unclear roles, little support from management and their peers, and, little


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acceptance to change due to unstable work environment. The OAES findings all support the overall

cultural assessment cited later in this document.

Relationships between scores are also important. The low results in every dimension, except for Work

Pressure (WP) should be cause for concern. Very low scores on Involvement (NV), Autonomy (AU), Task

Orientation (TO), Clarity (CL), Innovation (NV) and Change Readiness (CR), coupled with low scores on

Peer Cohesion (PC) and Staff Support (SS), indicate a group that feels generally disconnected, dispirited

and, in some areas more than others, beset with hopelessness. Such indicators are often displayed by

groups whose major accomplishments are a tribute to individual perseverance and work ethic.

Task Orientation is in the poor range for OSH. This generally indicates that employees struggle to

complete work done amidst some level of day-to-day chaos. It wouldnt be surprising to find that many

employees spend considerable time responding to emergencies and problems rather than addressing

critical long-term issues.

Low Task Orientation and Low Clarity can cause Work Pressure to be high. Currently, Work Pressure is in

the good range but very close to being too high. Without higher Clarity and Task Orientation, there

needs to be a great deal of structure, lots of rules and enforced procedures to ensure that work gets

done. In other words, in such cases rules and enforced procedures can actually assure that work getsdone. As is shown later in this document, other data suggests that separate power centers, aside from

the top leadership may be enforcing their own priorities. This causes a great deal of the workforces

talent and effort to be poorly utilized, unfocused or squandered. The most prevalent causes of low

perceived Task Orientation and the percentages of employees sharing that perception in each

represented group are displayed below in Table 2 - Sources of Low Perceived Task Orientation.

Table 2 - Sources of Low Perceived Task Orientation

Reason % Admin % Clinical % Nursing% Support

Services

Wasted time due to inefficiencies 87% 80% 78% 72%

Inefficient, low effort workplace 73% 89% 79% 72%

The most prevalent causes of perceived low Clarity and the percentages of employees who feel Clarity is

low are displayed below in Table 3 - Sources of Low Perceived Clarity.

Table 3 - Sources of Low Perceived Clarity

Reason % Admin % Clinical % Nursing% Support

Services

Things are disorganized 67% 86% 89% 81%

Rules and policies are constantly changing 80% 66% 80% 62%

Another scale to be concerned about is the Administration groups perception of Control. The low scoreindicates little structure to keep them on track. Coupled with the low Task Orientation, there is apt to be

a good degree of emotional detachment.

Every group scored low on Change Readiness. This is customarily an indicator of high resistance to

change and / or uncertainty. Results from the Online Survey and the Focus Interviews reveal that most

are ready for change. Yet, they feel stifled by their immediate or second level supervision from doing so.

Despite the willingness to change, theres also a level of apprehension due to the lack of stability.


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There should be some concern, particularly where the scores are lowest, that the four major group

profiles are not completely aligned. Some difference can be attributable to survey error or other factors.

However, it can also indicate four different organizations having disjointed perceptions about workplace

realities, and, more importantly, what should be done about them. This tends to suggest that a shared

vision with a common set of goals and standard processes have not penetrated through these groups. In

the absence of these essentials, factions within the organization have adopted their own unofficial sets

of priorities.

Clearly these issues must be addressed in order to compel a positive cultural change throughout OSH.

Later in this document, the results of the following cultural measurement instruments suggest further

recommendations and prescribed methodologies to move forward.

3. Focus Interviews: The richest source of in-depth cultural information was the collection of Focus

interviews. They were conducted with a total of 51 people, both staff and patients, representing several

disciplines and wards throughout both the Salem and Portland campuses. Newer employees, with less

than 6 months seniority, and, more senior employees with 30 years of experience were included. The

average length of seniority was 9.1 years. The interviews averaged 90 minutes in length. Held behind

closed doors, they were completely confidential and intended to identify organizational concerns and

barriers to effective implementation across several portions of the organization. Combined with theother methods of data collection, these were used to develop and refine responsive strategies,

interventions, countermeasures and communications.

A total of seventeen questions were designed to learn more about the existing culture and better

understand and validate the Quality and Compliance External Review Reportprepared in 2010. A card

sorting exercise was performed to help prioritize improvement categories. Cards containing issues that

normally influence Management and Staff interaction and similar issues that concern Patients were

sorted by respondents.

Management and Staff Issues raised were:

Training Communication Vision and Strategy Leadership Involvement Teamwork and Cooperation Accountability Organizational Structure Employee Recognition (Program) Defined Roles and Responsibilities Management Support

Patient Issues raised included:

Training Communication Safety Rules for Privileges Staffing Levels Planning and Scheduling Input to Treatment Plans Grievance Process

Note: a) Bold text = similar concerns.

Tabular results of the Management and Staff card sorting exercise follow in Figure 4 - Card Sort

Prioritization by Management / Staff. Similarly, tabular results of the Patient card sorting exercise

follow in Figure 5 - Card Sort Prioritization by Patients.


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Figure 4 - Card Sort Prioritization by Management / Staff

Figure 5 - Card Sort Prioritization by Patients

Weighted averages were developed based upon priorities to get a general sense of the issues most

preventing OSH from becoming a first class state psychiatric institution. The key issues identified were:

Priority #1 Priority #2 Priority #3 WT. Avg.

Lack of Vision / Strategy 41.38 % 3.85 % 7.14 % 52.37 %

Lack of Accountability 20.69 % 15.38 % 10.71 % 46.79 %

Poor Communication 13.79 % 15.38 % 3.57 % 32.75 %

Lack of Training 0.00 % 15.38 % 17.86 % 33.24 %

Coupled with the results of the OAES, a pattern of needs began to emerge. Yet, perhaps more telling

than these figures are the following transcripts of the specific responses by those interviewed. These

touch upon critical areas of concern as identified in meetings with the senior management and are in no

particular order. These comments and findings offer opportunities to make valuable and needed

changes to OSH culture.


