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Rural Physician Leadership Curriculum West Virginia University Rural Family Medicine Residency Program.

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Presentation on theme: "Rural Physician Leadership Curriculum West Virginia University Rural Family Medicine Residency Program."— Presentation transcript:

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2 Rural Physician Leadership Curriculum West Virginia University Rural Family Medicine Residency Program

3 Rural Physician Leadership Curriculum Module 6 Leading Change

4 Description Funded by HRSA Grant D22HP00306 Objective 1 –Develop a competency based longitudinal curriculum in Rural Physician Leadership Konrad C. Nau, MD Principle Investigator Chair, Dept of Family Medicine-Eastern Division WVU Rural Family Medicine Residency Program Rural Physician Leadership Curriculum

5 Learning Objectives : Module 6 Understand the importance of change Review the usual outcomes of change Develop a pathway for leading change Identify traits of successful “change agents”. Rural Physician Leadership Curriculum WVU Rural Family Medicine Residency Program

6 Change an event that occurs when something passes from one state or phase to another

7 Change undergo a change; become different in essence; losing one's original nature

8 Change WVU Rural Family Medicine Residency Program

9 Sources of Change Patients Payors Technology Regulations Competition Other businesses WVU Rural Family Medicine Residency Program

10 Change These sources of change will always be exist in rural medicine “Nothing endures but change.” Heraclitus Become a student of change. It is the only thing that will remain constant Anthony J. D'Angelo, The College Blue Book

11 Change and Time The rate of change is not going to slow down anytime soon. If anything, competition in most industries will probably speed up even more in the next few decades. John Kotter Harvard Business School

12 Change and Time Scientists test sex-change bears BBC Friday, 1 September, 2000, 18:12 GMT 19:12 UK

13 Change and Time Scientists test sex-change bears Elizabeth Salter, of WWF, the global environment campaign, told BBC News Online: "It seems to be the female bears on Svalbard that are acquiring male genitalia, a penis-like stump. "With other species affected by endocrine disrupters, it's more often the males that have genital abnormalities. "And what's happening to the bears is happening to gulls in the Arctic, too, because of PCBs, DDT and dioxins."

14 Change and Time

15 Rate of Change It takes 5 years to change someone’s mind…… Or to allow yours to change Tom Gilmore Center for Applied Research The Wharton School

16 In the Middle of Change Everything looks like failure in the middle. In nearly every change project, doubt is cast on the original vision because problems are mounting and the end is nowhere in sight. Edward O’Conner, PhD Taking Charge of Change, 2005 Tampa, Florida : ACPE, Interact Physician in Management Seminar.

17 Remember the place in between It’s not so much that we’re afraid of change or so in love with the old ways, but its that place in between that we fear….. Edward O’Conner, PhD Taking Charge of Change, 2005 Tampa, Florida : ACPE, Interact Physician in Management Seminar.

18 Successful Change Can be much more difficult than it seems Not as easy as “writing a prescription” Up to 80% of major change initiatives fail to realize intended objectives –On time –Within Budget

19 Successful Change Likelihood Of Change Implementation Success John P. Kotter Total Number of Changes

20 The Cost of Unsuccessful Change Personal Stress Worry Panic Blame Job satisfaction Health Organizational Time Money Trust Turnover Productivity Survival

21 Let me get this right….. Change is everywhere Change is coming faster Change is hard to do successfully Change if not done right is a mess Change is not as easy as lasix for pulmonary edema

22 That is why…… Physician leaders need to understand a successful process for change Physician leaders must learn how to effect change in organizations as small as their clinic/offices and as large as their hospital/health care system

23 Take a look at Change From a different point of view

24 The Change Model I) Plan the Change –Understand –Enlist –Envision II) Implement the Change –Motivate –Communicate –Act –Consolidate Edward O’Conner, PhD Taking Charge of Change, 2005 Tampa, Florida : ACPE, Interact Physician in Management Seminar.

25 Stages of Change Leadership Skipping stages creates the illusion of speed, but rarely produces success Expect a significant length of time to produce true lasting change – FBS vs HbA1C

26 The Change Model : Plan 1. Understand Gather information Understand the environment Understand the need for change

27 The Change Model : Plan 1. Understand Perform a Force Field analysis Forces Driving Change Forces Restraining Us from Achieving Goal

28 The Change Model : Plan 1. Understand = Ask effective questions What are we best at ? What contributes most to our success ? How would you describe the ultimate goal of this organization ? If we could achieve this, what would it do for you ?

