In Changing Times

Recently, we made some changes in our management team in an effort to operate more efficiently and be responsible stewards of our resources as our mission demands. Changes like this are always difficult, especially when impacting several long-term dedicated employees. During these types of changes, retention always remains a concern of leaders with a focus on keeping our talented team members engaged in our mission, vision and values. Our field, like many others, continues to have ongoing challenges around quality, compliance, safety, service, financial performance and growth. Our leaders and associates need to continuously build on their skill-sets to meet the ever-growing demands and changes. I want to thank our associates for all their support and efforts in meeting these demands. Without question, we have a strong organization that holds our senior management accountable. This is why I enjoy coming to work each and every day. There is not a day that goes by that I do not get a sense of my own personal and professional growth. If you ask me, this constant challenge is what also makes our industry and those we serve such an exciting and fulfilling endeavor.

I was reading an article on the 10 Principles of Change Management from a few years back by John Jones, DeAnne Aguirre and Matthew Calderone. Please let me know what you think. Though it is a little longer than usual for a blog entry, it certainly seemed worth sharing. I look forward to your thoughts and some of the challenges and solutions that you and your company face around change.

10 Principles of Change Management:

Way back when (pick your date), senior executives in large companies had a simple goal for themselves and their organizations: stability. Shareholders wanted little more than predictable earnings growth. Because so many markets were either closed or undeveloped, leaders could deliver on those expectations through annual exercises that offered only modest modifications to the strategic plan. Prices stayed in check; people stayed in their jobs; life was good.

Market transparency, labor mobility, global capital flows, and instantaneous communications have blown that comfortable scenario to smithereens. Successful companies, as Harvard Business School professor Rosabeth Moss Kanter told s+b in 1999, develop “a culture that just keeps moving all the time.”

This presents most senior executives with an unfamiliar challenge. In major transformations of large enterprises, they and their advisers conventionally focus their attention on devising the best strategic and tactical plans. But to succeed, they also must have an intimate understanding of the human side of change management — the alignment of the company’s culture, values, people, and behaviors — to encourage the desired results. Plans themselves do not capture value; value is realized only through the sustained, collective actions of the thousands — perhaps the tens of thousands — of employees who are responsible for designing, executing, and living with the changed environment.

Long-term structural transformation has four characteristics: scale (the change affects all or most of the organization), magnitude (it involves significant alterations of the status quo), duration (it lasts for months, if not years), and strategic importance. Yet companies will reap the rewards only when change occurs at the level of the individual employee.

Many senior executives know this and worry about it. When asked what keeps them up at night, CEOs involved in transformation often say they are concerned about how the work force will react, how they can get their team to work together, and how they will be able to lead their people. They also worry about retaining their company’s unique values and sense of identity and about creating a culture of commitment and performance. Leadership teams that fail to plan for the human side of change often find themselves wondering why their best-laid plans have gone awry.

No single methodology fits every company, but there is a set of practices, tools, and techniques that can be adapted to a variety of situations. What follows is a “Top 10” list of guiding principles for change management. Using these as a systematic, comprehensive framework, executives can understand what to expect, how to manage their own personal change, and how to engage the entire organization in the process.

1. Address the “human side” systematically. Any significant transformation creates “people issues.” New leaders will be asked to step up, jobs will be changed, new skills and capabilities must be developed, and employees will be uncertain and resistant. A formal approach for managing change — beginning with the leadership team and then engaging key stakeholders and leaders — should be developed early, and adapted often as change moves through the organization. This demands as much data collection and analysis, planning, and implementation discipline as does a redesign of strategy, systems, or processes. It should be based on a realistic assessment of the organization’s history, readiness, and capacity to change.

2. Start at the top. Because change is inherently unsettling for people at all levels of an organization, when it is on the horizon, all eyes will turn to the CEO and the leadership team for strength, support, and direction. The leaders themselves must embrace the new approaches first, both to challenge and to motivate the rest of the institution. They must speak with one voice and model the desired behaviors. The executive team also needs to understand that, although its public face may be one of unity, it, too, is composed of individuals who are going through stressful times and need to be supported.

3. Involve every layer. As transformation programs progress from defining strategy and setting targets to design and implementation, they affect different levels of the organization. Change efforts must include plans for identifying leaders throughout the company and pushing responsibility for design and implementation down, so that change “cascades” through the organization. At each layer of the organization, the leaders who are identified and trained must be aligned to the company’s vision, equipped to execute their specific mission, and motivated to make change happen.

4. Make the formal case. Individuals are inherently rational and will question to what extent change is needed, whether the company is headed in the right direction, and whether they want to commit personally to making change happen. They will look to the leadership for answers. The articulation of a formal case for change and the creation of a written vision statement are invaluable opportunities to create or compel leadership-team alignment.