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The good news is that many of th

changes in a positive light provide

members are looking for employm

time it has taken to get this far, or

impediments to positive change ex

Lack ofthese seven

characteristics in the

OSH workplace

significantly constrains

potential for consistent

top service delivery and

performance results.

Figure 6 - Focus Interview Disc

predominant obstacles to overcom

to snap the fingers and create t

communications become early wi

good news about all of these

countermeasures to resolve them

Lack of Accountability represents

identified in the Quality and Comp

show a lack of accountability a

management reviews with staff to

32% of staff has had a performa

employee, who has worked for the

evaluations. Another staff member

Along with lack of defined roles aenabler for problematic employee

enforce them if they are not clea

employee put it, [there is] far too

dont follow them. Another staff

doing things.

staff and management seem ready and willing t

the key findings are addressed. The bad news i

ent elsewhere because they have become upset

a perceived lack of willingness to tackle change.

pressed by the interviewees.

ssion Detail. Participants said that these char

e when crafting a cultural strategy moving forward.

ust, others such as role definition, training and

s in a new path forward as the deeper problem

categories is that there are finite problems

nd all have been solved in other workplace environ

I.Lacone of the greatest opportunities for improve

liance External Review Report, there are a variety

all levels. These range from a lack of consis

ignored policies and procedures. According to the

nce evaluation often or very often with thei

hospital for over 25 years, reported having had onl

has had only had two in nine years.

nd responsibilities, another key finding, lack of as. Where work standards exist, its very difficult

ly identified and performance is not measured p

much inconsistency; there are people who dont kn

member stated that, there are 22 wards and 22

I. Accountability

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Although patient and employee safety can be put at risk, lack of accountability appears to happen at all

levels of the organization, including at the patient level. When patients act out or cause injury, theres

often no retribution or accountability. This creates staff resentment, and possibly, harsher future

treatment. Conversely, some wards, such as 50E, clearly explain patient expectations and the reward

levels that are possible if good behavior is exercised.

Staff members referenced a lack of accountability at the top, reportedly sending requests to

Administration but never hearing back from them on a potentially dangerous situation. Staff feels that

they are: rarely asked for input and that Administration doesnt come to their unit and is not clinically

in touch. Rounding by the Superintendent seems to be helping, although more engagement by

Administration is whats truly missing, not just showing up on ward but actually getting involved in

patient care.

Interestingly enough in this slurry of observations, frontline staff consistently expressed that they seek

to be held accountable and expect it of their colleagues, as well. They noted that people typically do a

sub-par job when they are not held accountable. It has been said that, often the media and

newspapers are there to hold us accountable. A patient felt that line staff needs to treat patients

consistently, [yet] there can be different treatment depending on the staff member. Its difficult being

spoken down to. One staff member made it very clear in saying, I used to work in a restaurant and washeld more accountable as a waitress.

II. Lack of Shared Vision and Strategy

Most respondents were not familiar with the Mission, Vision and Values for the hospital. It was

identified by over 41% of focus interview respondents as the number one priority to achieving

significant performance improvement. Clearly, the majority of staff is interested in seeing a positive

change at OSH and desire success for the new Superintendent. However, in the absence of a clearly

articulated strategy, most are confused about how they can help. Data from the OAES showed 62% of

clinical staff and 65% of nursing staffare often confused about exactly what they are supposed to do.

There are several different approaches that can lead to deployment of a much needed strategicobjectives and measurable goals. Just as leadership involvement is a big part of creating an engaged

workforce and developing trust, listening and involving your staff in goal creation is an important path to

ownership and commitment. Staff commented that they liked that the Administration was crossing the

road to get more involved in patient care. In fact, one idea that a staff member proposed (which

Kaufman Global has actually implemented with other clients) is a Bring Your Manager to Work Day.

Rounding, practiced by the Superintendent, is having routine upper level management presence on the

wards. Staff says its essential. Staff would like other leadership to feel their pain, as well, and

experience what they do every day on their wards. They referred to it as visibility of Cabinet members

on the wards, [with] more involvement in delivery of care . This may involve signing up for some actual

work hours on the ward, possibly a rotation. (Such leadership standard workis now common in almost

every enlightened workplace.) Staff believes it would help top management better understand why staff

is asking for change, Walk the talk, they say, Demonstrate the culture and beliefs that you are trying

to get the rest of the hospital to adopt.

Employees and patients need to know that there is a plan and how they can positively impact it. The

mission, vision and goals are needed badly according to one respondent. Most Staff feel its just as

important that top leadership identify the strategy with input from them. Goals and objectives must be

clearly communicated to all disciplines and at all levels. They feel in the absence of a shared vision and


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strategy that, every discipline creates their own vision. Its believed that some of the lack of

cooperation between disciplines partially results from staff not knowing what they are supposed to do,

and, how they can beneficially link their work together. This isnt because they dont want to, but rather,

no one has ever taught them. As one interviewee stated, Traditionally, our education teaches us to be

the best nurses we can be or the best psychiatrist we can be, not necessarily to be part of the best team

we can be.

A staff member commented that, The culture here at OSH has always been get ready, get set No

one ever says go. Again, a clear vision with actionable, measurable goals would compel this to change.

Without it there continues to be a lack of continuity. The message can change from meeting to meeting

depending on what the focus or agenda is for that particular meeting. A senior manager commented

that If I dont know at my level, I feel that others have no clue.

