Introduction: What are we changing and why? * Culture change: from punitive to collaborative * Shared responsibility: what does it mean * Breaking the Blame Cycle * Code of Conduct

Recently our organization conducted a survey asking employees to identify sources of job satisfaction and dissatisfaction. This survey was part of a large scale effort to identify ways to improve performance, quality of care, patient outcomes, patient satisfaction, and nurse satisfaction. By allowing employees to engage in the process of shared diagnosis, we can create a sense of dissatisfaction with the status quo and begin to unfreeze behaviors that have been hindering our organization from reaching it’s full potential (Spector, 2010). The survey revealed that many employees feel we operate in a punitive culture. That is, when errors or missteps occur, employees are afraid to report these incidents due to fear of blame, punishment, and retaliation. Instead of operating in a punitive culture, the organization wishes to change our culture to one of collaboration. We desire to share responsibility for both triumphs and failures, to break the cycle of blame, and to operate within an environment in which all can learn from errors that occur, and that through collaboration, we can be an solution-focused organization. The purpose of this presentation is to introduce the new organizational Code of Conduct and to help managers at every level of our organization implement this culture change.

CODE OF CONDUCT
(Adapted from Rush Oak Park Hospital, 2015)

* Communicate professionally at all times with patients, colleagues, and anyone with whom we interact. Be mindful of non-verbal communication such as eye-rolling and body language. Take pride in ourselves and our organization. Embrace evidence-based practice driven change and support organizational goals, mission, and values. * Respect everyone and believe the best about them, even when we disagree. Allow everyone to be heard and support respectful expression of all opinions. Do not interrupt others when they are speaking. Seek opportunities to listen and learn. * Be willing to give and receive constructive, respectful feedback. Support an environment of collaboration. Do not bully or belittle others. Behave as if patient safety depends on this, because it does. * Work as a team. Discard the phrase, “That isn’t my patient.” Build each other up and be willing to pitch in and help where needed. Involve the patient, the family, and all disciplines in every plan of care. * Lead authentically. Practice with integrity and hold others accountable to do the same. Say what you mean, and do what you say you will do when you say you will do it.

This new Code of Conduct will become hospital policy, and as we adopt this as an organization, we must model it consistently. Up to this point, our organization has not had an official code of conduct. There have been policies governing legal and ethical matters, but no such policy governing how we treat one another within the organization. For this reason, a punitive culture has developed, one in which no employee feels safe. Survey results indicate that employees feel they will be “written up” if they ask questions or express opinions that go against the status quo. Employees also report that when they witness an error, they are afraid to report it because they fear retaliation from the person being reported. This Code of Conduct is intended to break the cycle of blame and govern how we interact with each other. Instead of reporting things punitively, employees are encouraged to speak their concerns in a respectful, constructive way. We suggest that the Code of Conduct be introduced in staff meetings, unit “Power Minute” inservice sessions, and posted in break rooms and/or conference rooms. In addition, a class will be provided for 2 contact hours (CEUs). Many barriers exist to implementing this change. We will discuss these barriers and strategies for overcoming them as this presentation continues.

Organizational changes may involve various things including but not limited to introducing a new business concept, merging departments, changing the culture, or outsourcing. In an effort to recognize the underlying forces of change, as well as the requirements of the effective implementation of change, it is imperative to distinguish the various approaches organizations can take. For companies to remain competitive, responding to the external environment and recognizing the need for change is of utmost importance to the organizational survival (Spector, 2010, p. 1-3). According to Spector, 2010, p. 3, in response to those dynamics, corporate leaders often decide to engage in a process of strategic renewal allowing them to alter the strategy of the organization with the intent of regaining sustainable competitive advantage. In addition, active strategic renewal requires, "leaders need to align internal processes, structures and system with the demands of the new strategy" (p. 5). On the other hand, behavioral change is another essential aspect of achieving and sustaining organizational performance. It involves what employees do, how they do it, the amount of effort they put into their roles as well as their persistence in achieving the desired outcome (p. 7).

Organizational change involves changing old beliefs and habits in order to accommodate new experiences. The evolution of society, as well as the changing demands, creates a need for new services. As a result, organizations may have an obligation to make changes in an effort to maintaining a competitive edge; therefore, companies that may want to survive are usually excited to adapt to change. In addition, organizational development may offer insight into the organization in an effort to help managers implement behavioral changes that may be useful and sustainable (Spector, 2010, p.34). Collaboration may also allow employees to understand that they are working in a friendly environment where they may not be afraid to share freely much of themselves (Tharp, 2009, p. 5). On the other hand, participation is essential in order to help in building employees commitment towards the new direction that my result from the process (p. 12). According to Spector, 2010, p. 12, by diagnosing the problem, understanding their importance, and being part of the process of formulating solutions, people develop a psychological sense of ownership over the outcome.

