1. What To Expect When You are Integrating
CDR Rosemary Perdue
Ms. Joan Loepker-Duncan
We want to share our experiences – core chiefs spoke yesterday – there is more of this coming down the road. It is all about change.
You may not ever go through a change like this but as a leader and an employee in any position in and organization, you will most certainly experience some type of change
Don’t want to concern you that your first thought or compared the integration to childbirth…thus the title
Despite pain, labor, challenging phases of the unknown get some amnesia and forget the lessons you learned
We wanted to make sure we remembered and let others know how to smooth their change/transition in their workspace
With hard work and persistence, it is still Possible to get a good result
Best if your share your experience with others to help ease their experience

2. A little about us CDR Perdue JOAN Active Duty Navy Nurse
Assistant Director for Medicine Directorate/Senior Nurse for Medicine Directorate
20 years experience in Navy medicine
Army Civilian Nurse
CNOIC, Cardiology
Department
18 years of experience in Army medicine
We both came to the merger with different perspectives and experiences and needed to work together to get staff through a major issue involving our area. That we will refer to throughout the presentation. Never met before despite both of us were working in the same directorate.
Cardiology - I had been an Army Civilian nurse for 18 years before that I worked in the civilian sector.

3. Show of hands Who has had to endure significant change?
Did you feel any of these?
Professional setting
Private life
Relationships
Routines
Fear
Frustration
Anxiety
Stress
Confusion
Apathy
Exhaustion
Throughout this whole experience of integration we felt most all these feelings on the right side of the page.
I remember sitting at the BOD meeting on day during the integration process and our Commanding Officer, ADM Nathan, said that we need to take a minute to check ourselves and make sure that we are okay. To make sure that we were doing alright because unless you were in a coma, you were feeling the affects of the integration and having feelings like these.

4. Background: Successful Grand Opening…just the beginning
September 2011 – Disestablishing two major commands and establishing through integration the Walter Reed National Military Medical Center (WRNMMC)
The Nation’s Military Medical Center
7,000 staff
243 acres, 2 million square feet of clinical space serving over 1 million patient visits annually
“A historic day for military medicine”
“The largest and most complex series of moves and relocations that we have ever had within the military medical system” Admiral Mateczun (September 2011)
7 months ago
Largest and most impressive integration in DOD history
Unprecedented merger of to major medical centers
Creating a new medical center that brings together the best things about both and attempts to “let go” of the bad..
Better together…patients could now go to one center for everything and not between two facilities…
It was a new beginning for the military and for the patients. It was exciting. Just as the core chief said “it’s all about the patient” – it is about the patient.

5. Objectives Share from our experience - lessons learned
Explore Change Theories
Identify key leadership tools
Discuss Organizational Culture
Define Transformational Leadership
Identify key traits of transformational leaders
Discuss how to Alleviate Ambiguity
Ultimately … increase your comfort level when you are integrating or experiencing change in your workspace
Somewhere in the thick of things, we looked at each other and decided that we needed to talk about this and share our experiences.
How you go about approaching change in your organization
Looking at key factors/indicators that influence culture
What leaders need to make sure they are doing everyday to assess and implement changes with staff

6. Integration Challenge
Unprecedented Merger of Two Major Medical Center’s representing two separate Service cultures
2005 Base Realignment and Closure
Core of an integrated military medicine system in the National Capital Region
Staffed by Army, Navy, and Air Force employees
Groundbreaking July 3, 2008 President George W. Bush
Located in Bethesda, MD on the grounds of former National Naval Medical Center
Magnitude in terms of number of people affected (6,900 people affected)/high visibility (long process from , well planned)
Big plans for the future
Many people affected
Highly politically charged, the Nation was watching.
President did the groundbreaking
This was all happening with the height of the wounded coming through both hospitals
And the priority at both facilities had to be the quality care provided to the Wounded, ill and injured
Until the last day…care could not be compromise
Someone compared what we were doing as starting a business and running a business at the same time.
“starting a business and running a business at the same time”

7. Army - Point of View Walter Reed Army Medical Center
Premier Hospital of Army Medicine
Named after Major Walter Reed (Army Physician who discovered the transmission of yellow fever)
102 year history of providing medical care
2,500 employees
The biggest challenge was that both employees and patients truly believed that the hospital would not close. Never, ever. Even as we were turning out the lights and closing the doors, there were those who couldn’t believe it was happening.
There was so much history at Walter Reed, it was the Army’ s best hospital, the war was ongoing and the wounded warriors were still coming in, day after day. How could we close? Surely Congress would intervene. We gave care until the very last day.
Many employees waited until the very end to complete paperwork, go to training, get new ID badges, etc.
The WRAMC employees had to find alternate routes to work and child care, consider commuting options related to parking
Many others were excited about the change. All care would be available in 1 place. No more going to WRAMC for Peds care and Peds subspecialty and NNMC for Labor and Delivery and NICU.