In order to know where youre going, there needs to be a meaningful strategy behind it. The recovery

model is a case in point. Most people could describe quite thoroughly the characteristics of the recovery

model and the expected outcomes of its successful implementation. Although the recovery model has

been identified by the Superintendent as the direction for OSH, theres still some apprehension on how

it fits into the existing culture of the units. Generally, clinical and medical staff had a much better

understanding of what patient centered care was designed to do, which is to give control of a patientstreatment to the patient themselves, whenever possible. Conversely, most support people, although

somewhat familiar with the term, had no clear understanding, allegedly having no formal training in the

recovery model since being employed at OSH. Some had received training as part of their formal

education.

Interviewees were asked if changes were successfully prioritized and implemented, what would the

chances be of implementing the recovery model of care from dont know or poor, all the way up

to good or even excellent. Seventy-nine percent of focus interview respondents felt that the hospital

had at least a good chance of implementing the recovery model. At the same time, one staff member

stated that theyve been in lots of meetings where people dont really even know what recovery

means.

Some respondents felt that there were conflicting messages in the amount of training on patient control

and the additional hiring of security staff versus the single day spent on recovery model training. Many

believe the hospital is currently a very prison-based system. There are still some wards that struggle to

implement this model due to both staff beliefs and the behaviors of some forensic patients. Some staff

come from a corrections background and have become accustomed to treating patients like prisoners,

so a major paradigm shift is needed. Building 50 seems to lead the way with some of these concerns.

Some programs are very goal oriented which makes implementing the recovery model much easier, as

in 35A for example, a transition ward. Their comments and recommendations touch on issues that will

greatly impact the success of the recovery mode at OSH. One staff member stated, Get rid of punitive

staff that is against the recovery model - telling patients that you are going to throw away their food

[and] sack., is not productive. Another stated, Several staff used to be corrections officers and they

need help to create mindset change. Punitive staff. It was also offered up, several times to, Increase

buy-in from MDs for recovery model, not all is on board. Provide additional training.

A shared vision would greatly benefit the Treatment Mall and Treatment Care Planning, as well. Theres

a wide range of implementation levels for treatment malls. Portland has had the treatment malls in

place for almost four years and they are working pretty effectively, although, content based on


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effectively addressed by the new Superintendent. It has been said that, People at the bottom want

change but they cant make it happen. Many respondents felt that hospital politics are the most

horrific. They see people being promoted outside of their skill base. Both lack of trust and fear of

retribution must be addressed now so that true culture change can begin.

Patient Grievance and Patient Care are extremely important to patients and consumer groups. With the

exception of the PSRB, its near the top of their list for improvement. During the card sort exercise, it

received the most first place votes as a priority for significant performance improvement at the hospital.

It was stated that when the patient grievance process isnt used on a ward it can lead to aggression and

acting out by a patient. Unfortunately, wards do not appear to promote the patient grievance process.

One indicator as to whether grievance procedures are used is to simply ask a patient where the forms

are when visiting a ward. Although some staff members dont seem to believe in allowing the patient to

have access to the grievance procedure, patients and patient consumer groups disagree. They feel that

grievances are a patient right and possibly might be a mechanism to keep them alive. Many staff

members arent against patient grievances as a voice for airing their concerns. However, the unwritten

law on the ward often dictates that the staff acts uniformly, even where it opposes patient concerns.

Patients acknowledge there are many wonderful staff members who are compassionate and interested

in patient recovery. Unfortunately, clinical-to-patient ratios are much too high to be fully effective,leading to burn out of social workers. The feeling today among several staff members is that, with

more social workers and lower case loads, there would be fewer emergencies and less crisis

management, especially if case loads could drop to a more reasonable 1:20 from the current 1:46.

Sound vision, strategy deployment, and disciplinary functions must be aligned to prevent current

functional silos. One respondent was quoted as saying, doctors, not being part of a group, pull rank

[they feel they] can change whatever I want. They dont trust lower job functions. (Note: Decision

making models, similar to those taught by Kaufman Global at the DHS Leadership Academy are targeted

at these types of attitudes and skill deficits.)

IV.

Lack of Defined Roles and Responsibilities

Most focus interview respondents recognized that there have been a variety of role changes over the

past several years, significantly impacting everyones job function. Only forty-six percent of online

survey respondents stated that their roles and responsibilities were very clear. This means that over

half of those completing the survey didnt have a strong understanding of what they were supposed to

be doing. Focus interviewees recognized defined roles and responsibilitiesas the third most important

management issue to address during the card sort exercise.

Some respondents mentioned that their Managers did meet weekly with teams, typically about

problems, successes and whats going on. Kaufman Global has advocated in previous DHS /OHA

development that daily shift startup meetings, called Huddles, are imperative to improve processes.

Such frequent, open and honest communication is needed to foster accountability. As one employee putit, The hospital needs to get back to basics with common sense do your job or expect consequences if

you arent willing to do your job.

To be a well respected mental health care provider, defined roles and responsibilities must be

established immediately, or de-facto substitutes shall continue to rule. Staff noted that constantly

varying roles and responsibilities result in a lot of judgment calls. Some managers are very clear in their

roles and responsibilities, and, are trying to put action plans in place to bring their teams up to speed on


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same. Many are lacking the training to clearly understand their roles. No one ever told me is a catch all

excuse for staff not doing their jobs. There are no written job descriptions for many positions, adding

to loose job responsibility interpretations. Roles and responsibilities need to be in writing and we need

to be able to measure job performance.

V. Poor Communication

Staff members receive their information from a variety of sources. Some are more effective than others

and include:

Email Meetings Hospital Newsletter Recovery Times Ward Newsletters Local Newspaper Word of Mouth

As in most large institutions, communication is a major concern. Email is the predominant avenue for

communicating and its fairly ineffective principally since so many people say they have no time to get

their email. Respondents feel that, (real) communication never makes it back down from

Administration level continuing that there needs to be some structure, more accountability and more

transparency with information transfer. An example cited in more than one channel during the cultural

assessment is the apparent communication breakdown with the treatment malls. Often, what happens

with a patient on the mall doesnt get communicated back to the patients ward. As a result, ward staff

isnt familiar with the patients progress. It was a concern of several staff members that, we need to

figure out how to communicate back to the wards what happened that day. Ward staff members really

dont know what patients have learned, or, if they are struggling and need to be retrieved. The reality of

this communication process and disconnect would be exacerbated by virtually any of the previously

cited cultural norms in play.

