1. Influencing Change through Collaboration Jerry D. VanVactor, DHA, FAHRMM U.S. Army Medical Service Corps Military Representative to the AHRMM Board of Directors

2. First…evaluate your perspective…. ++ 9

3. ++ 99

4. First…evaluate your perspective…. ++ 100

5. Agenda Objectives How difficult is change? Critical Thinking Resistance to change Equilibrium Linear Management Concept and Theory Chaos Theory Interconnectivity Stakeholder Management Collaborative Communications Model Succession Planning and Management

6. O BJECTIVES Can leaders influence change in organizational behavior through collaborative communications? Does permitting multifaceted ownership of processes throughout an organization aid in creating opportunities for change? How can change be inculcated into organizational processes and behavior? Who can best use collaborative communications? How can change help improve processes throughout an organization?

7. Managers among health care organizations must monitor change in anticipation of points of convergence among trends and to effectively meet challenges presented (Liebler & McConnell, 2012) “More than 80% of all change efforts fail” -- David Smith, Taking Charge of Change Some reasons include: - Underestimation of size and scope of initiative - Technical constraints - Lack of good leadership (Slone, Dittman, & Mentzer, 2010)

8. - Leaders set the direction for change - Challenge others to develop suggestions for how to best set a course toward organizational vision, mission, values - Develop metrics for assessing success - Initiatives must be nurtured, cultivated, and sustained

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10. Supply chain specific constraints - Fixing the wrong things - Failing to draw a line in the sand - Ability to say “no” or “not yet” - Ability to say “yes” at the appropriate time - Quantification of benefits with change - Inability to mitigate significant risks (SOURCE: Slone, Dittman, & Mentzer, 2010)

11. - Change cannot be happenstance or based on a preferred option - change should be evidence-based and data driven - Change should be orchestrated among the very people it will affect - inclusion = ownership - Develop a roadmap for change “If you don’t know where you’re going, you’ll probably end up somewhere else.” -- (Peter & Hull, 2009, p. 145)

12. “Would you tell me, please, which way I ought to go from here?” “That depends a good deal on where you want to get to,” said the Cat. “I don’t much care where —” said Alice. “Then it doesn’t matter which way you go,” said the Cat. “- so long as I get SOMEWHERE,” Alice added as an explanation. “Oh, you’re sure to do that,” said the Cat, “if you only walk long enough.” (SOURCE: Carroll, L. (1865). Alice's Adventures in Wonderland, Chapter 6) (SOURCE: Walt Disney) Cheshire Cat scenario…

13. How often do we hear… Employee says… question the motive ask for support for the statement what led the person to make this assumption show me data to support your claim ask to see products that reflect that idea as being the best practice You ask… I heard that… I think… We should probably… I believe… In other organizations… This is how we have always done it! WHY? Who made it policy? What do the rules/policies say?

14. Changing Organizational Culture - Change requires planning, time, and energy - Clarify the mission, vision, values, and need for change - Review and discuss frequently with those most affected by change - Communicate, communicate, communicate… - Demonstrate patients and persistence - Live the values being advocated - Empower others to embrace change – encourage acceptance and success (SOURCE: Swayne, Duncan, & Gintner, 2008)

15. Principles of Resistance - There is no change without resistance - Resistance doesn’t indicate that something is wrong; it indicates that something is happening - Can be overt or covert - Can be active or passive - “Pay me now, or pay me later”

16. Do we truly want equilibrium? - EVERY organization will experience degrees of disorder and chaos - Don’t allow yourself to fall victim to “equalitarianism” (Peter & Hull, 2009) - Equilibrium may be a sign of stagnation in an organization’s processes - Change, in this regard, CAN be a good thing for an organization

17. Linear Management 1 st Commandment of the Peter Principle: MUST “The hierarchy MUST be preserved” (Peter & Hull, 2009) SupervisorSupervisorSupervisorSupervisor SubordinateSubordinateSubordinateSubordinateSubordinateSubordinateSubordinateSubordinate SupervisorSupervisor SubordinateSubordinateSubordinateSubordinate ManagerManager

18. Chaos Theory - Not ‘too many things happening all at once while seeming out of control and incomprehensible’ -Chaos Theory defined = while operations will continue to occur over a period of time, outcomes will always involve degrees of variance and interconnectivity among an array of inputs - How many times in health care has the same physician asked for the same thing more than once? - Do we ever change requirements in health care?

