Contributed by Helen Chiu,  BC Provincial Renal Agency and the Nephrology Research Office. Helen was kind enough to chat with us about how her virtual, multisite workplace managed to build Change Day momentum and develop their team culture through a group pledge.

You were very involved in spearheading Change Day at the BC Renal Agency. How did you end up in that role?

I went to the 2015 Quality Forum, which is where Change Day was launched, so that’s where I heard about it. It made sense to me— it was very exciting, because everyone can do it, and it starts from little steps. So I thought I’d give it a try here at the Renal Agency, given my role, which is supporting quality improvement activities across the different provincial committees.

How did Change Day work in the Renal Agency?

At the BC Renal Agency, we work in a virtual network with the health authority renal programs to plan and coordinate care for patients with kidney disease. Our core staff members are located in several different locations, so it took some thinking in terms of how to organize it. I approached Dr. Adeera Levin, our executive director and Gloria Freeborn, an agency director, and they were very supportive. In fact, Dr. Levin, made the first pledge from the Renal Agency.

From the start I realized we couldn’t possibly promote Change Day in three different locations, and it wouldn’t be as effective if I was the only person doing it. So I put out invitations to potential “champions” at the other offices, and luckily there were some people at each office who took it on. Together we started organizing our internal effort. They were very excited; they thought it was something very meaningful to do.

In terms of the external effort, with the different renal programs and the other people involved in the renal community, I worked with Gloria and Stacey Richardson, our organizational development team. They helped us spread the word through social media, websites, a newsletter and helped us to set up the opportunity to promote it at BC Kidney Days (held October 1st and 2nd, and attended by 450 renal and kidney transplant care professionals). We had a table right next to the entrance of the plenary presentation hall, so there was lots of visibility.

What were your pledges for Change Day?

I had a couple. One was affirming and acknowledging people who have done something positive, whether it’s at my workplace or my family, or amongst my friends. The other one is about bridging people for better health and compassionate person-centred care.

Tell me about your pledge to bridge people for better care.

My role is focused on quality improvement and also knowledge translation, because I have a research background, so what I do is help to facilitate some of the translation of the research evidence into practice. So that’s bridging the knowledge translation gap, but also facilitating research that is more relevant to informing practice.

More recently, I’ve been involved in patient-oriented work, both in the planning of improvement work in renal care within the province, and on the research side of things. It’s been quite a rewarding experience for me. I hear a lot of stories from patients, and having their perspective inform how we should plan for care and being able to involve them in designing and developing studies—that’s a piece that I’ve been doing that speaks to that pledge.

Making the pledge made me stop and reflect more as to how to take the time to listen to what patients are saying, and reflect on incorporating their voices in the work.

And how is your pledge going to affirm and acknowledge people?

It’s going well! It’s good for me in the way that I start to notice the positive things about a person more, because sometimes we tend to focus on something the other person is not doing well. But in this case, I have to really make an effort to notice that good thing, acknowledge and highlight it, and then the other person will feel recognized and more motivated. So it spreads in that way- it’s kind of contagious.

Within my family too, I found that being more thankful and more acknowledging has changed our culture. We become more appreciative, and it’s easier to dialogue on a number of different things, so in that way it’s a small thing, but it has a substantial impact.

So are you still making an effort to do that, post-Change Day?

Yes! I found a lot of the pledges are ongoing, like our group pledge in this office. We made a pledge where we would get together every Wednesday- that’s the best time for everyone- and we bring our lunch and eat together.

Before, we’d just be eating at our desk, because we all have different schedules. Occasionally we’d meet each other sporadically in the lunch room, but now we all make an effort to have lunch together on that one day. It’s where we get to know each other, not just for the work we’re doing but as people. That’s important, because with research and improvement efforts in care, it’s all about the people we’re serving. My philosophy is that we have to start with the people in front of us; we have to get to know the person first, and that will impact the way we see and understand things. So that we can go out there and when we see the patients at the clinic, or in other settings, or working together, then we also know the person better as an individual.

Have the weekly lunches helped to develop your team culture?

Yeah, our group had a chance to bond better. Eventually we started to invite other people, from other offices who know we have lunch every week. We don’t formally invite people—it’s pretty casual, but everyone is welcome to lunch with us.

What did you expect from Change Day? Did it meet your expectations?

I think it’s not hugely different from what I expected, because I did believe from the beginning that every change starts with me making a conscious effort. But seeing how it rippled, and how it’s changed other people’s ways of thinking—I think is invaluable.

I didn’t expect that people would just pick up on it, and do it off the side of their desks but still feel quite excited to make a pledge and talk about it. It just naturally came up in that way. So it was good general team-building; Change Day made us more bonded, and it’s changed the culture in some sense between the three different offices.

For Change Day itself, on October 15, we wanted to have some sort of celebration, but I was so swamped— I had a big deadline, I just simply didn’t have the energy to plan. So I put it out there and asked if anyone wanted to have a party. I didn’t think I would get a response because we’d just had Kidney Days—you know how it is after a big event! I thought everyone would feel quite drained. But other people stepped up to plan a party at a pub, and we managed to have people from all three offices who all came out to have a small celebration together. I thought that was quite incredible, to bring everyone out to talk about this event.