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Got Change?Take the Journey at St. Vincent!

Pam Beitlich, DNP, ARNP, RN, NEA-BCSeptember 8, 2016

Our Agenda -

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Articulate the driving competing forces in the current healthcare environment

Commit to three strategies to improve your effectiveness leading through change and its accompanying transitions

Understand the basic tenets of a change model

• What is your WHY for being in healthcare?• What truly inspires you to get up every day and come

to work?

Ask Yourself…

Consider…

• What do you want to be known for?

• Are you exceptional or extraordinary?

• Please know – YOU create memories for your patients

How’s Your Day Going?

Being a leader in healthcare today is like continuously walking up a down escalator.

If one stands still they go backwards.

Your Mission -The mission of CHI St. Vincent and Catholic Health Initiatives (CHI) is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities.

Your Values -Reverence - Integrity - Compassion -Excellence

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Everything Starts Here -

Our Mission-To make healthcare a better place for

employees to work, physicians to practice medicine and patients to receive care

Our Missions Align -

• 1 million patient visits each year• Hot Springs, Little Rock, Morrilton and North Hospitals• More than 250 physicians• 4500 co-workers• Serving patients from all 75 counties in Arkansas• Nationally ranked Orthopaedic program - 8th largest spine

program in the United States • Arkansas Health Network -1,300 physicians and facilities,

including Arkansas Children’s Hospital to manage the health of over 56,000 lives in Central Arkansas

You Make Such a Difference

• St. Vincent Infirmary -first and only hospital in Arkansas to earn Magnet Designation

• St. Vincent Morrilton- first and only hospital in Arkansas to achieve the Pathway to Excellence® designation

• St. Vincent Infirmary - US News and World Report - best Arkansas hospital, top-performing excellence in six specialties

• Becker’s Hospital Review – only Arkansas hospital in the Top 100 for Neurosurgery

• Hot Springs St. Vincent Cancer Center accredited by the American College of Surgeons’ Commission on Cancer

• Arkansas’s only dedicated cardiac hybrid OR

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And There’s More -

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Execution Triangle

Execution FrameworkEvidence-Based LeadershipSM

Creating a Different Culture..

Culture means creating consistency and alignment in human behavior that is also in alignment with a

certain way of thinking and living.

Creating the right culture is of utmost importance.

-Quint Studer

Communicating: The Suggested Sequence

Why

What

How

The Real WHY..

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“We start each day with a purpose -Make our communities stronger, better than they were the day before. We’ve been doing that for 127 years.Just imagine what we can all do tomorrow.”

- Chad S. Aduddell

Situational Awareness-Key Changes in Healthcare

Change Today Happens Quickly…

$/N

Time

Healthier populationLower UseLower PricesHigher quality

2013

What is Reform Really About?

Seeing Beyond Reform: Governance and the Emerging New Healthcare; James Orlikoff, President; Orlikoff & Associates, Inc.; 4800 S. Chicago Beach Drive; Suite 307N; Chicago Il 60615-2054; 773-268-8009; j.orlikoff@att.net

Maybe a Better Definition -

No Outcome, No Income

• External occurrences• Internal changes• Individual occurrences

Three Distinct Forces

• Transparency/public reporting/consumer influence

• Technology• Research• Integration• Market changes• Episodic vs. continuous change

Other Significant Changes

• From illness to wellness• “Population Health” • From procedures to prevention• Care coordination• Virtual visits• Patient portal• Lab visits/clinics in shopping malls• Telemedicine

What’s Ahead -

Any Changes Here?

• Quality metrics• Patient experience• Financial stability• Efficiency, cutting out waste• Facilitating throughput• Reducing readmissions• KEEP employee engagement

Consider 3 or 4 changes you have experienced:

1. What was the change and how was it introduced? 2. What was your initial reaction?

Enthusiasm? “Wait and see” attitude? Ambivalence? Cynicism?

3. Did your attitudes change over time? 4. Was there a pattern to your response? 5. If you experienced ambivalence, how did you resolve

it? 6. How have these experiences colored your

expectations and feelings toward change in the future?