5. Create ownership. Leaders of large change programs must overperform during the transformation and be the zealots who create a critical mass among the work force in favor of change. This requires more than mere buy-in or passive agreement that the direction of change is acceptable. It demands ownership by leaders willing to accept responsibility for making change happen in all of the areas they influence or control. Ownership is often best created by involving people in identifying problems and crafting solutions. It is reinforced by incentives and rewards. These can be tangible (for example, financial compensation) or psychological (for example, camaraderie and a sense of shared destiny).

6. Communicate the message. Too often, change leaders make the mistake of believing that others understand the issues, feel the need to change, and see the new direction as clearly as they do. The best change programs reinforce core messages through regular, timely advice that is both inspirational and practicable. Communications flow in from the bottom and out from the top, and are targeted to provide employees the right information at the right time and to solicit their input and feedback. Often this will require overcommunication through multiple, redundant channels.

7. Assess the cultural landscape. Successful change programs pick up speed and intensity as they cascade down, making it critically important that leaders understand and account for culture and behaviors at each level of the organization. Companies often make the mistake of assessing culture either too late or not at all. Thorough cultural diagnostics can assess organizational readiness to change, bring major problems to the surface, identify conflicts, and define factors that can recognize and influence sources of leadership and resistance. These diagnostics identify the core values, beliefs, behaviors, and perceptions that must be taken into account for successful change to occur. They serve as the common baseline for designing essential change elements, such as the new corporate vision, and building the infrastructure and programs needed to drive change.

8. Address culture explicitly. Once the culture is understood, it should be addressed as thoroughly as any other area in a change program. Leaders should be explicit about the culture and underlying behaviors that will best support the new way of doing business, and find opportunities to model and reward those behaviors. This requires developing a baseline, defining an explicit end-state or desired culture, and devising detailed plans to make the transition.

9. Prepare for the unexpected. No change program goes completely according to plan. People react in unexpected ways; areas of anticipated resistance fall away; and the external environment shifts. Effectively managing change requires continual reassessment of its impact and the organization’s willingness and ability to adopt the next wave of transformation.

10. Speak to the individual. Change is both an institutional journey and a very personal one. People spend many hours each week at work; many think of their colleagues as a second family. Individuals (or teams of individuals) need to know how their work will change, what is expected of them during and after the change program, how they will be measured, and what success or failure will mean for them and those around them. Team leaders should be as honest and explicit as possible. People will react to what they see and hear around them, and need to be involved in the change process.

Most leaders contemplating change know that people matter. It is all too tempting, however, to dwell on the plans and processes, which don’t talk back and don’t respond emotionally, rather than face up to the more difficult and more critical human issues. But mastering the “soft” side of change management needn’t be a mystery.

Missed

Over the past couple of weeks I have heard about several "misses:"

"I just missed the rain."
"I just missed an 'eagle' on the golf course."
"I just missed getting into a car accident."
"I just missed your call."
"I just missed you at the event."

It made me think about how some of these "misses" are good and some are not so good.

In the hospital, we sometimes have "near misses." A "near miss" is defined as any process variation in our health care delivery that could have led to an adverse outcome or sentinel event but for any number of reasons, did not.

It’s important to evaluate what we learn from these "misses" or "near misses." We should use it as a means to change a process, plan or behavior.

By the way, for you golf fanatics: you know there was very little chance of you making that "eagle." :)

I look forward to hearing from you and potential "misses" in your personal or professional lives. Are there some lessons you could share?

New Grads

Walking down the hall today, I ran into, or I should say, stopped a group of our new nurse graduates.

To these graduates: I could not help but notice what great energy you all had. Thank you for bringing that energy to St. Joseph Medical Center and St. Mary's Medical Center (our sister hospital). You all had some great questions and I appreciated all your open and honest feedback.

Sorry for holding you up as you were en route to your education orientation. Thank you again for joining St. Joseph and St. Mary's. We are so pleased to have you here. I look forward to working with you. Keep those great spirits with you.

I look forward to hearing some 'new grad' stories so we could share...that includes those of you who are well past your new grad status.

Losing Sleep

On Wednesday, we had the opportunity to host the Kansas City Metropolitan Healthcare Council (KCMHA) District 2 meeting. Thank you to Julie Quirin, Council President, and to all of the executives who were able to attend.

It was great to hear updates from Tom Bell (Kansas Hospital Association), Mike Dunaway (KCMHA), Brian Woolley (Lathrop & Gage) and Marc Smith (Missouri Hospital Association). Marc will retire from his role as President and CEO this year and we wish him well in all his future endeavors. He has been a dynamic leader and a fierce advocate for Missouri hospitals and we will miss his leadership.

