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CHANGE, or Now What? Making Decisions, Creating a Future.

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Presentation on theme: "CHANGE, or Now What? Making Decisions, Creating a Future."— Presentation transcript:

1 CHANGE, or Now What? Making Decisions, Creating a Future

2 CHANGE Certainly a word we’ve heard A LOT lately...Certainly a word we’ve heard A LOT lately... But what does it really mean?But what does it really mean? –To make different in some particular –To make radically different, transform –To give a different course or direction to –To replace with another –To make a shift from one to the other –To put on different clothes

3 CHANGEABLE Able or apt to varyAble or apt to vary –Apply to us? Examples? Subject to changeSubject to change –What forces us to change? Capable of changeCapable of change –Here’s where it gets tough...

4 Needs Assessment to Action Since OBRA 1989 and the explicit requirement to conduct state-wide, population-based needs assessments, states have dramatically increased their data collection and analytic capacitiesSince OBRA 1989 and the explicit requirement to conduct state-wide, population-based needs assessments, states have dramatically increased their data collection and analytic capacities –We have changed staffing patterns, foci, products, orientation, etc States have significantly improved their relationships with stakeholders, public and private, professional and communityStates have significantly improved their relationships with stakeholders, public and private, professional and community

5 Needs Assessment to Action What states have done less well is move an agenda forward, even in the face of overwhelming evidence... derived from their very own needs assessmentsWhat states have done less well is move an agenda forward, even in the face of overwhelming evidence... derived from their very own needs assessments Why is this so?Why is this so?

6 So Why Doesn’t It Happen? Over-committed staffOver-committed staff Lack of political willLack of political will Committed to present activitiesCommitted to present activities Previous planning failuresPrevious planning failures Limited expertiseLimited expertise Insufficient resourcesInsufficient resources Competing priorities/desiresCompeting priorities/desires thanks, Bill!

7 CHANGE = ANXIETY Few of us like changeFew of us like change Most of us are risk-averse and prefer the familiarMost of us are risk-averse and prefer the familiar Change is perceived as disruptive and often irrational, unjustifiedChange is perceived as disruptive and often irrational, unjustified Given scarce (and dwindling) resources, doing something new may require that we stop doing something elseGiven scarce (and dwindling) resources, doing something new may require that we stop doing something else Change needs to be managed, like anything elseChange needs to be managed, like anything else

8 CHANGE Able or apt to vary = FlexibilityAble or apt to vary = Flexibility –Some level of this is tolerable and we are good at responding to short-term demands on our time and expertise –Assignments to ad hoc committees inside, task forces outside –Quick turnaround for the commissioner, the legislature, an advisory committee, a grant proposal, a technical assistance request, a speech –Emergency response

9 CHANGE Subject to Change = External MandatesSubject to Change = External Mandates –These require more communication and planning, but WE DO THIS ALL THE TIME –Usually accompanied by sighs, shaking of heads, rolling of eyes –First Lady Projects, Legislative Brainstorms, statutory changes, new MCHB guidance, budget reductions, union negotiations, etc –How are these handled?

10 CHANGE Capable of changeCapable of change –Not in response to an emergency... –Not because we are being required to do something new or different... –This time, the change must come from within and we must find the strength to make it happen ourselves We must make our own decisions and create our own futureWe must make our own decisions and create our own future

11 Needs Assessment and Change Needs Assessments are NOT a data exercise!Needs Assessments are NOT a data exercise! Needs assessments are intended and should be designed to give you information which allows you to make the best decisions about program direction, program design, site of intervention, assignment of staff time, allocation of resources, provision of technical assistance and consultationNeeds assessments are intended and should be designed to give you information which allows you to make the best decisions about program direction, program design, site of intervention, assignment of staff time, allocation of resources, provision of technical assistance and consultation Needs assessments give you knowledge on which to actNeeds assessments give you knowledge on which to act

12 Needs Assessment and Change Needs Assessment as Screening...Needs Assessment as Screening... –In a way it might even be unethical to conduct a huge population “screen” if you have no intention of following up with appropriate “diagnosis and treatment” –“What gets measured, gets changed” –Be prepared to deal with the unusual – rats, laundromats, Starbucks

13 Community-Engagement Back to BasicsBack to Basics –Needs assessment has to be community AND data driven – the public has to agree with your analysis of the challenges AND has to agree with your recommended solutions to those challenges –In essence, the community decides what are needs, what are priorities, what are deserving of action –Because ultimately, these are political exercises

14 Community-Engagement SolutionsSolutions –And the solutions will of necessity be along a continuum, from needing more evidence, to needing to test an intervention, to needing to implement what is known, to needing to engage others –Remember that much of what we are trying to achieve is outside of our direct control, BUT ENTIRELY WITHIN OUR MISSION (to assure the health of all...)

15 MAKING CHANGE HAPPEN Okay, so we’re back to the results of our own needs assessment staring us in the faceOkay, so we’re back to the results of our own needs assessment staring us in the face We may even have our own evaluation data suggesting that what we’ve been doing is not workingWe may even have our own evaluation data suggesting that what we’ve been doing is not working We may also have data (and public demand) suggesting that we need to do something newWe may also have data (and public demand) suggesting that we need to do something new Where are your opportunities to change?Where are your opportunities to change?