For the recovery model to be successful, communication has to be improved -- with the patients familyas well. Information isnt reliably being relayed to the Communication Center in building 35 which can

limit the information thats supposed to be given to family members. Often, a family member has

granted permission by the patient to receive certain information but Security doesnt always share it

with them. A big part of patient directed planning is improved communication with family. There must

be more family oriented education because we all need a support system. An example of how poor

communication affects the patients is when Security states that no one gets to take a walk, when clearly

some patients are allowed as part of their risk review and privilege level. When it comes to medical

information, Security may ask who am I allowed to give information to?When they dont know, they

dont provide, even if patients want to give family access to information.

Staff relies heavily on electronic media to get a message out to the masses due to its ease and simplicity.Although there are currently few other such timely distribution avenues, theres some information that

could be distributed better. Many people prefer face-to-face communication from the source so they

can ask questions if necessary. Minutes from a meeting or even material posted on area bulletin boards

also may be appropriate. All levels expressed seeking a clear and concise message from their superiors.

Ideally, information needs to be more transparent and we need to share information more clearly.

Both staff and patients commented dont know what rules I am breaking need to make rules more

visible.


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Kaufman Global 15

Its imperative that the ward staff communicate clear and concise expectations for each patient in each

ward. Patients feel that its sometimes hard to get in touch with their Interdisciplinary Treatment team

(IDT) and would like to have more clarification from the Psychiatric Security Review Board (PSRB). When

talking with some of the Consumer Groups they feel that the PSRB gives totally inaccurate

information.

In Portland, staff mentioned that there was a communication gap when it comes to their current

campus and whether it was going to remain open for much longer. A new facility in Junction City is

scheduled to be built by 2015 so that the Portland campus can transition out of their current campus.

There hasnt been any update. Staff feels that in the absence of information that its not going to

happen. When these types of communication gaps exist, theyre sometimes filled with rumors, or

misinformation. Much of the communication that patients and staff members receive about the hospital

is reportedly received from state and local newspapers.

VI. Lack of Training

The OAES Survey, Functional Mapping exercise and the Online Surveys also identified interest from both

staff and patient to improve knowledge and skills training. With several new employees, some having

little to no mental health awareness training, its imperative that more skills based, hands-on training be

provided. Many Managers became managers through internal promotion for performance in theirprevious positions at the hospital. The hospital hasnt been as diligent to provide the necessary training

for some of the new Managers in order that they might be effective and succeed in their new roles.

Twenty-seven percent of Managers interviewed stated that training for Managers in hospital is really

lacking.

Conversely, there are some competent Managers who are very well respected by their direct reports.

When asking the various respondents what made their Managers so effective, there were common

themes. They were involved in patient care and assisting staff, and, they were good communicators,

clear in their expectations and vision for the ward. Under their leadership, respondents felt that their

voice was being heard. However, its clear from some of the other data that theres an opportunity to

provide more mentoring and modeling of desired behaviors. Kaufman Global believes such training is anecessary investment in a much valued group at OSH, the caregiver staff. There has been some effective

knowledge based training provided for hospital staff by EDD, but normally, due to coverage issues

colleagues are unable to take the training together. This leads to staff members returning to their work

area with some new found beliefs and techniques to utilize, but without any acceptance from their

peers.

Training is generally offered during only day shift. This causes issues with staff members on both swing

and night shifts who would like to have access. They tend to opt out in order to neither lose pay nor

work two shifts in order to fit in training. Moreover, reportedly not all disciplines are provided the same

access to training due to availability. For example, Treatment Planning Specialists get good training while

Nurses are sometimes left out of the loop according to some respondents.

DHS staff has participated in the Leadership Academy training for leaders and managers with excellent

feedback and results. It is recommended that key OSH staff participate in similar training together with

the new Superintendent in order to help them align their beliefs and to create some unity across

disciplines.


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VII. Lack of Human Resources Emphasis

The hospital doesnt have its own human resources management office. Instead, DHS / OHA Human

Resources (HR) support is located on site. There seems to be a disconnect between what OSH Managers

expect in the way of HR support and that for which Human Resources actually feels responsible. This

topic resulted in substantial commentary, particularly among OSH Managers. One manager noted, HR

is a barrier, not a help. Im not abdicating my responsibility to train and supervise, but, HR isnt helping to

get rid of bad apples, not taking a stand. Traditionally, HR has monitored the performance

management process and helps to document poor performance. Several Managers cited incidents

where they had done everything that they were supposed to do to profile poor performance; still, the

underperforming employee was never dismissed. They feel that when poor performers are allowed to

stay in their jobs it undermines accountability.

Relationships with the Unions surfaced while discussing problem employees. Many managers feel that

the relationship between them and the Union is adversarial and they feel that every effort is made to

avoid any arbitration. Managers feel that the hospital needs to gain HR support to disposition staff

that exercise abusive behaviors. They want HR to be more integrated and functional. Perhaps contesting

the findings of the Quality and Compliance External Review Report, they say that they in fact do want to

manage their people. The feeling is that its not always easy to get information from HR. When

information is provided, its sometimes not provided in a timely manner. The comment, can be waitingfor months, was thought to be because decision making seems tied to a single delegated HR person.

Such slow decision making seems to promote stress, poor morale and sense of frustration.

