1. Change: Are you Swimming Staying Afloat, or Sinking? Jane Brandes RN MSN Twilla Harrington RN BSN CHPN WCC Providence Hospice September, 2014

2. Objectives On completion participants will understand their own personal change attributes Participants will be able to recognize how their change attributes impact change Participants will be able to utilize change theory as tool to successfully implement change

3. Change – noun a transformation or modification; alteration the substitution of one thing for another –verb to become different to become transformed or converted to substitute another or others for; exchange for something else, usually of the same kind

4. Strive for Balance Change and Loss make people feel out of balance

5. Change Personality Style What animal did you pick ? Why? What personality attributes do you feel you have in common with your animal?

6. Change Personality Style The Embracer/Activator Moves toward the change Manages multiple tasks Likes to be busy Learns quickly and adapts rapidly Thrives on uncertainty Becomes board easily – restless Needs a great deal of freedom Thinks “big picture” Often overlooks details Can be a controller

7. Change Personality Style The Aggressor Fights the Change (actively or passively) Often has “us vs. them” attitude Does not do well in new social situations Not motivated by recognition Will resist change on behalf of others Does not like uncertainty Usually has a committed group of friends Can be very black and white in thinking

8. Change Personality Style The Denier/Avoider Moves away from change Is a creature of habit Makes lists for lists Does not like uncertainty Can easily be swayed by the aggressor Does not like conflict Able to focus on the same task for long periods Often very detail oriented

9. Using Change Personality for Practice Improvement Time of Death Visits Background Project Goals

10. Types of Change 4 types of change: transformational, incremental, remedial, and developmental (McNara, 2006). Application of Kotter's Approach to Change

11. Kotter’s 8 Stage Change Process 1.Establish a sense of urgency 2.Creating a guiding coalition 3.Developing a vision and strategy 4.Communicating the change vision 5.Empowering employees for broad based action 6.Generating short term wins 7.Consolidating gains and producing more change 8.Anchoring change

12. Establishing a sense of urgency Key change in leadership and staff Feedback from family Regulatory Climate Attending 33% of TOD visits Key time to engage the denier/avoider and aggressor change personality

13. Creating a guiding coalition Developing a team charter Charter members were leadership, staff, and supervisors Purposeful recruitment of all change personality styles

14. Developing a vision and strategy Vision: To increase visits at time of death. Strategy: Improving team communication Data collection Survey reviews Education Having a diverse team with differing change personalities helped to develop a more comprehensive vision and strategy.

15. Communicating the change vision Newsletter Staff Meetings State of the union “To provide the best possible care for our patients and families our goal is to attend 100% of TOD visits”

16. Empowering for action Newsletter articles focusing on the importance of TOD visits Lunch and Learn for peer to peer discussion of best practices at TOD visits Staff handout that covers the therapeutic effect TOD visits can have on the grief process The key to this step was having staff with different change personalities engaging other staff.

17. Generating short term wins Ongoing feedback to staff on how our TOD visit completion rate Our TOD visit rate had doubled from 33% to 60% Continued reinforcement through discussion at meetings and the newsletter on the “urgency” of making this change

18. Consolidating gains and producing more change TOD visits consistently at 60% still needed a 40% improvement to meet the charter goal Charter team decided to re-message and create more urgency After re-messaging TOD visits has jumped to 98-100%

19. Anchoring change Celebrate success Ongoing reports to monitor success Continue sharing stories of how TOD visits impact families

20. Conclusion Identification of your change agent style can help you understand your reaction to change Using a model for change can help integrate change in a consistent successful way

21. References Kotter, J. (1996). Leading Change. Harvard Business School. McNara, C. (2006). Field Guide to Consulting and Organizational Development: A Collaborative and Systems Approach to Performance, Change and Learning. Authenticity Consulting.