huron county ccc group

                                                 The Huron County Culture Change Coalition.

What is Dawn?

Dawn is the first phase of the culture change journey. In this stage, members work together to establish a Culture Change Coalition that includes all key stakeholders in decision-making.  

It is important that the group takes the time to learn about and from each other, ensuring that all members develop the skills and knowledge necessary to meaningfully participate.

By the end of this phase, the coalition will have developed a shared purpose in the culture change journey and have gained the knowledge and skills required to begin the Discovery phase.

For an brief overview of Dawn please refer to our Dawn Fact Sheet.pdf

There is no set limit as to how long the Dawn phase should last. From our experience, it has taken anywhere from six months to a year. Your process may take more or less time depending on how frequently you are able to meet.  The PiDC Alliance Culture Change Coalitions meet monthly.

Establishing your Culture Change Coalition

Who should be involved in the culture change process?

To nurture a group, organization, or workplace culture change teams must consider and respect the voices of everyone involved. Everyone should be encouraged to “practice self-determination in meaningful ways at every level of daily life” (Pioneer Network).  In the long-term care (LTC) context, these voices include:

  • Older adults, including those living with Alzheimer’s disease and related dementias;
  • Partners in care, including family and other important people in the resident’s life before and during residence in a LTC facility.
  • Staff in LTC settings.

In order for the broadest range of voices to be heard, this should include a mix of front line and management staff, from the broadest range of shifts and backgrounds.

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Get support of key stakeholders

Why?

The Partnerships in Dementia Care (PiDC) Alliance believes that culture change works best through collaboration from members at all levels of an organization or group. Still, in order for the process to begin, you should connect with major decision makers, key stakeholders or leadership within your organization.

Culture change requires resources, including staff time and financial resources. Major decision makers may not be looking to change the current culture within their setting initially.

How?

Set a meeting with key stakeholders to discuss the need for culture change, the possibilities for the future, and the scale and scope of the proposed initiative.

To encourage participation, break away from ‘traditional’ problem solving:

To encourage decision makers to take part in the process, you should begin to model the methods of the process. This means adopting the language and approach of Appreciative Inquiry.

Traditional top-down approaches to problem solving tend to focus on the negatives in an effort to fix what is wrong. This approach searches for root causes of failure and problems to fix the past. When using this approach, people often become focused on what is not working and may feel overwhelmed, insecure, and powerless. These feelings do not encourage individuals to take part in a large scale culture change process.

Instead, we use an appreciative approach that looks at bringing forward the strengths of a community or organization, to begin envisioning possibilities for the future.

What does this mean?

The central idea of Appreciative Inquiry is to repeat and expand on positive processes in other parts of the group or organization to meet goals that have been agreed upon through collaboration. At your first meeting with key stakeholders, explain this process and highlight what you think are the strengths of your organization in explaining the Appreciative Inquiry process.  

The PiDC Alliance research shows that this methodology is very successful in bringing people together to collaborate for positive change.

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Preparing for your first meetings

Once leadership buy-in has been established, you will need to collectively plan for the establishment of a Culture Change Coalition (CCC). This coalition will be responsible for leading the initiative within the organization or community. Importantly, the person who leads this coalition does not need to be the person with the highest amount of authority in your group or organization’s leadership structure.

Who else should be asked to take part in the coalition?

There is no set list of persons who should be involved. Early discussions with decision makers and key stakeholders will include significant brainstorming about who will be asked to take part in the coalition.

NOTE: During your first meetings with those who have responded to your initial invitations, it is vital that you work hard to broaden the reach and representation even  further. Exercises for this appear in the Defining and Shaping the Coalition Section below.

Cast as wide a net as possible

We strongly suggest that the coalition include representatives from various areas within the organization, including front line staff and management, persons from different shifts or teams, and persons with diverse roles and responsibilities.

Most importantly, include persons who are most strongly impacted by the decisions of the group. These include residents of long-term care homes and family partners in care. Including the broadest range of voices in this process ensures that the CCC does not simply continue with the existing decision making structures. Including diverse perspectives from the beginning of the process will ensure that all persons play a role in shaping the future within the care setting.

How do we recruit people to the first meeting?

Depending on the size and existing communication strategies within your group or organization, consider the following options:

  • Word of mouth
  • Staff meeting announcements
  • Email notices
  • Online notices
  • Posters
  • Sending out invitations to stakeholders (ensure these are broad and inclusive)
  • Newsletters

Include groups such as residents, family members, partners in care, front line staff, volunteers, and community partners. Be creative and flexible to meet the diverse needs of stakeholders—do not assume that everyone is web savvy or that everyone pays close attention to printed media.