Cultural awareness, knowledge and understanding the cultures of those in the workplace will enhance communication, productivity, and unity. Often staff are often unaware of how to deal with diversity in the workplace. This lack of awareness can present challenges such as communication styles and ways of relating to others; which is often influenced by heritage. Other possible barriers include religious beliefs because different cultures also attend various religious services on different days of the week. The lack of cultural awareness and knowledge in a diversified workplace can create a sense of division among workers. Motivation is also a fundamental part of nearly everything we do, and the cultural aspects are crucial for a changing workplace such as health care organizations.
Individual factors such as capability, interest, values and needs originate directly from the characteristics of the person. If a person does not have the cognitive abilities to understand the issues occurring, there may be difficulties explaining to others. Therefore needs and personal values are not met. Organizationally, these type factors hamper individuals to showcase authorization, commitment and engagement amongst their staff. If an individual lacks motivating capabilities, they are limited to express or engage in knowledge maturing activities (Walinga, 2008). To make change successful, individuals need to know what needs to change and the best manner to competently carry out the change. People from other cultures may not find the communication as easy to understand. Common barriers include jargon, language, emotions, distractions, perception differences, and false assumptions. If there is no clarity, the lack of trust could development that could suppress productivity.

Different approaches will be effective for different people and different situations (Walinga, 2008). However implementing various educational materials such as booklets, videos, and Internet resources can have a crucial impact, yet still maintain the strong culture of the organization. Subjecting staff with sufficient communication and educational materials raise awareness about change occurrence. The staff can look at the different cultures and develop a better understanding. In order to understand the culture of the organization, one has to be able to visualize its organizational culture. Leadership and management tools are crucial. Ensuring the appropriate vision, conversations, role modeling, and control systems will be helpful in facilitating the actual change. Planning ahead allows a high possibility of clear expectations and reduced anxiety. Taking the time to be inclusive and engage the organization helps to build the support needed and assures the achievement of the change process.
Encouraging feedback involves demonstration reporting of information to individuals or organizations about their practice as part of a drive to improve quality. It is important to honor the strengths of the existing culture while also acknowledging new changes. Soliciting feedback is a positive way to generate an acceptance of the change. Coupled with educational materials, and information session this strategy can energize and engage the talents within the organization and enable them to collaborate more efficiently.

Opinion leaders use their influence to motivate and inspire their staff to achieve the best possible care for patients. Because people think and behave how they perceive how a situation should be, it is important to recognize the difference between beliefs, values and attitudes during a changing process (Walinga, 2008). The use of opinion leaders helps to influence how to disseminate information. Executing staff workshops and training courses are important factors that can influence cultural change and other developmental issues in the organization. The more interactive these sessions are, the more effective the outcome is in changing behavior. Additionally, executing these type educational meetings raise awareness and can prevent damage control during the transformation process. There a many factors that can influence change; however, the bottom-line is to use a method that will create value for staff and the organization.

One of the motivational theories is Satisfaction-Performance theory which is a theory that leads employees feeling satisfied or dissatisfied. “The Porter and Lawler model reflects that satisfaction results from performance itself, the rewards for performance, and the perceived equitability of those rewards” (Borwoski, 2005, p. 148). The theory let us know that an employee will make every effort to achieve the reward by performing very well on the job. It also tells us that if the employees received rewards for their performance then it results in job satisfaction.
Goal setting theory is another motivational theory which may seem simple and an easy concept, however, there must be careful planning involved. In Latham and Locke’s theory there are three steps to be followed such as: “goal setting, obtaining goal commitment, and providing supporting elements” (Borwoski, 2005). The goals should challenge the employee but must be attainable. Leaderships have to assess the level of their employee on an individual basis and set goals that fit their level of work.

The Equity theory is when an individual evaluates and compares their inputs and outcomes with another individual. The two major components of the equity theory are inputs and outcomes. Inputs is when the individual has contributed their time and effort into something for an exchange. For example, experiences, education, skills, and age (Borwoski, 2005). Outcomes is the result of the inputs. For example, receiving a degree, salary increase, and promotions. (Borwoski, 2005). When an inequity occurs between two individuals, it creates tension between them. When this occurs management has to address it and make the proper adjustments to resolve the matter.
The Expectancy theory is the person’s level of motivation based on their performance and desired outcomes. Vroom stated three factors that contributes to a person’s motivation: “valence, instrumentality, and expectancy” (Borwoski, 2005). Valence is the person’s wants and desires for a particular outcome. For example, an employee who wants a promotion may view that as an achievement, whereas, another employee do not desire a promotion because it requires more responsibilities. Instrumentality is “an individual’s perception that his or her performance is related to other outcomes, either positively or negatively” (Borwoski, 2005, p. 141). In other words, the person will do things because they understand there is a reward as an outcome. Expectancy is when the person perceives that their efforts and actions will be influence their performance. The person may think that if they accomplish a task then they can achieve the goal within the expected time frame. The danger with that is if the individual does not set realistic goals and time frame, then the expectancy is minimal.

Conclusion

* Understand the change (Code of Conduct) * Recognize the barriers to change * Design interventions to overcome the barriers * Involve employees in each step * Motivate, encourage, inspire, REPEAT!

In conclusion, as our organization moves toward the cultural change of adoption and implementation of a new Code of Conduct, it will be important for leaders to recognize the many possible barriers to change, including but not limited to those presented here. By recognizing and acknowledging these barriers, leadership can design interventions to overcome change barriers and effectively unfreeze current employee behaviors. By involving employees in the initial gap analysis and diagnosis, and by allowing them to participate in the design of interventions to overcome change barriers, mutual problem-solving and ownership of the change can occur. As leaders, we must continue to motivate employees by monitoring the change process and providing feedback as change is implemented. By motivating, monitoring, encouraging, and inspiring, leaders can protect the organization from further change, thus “freezing” the change into permanent behavior (Spector, 2010).