8. Navy – Point of View National Naval Medical Center
Flagship of Navy Medicine
The President’s Hospital (Founded by Franklin D. Roosevelt)
71 years of providing medical care
3,800 of employees
Remember NNMC and WRAMC were Brand names. They were know throughout history as the premier medical centers for their Services – now together they were going to be the Nation’s Medical Center
NNMC was the flagship of Navy Medicine. It was the President’s hospital.
AT NNMC, we believed the integration was going to happen as we saw our building morph before our eyes. New drywall went up daily, we saw and more green uniforms, we kept moving our clinics into new spaces in order to accommodate renovations and ultimately the move.

9. Air Force – Point of View
158 staff
Such a small percentage of the workforce
- Who advocated for their needs?

10. What was the same Premier medical care and long standing history
Focus on our nation’s heroes - wounded, ill and injured
All military beneficiaries and their families
Patient and family centered care
Our Nation’s leaders
Rich in military tradition
Uniformed employees
Civil service employees
Contract civilians
Patient loyalties
Proud and strong culture of leading the way for other military organizations
War time focus – emphasis at both facilities on wounded warriors and their families.
Multiple competing missions, retirees travel great distances for care, great pride in the Service they chose.
Nations leaders receiving care and also visiting casualties.
Increased turnover of staff (25%) deploying staff
Pride in hospital and pride in care delivered, pride in branch of service.
Both were teaching hospitals with training missions for Graduate Medical Education.
Multiple competing missions at both hospitals
Look at the slide, it says it all!

11. What was different Military specific organizations and culture
The way we did it before
Focused specialty care
Language/Jargon
Artifacts
Acronyms
Chain of Command
Culture, Culture, Culture
Feel of each hospital was specific to their service
Army centric …(WRAMC) staff took pride in walking into “their” facility everyday..pics of WR, Army colors, pictures on the wall…
Navy had same feel… atmosphere and speech was that of a ship
Quarterdeck
Navy Flags
People would describe the floors of the buildings as “decks” go to the “head” the “galley” was where you ate
Acronyms used AAR, BLUF, DON, DNS, CNOIC, DH, OER (banter) Directors, Chiefs – sitting in meetings and totally missing what the context of it was because you were trying so hard to decode the acronyms. (banter) – leadership considerations: State the obvious, don’t assume they know what you are talking about. Say the acronyms
Understand the origin of the Army (battle field) Navy (Ship sailing into the horizon) had to use the people and the resources you had with you.
Chain of command at Navy was much different then Army (neither was right,,, just different based on the history of how they served
(Navy followed chain of command very strictly and wouldn’t necessarily involve them as early as Army. CO may leave on a ship and not be able to communicate for days with the rest of the fleet so very controlled but also intuitive leadership..dealing with unknown and
Army typically had more staff and resources and land base. Essence of communication was very different as well as how leaders evolved.
Lots of unwritten rules about how you behave in leadership roles in “our facility” how you represent yourself as a leader…”very respectfully” at the end of s. Cc’ing or not with their leaders, developing SOP’s, what you would typically counsel for what you wouldn’t…
From a patient point of view you would go to the specific facility you needed for specialty care… (Labor and delivery, NICU (NNMC) Pediatric inpatient (WRAMC)