Finding Culture Change champions

You have recruited members for the coalition and your first meeting is scheduled. What now? Based on our experiences, we found it helpful to establish a ‘champion’ who will facilitate the Culture Change Coalition meetings. It would be helpful if this person had experience facilitating groups and had some background knowledge or information about the culture change initiative. This person does not need to be in a managerial or administrative role within your organization.

Setting an agenda

We have found that there are typically one or two people who take responsibility for setting up the agendas. As the group evolves, agenda-setting may become a more collaborative process.

When setting the agenda
  • Be sure to give enough time for each item as they often take longer than expected.
  • Circulate minutes. These help to keep track of decisions, action items, and ideas.
  • Use a note taker to ensure minutes are completed. You can share this responsibility, or it could be the same person each meeting.
  • Come prepared.  It is a good idea to be prepared for meetings with supplies, such as pens, paper, markers, flip chart paper, name tags, and so on. You may want to create a kit that contains these items to bring with you to each meeting.
  • Consider serving a light snack or refreshment.

Alter the templates below to meet the needs of your group or organization. Remember that some adults benefit from using a larger than standard font.

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Bringing the coalition together

Learning and sharing information

At your initial meetings you will want to ensure everyone has the information they need to fully participate, and the opportunity to learn about who is sitting at the table. This means providing the group with information regarding culture change, the coalition, as well as any other relevant information. You may want to prepare a brief handout about the coalition, including the purpose of the coalition as well as what will be expected of members. You may also consider creating a handout about the philosophies guiding the culture change, such as the Appreciative Inquiry approach and Authentic Partnerships.

Of particular importance is the culture change theoretical model. This model explains the culture change process, the guiding principles of the process, and the expected outcomes of culture change. You will refer to this model frequently either with the culture change coalition or independently, when planning next steps forward. This is a useful tool to refer to early in the process. 

Defining and shaping the Coalition

It will be helpful early on in the process to determine each member’s expectations for the coalition. This can include expectations for the coalition as a whole, but also expectations of what they personally hope to learn and achieve. This helps the coalition set goals, as it ensures everyone’s needs are considered. Based upon the group’s expectations, the principles guiding your partnership, and other feedback from the coalition, you will want to establish terms of reference to guide your Culture Change Coalition. Alter the template below to fit the needs of your group or organization.

Ongoing and critical reflection is important to a culture change process. It helps to ensure that the coalition remains on track and that members are continuing to meet expectations. It is helpful to reflect on aspects of the process that are working as well as those that need improvement. A space for open, honest reflection allows new insights to emerge throughout the process.

Below you will find an activity designed to help people talk with one another about why they have joined the Culture Change Coalition, and why they return to each meeting. This reflection reinforces the importance of the culture change to those who share as well as those who listen. You will also find a template for asking for comments and ideas from those more comfortable writing their thoughts.

Finally, the 'Mapping our Community' activity is an excellent tool to encourage your culture change coalition to assess whether there is the broadest diversity around your meeting table possible, and to identify potential gaps in inclusion.

Another aspect of critical reflection and dialogue is to challenge existing assumptions or stereotypes that exist. This is particularly important when your culture change process includes working with marginalized, less advantaged or traditionally unheard groups. For example, persons with dementia are often considered incapable of learning, and as a result are not often included in decision-making. We found it helpful to reflect on these assumptions and examine our own stereotypical thinking. This is critical if your coalition wants to ensure that all key stakeholders are represented in the culture change process. The activity below is dementia-specific, but the basic premise of the exercise can be duplicated with quotes about the group you want to include in your group or organization's culture change process.

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Creating a safe space for participation

Another enabler of Authentic Partnerships involves creating a safe space. Many groups or organizations have a very hierarchical decision making process. When team members are used to being given direct orders or associate giving their opinion with risk, it is important to take the time to create a space in which people are encouraged to share their ideas for change, even if they are not the most senior person at the table.

This involves taking time to get to know one another and working to create a space where everyone feels comfortable engaging in the culture change process. To create a comfortable and welcoming environment, we found it helpful to start meetings off with ice-breakers and getting-to-know-you activities. Other simple additions to the meeting, like bringing food, wearing name tags, and allowing natural conversations to occur, can also help to create a safe and welcoming environment.