3. Functional Mapping - Often, its very difficult for large numbers of employees and stakeholders to

express their concerns and attitudes about an organization in a focused, yet global, fashion without

having a roadmap to follow. Many lack an accurate view of the complexities of an organization outside

of their immediate work area. Others arent accustomed be being asked for their input. Similarly, some

find it difficult to offer constructive criticism several layers away without a sense of the limitations

others also face in doing their own work. For these reasons, Functional Mapping work was performed

with more than 450 stakeholders at more than two dozen sessions and in three locations; two in Salem

and one in Portland.

The response to the Functional Mapping exercises was overwhelming in its popularity, energy levels,

and engaged participation (Figure 7). Most appeared thoughtful and passionate about it, sharing similar

concerns regardless of work area or experience level. While Functional Mapping was conceived as an

inclusive and open process, some participants expressed concerns about workers and supervision being

up at the wall at the same time. Inability to effectively suppress that anonymity concern issue no

doubt accounts for as many as 10% of the contributors returning later to add information at some

locations. Finally, sessions with the Cabinet and Physicians were conducted primarily to identify

differences in perspective between line staff and more senior levels.


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Figure 8: Comments by Workforce

Figure 9: Comments by Cabinet

People and Training and Patient Services are the top two priorities, on both of the charts, by sheer

percentage of inputs. People and Training had high concentrations of the seventeen comment areas, in

the Human Resources group, relating to:

Accountabilities and Responsibilities Disciplinary Actions Performance Management Employee Communications

050

100150200250300

350400450500

Total Comments Per Function Group

Workforce

05

10

15202530354045

Total Comments Per Function Group

CABINET


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As evidenced below, in Figure 10 -

Map, there were high concentra

Obviously, thats an area of concer

Figure 10 - Snapshot of

The inputs were then preserved an

the dots were counted and display

11 - Seven Comments with Many

drew the next most inputs with Fo

Patient Interactions.

Figure 11 - Seve

The first big gap between senior

Services Nursing and Professio

and opportunities on the nursing s

in accountability and defined polic

Snapshot of Accountability and Responsibility

tions of comments in all areas on Education

.

Accountability and Responsibility on Salem Funct

d gathered electronically. Where numerous like co

ed along with the comments as shown below in th

People Reinforcing Them. In this particular figur

rensics Psychiatric Services opportunities and spec

n Comments with Many People Reinforcing Them

leadership and workforce views was surfaced

nal Services Clinical. Line and staff reported ma

ide. The workforce viewed Professional Services

ies and procedures. The Cabinet saw the largest

19

n Salem Function

nd Development.

ion Map

mments occurred,

e example, Figure

, Patient Services

ifically with Staff /

ith Professional

ny more problems

Nursing as lacking

eed in Nursing as


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Kaufman Global 20

more standardized work processes. Arguably, these can be two sides of the same coin depending upon

perspectives and proximity to the daily challenges, yet, they also provide clarity for some of the

comments received during the Focus Interviews.

Among the other areas of major concern with the leadership were the Health Information Group

(HIG), Operations, and Profession Services Nursing. Predominant comments from the workforce

showed a lack of understanding of the output produced by HIG. Most comments indicted that people

didnt know how the data was obtained and it provided no value to them. This doesnt mean the HIG

data is non-value added, but, it probably shows a lack of communication and partnership in obtaining

and analyzing the data.

In Operations, there was a lot of workforce energy and commentary focused at Food Services. Its

believed this is due to the workforce being at the source (patients) to hear the comments about quality,

type and amount of food served. Operations were at the bottom of the Pareto for the Cabinet. This

would hint at upper management not having the pulse of Operations.

Based on content, each comment was identified as being most symptomatic of one of the seventeen

major types listed below. These categories are no doubt to be pursued during this task's deliverable 1c,

technical support, in order to help implement the necessary OSH cultural changes. They also areprovided to the Cabinet to deploy for action throughout their organizations and for their own engaged

follow-up.

The type classifications and predominantly expressed key points are listed below:

1. Accountabilitya. Tasks not being completedb. Wasteful practicesc. Roles and responsibilities not being followedd. Corrective actions for employees consistently late or missing, do not follow hospital policies

2. Administrationa. Unclear administrative business practicesb. Requesting clothing allowance, meal subsidy, etc.c. Change in work hours, days off, etc.

3. Behaviors and Culturea. Derogatory remarks about another groupb. Old practices which cant be changedc. Perception of hospitald. References such as this isnt our problem

4. Communicationsa. Not knowing OSH vision and directionb. Ineffective verbal, written, or electronic communicationc. Not knowing current status of OSH changesd. Failed submitted ideas and missing follow-up


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5. Facilitiesa. Size of rooms, people per room, etc.b. Need for equipment, furniture, etc.c. Maintenance of propertyd. Property, buildings or equipment being unsafe

6. Organization / Structurea. Anything concerning adding or deleting positionsb. Combining groups or moving groups to another part of the organizationc. Need for certain groups, such as committees, cabinet members or functional groupsd. Reporting structure and chain of command

7. Patient Carea. Quality of life for patientb. Neglect or abuse of patientc. Monitoring patient improvementsd. Needs: medical, psychological, treatment mall, dietary, etc.

8. Planning and Strategya. Comments on wanting to be involved in planningb. Not knowing what the future (usually 5 years) looks likec. Questions on how Planning and Strategy take place

9. Policies, Procedures, and Documentationa. Not knowing what the policies or procedures areb. Need for updating policies and proceduresc. Not having the correct documentationd.

Questioning the need for certain documentation

e. Use of documentation (i.e., required by law, used for improvements or fixes, or, it isnt used)10.Process / Standard Work

a. Questioning if there is a process for a certain functionb. Requesting processes to be developedc. Call for consistency in performing processesd. References to standardization being necessary on certain functions

11.Qualitya. Quality of deliverable on any functionb. Patient carec. Quality of what is offered to the patient in treatment mallsd. Daily patient hygiene, diet, room and building cleanliness, etc.)e. Care of the employee (right equipment, safe environment, acceptable work environment, etc.)


