B HEALTH CARE SYSTEM o y k in • TRANSFORMATION FOR NURSING AND HEALTH CARE LEADERS Sc h o e n h IMPLEMENTING A CULTURE OF CARING o fe r • Anne Boykin, PhD, MN, Savina Schoenhofer, PhD, MEd, MN, Kathleen Valentine, PhD, RN, MS Va le n t in e “The authors’ approach to creating a transforming culture through use of foundations laid in the H H EALTH CARE SYSTEM theoretical development of Nursing as Caring offers a solid foundation upon which to recalibrate E A and reconfi gure toward a caring organizational health system.” L T —Tim Porter-O’Grady, DM, EdD, APRN, FAAN, FACCWS H Associate Professor, College of Nursing and Health Innovation, Arizona State University CA TRANSFORMATION FOR NURSING Clinical Professor, College of Nursing, The Ohio State University R E S This is a time-tested, practical guide for nurses and other health care professionals who wish to transform Y HEALTH CARE LEADERS their health care systems through the promotion of caring values. It describes a model created by nurses S AND T to transform the culture of health care systems at all levels, and features specifi c strategies for planning and E M instituting change. T R A cornerstone of this approach is the engagement of the leadership team in implementing change and A IMPLEMENTING A CULTURE OF CARING N promoting intra- and inter-professional dialogue. At its most basic level, this model, the Dance of Caring S F Persons, expresses the fundamental beliefs that each person in the health care system cares meaningfully O R in unique and valuable ways, and the contributions of each person are signifi cant to the whole of the enter- M prise. The book features examples of how various units of the health care system can successfully apply A T I specifi c strategies to their work, and describes in detail how to engage and sustain authentic dialogue O N among and between stakeholders. F O R The book also includes a timetable to change a culture as well as practical strategies for transforming the N organizational mission, leadership structures and processes, communication, and outcomes of the system. U R Chapters feature information from a variety of health professionals. The book refl ects the interests of such S I major stakeholders as patients, families, nurses, physicians and other providers, administrators, and man- N G agers. Chapters include questions to consider and suggested resources to help with implementation of A N strategies. The text incorporates professional standards and essentials from The Joint Commission, ANCC, D and AACN (DNP). H E A Key Features: L T H • Presents a theoretically grounded and proven caring-based model for health care system change for C A all stakeholders across the continuum of care R E • Provides practical strategies for transformation L E • Describes how health care system change happens, who initiates it, and how to sustain it through A D caring science E R S • Includes success stories from patients and their families, nurses, physicians, ancillary service providers, health care administrators, and others • Promotes intra- and inter-professional dialogue and collaboration Anne Boykin ISBN 978-0-8261-9643-9 Savina Schoenhofer 11 W. 42nd Street New York, NY 10036-8002 Kathleen Valentine www.springerpub.com 9 780826 196439 Health Care System Transformation for Nursing and Health Care Leaders BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd ii 88//1166//22001133 1111::0044::1188 AAMM Anne Boykin, PhD, MN, founding dean of the Christine E. Lynn College of Nursing, Florida Atlantic University, is currently professor emeritus (retired). She is recognized internationally and nationally as an authority on caring science, and has coauthored and edited several books including Nursing as Caring: A Model for Transforming Practice (1993, 2001) and Living a Caring-Based Program (1994). She is a contributing author for many book titles and has authored more than 20 journal articles. Dr. Boykin is the past president of the International Association for Human Caring, and has served as a member of several boards at the international, national, state, and local levels, including the American Association of Colleges of Nursing, National League for Nursing, Southern Education Board Council on Collegiate Education for Nursing, and the Florida Association of Colleges of Nursing. She now serves as a consultant on nursing, nursing theory, and transforming health care environments, and works with a growing list of hospitals and hospital chains locally and nationally. Savina Schoenhofer, PhD, MEd, MN, is professor (part-time) at the University of Mississippi Medical Center School of Nursing. Earlier academic appointments include those at Florida Atlantic University, Alcorn State University, Texas Tech University, and Wichita State University. As the collaborating author with Anne Boykin, Dr. Schoenhofer has published Nursing as Caring: A Model for Transforming Practice, and has written chapters in numerous other books and authored multiple journal articles in Nursing Science Quarterly, Advances in Nursing Science, International Journal for Human Caring, and others. She is noted as an authority on caring science and was named “Living Legend” in 2003 by the International Association for Human Caring, in recognition of her nursing scholarship. Kathleen Valentine, PhD, RN, MS, is associate professor and associate dean for clinical affairs and community engagement at the School of Nursing at MGH Institute of Health Professions. At the time of writing this book, she was the director of the Louis and Anne Green Memory and Wellness Center and the Diabetes Education and Research Center at the Christine E. Lynn College of Nursing, Florida Atlantic University. Formerly, she was associate dean, College of Nursing, Florida State University, and department chair, University of Wisconsin, with clinical positions as practice director, Clinical Practice Model Resources Center, Grand Rapids, MI, and director, Health Care Delivery, Kaiser Permanente, Oakland, CA, among others. She has been awarded 18 research/practice grants, seven of them in the amount of six and seven fi gures. She has authored 15 journal articles, and presents nationally and internationally. She received her doctorate from Cornell University, specializing in human service program evaluation. She has worked on health system transformation as a specialty. BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd iiii 88//1166//22001133 1111::0044::1199 AAMM Health Care System Transformation for Nursing and Health Care Leaders Implementing a Culture of Caring Anne Boykin, PhD, MN Savina Schoenhofer, PhD, MEd, MN Kathleen Valentine, PhD, RN, MS BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd iiiiii 88//1166//22001133 1111::0044::1199 AAMM Copyright © 2014 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Joseph Morita Composition: Newgen Imaging ISBN: 978-0-8261-9643-9 e-book ISBN: 978-0-8261-9644-6 13 14 15 16 17 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reli- able to provide information that is accurate and compatible with the standards generally accepted at the time of publication. The author and publisher shall not be liable for any special, consequen- tial, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Boykin, Anne, author. Health care system transformation for nursing and health care leaders : implementing a culture of caring / Anne Boykin, Savina Schoenhofer, Kathleen Valentine. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8261-9643-9 — ISBN 978-0-8261-9644-6 (e-book) I. Schoenhofer, Savina O’Bryan, author. II. Valentine, Kathleen Louise, author. III. Title. [DNLM: 1. Models, Nursing. 2. Nursing Theory. 3. Nurse Administrators—psychology. 4. Nursing Care. WY 86] RT41 610.73--dc23 2013017306 Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036–8002 Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 E-mail: [email protected] Printed in the United States of America by Bradford & Bigelow. BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd iivv 88//1166//22001133 1111::0044::2200 AAMM We dedicate this book to all health care providers, especially those in leadership roles, who commit themselves to humanize and transform systems of care. To my husband, Steve Staudenmeyer, whose love, support, caring, and encouragement allow me to live my passion for nursing.—Anne Boykin For Gwen, Carrie, and Emma, my love and gratitude. —Savina Schoenhofer To my husband George DePuy and the extended circle of family, friends, and colleagues who help me to grow in caring. With love, always.—Kathleen Valentine BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd vv 88//1166//22001133 1111::0044::2200 AAMM BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd vvii 88//1166//22001133 1111::0044::2200 AAMM Contents Foreword by Tim Porter-O’Grady, DM, EdD, APRN, FAAN, FACCWS ix Preface xiii Acknowledgments xv Introduction by Ron Paulus, MD, MBA xvii SECTION I. PREPARING FOR THE DANCE OF CARING PERSONS: WHY TRANSFORMATION IS NEEDED AND WHY CARING IS THE ESSENTIAL VALUE TO GUIDE SUCCESSFUL TRANSFORMATION 1. Challenges to the Effectiveness of Health Care Systems 3 Response by Zane Robinson Wolf 2. The Dance of Caring Persons: A Values-Based Model for Health Care Systems Transformation 25 Response: Group Dialogue by Rev. Ruth W. Black, W. Richard (Rick) Boyte, Ralph Didlake, Susan Shands Jones, and Mary Mixon 3. Cultural Factors That Infl uence Transformation 51 Responses by Wendy Bailes and Suzanne C. Beyea SECTION II. PRACTICAL RELEVANCE OF THE MODEL AT ALL LEVELS OF THE SYSTEM 4. Readiness for Health Care System Transformation 81 Response by Nancy Hilton 5. Gathering and Applying Resources: Action Toward Practice Change 109 Response by Valerie Fong SECTION III. STRATEGIES FOR CREATING A TRANSFORMATIONAL CULTURE OF CARING IN HEALTH CARE SYSTEMS 6. Transforming the Organizational Mission 133 Response by Janet Y. Harris vii BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd vviiii 88//1166//22001133 1111::0044::2200 AAMM viii CONTENTS 7. Transforming Leadership Structures and Processes 147 Responses by Raymond Barfi eld and Karen Olsen 8. Transforming Communication Processes 175 Response by Donna Linette 9. Prizing, Valuing, and Growing: Outcomes Reframed 193 Response by Marian C. Turkel SECTION IV. RESOURCES Resources by Chapter 213 Reading List 219 Index 227 BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd vviiiiii 88//1166//22001133 1111::0044::2200 AAMM Foreword We are deepening our understanding of the operation of a complex world and the structures and processes that demonstrate its interactions. The introduction in the United States of concepts associated with complex adaptive systems has radically changed our understanding of human dynamics and the organizations and structures that support and advance them. Traditional industrial and linear notions of structure, culture, and leadership have essentially been eclipsed by the deeper richness of the levels of understanding of how people live, relate, interact, and work in highly com- plex systems. As a result of this deeper understanding gleaned from the translation of com- plex adaptive systems into human organizations and relationships, much confl ict and confusion with traditional structures and approaches to aligning, understanding, and applying developed processes to human dynamics have emerged in our traditional organizational constructs. The architecture, structure of work, characteristics of inter- action, management and leadership capacities, and relational dynamics that devel- oped over the full course of the 20th century have become less relevant and viable, and increasingly lacking in effectiveness. The more linear two-dimensional, vertical, hierarchical models and mechanisms of structuring work and relationships that were developed throughout the 20th century have become nonrelevant in a 21st-century social context. The growing digital reality that increasingly defi nes and infl uences contempo- rary human experience has substantially changed the rules of the game with regard to human dynamics, interaction, and work. In the industrial age, models of work were fi xed, fi nite, functional, and institutional. Twenty-fi rst–century work and workplaces are characterized by structures and processes that are more fl uid, fl exible, focused, portable, and mobile. The portability and mobility of human life, relationships, interactions, and dynamics have altered our understanding of the operation of systems structures, pro- cesses, relationships, and leadership. This deepening understanding of the complexity that characterizes life at both the universal and subatomic levels has redefi ned the param- eters within which human interaction unfolds and progresses. Our understanding of complex adaptive systems leads us to raise questions about our ability to predict and adapt these forces for good use and their implications and ix BBooyykkiinn__9966443399__PPTTRR__CCHH0000__1133--0088--1133__ii--xxxx..iinndddd iixx 88//1166//22001133 1111::0044::2200 AAMM