supporting managers through disruptive change€¦ · strategies for coping with the covid-19...

Strategies for coping with the COVID-19 challenge

Supporting Managers Through Disruptive Change

Bec Richmond [email protected]

@BecR27

mailto:[email protected]

© 2019 Advisory Board • All rights reserved • advisory.com

5

Relying on Managers to Bridge the Gap

New Protocol

Goal achieved

Managers must: • Learn and internalize the proposed change themselves

• Introduce and communicate the change to frontline staff

• Develop department/unit-specific timeline and milestones

• Implement new policies, procedures, and process steps

• Help frontline staff understand how their actions impact goals

• Monitor and track adoption of the change over time

• Keep costs within or below budget

“Strategy Execution”

http://www.advisory.com/



6

Representative Change Initiatives from ExecutivesExecutive Asks Often Make Manager Role Harder

CQO CNO CHRO CFO

Culture of Safety

Action Plan

MagnetRedesignation

Action Plan

Engagement Action Plan

Labor Savings Action Plan

Culture of Safety

Magnet Redesignation

Employer of Choice

Cost Savings Initiatives

Number of annual change initiatives at one representative

health care organization BEFORE COVID-19

400

Number of individual change initiatives hitting a manager at any one time

5–15




7

Three Interventions to Stop the Overload

Help Managers Help ThemselvesInvest in developing skills to increase manager capacity

Build Support into Manager RoleAlleviate span of control and workload pressures on managers

Filter Initiatives from AboveControl the stream of new initiatives and unplanned work falling on managers




8

Source: Texas Health Presbyterian Hospital, Dallas, TX; HR Advancement Center interviews and analysis.

Surfacing Demands from Other Departments

Critical Components for Effective Senior Leader – Manager Conversations

Establish a Dedicated Block of Time

1Steer the Conversation Towards Solutions

Create a Safe Space for Managers to Surface Issues

2 3Follow Throughand Communicate Candidly

4

“Conversations with Cole”• 90-minute quarterly meeting• All nurse managers invited• Voluntary, but encouraged

attendance • Open agenda, conversational style

Culture of Connection

“We need to authentically connect with managers and address the things that prevent them from being great leaders.”

Dr. Cole Edmonson, CNOTexas Health Presbyterian Hospital





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Component #2

Create a Safe Space for Managers to Surface Issues

Set Ground Rules Keep strict confidentiality; don’t track attendance or take minutes; let managers suggest other rules

Be Transparent Be transparent about the purpose of the conversation and what nurse managers can expect from leaders

Listen to Managers’ ExperiencesEncourage sharing, listen, and remind leaders to refrain from giving too much unsolicited advice

Exemplify Your Own TenetsModel free and open communication and encourage the same from leaders and managers





11

Steer the Conversation Towards SolutionsComponent #3

How much time do you spend managing __________________each week?

What is a particular pain point caused by other departments?

1

2

In the last six months, is there something another department did that helped address these issues? 3

Starter Question Set

Cross-disciplinary issues





12

Follow Through and Communicate CandidlyComponent #4

CommunicationLoop

Solicit input from managers during regular forums

Honestly report back what will be addressed and how; what will not be addressed and why

Share themes with senior leadership; exclude unit-specific identifying details

Determine action steps with senior leaders





13

Sourcing Actionable Solutions from Managers


Three Components

1 2 3A specific priority that needs manager input

Dedicated working time in meetings

Executive-level participation




14

Component #1: A Specific Priority that Needs Manager Input

Valley Children’s Monthly Leadership Meeting TopicsOctober 2016-February 2017

October

Topic: Transparent budget process

Group discussion: How do we talk about budget approvals and limitations to better engage staff?

November January February

Topic: Staffing

Group discussion: What does our engagement survey data have to say about staffing?

Topic: Strategic planning

Group discussion: How does engaging staff support our strategic plan?

Topic: Resource allocation

Group discussion: How can we use staff input to best allocate resources at the department level?




16

Characteristics of a Challenge That Needs Manager InputChoosing the Right Challenge for Discussion

It will impact managers—either immediately, or in the long-term.

It crosses multiple boundaries—limiting a single executive from having the full picture.

It has not been resolved yet—executives have not decided on a course of action and manager input could still be incorporated.




17

Component #2: Dedicated Working Time in Meetings

Before

Agenda

80% Update

20% Q&A

AfterAgenda

20% Update

80% Exercises and discussion

• Lengthy top-down updates• Disengaging “data-dumps”• Rushed or non-existent

questions from managers

• Digestible updates• Engagement with issues• Meaningful dialogue and

thoughtful questions




18

Breakdown of Valley Children’s Agenda on StaffingValley Children’s Restructured Leadership Meetings

Identify the Challenge or OpportunityShare data to demonstrate that “my unit/department has enough staff” has been a consistent opportunity on the engagement survey

Roundtable Discussion• What causes staffing challenges?• As a leader, what do you have control of

or influence over that impacts staffing?

