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Leading Through Change
Shannon Studden
Program Specialist II
July 18, 2018
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Rural Health Innovations’ Purpose
Rural Health Innovations (RHI), LLC, is a subsidiary of
the National Rural Health Resource Center (The Center),
a non-profit organization. Together, RHI and The Center
are the nation’s leading technical assistance and
knowledge centers in rural health. In partnership with
The Center, RHI connects rural health organizations with
innovations that enhance the health of rural
communities.
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Upcoming Initiatives
• Create a culture of learning
• Develop capacity of local EMS to deliver classes
• Develop capacity of hospital Laboratory
departments to provide hands-on components
of MLT/MT curriculum
• Expand relationships with health care facilities
• Create/expand local or regional health care
academy
• Create a Workforce Development Committee
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More Upcoming Initiatives
• Identify services that will be discontinued
following grant period
• Promote collaboration between entities that are
competitors
• Hand off leadership of stakeholder group
• Develop a pilot program to provide
transportation to health care appointments
• Find solutions to barriers that arose during
grant period
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You Know How!
• Created a Bachelor’s degree program
• Built relationships with academic institutions
• Built relationships with health care facilities
• Increased awareness of Allied Health disciplines
• Convinced educational partners to expand
programs to rural sites
• Collaborated with local community college to
expand high school health care career academies
• Convinced employers and job seekers to use
website for employment (ruralhires.org)
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You Really Do Know How!
• Broadened scope of traditional health care
network participants
• Educated 229 people on EMS-related topics
• Increased number of EMT students passing
the state exam
• Implemented CHW training program
• Created Health Care Academy offering
CE/CME to rural health care organizations
• Implemented school-based health center
management
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Questions We’ll Answer
• Why do people react differently to change?
• How can we help others navigate the change
process?
• How can we manage our own emotions during
the change process?
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Rider vs Elephant
Rider: Rational
Elephant: Emotional
Jonathan Haidt, The Happiness HypothesisChip and Dan Heath, Switch
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Recent Research on Emotion
Clinical Decision Making
Providers’ clinical decisions are influenced by their own emotions, particularly anxiety, stress, fear, and denial (Kozlowski et al.)
Behavioral Economics
When we’re feeling sad, we’ll pay higher prices than when we’re feeling disgusted (Lerner et al.)
Emotional Contagion
Nurses implementing a Shared Governance initiative “caught” emotions from their colleagues, influencing perceptions of the intended change (Bartunek et al.)
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Change Curve
Kubler-Ross, E., 196910
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The Journey Through Grief
The Journey Through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation
Scheck McAlearney et al., 201511
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Change Curve: Denial
“It’s probably been one of the most unsettling things I’ve seen for physicians throughout our entire system.”
Scheck McAlearney et al., 2015
Denial
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Change Curve: Anger
“By the time you’ve actually done all that, your patient encounter is halfway over.”
Scheck McAlearney et al., 2015
Anger
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Change Curve: Bargaining
“Why do we need a cover letter? Isn’t it enough if I add a progress note?”
Scheck McAlearney et al., 2015
Bargaining
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Change Curve: Depression / Trap Door
“The first two weeks, I could have quit medicine.”
Trap
door of
despair
Scheck McAlearney et al., 2015
Depression
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Change Curve: Acceptance
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Acceptance
“I have all I need at my fingertips. I think it’s a great system.”
Scheck McAlearney et al., 2015
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Why do people react differently to change?
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Reasons for Different Responses to Change
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Difference in Circumstances
• Input during the change process
• Understanding
• Nature of the change
• Impact of the change
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Areas of Impact
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Technical: Resources & Knowledge
Does the organization have the technical resources
I need? Do I know enough?
Political: Power & Influence
How much power will I have to affect my
environment?
Cultural: Values, Norms, Mindsets
What’s important to me? How are things normally
done around here?
Tichy, 1982
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Differences in Personal Characteristics
• Experience with the topic
• Openness to experience
• Comfort with ambiguity
• Anxiety
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How can we help others
navigate the change process?
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Appeal to the Rider and Elephant
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Riders without
elephants: Understanding
without motivation
Elephants without
riders: Passion without
direction
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Denial
• Manage expectations (“the party’s over”)
• Make the case for quality
• Communicate the vision
Scheck McAlearney et al., 2015
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Denial
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Anger
• Acknowledge difficulties and affirm support
• Communicate the vision
• Form a coalition or find a champion
Scheck McAlearney et al., 2015
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Anger
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Bargaining
• Listen to and implement suggestions
• Acknowledge competing priorities
Scheck McAlearney et al., 2015
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Bargaining
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Depression
• Allow time to adapt
• Reiterate support
Scheck McAlearney et al., 2015
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Depression
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Acceptance
• Reaffirm positive statements
• Continue to ask for input
Scheck McAlearney et al., 2015
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Acceptance
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Addressing T, P, and C
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Addressing Personal Characteristics
Less experience
• Time to absorb and adapt
• Direct support
Less comfort with ambiguity, higher anxiety
• Defined plan
• Clear end vision
• Frequent check-ins
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Don’t Forget
• You may be farther along than they are
• Fundamental attribution error
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How can we manage our own emotions during
the change process?
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Manage Your own Elephant
• Pause
• Acknowledge feelings
• Avoid judgement
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Where are you Stuck?
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Technical: Resources & knowledge
Political: Power & influence
Cultural: Values, norms, mindsets
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When You’re REALLY Stuck
• What’s the story?
• What are some alternative stories?
• If a given alternative story is true, how might
you respond?
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Helpful Resources
Books
• Susan David, Emotional Agility: Get Unstuck, Embrace Change, and Thrive in
Work and Life
• Chip & Dan Health, Switch
• Daniel Kahneman, Thinking, Fast and Slow
• John Kotter, Our Iceberg is Melting
Podcast
• Hidden Brain, March 12, 2018: Daniel Kahneman: On Misery, Memory, and Our
Understanding of the Mind
Blog Post
• Marshall Goldsmith: Learn to Respond, Not React!
National Rural Health Resource Center Website
• www.ruralcenter.org
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References
Bartunek, J., Rousseau, D., Rudolph, J., & DePalma, J. (2006). On the receiving end: Sensemaking, emotion, and assessments of an organizational change initiated by others. Journal of Applied Behavioral Science, 42:2.
Bridges, W. (2003). Managing Transitions: Making the Most of Change. Philadelphia: DaCapo Press.
Kozlowksi, D., Hutchinson, M., Hurley, J., Rowley, J., & Sutherland, J. (2017). The role of emotion in clinical decision making: An integrative literature review. BMC Medical Education, 17:255.
Kubler-Ross, E. (1969). On Death and Dying. New York: MacMillan.
Lerner, J., Small, D., & Loewenstein, G. (2004). Heart strings and purse strings: Carryover effects of emotions on economic decisions. Psychological Science, 15:5.
Scheck McAlearney, A., Hefner, J., Sieck, C., & Huerta, T. (2015). The Journey Through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation. Health Services Research, 50:2.
Tichy, N. (1982). Managing change strategically: The technical, political, and cultural keys. Organizational Dynamics, 11(2), 59-80.
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Get to know us better:http://www.ruralcenter.org
Contact Information
Shannon Studden
Program Specialist II
218-216-7044
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