Template for Leading Through Chosen Change MGMA Scott Foster

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Share Success Stories “What caused these conversations to go well?” “What could have made it go better?

People Resist Change When: •They believe it is unnecessary or will make the situation worse. •They fear that the change will mean personal loss of security, money, status, friends, freedom, and so forth. •They don’t like the way the change was introduced. •They had no input into the decision. •The change was a surprise. •They are not confident that the change will succeed. •They feel manipulated because the changes were kept secret during the planning stage. •The timing of the change was poor. •They subscribe to the belief that “if it’s not broken, don’t fix it.” •They believe that you don’t have the necessary resources to implement the change.

People Support Change When: • They expect that it will result in some personal gain. • They expect a new challenge as a result. • They believe that the change makes sense and is the right thing to do. • They were given an opportunity to provide input into the decision. • They respect the person who is championing the change. • They believe that it is the right time for the change.

The Change Process

Key Inputs for Success

VISION- When You see Confusion, ASK: 1. Is the vision clearly articulated? 2. Do people understand the reason for the change? 3. How do you know that they do or do not understand? 4. Have you articulated the vision in consistent terms, in multiple media sources, over a long period of time? 5. Are all levels of the organization communicating the reason and need for change in the same way? 6. Are front line managers communicating it as enthusiastically as senior leaders? (Staff will take cues from their immediate boss.) 7. Are the messengers seen as credible and honest or have they backed down from initiatives in the past?

VISION- Things You can do: 1. Be willing to break old relationships to get new and fresh ideas. 2. Clearly and succinctly articulate the reason for the change and the vision for the future. 3. Articulate the advantages or possibilities of the new way rather than dwelling on the “take aways.” For example, you could say, “The new north/south structure will allow us to compete together rather than against each other.” Or “The new neurosciences product line will allow us to concentrate some high tech resources to be able to take care of patients we would previously had to send out of network.” 4. When people talk about “we’ve tried that before,” help them recall how things have changed over the past few years and the plan is being implemented in a totally different environment. 5. Remind people of the facts of our current financial and satisfaction position. Maintaining the status quo is not an option.

SKILLS When you see anxiety ask yourself: Things to consider: 1. Does this person currently have the skills to function in the new environment/role? 2. If they do not currently have the skills, do they have the ability and/or the desire to acquire them? 3. Are they afraid they will look “dumb” learning a new role? 1. When people exhibit anger or negative reaction that seems disproportionate to the situation, consider that they may be afraid of something. They may be afraid of losing status, control, etc.

SKILLS- Things You can do: 1. Give people the facts about the training or transfer options that are available to them. 2. Provide shadowing or mentoring opportunities as appropriate. 3. Select mentors who have patience and the ability to teach. This will not always be the “best” clinicians or staff member. Sometimes things come very easily to “the best” and they cannot relate to someone who struggles or is learning. 4. Be willing to change leadership, partners, or staff. 5. Listen to the employees’ fears and concerns. Reassure them that such fears are normal and expected during early stages of change. However, remaining stuck in these fears is not healthy for the individual or for the organization.

INCENTIVE Things to consider: When you see gradual change (when rapid change is expected) ask yourself: Things to consider: 1. Does the person see a value/reason for the change? Why should they change? 2. Do they feel the change is worth the effort? 3. Do they feel that they are able to make the change you want them to make? 4. Have you created a sense of urgency? 5. Are people “bogged down” in trying to reach consensus? 1. If people want to maintain the status quo it is very unlikely they will believe anything you say to get them to change their mind.

INCENTIVE- Things You Can Do 1. Personal experiences are the primary way to get people to change their mind. Can you put the person in a situation where they will feel the benefit of the change? 2. The second best way to get people to change is for them to have a vicarious experience. This can be done by vivid storytelling that allows the listener to feel and empathize with the subject. 3. Help people see the pros and cons of decision making by consensus.

RESOURCES When you see OR HEAR FRUSTRATION ask yourself: Things to consider: 1. Does the person/team have the resources necessary to do what we are asking them to do? 2. Resources include the following: a. Staff – both number of people and skill level b. Time – does the manager have too large of a span of control, have we established reasonable priorities c. Autonomy and/or access to decision makers d. Access to learning/mentoring e. Equipment/tools 1. Managers who performed successfully under the “old” structure and expectations will not necessarily do so under the new structure and expectations.

RESOURCES Things You can do: 1. Manager can set clear expectations to avoid rework, low productivity, etc. 2. Generate list of people who can mentor or help redesign processes. Includes HR, Quality dept., ETC. 3. Share system wide best practices.

ACTION PLAN When you see false starts ask yourself: 1. Does the plan have a champion? 2. Does this manager have an action plan on a macro and micro level? 3. Are they willing to adapt their plan to new and changing information? 4. Are areas of responsibility clearly identified and do the people have the skills and resources necessary to implement the plan? 5. Are they holding themselves and others accountable for the plan? 6. Does the department plan flow reasonably from the entity plan? 7. Are people being recognized and rewarded as they reach milestones in the plan? If not, they may get frustrated or “disenchanted.” THINGS TO CONSIDER: 1. Does the person understand the big picture and where they fit into it?

ACTION PLAN Things You can do: 1. Encourage sharing of best practices. 2. Analyze reasons for false starts and readjust as necessary. 3. Make sure all of the necessary departments are involved in the action plan. Most processes involve multiple departments. 4. Create a sense of urgency. 5. Focus on the long term goal.