12. Cardiovascular Health & Interventional Radiology (CVHIR)
New area for the hospital combining 5 separate services (Cardiology, CT Surgery, Interventional Radiology, Neuro Interventional Radiology, and Vascular Surgery)
Patient Centered Experience
Multiple levels of ownership
Competing missions impacted forward movement
Huge challenge that represented the multiple factors that come together during change
Product line of services was created and grouped together, similar to product lines seen in many civilian institutions.
Prep/Recovery area was situated in the CVHIR to the support of patients undergoing procedures there. Similar area (on a smaller scale) was at WRAMC, called the CSSOC and worked well there for just Cardiology/Vascular patients. However, staffing for the area wasn’t allocated. Vision was that all services involved would contribute to staffing pool. Reality was that each Service was protective of their resources and they were not willing to give up personnel. Left the P/R with a mission but no personnel support.
Each specific service were concerned initially about the “unknown” – unsure of what the patient load would be, how things would work and thus worried about losing staff to the P/R area. Prior to merging, only Cardiology was responsible for staffing CSSOC so difficultly understanding why this mission/staffing should change.
This was a physician concept of operations. They were deliberate in their concept which was patient centered and shared resources but not details were worked out regarding staffing, budget, equipment, etc. However, nursing was left out. There was no staffing model for the area and no input from nursing until just prior to the merger. This is when our “world’s collided”. CDR Perdue started Multi-D meetings to get the P/R area to work. She showed up in my area to help with the change process. Ultimately it boiled down to nursing staffing issues and nurses throughout the command came together to help. We got the right people at the table.
We came up with both short and long term staffing solutions (which I will expand upon later).
Staffing solution – long term – finally have integration of nurses from Interventional Radiology and are in the process of cross training IR, Cath lab and P/R nurses to all areas.

13. Here’s the story…
“Nothing is so painful to the human mind as a great and sudden change.”
Mary Shelley- Frankenstein
Let’s tell you a little bit about this monster transformation
Even if you were as well informed as we were (in the know)…it still could not have prepared us for what we were about to face. Although we were preparing for 2005
WRAMC stayed open until the end…some staff were working in the facility one day and another the next…
We are going to share with you stories that are examples of leading during change. Each isolated story is in itself a testament to organizational change. But all these stories together – the ones that we share and those that we don’t’ have time to share, make up but a small part of the historic change that BRAC brought about in the National Capitol Area.

14. Change defined (dictionary.com)
to make the form, nature, content, future course, of (something) different from what it is or from what it would be if left alone
transform or convert
substitute another or others for; exchange for something else, usually of the same kind
to give and take reciprocally; interchange
to transfer from one (conveyance) to another
Lets start with the basics..what is change?
Sounds simple
Look up some quotes for change, you will see that there is a tremendous emotional component involved the definitions don’t describe the emotional/human part
Rose: holding a leadership position during this significant period of change was the most challenging leadership opportunity in her 20+ year career and fundamentally change the way she approached her position
Joan would say… I felt like I was living the theories and emotions that I learned about in my Master’s courses. It was eye opening. For me the hardest thing to deal with wasn’t the actual physical changes, but the emotions that went along with them. Not only the employees I supervised, my co-workers, but more importantly, my own.

15. Change Theory
What do the experts say about how to approach change successfully?
Lewin’s (Change process)
Lippit, Watson, & Westley (Change agent)
Prochaska & DiClemente (Person changing)
Social Cognitive (Behavior)
Use of variety of theoretical frameworks to guide and ensure success
Definition of change:
How approach – many different ways…we will hit the highlights and make the point that you may want to look at it from different aspects
2 ways of looking at change: process or the people:
Models: One looks at the change agent and their role (Lewin)
The other looks at the people going through the change (Social change) and developing self- efficacy
____________________________________________________________________________________________________________________
Lewins: (evolution of change itself)
Process is Unfreeze, Movement, and Refreeze – focus is on the change agent and going in the direction of the planned change
Unfreeze: (get rid of status quo) – good example is choosing Integrated chiefs
Movement: (address restraining forces that negatively affect the change = move to a new level) - good example is working together on “best practices” - creating ideal units/clinics/processes
Refreeze: (stabilizing the new equilibrium/change – not moving backward) – making sure things “stick” (New WRNMMC SOPs)
Lippit , Watson, Westley - (focuses on role and responsibility of the change agent)
Created 7 step theory (extending Lewin)
Prochaska, DiClemente: ( model of change behavior)
cyclical change: relapse of change behavior – precontemplation, contemplation, preparation, action, and maintenance
*Comparison of Change Theories – 2004 – Alicia Kritsonis

