Breakout Session 201: Change & Resistance Lizza Robb, MSW

POP Model for Purposeful Action Purpose: Why is this important? Why is it a valuable use of my time and energy? Outcomes: What do I hope to accomplish? Process: How am I going to do it? The POP Model for purposeful action comes from Robert Gass’s work through the Social Transformation Project

Purpose: Why is this important? Change is inevitable, unpredictable and unrelenting Managing resistance with intention supports groups to navigate change with openness and resilience How leaders manage change is a core part of their organization’s culture

Outcomes: What we hope to accomplish Understand the cycle of change in organizations Explore how systemic resistance manifests and identify productive responses Discuss several simple change management tools Begin to workshop a current change facing your medical group and leave with a template for further work

Process: How we’ll get there Topics: Cycle of change in organizations Systemic resistance and responses Force-field analysis Format: Teaching Discussion Personal reflection

A few of the Significant challenges facing medical groups Preparing for value-based payment Operating costs constantly on the rise Changing reimbursement models EHR meaningful use Increase in high-deductible health plans Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs.  

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Change in Your Organizations What kinds changes are your medical groups facing? Where do changes most often originate? As a medical group manager, what is within your control?

Change Reflection Activity Describe a specific change that your medical group is currently facing (or preparing to face). What challenge is driving the change? Why is the change important? What purpose does it serve? What are the anticipated outcomes of the change? Who is responsible for implementation? Who in your group will be most effected by the change? Whose buy-in is important for successful change? On your own – 10 minutes Debrief, capture change themes

EXCITE see the challenge Cycle of Change EXPLORE in the dark EXCITE see the challenge EXAMINE get started EXECUTE roll out EVALUATE results EXIT time to move on Closure Awareness Explore: In the dark; this is about sensation and awareness Excite: See the challenge and feel a need to take action Examine: Get started; plan, set goals Execute: Roll out; say, go do it Evaluate: Results Exit: Time to move on to something new

Zeigarnik effect The human tendency to exhaust mental energy on things that have been opened but not closed. Puzzle piece

MAKING A COMPELLING GETTING STARTED CASE TIME TO MOVE ON EXPLORE EXCITE EXAMINE EXECUTE EVALUATE EXIT EXPLORE EXCITE EXAMINE EXECUTE EVALUATE EXIT MAKING A COMPELLING CASE GETTING STARTED EXPLORE EXCITE EXAMINE EXECUTE EVALUATE EXIT EXPLORE EXCITE EXAMINE EXECUTE EVALUATE EXIT Explore excite takes time It’s announced; go do it People have questions they need time and information to catch up This is where resistance shows up TIME TO MOVE ON KEEPING CHANGE ALIVE Rick Maurer

Resistance Resistance is energy.

Level One Resistance: I don’t get it Facts, figures and ideas missing critical information disagreement over interpretation of data confusion about what the data means

Level One Resistance: I don’t get it Provide more information/ data, possibly in a new format RESPONSE Getting upset or defensive when the information is challenged RISK RESPONSE: give people the information they want and need in a language they understand RISK: getting upset or defensive when the information is challenged

Level two resistance: I don’t like it Emotion and Fear Fear is a powerful force for resistance.

Level two resistance: I don’t like it Engage people on an emotional level; empathy RESPONSE Ignore emotional issues by responding with facts and information RISK Response: engage people at an emotional level Risk: ignore emotional issues by responding with facts and information; run or blame

Level three resistance: I don’t like you Mistrust and Suspicion Typical reasons for this type of resistance: history is problematic no follow through in past lacks courage to make tough decisions constant movement seen as a puppet for big boss you represent people they don’t like

Level three resistance: I don’t like you Understand how and why trust has been eroded RESPONSE Thinking this level of resistance and be ‘fixed’ quickly RISK Response: takes time and skill to become more trustworthy remember: the criticism doesn’t have to be true Risk: speech or dramatic event; getting angry, defensive, discounting the resistance

Force-Field Analysis DRIVING FORCES (forces for change) RESTRAINING FORCES (obstacles to change) 5------------------------------------1 1------------------------------------5 Staff dissatisfaction Staff burnout/ fear of unknown Policy mandate Finance director Which driving forces do you harness and how? Which restraining forces do you address and how? Lack of clear directive from top Deadline My workload Staff bright spots