29 The Change Model : Plan 2. Enlist Select champions –People with vision,motivation Address stakeholder resistance –What is the organizations readiness to change Build a change team –People with position, power, experience, management

30 The Change Model : Plan 3. Envision Develop a vision –“where you want to go” –Feasible, tangible, simple picture of the desired future Develop a strategy –“how you’ll get there” –Framework for operational decisions

31 The Change Model I) Plan the Change –Understand –Enlist –Envision II) Implement the Change –Motivate –Communicate –Act –Consolidate Edward O’Conner, PhD Taking Charge of Change, 2005 Tampa, Florida : ACPE, Interact Physician in Management Seminar.

32 The Change Model : Implement 4. Motivate Set ambitious stretch goals Identify a crisis Create a crisis

33 The Change Model : Implement 5. Communicate Keep it simple Tell the story with analogies, examples and metaphors Repeat the story Share information Use multiple media

34 The Change Model : Implement 6. Act Keep structure compatible with the vision Train employees Generate and publicize short-term successes Deal with those who undercut needed change

35 The Change Model : Implement 7. Consolidate Change policies and systems that don’t support the change Hire and nurture employees who can implement the vision Use new projects and change agents to re-invigorate the change process

36 “In the final analysis, change sticks when it becomes the way we do things around here.” John Kotter Leading Change

37 Resistance to Change Remember not all challengers are “opposition” “How do I know what I think until I hear what I say” Early vocal critics can become strong later stage allies.

38 Resistance to Change Remember not all challengers are “opposition” “How do I know what I think until I hear what I say” Early vocal critics can become strong later stage allies.

39 Encourage Visible Resistance Often difficult Can increase the likelihood of change management success Covert resistance (especially emotionally based) often lowers performance and dooms the change

40 Creating Visible Resistance Hold meetings and informal discussions Ask open-ended questions and listen Conduct anonymous surveys Bring in an outside ‘consultant’

41 Handling Visible Resistance Demonstrate openness Demonstrate understanding Implement or at least clarify their suggestions Avoid negative consequences in response to unwanted comments Provide visible rewards to encourage the process

42 Handling Visible Resistance Relationship development is important in minimizing the effect of the resistance Clarifying how your change gets others what they want increases the likelihood of their eventual support

43 Visible Reactions to Change People with different histories will see emotionally different possible outcomes when viewing identical facts

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45 Handling Visible Reaction The Denial Group –“this will never happen here” –“why change, we’re doing just fine”

46 Handling Visible Reaction The Denial Group –Strengthen your relationships –Provide information from diverse sources –Focus on first steps

47 Avoid confrontation

48 Handling Visible Reaction The Hopeless Group –“We should never have done this, - I told them so…..”

49 Handling Visible Resistance The Hopeless Group –Obtain needed information –Acknowledge their reality –Paint a picture of the future –Demonstrate commitment

50 Handling Visible Reaction Naïve Enthusiasm –Things are great !!!! and –This will easily make it even greater !!!!!!

51 Handling Visible Reaction The Naïve Enthusiasm –Get them started before they wear out –Develop realism –Begin the concept of measuring results –Acknowledge success

52 Develop Realism with Targets

53 Handling Visible Reaction The Confident Group –This stuff makes sense –When do we get started –We can even have some fun doing it

54 Handling Visible Reaction The Confident Group

55 Aoccdrnig to a rscheearch at Cmabrigde It doesn’t mttaer in waht oredr the ltteers in a wrod are, the olny iprmoetnt tihng is taht the frist and lsat ltteer be at the rghit pclae. The rset can still be a total mses and you can still raed it wouthit porbrlm. This is bcusese the huamn mnid deos not raed ervey lteter, but the word as a wlohe. Edward O’Conner, PhD Taking Charge of Change, 2005 Tampa, Florida : ACPE, Interact Physician in Management Seminar.

56 Handling Visible Reaction The Confident Group –Remove barriers to success –Maintain the gains –Identify the next opportunities –Apply their learnings to next transition

57 Celebrate and Reward Success

58 Change is a Decision Decision Effectiveness = f (Timing, Sequence,Execution) Edward O’Conner, PhD Taking Charge of Change, 2005 Tampa, Florida : ACPE, Interact Physician in Management Seminar.