Brainstorm ResourcesExecutives role play how to have difficult conversations and provide adequate transparency on organizational decisions

9:00–9:15am

9:15–9:45am

9:45–10:00am

Source: Valley Children’s Healthcare, Madera, CA; HR Advancement Center interviews and analysis.




19

Keep Discussions on Track

Source: HR Advancement Center.

Tool 7E: 10 Tips for Troubleshooting Focus Group Pitfalls

Excerpt of the ToolSituation Recommended Technique and

Scripting

Teasing out partially formed ideas: You should clarify and get more information from the participant when you hear a partially formed idea.

“I think I hear you saying…”

“What do you think is causing that to happen? What else?”

“Can you expand on that? Can you tell me about a time when that happened?”

Determining if a new idea has merit: Engage the group to evaluate the idea and determine its relative importance.

“Do others in the room agree with that thought?”

“How many of you feel that this is one of the 2 or 3 most important causes of our problem?”

Access The HR Business Partner’s Guide to Better Solutions at advisory.com/hrac.com




20

Representative Video Town Hall at Texas Health ResourcesComponent #3: Executive-Level Participation

Local Facility DiscussionFacility CNO facilitates in-person discussion with managers to surface questions, concerns, opportunities

15 minutes

System CNE Video UpdateGives an update on a system priority to all facilities at once

15 minutes

System-Wide Virtual DebriefLocal facilities report out to give leaders a system-wide perspective

20 minutes

Source: Texas Health Resources, Arlington, TX; HR Advancement Center interviews and analysis.




22

Rethinking the “Command and Control” Approach

Collaborative Approach

1. Seek input early, before executives make a decision

2. Incorporate manager feedback into solution

3. Agree on a single course of action

Command and Control Approach

1. Senior leaders make an executive decision

2. Cascade decisions down to the manager ranks

3. Invite feedback, largely after the fact




23

Cheyenne Regional’s Criteria for EMR Optimization RequestsWhat We Can Learn From Our IT Colleagues

Gives executives a way to objectively compare proposed changes and make consistent decisions

Considers the people impact of proposed changes

Criteria is weighted based on strategic priorities to give each proposed change a ranking/score

Additional criteria used in tool includes Provider Efficiency, Revenue Impact, and Compliance

Prioritization Criteria

Impact Score Average Score

Resource Conflicts -1 = No internal resources available for timeline proposed1 = Internal resources available for timeline proposed

Patient Safety Ramifications -1 = Decreased patient safety with change0 = No effect to patient safety with or without change1 = Minimal increase to patient safety with change2= Significant increase to patient safety with change

Staff Efficiency -1 = Cost > 5 minutes per day with change0 = No impact with or without change1 = Savings of 0 to 5 minutes per day with change2= Savings of > 5 minutes per day with change

Cost Impact -1 = Increased cost with change0 = No impact with or without change1 = Minimal decrease to cost with change2 = Significant decrease to cost with change

Training Implications -1 = System-wide face-to-face training with change0 = Face-to-face training needed for at least half of users1 = Face-to-face training needed for less than half of users2 = Minimal to no training needs required with change

Source: Cheyenne Regional Medical Center, Cheyenne, WY; HR Advancement Center interviews and analysis.




25

Cheyenne Regional’s Decision CategoriesMake Principled Decisions Based on Criteria

The “No List”(Score: -100 to -50)

Changes not pursued

The “Magic Quadrant”(Score: +101 to +200)

Changes resourced now

On Deck(Score: +1 to +100)

Changes approved, but will be resourced later

On Hold(Score: -49 to 0, or no

resources are available)

Changes on hold, or need more information

Source: Cheyenne Regional Medical Center, Cheyenne, WY; HR Advancement Center interviews and analysis.




26

Lifecycle of a Doomed InitiativeDo Away with the Projects that Won’t Die

Project Behind Schedule…

Project Paused

Key Milestone Missed…

Project Launched…

Project Re-Launched…

Project Behind Schedule…

Zombie Projects“Projects that, for any number of reasons, fail to fulfill their promise and yet keep shuffling along, sucking up resources without any real hope of having a meaningful impact on the company’s strategy.”

–Harvard Business Review

Unanticipated Barrier…

Source: Anthony S, Duncan D, and Siren P, “Zombie Projects: How to Find and Kill Them,” Harvard Business Review, March 2015; HR Advancement Center interviews and analysis.




