managing change: when a hammer won’t fix everything it’s tool time ! judy a. cordeniz, mha,...
TRANSCRIPT
Managing Change: When a hammer won’t fix everything
IT’S TOOL TIME !
Judy A. Cordeniz, MHA, FACHEVice President Strategic Planning
Holy Rosary Medical Center, Ontario, OR
October, 2007
Presentation Overview
The elements affecting healthcare that are prompting a rapid change approach
Setting up for successful change
Skills Inventory
Routine maintenance of change
Elements effecting change (or there used to be space for an engine to
breathe under the hood!)
Complexity, technology, plus regulatory, consumer and competitive demands are giving cause to many a scraped knuckle
Expectations Requirement of CONSTANT high performance and efficient productivity crowd out the chrome
The quarter mile is no longer a straight line
Elements effecting change (AND keys used to be required to start an
engine!)
Changing work force Silent (1925-42) 63 million
Ready- Ready- Ready-Aim-Fire Baby Boomers (1943-61) 77 million
Ready-Aim-Fire Gen X (1962-81) 44 million
Ready-Fire-Aim [Learn, Experiment,Adapt] Gen Y (1982-98) 70 million
Fire-Fire-Fire-Aim-Fire [x-Box]
Elements effecting change
Generational differences Communication styles Work styles Attitudes about work/life balance Comfort w/ technology Views re: loyalty and authority Acceptance of change
Elements effecting change(never did like those stock mufflers!)
Silent BB Gen X Gen Y
Outlook Practical Optimistic Skeptical Cautious
Work Ethic Dedicated Driven Fee Agent ?
Authority Respectful Challenge Unimpressed ?
Leadership
Relationships
Hierarchy
Self sacrifice
Pay your dues
Personal Gratification
Competence
Reluctance to committee
?
Inclusive
Elements effecting change
FOR SALEOr Lease
Or Joint Venture
Or Merge
Or Outsource
Or Buyout……
$$
$
$
$$
Setting up for successful change
What’s in YOUR garage! Who are the change agents in your organization? Officially &
Unofficially
Are their skills current or do they need a tune up?
Do the efforts around the changes being made tie into the overall objectives of the strategic plan?
Setting up for successful change
What’s in YOUR tool box? Top Drawer
When to use the tried and true – (screwdrivers & pliers)
Flow Charting
Cause & Effect (Fishbone)
EffectEffect
MaterialMaterialPeoplePeople
MachinesMachines MeasurementMeasurement
Type of MaterialType of Material
AttributeAttribute
When problem solving: To understand what When problem solving: To understand what may be causing the results you don’t want – may be causing the results you don’t want – the root causes.the root causes.
SWOT & Brainstorming
Strengths Weaknesses
Opportunities Threats
Easy Doable Stretch
Tool Box Inventory
Plumb lines, stud finders & other gizmos:
When to bring out the laser tape measure
Charts, bars and data points
1 1.031.09
1.44
0.88 0.880.77
0.970.85
0.68 0.68
0.86
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Median 0.93
Infe
cti
on
Ra
te
Nosocomial Infection Rate
Tool Box Inventory
When you need more than just the owner’s manual!
A-M-C and PDSA
Accelerated Processes Work Out Lean Six Sigma
Formula for results
Q x A2 = E
Effective results (E) are equal to the Quality (Q) of the solution times the Acceptance (A) of the idea and Accountability (A) of the implementation.
Accelerated Change Processes
High level focus w/ a Champion (sparkplug)
Gets everyone on the same page
Focuses on the “A” (Acceptance) in QxA2=E
Stimulates dialogue w/ simple tools & defines actions
Makes the change stick
What are you trying to accomplish?
How will you know if you are successful?
What are the changes you think will result in improvement ?
P
D
S
A
Aim
Change
Measure
Aim-Measure Change Model
The process ___________ is important to work on now The process ___________ is important to work on now because ________________________________________because ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________Measure/s: ______________________________________Measure/s: ______________________________________Goal: __________________________________________Goal: __________________________________________Guidelines, boundaries or constraints: Guidelines, boundaries or constraints: ______________________________________________________________________________________________Process inputs:___________________________________Process inputs:___________________________________Process outputs:__________________________________Process outputs:__________________________________Stakeholders: ____________________________________Stakeholders: ____________________________________
Aim for Process Improvement
How will we know the change is an improvement?