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12.Roles / Responsibilitiesa. Not knowing what a persons duties / tasks areb. Tasks not being done because it was unclear who should do itc. New hires having to learn their job by tribal knowledged. Claims that someone else should have done a task

13.Salary and Payrolla. Complaints about pay structureb. References that one person gets paid more than anotherc. Problems with getting paid (no comments were found on this)d. Mandated OT may be here depending on context of comment. Most mandated OT comments

were placed in Accountability or Planning depending on the reason for the OT.

14.Security / Safetya. Security concerning building access, badges, helping to secure a patient, transportation, etc.b. All references to physical threats or actions to employeesc. All references to unsafe conditions due to building maintenance problems, broken or wore out

equipment, night lighting in parking lots, contact by patients (physical, verbal, or email

messages), lack of help to defend against patient aggression

15.Skills and Traininga. Amount of training (lack of or too much)b. Quality of trainingc. Needing a specific skill or trainingd. Training delivery (classroom, web-based, self-paced, etc.)e. Skill sets or training needed by patients to prepare them outside of OSH

16.Support (Agency, Community, etc.)a. Individuals or groups outside of OSH who help patientsb. Involving the patients in community based programsc. Family members being involved in the treatment plan of the patient

17.Technology / ITa. New technology to streamline or improve hospital practicesb. Software applications for different functionsc. Needing computers, printers, copiers, etc.

At the conclusion of the Kaufman Global analysis of the Functional Mapping exercises, the trends of the

previous analyses were both reinforced and made increasingly clear. As was expected there were somedifferences in perception between where workers had experienced severe issues and where senior

leadership saw areas for improvement. This is apparent below inFigure 12 - Comments by Workforce,

and Figure 13 - Comments by Cabinet, respectively. Kaufman Global believes that most of these

differences are attributable to readily solvable problems with communications.

Disturbingly, and as validation of some other findings, some participants in the mapping exercises

expressed a fear of stating their true opinion with supervisors in the room. More than half of those


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expressing this fear returned at a later time to post their concerns. This indicator of the level of fear

among subordinates indicates a destructive cultural norm beyond whats normally encountered by

Kaufman Global. It may also be a further indicator of a lingering fear of retribution, and sub-optimization

that have resulted from a past, prolonged environment of blame as cited in the focus interviews and in

interviews on the wards.

Also in what appears to be a related set of events, Kaufman Global experienced efforts by some

functional areas to avoid on-site interviews, attempts to control the dialogue, or both. These simply may

have been attempts to avoid additional painful scrutiny, or, may reinforce a belief in the cultural findings

cited later in this document.

Figure 12 - Comments by Workforce

0

50

100

150

200

250

300

350

Total Comments Per Classification

Workforce


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Kaufman Global 24

Figure 13 Comments by Cabinet

Interestingly, among the first eight priorities cited by comment type and not functional area, Workforceand Cabinet share the same concerns with only minor changes in their ranking position. Table 4 -

Differences in Frequency of Comments by Category, Workforce vs. Cabinet (below) shows a side-by-

side comparison of the categories and their ranking with minor out-of-sequence ranking highlighted.

Table 4 - Differences in Frequency of Comments by Category, Workforce vs. Cabinet

Workforce Ranking Classification Cabinet Ranking

1 Policies, Procedures, and Documentation 1

2 Accountability 2

3 Skills and Training 5

4 Behaviors and Culture 4

5 Communications 36 Organization / Structure 6

7 Roles / Responsibilities 7

8 Processes / Standard Work 8

0

5

10

15

20

25

30

35

40

45

50

Total Comments Per Classification

CABINET


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Kaufman Global 25

4. Online Surveys Two on-line surveys were posted, one for the workforce and one for the Cabinet.

The survey questions were identical, but less demographic information was solicited from a small intact

cabinet organization. 648 people completed the workforce survey and 13 Cabinet member surveys were

completed. They were electronically tabulated with results and demographics for respondents.

The online survey questions and responses are depicted below in Figure 14 - How much knowledge do

you have about the OSH Excellence Project, and the changes being made? , and, Figure 15 - Your

defined roles and responsibilities are . . .

These are two more examples of differences between workforce and senior leadership perspectives.

Again, solvable communications issues and ensuring a keenly understood sense of roles and

responsibilities is suggested for future implementation actions.

Figure 14 - How much knowledge do you have about the OSH Excellence Project, and the changes

being made?

Figure 15 - Your defined roles and responsibilities are . . . .

0%

10%

20%

30%

40%

50%

60%

None Very Little Fair

Amount

Quite a

bit

A lot Don't

Know

Workforce

Cabinet

0%

10%

20%

30%

40%

50%

60%

70%

80%

Workforce

Cabinet


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Kaufman Global 26

Just as the OAES survey indicated that Clarity was lower at OSH than any other factor, the Online

Survey provides us another indicator of a situation validating that employees arent sure of their roles

and responsibilities. The Cabinet seems to feel they are aware of their roles and responsibilities much

better, but, still arent completely clear. As they should have the greatest access to information,

initiatives and direction, this speaks to a decided opportunity to formalize and effectively communicate

an organizational strategy. That would surely be the first step in eradicating misunderstood policies and

procedures as well as a decided organizational dependence upon unofficial (and sometimes inaccurate)

lines of communication.