Reactions to Change are Personal

Healthcare Today -

• Push for transparency• Consumer Influence very strong –• Have lost patience with medical errors• Publicly reported data• The need to exceed your patients’ and families’

expectations. • The need to add a “wow” factor• To be successful, you need to be more than just

technically competent to do your job

Engaged – work with passion and feel a profound connection to their company, drive innovation and move the company forward

Not-engaged – essentially “checked-out” or sleep-walking through their day, putting time in but not energy or passion in their work

Actively dis-engaged- not only unhappy at work but actively acting out their unhappiness. Every day these workers undermine what their engaged co-workers accomplish.

- Gallup

Engaged Co-Workers

Patients want to be cared for by a friendly, caring, and empathetic team

Behavior Standards are so Important

1. Willing to invest discretionary effort

2. Likely to recommend the employer

3. Planning to stay for the foreseeable future

4. Inspired by his/her hospital

-Gallup

Engagement…

Engaged vs Satisfied

There’s nothing wrong with being satisfied, but the world is full of satisfied employees who come to work, play solitaire, surf the net, do the bare minimum and collect a paycheck while waiting for retirement.

Engaged employees are a different animal. They go above and beyond, they’re focused on achievement, and they have an emotional attachment to their company or business unit.

Owner or Renter?

High Performer?

As Little Work as Possible?

Failure to Deal with Low Performers

“Our industry is loaded with compassionate people. This may prevent us from dealing with performance issues. What makes us good at the work of healing holds us back in weeding out problem staff members.”

“Straight A Leadership”, Quint Studer

Consider –

- Do you quickly move people out of the organization if they don’t fit the culture or violate your behavior standards?

- How long do you think leaders should be allowed to stay in their role if they don’t get good results?

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The Boss Relationship Matters

According to Gallup, 50% of

employees in the US said they

have left a job to “get away from

their boss.”

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The Boss Relationship Matters

37% of employees in the US

responded to a survey by saying they

would be willing to give up their

annual raise in exchange for their

boss getting fired.

Communicate – content, frequency and mode (intentional about team and individual)

Expectations and accountabilityRecognition and constructive feedbackDevelopment approaches – assisting team members to

growAccessibility – informed, responsive, available, and

willing to discuss anything?- Gallup

Five Behaviors of Engaging Leaders -

Everyone thinks of changing the world, but no one thinks of changing himself

-Leo Tolstoy

All of us must first feel inspired, engaged, and connected before able to give our best work. Without a connection, we will still work, but not as well as needed or desired.

Connection truly is a distinguishing factor

Can you Connect?

• No victim thinking• Control our own destiny• People need you• You not only save lives but you save healthcare

Observations

Compliance

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When do people comply?

Compliance

When they

WANT to

When they

HAVE to

OR

• It fits their values (The Why)• It improves operations• It improves clinical outcomes• It makes their life better

People WANT to comply when . . .

Compliance

• The outcome of not changing behavior is worse than the discomfort of changing behavior

• Even though a person may not feel they have the skill set or the desire to be successful, they know that their compliance will be validated

People HAVE to comply when . . .

Compliance

• Don’t assume that a person knows how to change• If an organization’s results are not where they need to be,

it is either a will or a skill issue• There are bright spots in the organization - it is not

geography, skill, facilities, compensation, or corporate – It rests in the heart and minds of individual leaders

What Does this Mean?

Leading through Change

Best Practices for Leading Change

“People wish to be settled; but only as far as they are unsettled, is there any hope for them.”

- Ralph Waldo Emerson

Unsettling occurs when a culture of optionality

changes to a culture of accountability

Thinking Differently1. Analyze - Give the data and the

evidence

2. Think – Data and analysis influence how we think

3. Change – New thoughts can change or reinforce changed behavior

Both Thinking and Feeling are Essential

Feeling differently -1. See – help people “see” by

creating surprising and compelling visual experiences

2. Feel – seeing something new hits the emotions

3. Change – emotionally charged ideas change behavior

Behavior Changes when we Feel…

Critical Elements of Successful Change

-VanDeusen Lukas et al (2007), Kotter, 2002)

• Compelling reason for change to achieve something better

• Alignment with mission, goals, resources• Leadership commitment to support the

change• Active engagement of staff • Connections and collaboration across

boundaries (silos) • Effective communication techniques that

inform and inspire an emotional response

• An important element: realign skill sets of leaders• Without leadership skills, change “ain’t gonna work”• Ties in with evaluation

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Basic Tenets -

What are 3 skill sets you would like to improve as a leader?