The featured speaker at our meeting was Martie Ross, who presented information on RAC Audits and new HIPAA regulations. For those unfamiliar with RAC, it stands for the Recovery Audit Contractor program which is charged with auditing and detecting improper payments made on claims of health care services provided to Medicare beneficiaries. RAC requests and reviews are a subject of great interest to hospital administrators, as you might guess. Our speaker noted that this relatively new program raises a great number of questions concerning procedural strategy.

How will we track RAC requests and deadlines?
What checklist will we use to gather the records?
Who will be responsible for gathering responsive records?
What format will we use to produce the records?
Where do we send the response?
How will we track the response?
What happens if we need to file an appeal?

All these questions are enough to keep a hospital CEO up nights and I have only listed a few of the ones presented!

While we all have our individual opinions on running our particular healthcare organizations, one thing remains constant – the ongoing challenges and complexities we face on a daily basis. Our number one focus will always be around providing the community we serve optimal and effective care. Thank you to our hospital and healthcare system leaders for the strength they show in managing their system’s operations.

I look forward to hearing from you and what makes you "lose sleep at night" around your business’ operations.

Your Personal Effectiveness

A few months ago, I was in an interview with a candidate for our VP of Strategic Planning and Business Development. A few members of our executive team participated in the interview. Our Chief Nursing Officer (CNO) asked the candidate, "How do you evaluate or assess your personal effectiveness?"

Great question (those of us interviewing the candidate were glad we were not put on the spot for that question). Our CNO later shared with me that she views "personal effectiveness" as the value one brings to an organization along with the balance one values in their personal life.

Many of us look at our health as one of the key things we value and need to balance in our lives. We look toward healthcare providers as resources to help us. One of our employees shared the following email with our Radiology team (of course, her name has been left out for privacy).

Cheryl:
Just wanted to send a quick note……I had a mammogram this a.m. and your staff was fabulous!

1) Hannah asked for my driver's license and insurance card upon registration--even with my employee ID on. (Compliant with Red Flag Rules!)

2) They placed the ID Band on me, which I don't recall with prior visits, but could have happened before. (Compliant with ID Banding!)

3) Misty checked my name and birthdate prior to performing the exam. (Compliant-National Patient Safety Goals of two-IDs)

4) They were just delightful in personality, as well.

I know people are quick to complain when things go wrong, but I like to let others know when they have done a job well!

This really showed me the "personal effectiveness" that our team displayed toward their co-worker and patient. Thank you team.

Wondering about that interview? We hired the candidate and she has been a great addition to our team.

How would you evaluate or assess your personal effectiveness? I look forward to hearing from you.

Scholarships

The significant problems we face cannot be solved at the same level of thinking with which we created them.
--Albert Einstein

Recently the Missouri Hospital Association offered scholarships to MHA-member hospital employees seeking education or training for any accredited certification, vocational or degree program. Recipients received up to 50 percent of tuition and academic fees up to a prescribed amount per year. I am so proud to let you know that four of our employees have received a Missouri Hospital Association Scholarship. Congratulations to Jennah (Admissions Unit), Lisa (Nursing Education), Megan (Well Life), and Lori (Pharmacy).

Non-Negotiables

A couple of days ago, I participated in a Joint Commission Mock Survey. The Joint Commission (TJC) accredits and certifies more than 16,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. Simply put, TJC reviews a healthcare facility’s compliance with a set of rules that ensure patient’s health and safety:

Typically a TJC review involves pulling at least 12 months of continuous data to check on compliance. Several Joint commission requirements align with CMS (Center for Medicare and Medicaid Services) Conditions of Participation. CMS is the U.S. federal agency which administers Medicare, Medicaid, and the Children's Health Insurance Program.

As part of the initial discussion, we learned of the various levels around the Environment of Care, Life Safety and Emergency Management Standards:

Level 1: an immediate threat to health and safety

Level 2: a situational or decisional rule

Level 3: direct impact requirement

Level 4: indirect impact requirement

The presenter spoke about Level 1, 2, and 3 being like picking up $100, $50, and $20 bills, respectively. Level 4 were the pennies. Not that the pennies are not important, but they just become a lower priority to ensure that you pick up the larger bills. While we all know that little things count, we also know that the big things can shut us down. In this case, the Level 1 immediately would stop the Joint Commission survey with a preliminary denial.

The key seemed to be, how do we stay focused on the most critical things first? Earlier this week I spoke about things patients value most.

My neighbor shared a funny story with me:

A man showed up to work one day with no clothes on. His boss was outraged, of course, and demanded the man explain himself.

