1. Managing Change: When a hammer won’t fix everything IT’S TOOL TIME ! Judy A. Cordeniz, MHA, FACHE Vice President Strategic Planning Holy Rosary Medical Center, Ontario, OR October, 2007

2. Presentation Overview The elements affecting healthcare that are prompting a rapid change approach Setting up for successful change Skills Inventory Routine maintenance of change

3. 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

4. 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]

5. 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

6. Elements effecting change (never did like those stock mufflers!) SilentBBGen XGen Y OutlookPracticalOptimisticSkepticalCautious Work EthicDedicatedDrivenFee Agent? AuthorityRespectfulChallengeUnimpressed? Leadership Relationships Hierarchy Self sacrifice Pay your dues Personal Gratification Competence Reluctance to committee ? Inclusive

7. Elements effecting change FOR SALE Or Lease Or Joint Venture Or Merge Or Outsource Or Buyout…… $ $ $ $ $ $

8. 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?

9. Setting up for successful change What’s in YOUR tool box? Top Drawer When to use the tried and true – (screwdrivers & pliers) Flow Charting

10. Cause & Effect (Fishbone) Effect MaterialPeopleMachines Measurement Type of Material Attribute When problem solving: To understand what may be causing the results you don’t want – the root causes.

11. SWOT & Brainstorming StrengthsWeaknesses OpportunitiesThreats EasyDoableStretch

12. Tool Box Inventory Plumb lines, stud finders & other gizmos: When to bring out the laser tape measure Charts, bars and data points Median 0.93 Infection Rate Nosocomial Infection Rate

13. Tool Box Inventory When you need more than just the owner’s manual! A-M-C and PDSA Accelerated Processes Work OutLean Six Sigma

14. Formula for results Q x A 2 = 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.

15. Accelerated Change Processes High level focus w/ a Champion (sparkplug) Gets everyone on the same page Focuses on the “A” (Acceptance) in QxA 2 =E Stimulates dialogue w/ simple tools & defines actions Makes the change stick

16. 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

17. The process ___________ is important to work on now because ________________________________________ ______________________________________________________________________________________________ Measure/s: ______________________________________ Goal: __________________________________________ Guidelines, boundaries or constraints: _______________________________________________ Process inputs:___________________________________ Process outputs:__________________________________ Stakeholders: ____________________________________ Aim for Process Improvement

18. How will we know the change is an improvement? Develop measures: Outcome Measures Process Measures Measures provide Direction Learning Evaluation Balance Aim: Decrease the rate of harmful falls on the 3 rd floor Outcome measures: Decrease falls by 50% from 6.3 to 3.15. or increase intervals between falls. or increase intervals between falls. Process measure: Falls risk assessment done at time of admission

19. 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

20. Worksheet PDSA Cycle

21. PLAN: based on theory/prediction ACT: adopt adapt abandon DO: small scale STUDY: to learn. Theory confirmed? 5

22. 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?

23. Accelerated Processes Examples: Work-Out™Six Sigma Addresses passionate issues/problemsStatistically driven People who do the wok determineRigorously analytical the improvements “Customer” defines defects Issues are specific & well-definedAddresses variations Decision-makers provide immediateFacilitated by a Maste Black closure Belt/Black Belt/Green Belt Starts with quick fixes Uses trained facilitators 30-60 day fixes

24. Work-Out™ road Map Champion Scope Identify Problems Identify Solutions Action Plan Yes No Need Info 4-6 hours

25. Work-Out™ Session Owners 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

26. 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

27. Work-Out™ Session Owners 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

28. 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

29. Agenda Format Attendees: Reflection: Ground Rules: Expectations: ItemDiscussionActionPoint PersonCompletion Date Parking Lot Items: Next Meeting: Blaming Complaining The past is honored not blamed.

30. 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 www.rkma.com  judycordeniz@chiwest.com; Ph: 541-881-7253 Fx: 541-881-7184 judycordeniz@chiwest.com

31. What’s in YOUR tool box? DISCUSSION Judycordeniz@chiwest.com 541-881-7253 Office 541-212-6039 Cell