59 Change is a Decision Timing = how well tactics are matched to the appopriate stage Sequencing = tactics are preceded by associated steps Execution = critical tactics are well executed

60 Summary of Successful Change Leadership Prepare for change Keep the change effort focused Demonstrate effective teamwork Model beneficial behaviors Establish operating guidelines

61 Change Leadership Summary Prepare for change –Multi-staged approach –Don’t skip steps

62 Change Leadership Summary Keep the change effort focused –Make the objective clear –Limit the scope of change

63 Change Leadership Summary Demonstrate effective teamwork Model beneficial behaviors –Active listening –Support and build consensus –Respectful differing and confrontation

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65 Change Leadership Summary Establish operating guidelines –Time management –Roles and responsibilities –Organized discussions

66 Change Leadership Summary Remember that 80% of major change initiatives fail to reach their intended goals

67 Change Leadership

68 Change Leadership Summary The most challenging obstacles to success Human acceptance Adoption of a change

69 Change Leadership Summary So……. When you do succeed RECOGNIZE

70 Change Leadership Summary So……. When you do succeed REWARD

71 Change Leadership Summary CELEBRATE Successful CHANGE

72 Illustration Credits Reaction to Change – Captain Bob Webb –http://www.motivation-tools.comhttp://www.motivation-tools.com Metamorphosis - M Roussev –members.tripod.com/ mroussev/Metamorphosis.htmmembers.tripod.com/ mroussev/Metamorphosis.htm Monarch Metamorphosis –MSN Encarta – Children crossed arms – DennisJones Gallery –www.dj-art.com/ Children/children_1.htmwww.dj-art.com/ Children/children_1.htm Greece Soccer Team – CNN –http://edition.cnn.com/SPECIALS/2004/euro2004/http://edition.cnn.com/SPECIALS/2004/euro2004/

73 Illustration Credits Enthusiastic Dog –www.dogtrainingraleighnc.net/ BuildingToyDrive.htmwww.dogtrainingraleighnc.net/ BuildingToyDrive.htm Enthusiasm Poster –www.dribbleglass.com/ misinspired/enthusiasm.htmwww.dribbleglass.com/ misinspired/enthusiasm.htm Anger Cartoon –www.explodingdog.com/ mayfourteen/angerwo.htmlwww.explodingdog.com/ mayfourteen/angerwo.html Favre Concussion – NFL –www.nfl.com/news/ story/ www.nfl.com/news/ story/ Hour Glass- Doan –www.doan.com/summary_ services.htmlwww.doan.com/summary_ services.html

74 Illustration Credits Microscope –www.washington.edu/ research/atuw/economic.htmlwww.washington.edu/ research/atuw/economic.html Polar Bear Change –news.bbc.co.uk/.../ tech/newsid_906000/ stmnews.bbc.co.uk/.../ tech/newsid_906000/ stm Winds of Change –hypnodreams.org/free_ hypnosis_download.htmhypnodreams.org/free_ hypnosis_download.htm Hopeless man –www.firewise.org/.../ structure_triage_III.htmlwww.firewise.org/.../ structure_triage_III.html Calendar –www.therefill.com/ RefillLooseLeaf.htmlwww.therefill.com/ RefillLooseLeaf.html

75 Illustration Credits Failure cartoon –www.markstivers.com/ cartoons/main.htmlwww.markstivers.com/ cartoons/main.html Failure poster –byerly.org/ posters/failure.htmbyerly.org/ posters/failure.htm Time Mgmt Meeting –www.rogerreece.com/ time-management-seminar.htmwww.rogerreece.com/ time-management-seminar.htm Doctors meeting cartoon –www.cartoonstock.com/ directory/d/doctor_gifts.aspwww.cartoonstock.com/ directory/d/doctor_gifts.asp Chunk of Change Poster –schools.sd68.bc.ca/.../ idioms2003/idiaomsa.htmschools.sd68.bc.ca/.../ idioms2003/idiaomsa.htm

76 Illustration Credits Zion Chain –earth2marsh.com/images/ ontheroad/parks_page.htmearth2marsh.com/images/ ontheroad/parks_page.htm Celebrating fans –www.wvu.edu/football_ tickets/footballFAQ.htmlwww.wvu.edu/football_ tickets/footballFAQ.html –www.inkiboo.com/?go=/ 2002_06_01_archive.aspwww.inkiboo.com/?go=/ 2002_06_01_archive.asp Denial hand –http://www.guiadoimigrante.com/service/default.asp?not_id=1557&l anguage=Phttp://www.guiadoimigrante.com/service/default.asp?not_id=1557&l anguage=P Confident worker –www.selectcrawfordcounty.com/ business.phpwww.selectcrawfordcounty.com/ business.php


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