“I was so busy this morning!” the employee said. “I had to shower, get the kids ready, put on coffee and a million other things! I had every intention of getting dressed, but just did not have the time to put on my clothes!”

In our busy, hectic days, how do we stay focused on the “non-negotiables” – things which must happen? Do you have a daily plan to ensure you handle the highest risks and priorities?

I look forward to hearing about the “non-negotiables” in your business or personal life.

The Ceremony

This past weekend, I was fortunate to witness a marriage between two people of different cultural and religious backgrounds. What was most fascinating to me was how the cultures were able to be combined into a crisp ceremony which brought out the key and most important elements for all to witness..the legal union of a couple.

As an attendee at this ceremony, I could not help but think that there must have been a lot of focus on making sure all the "key players" (in this case family, friends, religious leaders, musicians, caterers, bridesmaids, groomsmen) and "perspectives" (e.g., the different cultural and religious beliefs) were considered prior to the actual ceremony.

In the hospital world, we all seem to understand the need to provide a great experience for our patients. When you think about it, most of our patients really value these seven things:

• Quality of care and safety
• Respect: an individual and their time
• Communication
• Pride and Spirituality
• Coordinated care
• Facility
• Cost

Many of the same things our patients value in our hospital are the same things they value outside of the hospital...

Getting back to the ceremony: first of all, we all know that cost plays a part in a wedding, but that is often understood and accepted as long as the other values are met. The wedding took place in a beautiful facility. But what mattered even more was that the room where the ceremony took place was perfectly set-up to create a warm and inviting environment for the marriage.

The designated food was extremely important and there were two different caterers to ensure the quality and safety of the food preparation. The ceremony and speeches during the dinner really showed the respect that everyone had for each other as individuals.

There was so much coordination throughout the evening and it was so well orchestrated. In the program and throughout the ceremony and celebration, the religious leaders communicated what was happening and why and how it would have a positive impact on our marrying couple. There was a pride in sharing both cultures' viewpoints and traditions. Amazingly, the program was similar to an operational tactical plan. It really explained things well and helped shape the overall experience of the ceremony. The end result was the happiness, safety and protection of the couple. It was such an inviting event. It reminded me of the time when I worked for a Michigan hospital and we set up an interfaith meditation room. The VP of Mission Services, at the time, shared with me that she wanted the room to represent one key value: "We Welcome All."

Our hospital also has many "key players" and "perspectives" which we must consider before delivering care to our patients. We strive to stay focused on those core values for our patients. Every day, there are opportunities to lose focus on these things our patients value most. Therefore, every day we continue to challenge the way we do things and remember why we do them. We constantly try to work together even with our different backgrounds and perspectives. As it was for the couple I mentioned, we continue to strive for the safety, protection and happiness of those we serve.

As always, I look forward to your thoughts and comments. Let me know if there are some other key things you think patients value most.

Like Riding a Bike

Well, today I was on vacation and went for my first bike ride on a road bike. I must say that I was a little nervous at first since you hear about a lot of bike crashes. As a runner, I am used to being closer to the ground.

Getting ready for the ride felt similar to getting prepared for a day in the hospital - like what we expect for our patients going through our system (e.g., emergency room, radiology, surgery).

We put together "The Plan." Many support areas were involved in our preparation...Nutrition Services (my Clif Bar), Laundry (my clothes), of course the vendors (my bike and helmet), nursing (lotion for my face to prevent sun exposure) and X-ray (the local hospital) was on stand-by. We even had a "time out" with the "physician" (in this case my father-in-law) to see that we remembered everything for the journey.

We discussed the plan and mapped out where we expected to go and the route to get there. We discussed potential obstacles along the way and how long it would take to get through the ride (e.g., hills, gravel roads, crosswalks).

In our ER at St. Joseph Medical Center, we are working on decreasing the average patient length of stay by half. While it may take us several months to get there, we constantly look for ways to improve the patient experience and the overall processes. About 85% of our patients go home the same day so it is reasonable to expect that we should be able to decrease the time they are here with the same or better outcomes. We are looking at the entire process and experience from time of arrival until discharge. Many support areas are involved in making this happen.

Back to my ride...did I remember to say that we forgot the tire pump as our one member of our "medical team" had not had a flat tire in the past while on this ride? We had to stop our ride short. I bet the pump will be brought along in the future.

While we may not be prepared for every situation, one thing we know for sure: if we get a little bit better every day in our ability to anticipate and improve processes, we will surely improve ourselves along with those we serve. Just striving for a "cumulative" 1% improvement every day will show a 365% improvement throughout the year.

It is certainly not a failure if you do not achieve what you expect every time. Learning and building on that experience will make us stronger each and every day.

I look forward to hearing from you.