16 Opportunities to Change You can take the flexible approach and absorb much of this within day to day operations (i.e. subtly and slowly ease people from one set of tasks to another set)You can take the flexible approach and absorb much of this within day to day operations (i.e. subtly and slowly ease people from one set of tasks to another set)

17 Opportunities to Change You can take the subject to change approach (works well if you can actually get an external mandate [and $$$] which is where your stakeholders come in) and announce the response to the demandYou can take the subject to change approach (works well if you can actually get an external mandate [and $$$] which is where your stakeholders come in) and announce the response to the demand Though for most of us, the scenario will not involved new money but reductionsThough for most of us, the scenario will not involved new money but reductions How will you optimize those opportunities?How will you optimize those opportunities?

18 Opportunities to Change When in doubt, reorganizeWhen in doubt, reorganize –Or at least create some new work teams –And think creatively about this... –Do you routinely evaluate your teams? –Which are overworked and understaffed? Overstaffed and underworked? –Where do you have room to maneuver? –Requires throwing out old models/rules...

19 Opportunities to Change Who are your shining stars? Are these opportunities to give them more responsibility?Who are your shining stars? Are these opportunities to give them more responsibility? Are these opportunities to advance someone into a managerial or leadership role?Are these opportunities to advance someone into a managerial or leadership role? Or, are these opportunities to move someone back into program/project work?Or, are these opportunities to move someone back into program/project work?

20 Opportunities to Change What if you have to stop doing something?What if you have to stop doing something? How large is the constituency for this service?How large is the constituency for this service? Can it be provided any other way?Can it be provided any other way? –Within the agency, in another agency –In the community, through the private sector What if you have to let people go?What if you have to let people go? What opportunities do you have to develop or retrain some of your staff for new assignments?What opportunities do you have to develop or retrain some of your staff for new assignments?

21 Opportunities to Change Have you assessed the capacity and talent within your grantees?Have you assessed the capacity and talent within your grantees? –Could they be induced to do something new? –Do some of them need to rethink their roles in your overall system? –How do you evaluate your grantees? Do you hold them accountable for YOUR goals? –Is it time to rethink the type of grantees, the funding formula, or the scope of work to better align with your new objectives?

22 Opportunities to Change Or we can make ourselves more capable of changing, more adaptable, more risk-tolerantOr we can make ourselves more capable of changing, more adaptable, more risk-tolerant This is where leadership becomes necessaryThis is where leadership becomes necessary –Dr. Peter Ginter, Professor of Management at the UAB School of Public Health said in a recent talk at the MCH Leadership Skills Training Institute: “Leaders do two things. They set organizational direction and they create organizational culture. Guess which is more important?”

23 Creating a Culture of Change Difficult in entrenched bureaucracies, but it can be done Nothing is more important than open and honest communicationNothing is more important than open and honest communication Need to assess barriers (e.g. job descriptions, work rules [real or imagined], work space, busy- work) and facilitators (e.g. incentives and rewards, challenges and opportunities) and motivators (e.g. the little things matter)Need to assess barriers (e.g. job descriptions, work rules [real or imagined], work space, busy- work) and facilitators (e.g. incentives and rewards, challenges and opportunities) and motivators (e.g. the little things matter)

24 Creating a Culture of Change Nothing is more important than communicationNothing is more important than communication Requires an honest appraisal of where you are nowRequires an honest appraisal of where you are now –What is our current culture? –How does it enable or inhibit our ability to be nimble? Engage people in discussion about how things are going, where they might be headed, what makes the most sense – they may surprise youEngage people in discussion about how things are going, where they might be headed, what makes the most sense – they may surprise you

25 Creating a Culture of Change Ask people about their hopes and dreams – what do they think the organization can do? what would they like to do? (again, look for the surprises)Ask people about their hopes and dreams – what do they think the organization can do? what would they like to do? (again, look for the surprises) Invite people to tell you the three stupidest things they do (surprise) and then work to eliminate those thingsInvite people to tell you the three stupidest things they do (surprise) and then work to eliminate those things Look to change individual job descriptions (static) to team task assignments (dynamic)Look to change individual job descriptions (static) to team task assignments (dynamic)

26 Creating a Culture of Change Allow your work teams the flexibility to respond to the “capable of change” proposition:Allow your work teams the flexibility to respond to the “capable of change” proposition: –Here are the data, here is the priority, here is the action plan –How do you think we should make this happen? Give them deadlines to get back to you with their proposals Give them deadlines to get back to you with their proposals Discuss them openly (did I mention the importance of communication?)Discuss them openly (did I mention the importance of communication?)

