Managing Change Better Health Together Cathy Kaufmann MSW

Managing Change Better Health Together Cathy Kaufmann, MSW Kaufmann Strategies

About me • Independent health & social policy consultant • Worked with BHT and ACHs across the state for last 3+ years • Also work with states Medicaid agencies, Medicaid managed care plans and organizations focused on health care and social services • 20+ years experience working in health and social systems • Helped lead health systems transformation efforts for State of Oregon: • Founding Director of Oregon Transformation Center • Implemented Oregon Healthy Kids Program • Past work includes child and family policy advocacy (Families USA, Children First for Oregon, co-chair Human Services Coalition of Oregon) Cathy Kaufmann, MSW Kaufmann Strategies

• What is Change Management? • Popular Models of Change Management: Agenda • • • ADKAR Model Kotter 8 -Step Model Lewin’s Change Management Model Mc. Kinsey 7 -S Framework Science of Improvement • Cross-Sector Change Management • Why Change Efforts Fail • Importance of Change Leadership • Q&A

What is Change Management? Change is hard – in fact, so hard that most change efforts fail Change Management is a systematic approach to helping people and organizations successfully implement change

Change Management is not Project Management: Technical side of moving from the current to the future state Change Management: People side of moving from the current to the future state

Change Management Models • Most change management models assume you already know what change you want to implement • Some are based on a top down (leadershipdriven) approach to managing change • Some are based on a bottom up (people-driven) approach to managing change • Other models focus on how to identify what changes are needed

ADKAR model Popular Change Management Models Kotter’s 8 -step change model Lewin’s Change Management model Mc. Kinsey 7 s model Science of Improvement PDSA model

Awareness of the need for change ADKAR Model Focuses on five concrete outcomes that people need to achieve for lasting change Desire to support the change Knowledge of how to change Ability to demonstrate change Reinforcement to make the change stick

1. 2. Kotter 8 -Step Model for Change 3. 4. 5. 6. 7. 8. Develop a sense of urgency around the need for change using open and honest dialogue. Don’t skip this step or move too quickly through it! Build a coalition of change leaders. Make sure you have a good mix of people and that you have their buy-in and real emotional commitment. Create a vision for change, including an “elevator pitch” and strategy Communicate the vision frequently and passionately. Address peoples' concerns and anxieties, openly and honestly Remove obstacles and empower action. Address people, processes or structures that are getting in the way and encourage, support and reward the change. Get Quick Wins. Identify and celebrate feasible short-term wins to keep people motivated and win over (or neutralize) critics. Leverage Wins to Drive Change: real change is hard and takes time. Build a culture of continuous improvement. Celebrate and learn from interim successes (and failures). Embed Change in the Organizational Culture. To make any change stick, it should become part of the core of your organization.

Kotter 8 -Steps

Lewin’s Change Management Model First, a team or organization must “unfreeze” their current process and perceptions when preparing for upcoming changes. Next, it’s time to implement changes. Effective change requires clear and constant communication both during and after deployment. Assuming accurate feedback and ongoing communication occurred during the “change” step, the refreeze step locks into place the new process.

Lewin’s Change Management Model Unfreeze: Change: Refreeze: • Determine what needs to change and why • Ensure there is strong support from leadership / management • Communicate a compelling message about why change has to occur • Use open dialogue to manage and understand doubt and concerns • Communicate often, preparing everyone for what changes will occur and reminding them why • Dispel rumors through honest answers to questions and dealing with problems as they arise • Engage people in the change and generate short-term wins • Embed changes in the organizational culture • Identify ways to sustain the change, including rewards and feedback systems • Keep people informed • Provide support and training • Celebrate sucess

Mc. Kinsey 7 s Framework • Looks at 7 interconnected areas of an organization to identify needed changes and guide implementation of change 1. Strategy 2. Structure 3. Systems 4. 5. 6. 7. Shared Values Skills Staff Style • All the areas are equally valuable and interconnected, which means change to one area will have implications for all other areas • Shared organizational values are at the center of the model

Science of Improvement • This model has been used very successfully by hundreds of health care organizations in many countries to improve many different health care processes and outcomes. • Not meant to replace change models that organizations may already be using, but rather to accelerate improvement. • The model has two parts: • Three fundamental questions, which can be addressed in any order. • The Plan-Do-Study-Act (PDSA) cycle** to test changes in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.

Science of Improvement Steps 1. Form the Team. Be sure that the team includes members familiar with all the different parts of the process — managers and administrators as well as front-line workers. Each team needs an executive sponsor who takes responsibility for the success of the project 2. Set aims: What you are trying to accomplish? The aim should be time-specific and measurable; it should also define the specific population of patients or other system that will be affected. 3. Establish measures: How will you know the change is an improvement? Establish measures. T eams use quantitative measures to determine if a specific change actually leads to an improvement. 4. Select changes: What change can you make that will result in improvement? Ideas for change may come from those who work in the system or from the experience of others who have successfully improved. 5. Test changes on a small scale using a PDSA cycle. The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method adapted for action-oriented learning. 6. Implement Changes. After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the team may implement the change on a broader scale — for example, for an entire pilot population or on an entire unit. 7. Spread Changes. After successful implementation of a change or package of changes for a pilot population or an entire unit, the team can spread the changes to other parts of the organization or in other organizations.

Cross-Sector Change Management • Complex challenges require cross-sector collaboration in order to develop solutions • Too often approaches are piecemeal / siloed • Generally speaking, the approaches to change within an organization are the same strategies / steps needed for crosssector change • Cross-sector collaborations for change also need to: • Shared understanding of prior initiatives / efforts • Develop effective governance structures and mechanisms • Trusted partnerships • Shared responsibility and accountability (with ways to measure) • Leadership is crucial

Readiness for Cross-Sector Collaboration • Public Health Foundation developed a matrix for potential cross-sector collaborative members to use to prepare for a change initiative • The matrix provides a structure for members to discuss what they have in common, their differences, barriers holding them back from collaborating, and what it will take to collaborate. • After going through this process, the collaborative is ready to determine the focus areas of the crosssector initiative.

Cross-Sector Collaboration Readiness Matrix 1. Commonalities 2. Differences 3. Barriers 4. Collaboration Areas

Example Readiness Matrix:

Why Change Efforts Fail • Change is hard. The effort needed to implement change must be appreciated. • Research shows as many as 75% of all change initiatives fail. Why is this? • No clear vision • Lack of leadership / minimal engagement of leadership • Not establishing a great enough sense of urgency • Under-communicating • Dismissing concerns, no honest dialogue or understanding of barriers/ motivating factors for change • No measurement plan • No short-term wins • Declaring victory too soon

Failure occurs when change management is mistaken for project management. Don’t focus on processes, policies and technology without focusing on the people side of change

The Three Cs of Change Leadership 1. Communicate • Unsuccessful leaders tended to focus on the “what” behind the change. Successful leaders communicated the “what” and the “why. ” • Leaders who explained the purpose of the change and connected it to the organization’s values or explained the benefits created stronger buy-in and urgency for the change. 2. Collaborate • Successful leaders work across boundaries, encourage employees to break out of their silos, and refused to tolerate unhealthy competition. They also included employees in decision-making early on, strengthening their commitment to change. • Unsuccessful change leaders failed to engage employees early and often in the change process. 3. Commit • Successful leaders make sure their own beliefs and behaviors supported change, too. They also devoted more of their own time to the change effort and focused on the big picture. • Unsuccessful leaders failed to adapt to challenges, expressed negativity, and were impatient with a lack of results.

Questions?