•Develop measures:
•Outcome Measures
•Process Measures
•Measures provide
•Direction
•Learning
•Evaluation
•Balance
Aim:Aim: Decrease the rate of Decrease the rate of harmful falls on the 3harmful falls on the 3rdrd floor floor
Outcome measures:Outcome measures: Decrease Decrease falls by 50% from 6.3 to 3.15.falls by 50% from 6.3 to 3.15. or increase intervals between or increase intervals between falls.falls. Process measure:Process measure: Falls risk Falls risk assessment done at time of assessment done at time of admissionadmission
What changes can we make that will result in an improvement?
• Idea sources• People who work in the process
• Subject-matter experts and relevant data
• Evidence-based research
• Process benchmarking
• Methods to Generate Ideas• Study and use flow chart to identify complexity, redundancy,
duplication, and non value-added work• Cause & Effect Diagram• Brainstorming
Worksheet
PDSA Cycle
PDSA CyclePLAN: based on theory/prediction
ACT:adoptadaptabandon
DO: small scale
STUDY: to learn. Theory confirmed? 55
Plan-Do-Study-Act
Plan
Objective of cycle
Predictions
Plan to carry it out
Who
What
Where
When
Do
Carry out the test (small scale)
Problems encountered, unexpected observations
Begin analysis of data
Study
Compile analysis of data
Compare data to predictions
Summarize what was learned
Act
What changes are to be made?
What will be the next cycle?
Accelerated Processes
Examples:Work-Out™ Six SigmaAddresses passionate issues/problems Statistically drivenPeople who do the wok determine Rigorously analytical the improvements “Customer” defines defectsIssues are specific & well-defined Addresses variations Decision-makers provide immediate Facilitated by a Maste Black closure Belt/Black Belt/Green BeltStarts with quick fixesUses trained facilitators30-60 day fixes
Work-Out™ road Map
ChampionScope
IdentifyProblems
Identify Solutions Action Plan
YesNo
Need Info
4-6 hours
Work-Out™ SessionOwners Manual Table of Contents
Introductions/Race Rules ……………………………….
Identify a Shared Need ………………………………………..
Why we are here? What are our objectives? Goals? Why do we need
to made the change?
Develop a Shared Vision ………………………………………
What is in scope? What is out of scope? What do we want more of?
Less of?
Jump Start Commitment …………………………………
The Willing, The Vacationers, The Prisoners
Unaware Aware Understand Collaborate Commit Advocate Plan for Improvement
Hear Ye, Hear Ye…..
The Elevator Speech
What our project/meeting/task force is about……
•Why it is important to do ………………..…
•What success will look like ……………
•What we need from you …………
Communicate***Communicate***Communicate
Work-Out™ SessionOwners Manual Table of Contents
Making Change Last …………………
Face the opponent – What will hinder the change?
Fuel the accelerant – What will help make the change?
(AKA Force Field Analysis)
Keeping the Momentum ………………………
ACTION PLAN: Who, What, Measure, When
Agree on the key objectives to be monitored (KISS)
Agree on milestones to celebrate, advertise, COMMUNICATE
Stick to the 30-60 days completion plan complete with postmortem
Routine Maintenance of Change
The road test – the tire spikes are plentiful!
Change fails when: a foundation is not firmly established all the stakeholders have not been engaged leadership is not working together there are too many competing initiatives a regular pulse is not taken
Agenda Format
Attendees:
Reflection:
Ground Rules:
Expectations:
Item Discussion Action Point Person Completion Date
Parking Lot Items:
Next Meeting:
Blaming
Complaining
The past is honored not blamed.
References
When I’m 64 http://www.aha.org/aha/content/2007/pdf/070508-boomerreport.pdf
Change Acceleration Process – GE http://www.gecorporatefinance.com/access_ge/briefings.html#businesstools
Recruitment, Retention, and Management of Gen X, Journal of Healthcare Management ; Chicago, Jul/Aug 2002; Judy A. Cordeniz, MHA, FACHE
2007 Healthcare Business Market Research, R.K. Miller & Associates, www.rkma.com
[email protected]; Ph: 541-881-7253 Fx: 541-881-7184