27 Creating a Culture of Change Alternatively, if you know your team needs more direction:Alternatively, if you know your team needs more direction: – Assign them specific tasks and reward every accomplishment –Make the tasks increasingly more challenging –Step in as necessary to provide guidance –Manage the “task” and the “relationship”

28 Spreading the Leadership Throughout the process:Throughout the process: –revisit priorities as well as the programs you will continue and those you will explore –revisit the strategies selected – remember, “things happen while you plan” –everything needs to be monitored and evaluated –communicate where you are each step of the way –Let your teams own the change

29 Spreading the Leadership Periodically checking in with your stakeholders is also importantPeriodically checking in with your stakeholders is also important You not only want to monitor the progress of your efforts internally, you want feedback on how it looks from the outsideYou not only want to monitor the progress of your efforts internally, you want feedback on how it looks from the outside –They can also be helpful if efforts are being stalled somewhere One more reason to keep those advisory groups going stakeholders are important to us wherever we are in the planning processOne more reason to keep those advisory groups going stakeholders are important to us wherever we are in the planning process

30 Spreading the Leadership The responsibility for much of what effects MCH rests with other agenciesThe responsibility for much of what effects MCH rests with other agencies Seek to form partnerships as you seek to develop systems that are responsive to the needs you’ve identifiedSeek to form partnerships as you seek to develop systems that are responsive to the needs you’ve identified Find common ground – invite them over – share your data – support their efforts – consider a joint effort or a swap – form teams across agencies - do the right thing togetherFind common ground – invite them over – share your data – support their efforts – consider a joint effort or a swap – form teams across agencies - do the right thing together

31 Scenario for CHANGE Your thoroughly and comprehensively conducted needs assessment revealed a truism: things need to changeYour thoroughly and comprehensively conducted needs assessment revealed a truism: things need to change You will be assigned one of the following scenarios and will discuss as a group how you might approach this necessary change This is, like in real life, a zero sum game. You have no new resources, but none are taken away, either.

32 Scenario for Change Here is your charge:Here is your charge: First, list the barriers that immediately jump to mind – all the reasons why this can’t be doneFirst, list the barriers that immediately jump to mind – all the reasons why this can’t be done Second, think about some of the things that would make this possible – what action steps might you take to move from A to BSecond, think about some of the things that would make this possible – what action steps might you take to move from A to B Third, think of the “people” issues that you will have to address and how you will do thatThird, think of the “people” issues that you will have to address and how you will do that

33 Things Need to Change You need to shift emphases from lead poisoning prevention to childhood injury prevention, in the central office You need to transfer from a paper chart system to an Electronic Health Record for locally delivered well-child services (assume the EHR system is paid for) You need to shift funds from traditional hospital grantees to ambulatory care centers for prenatal care

34 Things Need to Change You need to get every child into a medical home Your local grantees have to shift away from direct provision of care and toward more advocacy, information, resource and referral activities for low income populations Your adolescent pregnancy prevention program must shift from an abstinence-only model to a comprehensive reproductive health service model

35 Things Need to Change You must organize a systems-level approach to preventing obesity in young children You need to design a program whereby preventive dental services are provided in pediatricians offices (not by dentists) You have to shift your grantees from a contract model to an allocation formula model

36 From So What to Now What? The Needs Assessment requirement is actually a giftThe Needs Assessment requirement is actually a gift Being required to do this gives you the luxury to do what you would have done anywayBeing required to do this gives you the luxury to do what you would have done anyway Because you must “know” before you can actBecause you must “know” before you can act The challenge is acting once you “know”The challenge is acting once you “know” Because change is always hardBecause change is always hard

37 You Can Do it! You can create a culture of changeYou can create a culture of change You can keep your focus on the larger vision that is MCHYou can keep your focus on the larger vision that is MCH You can maintain the broad and shallow while determining where you and you alone need to go deepYou can maintain the broad and shallow while determining where you and you alone need to go deep You can advocate with others towards creating a true system that anticipates the needs of familiesYou can advocate with others towards creating a true system that anticipates the needs of families

38 You Can Do It! Use this opportunity to continue to build your data capacity while building your internal and external relationships and partnershipsUse this opportunity to continue to build your data capacity while building your internal and external relationships and partnerships Listen honestly and seriously to what people are telling youListen honestly and seriously to what people are telling you Engage your leadership team, your professional staff, your entire unit in making the tough decisionsEngage your leadership team, your professional staff, your entire unit in making the tough decisions If they own it, it will endure (i.e. outlast YOU)If they own it, it will endure (i.e. outlast YOU)

39 We need you to do it! We’re all in this together, so feel free to call upon us, other university partners, other states to get ideas, share strategies, celebrate accomplishmentsWe’re all in this together, so feel free to call upon us, other university partners, other states to get ideas, share strategies, celebrate accomplishments Your individual success leads to our collective successYour individual success leads to our collective success And when you’re feeling down, remember the remarkable longevity of this thing we call MCHAnd when you’re feeling down, remember the remarkable longevity of this thing we call MCH

40 CHANGE We have always embraced changeWe have always embraced change We’ve done it before, we can do it againWe’ve done it before, we can do it again Only this time, it’s going to be on our termsOnly this time, it’s going to be on our terms Good luck!!!!!Good luck!!!!! And thanks for letting us be with you


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