Below are several ice-breaker and other activities that are easily incorporated into a meeting. These range from the simple, like having partners quickly interview and then introduce one another to the larger group, to more ambitious and active activities, like the Marshmallow challenge and the candy game. Don't be afraid to ask people to engage in a slightly 'silly' or childlike game in order to break the ice - having fun together is a great way to create a safe space!

Creating and setting guidelines so that everyone feels secure

Early in Dawn the PiDC Alliance found it important to introduce the ideas related to an 'authentic partnerships'. Working within an authentic partnership framework is critical to creating the kind of safe, inclusive space necessary for culture change. While reading about these principles is important, we also found it helpful to work together as a team to create personalized guidelines for the process. 

We do this by reflecting on the factors the group determines are necessary to create a safe and secure environment. We used these guidelines to determine principles that guided our ongoing partnership. These guidelines can be used to introduce new members to the group and reinforce inclusive non-hierarchical behavior. Re-visit these principles frequently to make sure they are up to date and to remind the group of their importance. Below are three activities to help guide your group in creating a safe space and in linking the idea of a safe space with the principles of Authentic Partnerships.

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Building the Appreciative Inquiry knowledge base

We found it helpful to provide opportunities for all members to be trained in the Appreciative Inquiry process. You can do this by hiring an Appreciative Inquiry consultant to lead a one-day workshop, or you can create your own training session based on the resources available in this toolkit. We found that Culture Change Coalition members were able to internalize the Appreciative Inquiry process when they were provided with an opportunity to experience it first-hand.

Refer to the PiDC Alliance Appreciative Inquiry Retreat Report for a description of our Appreciative Inquiry Retreat.

How do I know when Dawn is over and how do I transition to Discovery?

Dawn is a time when the principles of Appreciative Inquiry and Authentic Partnerships are introduced to the culture change coalition. The amount of time that Dawn takes depends on the current culture in your group or organization, and how different this culture is from the Appreciative Inquiry approach. We have found in our culture change process that Dawn never ends entirely. The principles of Dawn are constantly re-visited and at all times during the process, we engage in critical reflection to ensure that we are engaging in authentic, trusting relationships with one another and that every member of the culture change coalition feels secure, valued, and heard. 

However, at some point, culture change coalition members will be ready to begin the work of gathering positive stories in the 'Discovery' phase of the Appreciative Inquiry process. To prepare the coalition for the work of discovery, consider including the activity below, which clearly introduces the Discovery phase, and begins to build the skills necessary for the coalition to succeed.

Reflect on the current culture of your group or organization

After you have established a strong safe space in which people can share their experiences and perspectives, and before you move on to discovery, it is important to ensure that you set a 'baseline' of the the current care culture (or work culture) of your group or organization. The exercises below reinforce skills in conducting regular critical reflection and dialogue. These are key enablers of the Authentic Partnership process. They also create a snapshot of 'pre-culture change' culture at your group or organization. This snapshot will be an important tool to compare pre-culture change culture with post-culture change culture. It is important in the Dawn phase to work with the group on reflecting on the current state of the organization or community.

To do this, use activities that encourage members to reflect on the current culture within the organization and to begin visioning an ideal culture for the future. It may be helpful to ‘map out’ the organizational community to ensure everyone has a shared understanding of all the stakeholders both within and beyond the organization. By doing this, you may discover that there are stakeholders that need to be included in your culture change initiative. See below for two linked activities that are help to create useful comparative tools as you move through the Appreciative Inquiry journey.

Is your organization experiencing challenges with the Dawn phase?

For assistance with overcoming culture change barriers see our guide to overcoming barriers to culture change.

Continue to Phase 2: Discovery

References

Pioneer Network. (2014). What is culture change? Retrieved from http://www.pioneernetwork.net/CultureChange/

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Appendix: 1. Dawn Tools and Resources

Dawn Overview Fact Sheet

Preparing for your first meetings

Learning and Sharing Information

Defining and Shaping the Coalition

Creating a Safe Space for Participation

Creating and Setting Guidelines so Everyone Feels Secure

Building the AI Knowledge Base

References

Dupuis, S.L., McAiney, C.A., Fortune, D. B., Ploeg, J., & de Witt, L. (2014). Theoretical foundations guiding culture change: The work of the Partnerships in Dementia Care Alliance. Dementia Online First, January 13, 2014. Available from Sage Journals Online

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For more information on any of the PiDC Alliance initiatives, contact Sian Lockwood, Knowledge Translation Specialist.

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