What interest/strength do you have that you are not currently using to your potential?

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Models of Change

Change not Always Bad or Feared

“Change management is an approach to transitioning individuals, teams and organizations to a desired future state”

• Operational Framework• Managing Organizations and Change• Managing Individual Change

Leading Change

Phases of Organizational Change

PHASE 1:THE

HONEYMOON

PHASE 2:REALITY SETS IN

PHASE 3:THE

UNCOMFORTABLE GAP

PHASE 4:CONSISTENCY

Sense of excitement

Right “to do” list

Things will get better (hope)

Quick fixes are implemented

Team in place

Some skeptics

Overall lots of enthusiasm

We/they Inconsistency

apparent Bigger challenge

and more work than thought

This will impact me – Change for all

Some are getting it and getting it faster

Some are not and may not

Performance gap is evident

Tougher decisions must be made

Process improvement increases due to accountability and skill level

Inconsistencies obvious that if not fixed, progress will halt and organization will go backwards

High performing results

Everyone understands the keys to success

Disciplined people and disciplined processes displayed in organization

Proactive leadership

Even with Positive change, there is Resistance

Phases of Competency and Change

Novice (Incompetent?)

Expert? / Competent

Unconsciously

Skilled

Consciously

Skilled

Unconsciously

Unskilled

Consciously

Unskilled

• Kurt Lewin

• Everett Rogers

• John Kotter

• “Switch” - Heath and Heath

Many Change Models -

- Everett Rogers

Adoption of Change Occurs over Time

Kotter’s Eight-Stage Change Model

Creating the Climate for Change

Create a Sense of Urgency

Help Others Feel a Gut-level Determination to Act, NOW

Create the Guiding Team

Put Together a Group with enough Power and Skills to Lead the Change

Develop a Change Vision and Strategy

Clarify how the Future will be Different from the Past

The biggest obstaclein achieving high performance is not

achieving the needed urgency for change

Kotter, John P (2008) A Sense of Urgency. United

States: Harvard Business Review Press.

Engaging and Enabling the Organization

Communicate the Vision

Ensure Stakeholders Understand/ Accept the Vision

and Strategy

Empower Broad-Based

Action

Remove as Many Barriers as Possible- Unleash People to do

their Best

Generate Short Term Wins

Create Visible Success ASAP

• Communicate a sensible vision

• Make structure compatible with the vision

• Provide the training employees need

• Align information and personnel systems

• Confront leaders who undercut needed change

Empowering People to Effect Change

• High risk for loss of momentum and the onset of

disappointment

• What is the compelling evidence that their efforts are

bearing fruit?

• Balance “preparing for” and “implementing”

• PLAN short-term gains, hit them, celebrate them -

“Hope is not a plan”

• Short-term wins keep the urgency level up

Create Visible Successes

Implementing and Sustaining Change

Don’t Let

Up

Maintain Momentum - Consolidate Gains and Produce more Change until

the Vision is a Reality

Make the Change Stick

Anchor New Approaches in the Culture for Sustained Change

Which Phase is Biggest Opportunity?

One that someone at your table has, is or will be experiencing

Develop the “WHY” that supports the change. What will capture head and heart to begin adoption of the

change and embracing it?

Identify a Change, Initiative or Project

Your Opportunities to Influence Change

How do YOU Respond to Change?

Phases of Individual Change

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Denial Commitment

Resistance Exploration

Driving Performance

• Persuasion• Relationship building and

networking• Develops others• Provides rewards and

recognition

Champion of Change Competencies-

• Practices inclusion and values diversity

• Innovates• Drives for results• Willing to take risks/

challenge the status quo• Provides strategic direction -

Zenger/Folkman

• Acts as a role model in the organization

• Adapts influence strategies to individuals

• Creates a learning environment• Sets high personal standards• Innovates

Inspire and Motivate Competencies

• Keeps the team informed • Ensures agreement on

priorities• Creates a compelling vision• Concern and consideration

for others• Empowers others to take

responsibility for projects• - Zenger/Folkman

Change vs. TRANSITION

• Most people don’t fear change, but the loss that comes with it

• Stages are characterized with typical reactions –normal and healthy

• Chaos and loss of equilibrium• Regaining balance and a new beginning• Helps us prepare and plan