27

Decide When to Stop an Initiative—at the Start

Planned AbandonmentThe planned, purposeful review and abandonment of initiatives the organization is already doing

Source: Drucker P, “The Essential Drucker: The Best of Sixty Years of Peter Drucker's Essential Writings on Management,” Harper Collins: New York, NY, 2001.




28

List of Potential “Stop Triggers”Option #1: Set “Stop Triggers” for Each Initiative

Stop Trigger When to Use What To Do

A predetermined end date

• When other large changes are scheduled in advance, for which you’ll need capacity

• When piloting an initiative• Reapply standard initiative prioritization criteria

to makea principled decision to stop or continue the initiative

• For initiatives that end, communicate decision to all managers

A threshold for how “past due” an initiative can be • When the success of an initiative is particularly uncertain

• When organizations want to proceed with caution; provides an “easy out” of an initiative

A threshold for how over budget an initiative can be

An interim milestone that must be met

A target goal that’s maintained for a certain duration

Recommended for all initiatives; clarifies when even a successful initiative should end

• Celebrate initiative’s success• Communicate to all managers that the initiative

has ended




29

Two Questions To Assess Your Change PortfolioOption #2: Rationalize Your Entire Inventory

Health Plan Advisory Council interviews and analysis.

1 If we weren’t already doing this today, would we start it tomorrow?

2 If we want to start doing something new, what will we stop doing?




30

Source: Stampler L, “Science Says Stress is Contagious,” Time Magazine, May 1, 2014; Robinson J, “Wellbeing is Contagious (for Better or Worse),” Gallup, November 27, 2011

Stress—and Wellness—Affects the TeamFar More Than a “Personal Issue”

Stress Is Contagious…

People who experience “second-hand stress” and increased cortisol levels

30%

Increase in wellbeing when people’s colleagues have healthy stress habits

…But So Is Wellness

20%

Case in Brief: Second-Hand Stress

• German study from the Max Planck Institute for Cognitive and Brain Sciences

• Participants who watched others go through stress test had increased stress hormones

• Participants who watched stressful TV scenes also had increased levels

Case in Brief: Second-Hand Wellbeing

• Gallup study of wellbeing across individuals in 105 workplace teams

• Participants 15% more likely to have high wellbeing if their managers did

• 20% more likely to have colleagues with high wellbeing six months later




31

Four Types of Stress TendenciesPinpoint Your Blind Spot

Avoidance (A)Tendency to distract yourself from your stressor and to procrastinate

Complaint (C)Tendency to externalize stress and negative emotions onto others

Obsession (B)Tendency to focus all of your time and energy on the stressor

Self-Doubt (D)Tendency to blame yourself for your stress and second guess your actions

Source: “Stress in America: Paying with Our Health,” American Psychological Association, 2014.




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Tactics at a GlanceIntervene On Your Own Behalf

Avoidance (A)Tendency to distract yourself from your stressor and to procrastinate

Complaint (C)Tendency to externalize stress and negative emotions onto others

Obsession (B)Tendency to focus all of your resources (time, energy, etc.) on the stressor

Self-Doubt (D)Tendency to blame yourself for your stress and second guess your actions

Engage more with your stressor

Take breaks from your stressor Give yourself the benefit of the doubt

Get a more objective view of your stressor




33

Reacting Productively to Stress: A simple Tool





34

Reacting Productively to Stress: A simple Tool


Choose one tactic you want to try, and apply to the stressor.

Identify a current or recent stressor.

Describe how the tactic would help you respond differently to the stressor.



LEGAL CAVEAT

Advisory Board has made efforts to verify the accuracy of the information it provides to members. This report relies on data obtained from many sources, however, and Advisory Board cannot guarantee the accuracy of the information provided or any analysis based thereon. In addition, Advisory Board is not in the business of giving legal, medical, accounting, or other professional advice, and its reports should not be construed as professional advice. In particular, members should not rely on any legal commentary in this report as a basis for action, or assume that any tactics described herein would be permitted by applicable law or appropriate for a given member’s situation. Members are advised to consult with appropriate professionals concerning legal, medical, tax, or accounting issues, before implementing any of these tactics. Neither Advisory Board nor its officers, directors, trustees, employees, and agents shall be liable for any claims, liabilities, or expenses relating to (a) any errors or omissions in this report, whether caused by Advisory Board or any of its employees or agents, or sources or other third parties, (b) any recommendation or graded ranking by Advisory Board, or (c) failure of member and its employees and agents to abide by the terms set forth herein.

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supporting managers through disruptive change€¦ · strategies for coping with the covid-19...

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