The last question of the online survey gave each participant a chance to make comments and be

completely candid. The surveys had no names or I.D. numbers assigned to them, so, the information was

strictly confidential. This helped ensure a sense of complete candor. 248 unsolicited remarks were

posted by the workforce. Many of them indicated dissatisfaction with the current culture and reinforced

the findings cited later in this document. The general tone and content of these were briefed to

leadership. With fully 38% of the surveys having such comments with a similar or common theme, the

issues of accountability, standard work, roles and responsibilities, communication, and training once

again came to the foreground. As demographic information didnt appear on these comments, thereby

protecting the respondents, its believed that these comments were sincerely offered and perceived tobe true.

5. Workplace Interviews As the hospital was quite open regarding access to the work areas, wards and

offices, we were able to capitalize on any time available to learn and refine recommendations sourced

though other channels. While theres not a huge summary to be made concerning this method, it in fact

created opportunities to gather less structured opinion in an ad hoc fashion during the course of the

work. Moreover, it offered another important aspect of stakeholder involvement, particularly with

patients. It served to facilitate follow-up discussion where more topical clarity was needed from other

discovery tools. This learning has been incorporated in other sections of this document. Lastly and

importantly, it offered a chance to communicate about a brighter future with so many. The power of

these interactions moving forward cannot be underestimated.

Current Cultural Norms: Each of these instruments were used individually and collectively to evaluate

gaps between where the organization sees itself performing today versus where it aspires to be, and to

identify differences in perception between the different stakeholder populations involved. On the

positive side, the great majority of the workforce is here because they want to make a difference, care

deeply for the welfare of the patients, and, are committed to the welfare of their community.

Repeatedly, these traits were demonstrated as the Kaufman Global consultants and analysts went about

the task of collecting cultural data. These traits bode well for OSH becoming a center of excellence in

care and patient progress. Unfortunately, as has been pointed out, there are significant concerns as

well. Those factors can be separated into seven major categories, most of which are related and

therefore have similar or common causes and solutions.

Kaufman Global believes that, during prolonged periods of crisis management and change, sub-

organizations, including all levels of leadership as well as the workforce, can and often do tend to revert

to an attitude of self-protectionism. That is, since everything is constantly in flux, each area tends to

expend most of its resources -- whether informational, material, or people energy -- to ensuring that

particular area does not fail and lay itself open to even more pain and suffering, even if the rest of the

organization might.


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Kaufman Global 27

This break in faith with the larger organization gives rise to separate agendas. Subsequently, the lines of

communication in practice, not necessarily the official communications channels, are sometimes used to

subvert whats required and what is not. Therefore, accountability, communications, shared

organizational values and vision, and, defined roles and responsibilities suffer. At OSH, other factors

such as a prolonged past history of tightly controlled employees and a recent deep and sometimes

painful spike through external scrutiny have led to an imbedded culture of blame and protectionism in a

few functional areas. In those areas, individual desire to improve often competes with the need for

professional self-preservation.

D. Cultural Changes to be InstilledDiscovery in this document supports the assumption that the following cultural factors and

characteristics must be addressed. Theyre what will most likely prevent OSH from becoming the mental

health excellence center it desires to be regardless of the quality of their facilities or level of resources.

Recapped, those cultural factors are:

1. A lack of accountability2. Lack of a shared organizational vision and strategy3. Lack of trust and fear of retribution4. Lack of defined roles and responsibilities5. Poor communication6. Lack of training7. Separate agendas at some levels and in some functional areas

Kaufman Global believes these are common ills for complex, diverse, highly visible organizations. Many

are inter-related. That means that improvements in one area may drive and yield improvements in

others. Yet, they deserve a comprehensive approach to ensure needed changes can take place. OSH is

fortunate to have a Superintendent and DHS / OHA top leadership team with the wisdom and resolve to

make the necessary changes. As it took a long time to get this way, it predictably wont change

tomorrow. It requires time, effort and support over a long-term. Yet important wins can launchimmediately in terms of setting the vision and communicating progress. A re-alignment of the leadership

team accountabilities is indicated, and, depending upon the willingness of key players to adapt to a

shared organizational vision rather than their personal agenda, mid and upper-level leadership changes

may be required. But, to do so without substantive improvements in other areas of concern would be

purely cosmetic.

People must be held accountable to the senior leaderships vision regardless of interim or opposing

loyalties. This isnt a blanket indictment of past leadership or factional solutions; they had their reasons

to make the choices they did. Rather, its a systematic set of steps that must include informing everyone

of what is expected of them and holding them accountable. Related to this issue is a lack of a shared

organizational vision and strategy which has several independently moving parts. All must be addressedas stated below. Poor communication need be addressed on many levels as must a lack of training.

Reversing issues around trust and fear of retribution requires action, evidence and above all the

leaderships continued interest and attention.

Finally, overcoming a lack of defined roles and responsibilities must occur on many fronts as well.

Clearly, every nuance of a job cannot be etched in stone without sacrificing the agility OSH needs in this

changing environment. At the same time, its hardly too much to ask to document accurate position

descriptions as an important part of the solution. Perhaps the HR issues raised are simply related to


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improved information being provided to the managers. Or, it may require a better, perhaps OSH-owned,

HR presence. That sorts out in the next steps. That is the power of a common shared vision.

E. Strategy for Bringing about Cultural ChangeIntroduction: As a result of these findings regarding as-is cultural norms, several next steps are

recommended, anticipated and planned as part of the strategy to transform both the hospital culture,and in turn, hospital performance so that it meets and exceeds first class state psychiatric facility

standards.

In order to meaningfully and sustainably influence that culture, the leadership vision must be one, its

objectives and measures clear, and, the continuum of care refined and stated. Effective steering and

governance for change must be put in place and sustained. They must set the vision, remove obstacles

and barriers to change, and, reinforce and communicate continually about the good things that are

happening and how to tackle challenges.

From that fundamental platform of leadership excellence, peoples roles and responsibilities can be

captured and documented, then, unambiguously stated and imposed. A system of both recognition and

consequences against that very performance standard is then legitimately installed for all stakeholders.