Transition – the Emotional Process

• Letting go of what’s old and familiar• Sitting with what’s unknown and uncertain YET

avoiding the “learned helplessness syndrome”• Adjusting to what’s new and unfamiliar• We all have multiple experiences of change• Resilient to change

Successful Transition through Change -

Round on your Team and Ask-• - How are you doing? • - What are you thinking? • - How are you feeling? • - What’s working?• - What’s not working?• - How can I help? Rounding on patients Thank You’s and Recognition

Your Role in Navigating through Transitions

Before After During

• They dislike uncertainty

• Often the last to adopt

• Point of reference may only be the past

• Little tolerance for uncertainty

• Suspicious of innovation and change agents

Assist the Skeptics and the Laggards -

• Feel same level of commitment, control and challenge as their leaders

• Understand that change is important• Believe they can influence decisions and outcomes• Experience the journey not as a threat but an

adventure• Leadership from top down must create conditions to

make that possible- Bridges, Managing Transitions

Co-Workers Cope Better

Lead and Inspire Others

“Leader rounding is not optional. It has to be looked at as seriously as giving correct

medications.”

- Quint Studer

Senior Leadership Sets Expectations

Best Advice from the Best Leaders

“Consistency is the key to success of a highly reliable organization. We have ‘non-negotiable’ behaviors. It is more than just ‘rolling out’ the training and assuming it is being done. It is my job to make sure they have the training and coaching to be successful. We validate and follow-up daily.”

- Dr. Rhonda Scott, Chief Nursing Officer

Grady Memorial Hospital

Connecting Heart and Mind

Heart Mind

What is Constant in Healthcare

• Passion• Fortitude• Willingness to learn• Desire to have purpose, do

worthwhile work and make a difference

-A Culture of High Performance Quint Studer

You Can Only Take Someone as Far as You Take Yourself

• Find your connection and stay there• Leaders set the strategy and expectations• Keep a sense of urgency• As a leader, YOU must go first• Become an “always” leader• Transformation begins with transformational leaders

Tips -

• Ability to endure adversity• Capacity to experience and process emotions from

difficult life experiences• Psychological strength to rebuild after loss, tragedy or

unexpected change• Capacity to problem-solve in high stress circumstances

- Coutu, “How Resilience Works”, HBR

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Stay Resilient

Notice the Miraculous –

• Peaceful Workplace• See the good in others• Appreciate Humor• Share your stories• Inspire forward

“Practicing gratitude awakens our senses, stirs our spirit

and opens our heart”

Gratitude Changes Everything

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Become a Champion of Change -

Inspire and Motivate

“A leader takes people where they want to go. A great leader takes people where they don’t want to go, but ought to be.”

- Rosalynn Carter

Hhmmmmm..

Thank You for the Difference

YOU Make in the Lives of

So Many

Pam Beitlich, DNP, ARNP, RN, NEA-BC

Studer Group International Speaker

Pam.Beitlich@studergroup.com

850-439-5839

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.Bridges, W. (2003). Managing Transitions: Making the most of change. (2nd Ed.).Cawsey, T. Deszca, G., Ingols, C. (2011). Organizational Change: An action oriented

toolkit. Thousand Oaks, CA: Sage.Heath and Heath (2010). Switch: How to Change Things when Change is Hard.Kotter, J. P. (1996). Leading change. Boston: Harvard Business Press. Kotter, J.P. (2002). The heart of change. Boston: Harvard Business Press. Kotter International (2012). Retrieved from: http://www.kotterinternational.com/our-

principles/changesteps/changestepsLewin, K. (1947).Frontiers of Group Dynamics: Concept, method and reality in social

science, social equilibria, and social change. Human Relations, 1,5-41.Ritter, J. (2012). Resistance to change and change management. In N. Borkowski (Ed.),

Organizational behavior in health care (pp. 373-397). Boston: Jones & Bartlett. Rogers, Everett M. (1983). Diffusion of Innovations. New York: Free Press.Studer, Quint. (2014). A Culture of High Performance. Firestarter Publishing.Zenger | Folkman Company. All rights reserved. UWMC.PM-CCDG.EL4.0 Rev 05.02.06

References and Resources