1. Breakout Session 201: Change & Resistance
Lizza Robb, MSW

2. 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

3. 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

4. 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

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

6. 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.

7. mgma.org/polls

8. 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?

9. 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

10. 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

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

12. 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

13. Resistance
Resistance is energy.

14. 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

15. 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

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

17. 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

18. 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

19. 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

20. Force-Field Analysis DRIVING FORCES (forces for change)
RESTRAINING FORCES (obstacles to change)
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