Communications becomes integral and important. Positive work reconfigurations can be implemented

and sustained. Teams themselves work to establish meaningful metrics. People begin to see their work

add up to a common good.

Early Wins and Essential Quick Hits

Cabinet and Continuous Improvement Governance Structure The key to so many of these changes is

a re-vitalization and re-alignment of the senior leadership and the continuous improvement governance

structure. To that end, Kaufman Global, in consultation with the senior leadership at OSH, has

recommended a new Cabinet structure and concepts surrounding its specific makeup to the

Superintendent. It includes a new position of Project Management Officer (PMO). The purpose of thePMO would be to have a certified Project Management Professional to ensure all projects stay on or

ahead of schedule, on or under budget, and, enjoy appropriate risk, stakeholder, and communications

planning.

Robust Communications Framework and Protocols to Displace Current Channels Kaufman Global is

slated to work with OSH to help expand and enhance the internal communications infrastructure. This

helps to fill the perceived void in information at OSH while reducing reliance upon third party and

unregulated sources. Doing so requires improving measurable communications accountability. Thats

likely best achieved by centralizing and endowing the Communications Office with oversight

responsibility for all corporate communications. With help from Kaufman Global, OSH can better

leverage local communications initiatives while both simplifying and amplifying the message regardingOSH Excellence with a strong identity. With an expanded, more functional communications

infrastructure alongside better sharing of critical functional information, OSH can celebrate successes

and progress the many good things that are changing.

Performance Feedback Several weeks ago at the prompting of Kaufman Global, a new performance

feedback system was initiated in OSH by HR personnel. In the majority of work centers, this change has

gone mostly unnoticed and has been poorly reacted to. This brings two additional factors to light that

must be addressed for accountability to improve. There must be a more robust system of official


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Kaufman Global

communications from the top do

desires is in conflict with the prior

accountable to the senior leader

organizational power centers that

must change direction or lose that

Setting the Course In order to se

2011 Strategy Development Rapid

forward from now as follows (Figur

Figure 16 Rapid Process Improve

steering / Cabinet to establish

performance. It meets the needs

work to-date and participant kno

going forward.

Building off of Task 2, Objectives

change and engage the right p

improvements. Were thrilled to b

together needed facts, the right t

OSH Improvement Strategy. While

wn that transcends those areas where what the

ities of middle managers. The layers of managem

ship in ways that they havent experienced for

are opposing the changes that the Superintende

power.

cure top leadership engagement and involvement,

Process Improvement (RPI) workshop is planned fo

e 16):

ment Workshop. This chartered workshop brings

a credible foundation for continual improvem

f the organization and the cultural transformatio

whow to create potent outcomes potentially re

and Measures, this RPI workshop is essential to

eople in leading, resourcing, monitoring and

e conducting this timely and collaborative event

am and a lot of important knowhow to set the s

performing this workshop and achieving its delive

29

senior leadership

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transcends a cultural assessment or a simple table of metrics, it also server to accelerate the pace of

change and produces a better outcome for the hospital and its stakeholders.

Anticipated Follow-on Implementation

Tasks to come are shown in Figure 16, above. There is an ample dosage of implementation and practical

skill transfer to come. Although all tasks to come remain priorities in our planning and delivery, Kaufman

Global intends to take an active role during Task 1s deliverable 1c in order to:

1. Help strengthen accountability throughout OSH to ensure projects stay on schedule, on budget,react well to risks and opportunities, stakeholder needs and communications plans. Kaufman

Global has a certified and experienced Project Management Professional on-site. Mentoring to

the superintendent and cabinet are available and are being offered.

2. Counter a lack of a shared organizational vision and strategy, better define both the roles andresponsibilities, and strengthen processes, through coaching and mentoring based upon vast

governmental experience.

3. Help re-vitalize and re-align the senior leadership at OSH to include an effective continuousprocess improvement governance structure, add expertise and support to that transformation.

4. Take positive and proactive measures to help rebuild trust and eliminate acts of retribution, realor perceived, through education, coaching and mentoring.

5. Providing much needed training in all of these concepts, especially in the areas of leadershipand management as has proved successful at the DHS Leadership Academy.

6. Teach ways to expose, make unnecessary, and eliminate any separate agendas in a blamelessenvironment design to foster continuous improvement.

7. Accessing proven Kaufman Global tools already in place throughout as a result of the DHS / OHATransformation including the full LDMS with 20 Keys. 20 Keys should prove exceptionally

important to put world class benchmarks and a linkage to the OSH Vision, Mission and Values at

everyones fingertips in every workgroup. With 15 joint keys in place, and five ready for OSH

customization, this proven tool makes improvement predictable.

Summary: Many improvement efforts often upset an uneasy equilibrium and seem to make things

worse in the short-term. Its incumbent upon the senior leadership at DHS /OHA, the Addictions and

Mental Health Division, and, at OSH to stay-the-course, remain committed to resolve these issues, and,

make the lasting improvements the leadership, staff, workforce, patients, community and State of

Oregon deserve. Kaufman Global has overwhelmingly observed that both the OSH workforce and

leadership have demonstrated a very deep desire to make a difference for the better. Kaufman Globalfinds this consistent with an almost universal regard for co-workers and the patients. Their honesty and

openness are at the same time impressive and inspirational. Its now incumbent upon OSH leadership

and stakeholders to help ensure these steps are taken to become the first class organization that it can

be. To that end, Kaufman Global pledges its intent not only to reveal those cultural issues that must be

changed as it has here, but, to roll up our sleeves to help implement those changes. The forgoing culture

assessment and strategy has been only the first step.

OSH Task Report 1 - Cultural Excellence

Documents

Transcript of OSH Task Report 1 - Cultural Excellence