19. - Resilience is defined by an organizations ability, not to live under chaos, but to thrive within it - Organizations today operate in decentralized business units and teams - Much closer to customers than corporate staffs - Change should originate at operating staff level - Allows more ownership in the process of change

20. Interconnectivity of an operational environment (SOURCE: US DoD, JP 5-0) Management Social Political Infrastructure Information Economic Node Link

21. Who are stakeholders? - Anyone with an interest in a process or outcome - Anyone who may need to support change - Anyone who casts a “vote” on your success – directly/indirectly; overtly/covertly - May be an individual, group, organization, or otherwise

22. Closing Stakeholder Gaps - Demonstrated commitment to change - Involve all stakeholders in change teams and planning processes - Ask questions – seek input from others and listen - Use feedback to shape solutions and build support - Regular, ongoing, constant communication

23. Operational Environment Strategic Thinking Strategic Planning Strategic Momentum Ends (What is the anticipated outcome?) Ways (How does an organization perform the mission?) Means (What does an organization do?) Ends (What is the anticipated outcome?) Ways (How does an organization perform the mission?) Means (What does an organization do?) Collaborative Communications (Who else needs to know?) Collaborative Communications (Who else needs to know?) (SOURCE: Adapted from Swayne, Duncan, & Gintner, 2008)

24. Criteria for establishing a need for change - Based on a business need, priority or benefit - Identify a clear objective - Have a clear beginning and end - Within your “circle of influence” - Challenging, but achievable - Requires support and involvement - Not your entire job

25. The science of Process Improvement and Change Management… 1.Identify the problem 2.Hypothesize 3.Develop questions for analysis 4.Analyze potential solutions and root causes 5.Develop evidence-based conclusions 6.Identify possible solutions 7.Implement focused changes –Pilot a solution –Full implementation

26. Critical thinking skills… - Process by which the thinker improves the quality of his/her thinking by skillfully taking charge of the structures inherent in thinking and imposing intellectual standards upon them - Self-directed, self-disciplined, self-monitored, and self-corrective thinking - Seldom should you accept the very first right answer – there is often more than one right answer

27. Input Output Input Demand Satisfaction Demand Satisfaction Senior Levels of Management Junior Levels of Management Corporate Vision Development Procedural Guidance Decision-Making & Process Implementation Process Improvement Ideas Mission Input Mission Input Collaborative Communication Feedback Loop Stakeholder Demands Stakeholder Demands Strategy Development Process Development & Decision-Making Compliance with Strategic Goals Mission Accomplishment Strategic Management Strategic Management Operational Management Operational Management Tactical Management Tactical Management Collaborative Communication

28. Succession Planning - Changes in leadership at the top levels of any organization will cause stress and uncertainty - Succession planning is often NOT a core competency for health care organizations - Strongest influence on succession planning = historical precedence - NO prevailing theoretical model exists concerning “correct” succession planning

29. Reasons for not naming a successor Response ChoiceN(%) Not a high priority27646 Current CEO is too new18731 No internal candidate to prepare15425 Other12020 Not part of the organizational culture12721 Not offered a package8716 Challenge of too many qualified candidates7412 Not viewed as useful71 (N = 606 freestanding hospitals surveyed) (SOURCE: Garman, A. N., & Tyler, J. L., 2004, Table 3, p. 13)

30. Succession Management - Early identification of talent - Developmental assignments - Internal vs. external successors - Measuring success - Transition process - Allowing leaders to lead

31. Summary Objectives How difficult is change? Critical Thinking Resistance to change Equilibrium Linear Management Concept and Theory Chaos Theory Interconnectivity Stakeholder Management Collaborative Communications Model Succession Planning and Management

32. References Carroll, L. (1865). Alice's Adventures in Wonderland. New York, NY: Barnes & Noble Classics (1994 ed.) Garman, A. N., & Tyler, J. L. (2004). CEO succession planning in freestanding U.S. hospitals: Final report. Chicago, IL: ACHE Harrison, J. P. (2010). Essentials of strategic planning in healthcare. Chicago, IL: Health Administration Press Liebler, J. G., & McConnell, C. R. (2012). Management principles for health professionals (6 th ed.). Sudbury, MA: Jones & Bartlett Learning Peter, L. J., & Hull, R. (2009). The Peter Principle: Why things always go wrong. New York, NY: Harper Business Books Slone, R. E., Dittman, J. P., & Mentzer, J. T. (2010). The new supply chain agenda: The five steps that drive real value. Boston, MA: Harvard Business Press Swayne, L. E., Duncan, W. J., & Gintner, P. M. (2008). Strategic management of health care organizations (6 th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

33. Jerry D. VanVactor, DHA, FAHRMM jerry.d.vanvactor@gmail.com