16. Lewin’s 3 step Change Theory
Unfreeze:
Get rid of status quo
Movement:
Move to a new level
Refreeze:
Stabilize the equilibrium
Leadership considerations
Entire integration (change itself)
This theory looks at the evolution of change and at the forces that promote or inhibit change.
Change will occur when the combined strength of one force is stronger than the strength of the opposing forces
Unfreeze: get rid of status quo – New CVHIR area, new location, new name
1. Motivate to participate, build trust, actively participate, brainstorming – doctors did this
Movement:
target a new level of equilibrium
Persuade staff to new fresh perspective
Work together quest for new
Connect views of the group to well connected, powerful leaders
Everyone has a voice at the table – CVHIR work group to increase driving forces away from status quo – hoarding staff for their areas, needed to give up persons –– used pt as the guide to have the right level of staffing for a patient centered experience. Interventional Radiology to use IR nurses as part of staffing for the whole area. Allowing RN’s from all areas to cross train.
Refreeze:
After the change, want things to stick, want new values and traditions, stabilize new, balance the driving forces
working on refreezing, putting policies in place, training up staff to cross train.
_________________________________________________________________________________________________________________
Clear organizational chart – new
Compatibility charts – rank equivalents
Lexicon use – BLUF, Very Respectfully,
State the obvious
Develop trust
Express clear expectations
Notes: changing mottos (it’s my house/what I do matters) and “on Georgia Ave” vs at Walter Reed/Navy/Bethesda; new lab coats; new logo

17. Change Agent/Lippitt, Watson, & Westley
Expanded on Lewin’s Theory
7 step approach
Focus on the roles and responsibilities of the change agent
Leadership Considerations
There are many steps involved, you may want to explore them. Looking back, this is what I did when I created the CVHIR work group to address the staffing issues they had. I stepped away from the group…………
Change agent
Diagnose the problem
Assess motivation and capacity of change
Assess recourses and motivation of change agent
Choose progressive change objects
Select role of change agents
Maintain the change
Terminate from the helping relationship
Leadership considerations: prep and recovery workgroup (CVIR)

18. Behavior/Prochaska & DiClemente
5 stages: focus on individual going through the change
Pre-contemplation, complementation, preparation, action and maintenance.
Cyclical not linear
Leadership Considerations
Initially, Prochaska and Di Clemente defined behavioral change as the patient’s journey into a healthy behavior. Later the theory was extended to the other incidences
Pre-contemplation: unaware or fails to acknowledge, doesn’t want the change
Contemplation: raised consciousness of issues, begins thinking about it
Preparation: ready to change and plans to do so within 2 weeks – needs counseling, support and assistance with problem solving
Action: increase in coping and engages in change activities
Maintenance: actions are in force – changes are taken along with establishing new behavior change to lifestyle and norms. May last 6 months to lifespan. – needs counseling to avoid relapse to ensure long term change.
Individual were in different stages throughout the entire integration – person can exit at any time.
Cyclical –takes into account relapses or return to previous behaviors. (not linear like the others previously discussed). May return to contemplation and prepare for future/learn from relapses
Light‘s off still did not think this was going to happen
People coming over to plan out spaces, processes, and flow
Leadership considerations:
Assess where individuals
Counseling
Social support
Assistance with problem solving
So even though a the IR nurses integrated with the P/R plan (action) – they sent a nurse to help each day but then they reverted back to pre-contemplation stage and didn’t want to return to the action.
“maintenance can last 6 months up to the life span of the individualist”
cyclical: individuals have the ability to exit at anytime if they decide

19. Behavior/Social Cognitive
Developing self-efficacy (belief in one's capabilities to achieve a goal or an outcome)
Behavior Change is affected by environmental influences, personal factors, and attributes of the behavior itself
Leadership Considerations
Previously called “Social learning”
Individuals learn by direct experience, human dialogue and interaction and observation
Leadership consideration:
Increase self efficacy: providing clear instruction, opportunity for skill development and training, and model the desire behavior
(integration staff, concrete things, day in the life, both facilities training on new equipment, iv pumps, modeling behavior “everybody is so excited…blah, blah, blah,,,,party lines…
Important when implementing employee training programs: There are 4 processes to increase the likelihood of success:
Attentional processes – make it relatable (day in the life)
Retention processes – they can remember
Motor reproduction processes: converts seeing to doing
Reinforcement processes: use rewards/incentives (behavior is the result of the consequences of the behavior)
Observers must have trust, admiration, and the respect evoked from the models. Models should not be something observer can’t visualize
“mottos, buzz words/phrases…better together…its my house”…”what I do matters” – PR for this throughout the facility via the Newspaper, every square foot walk around, etc. Rewarded with the pin with by Chief of Staff , these pins were numbered. People knew.
Best practices
Better for the patients
Combined services
________________________________________________________________
Lewin’s- very practical does not consider human feelings and experiences
Not an exact science, use different approaches

20. Optional Leadership Tools for Change
Make it as easy as possible:
Effective communication
Development of self-efficacy
Consider the human experience
Addressing physical requirements:
State the obvious – over communicate
Ensure that everyone is told at same time about things to decrease “gossip mill” but also take the time to “walk around’” and allow for 1:1 questions and to reinforce the message.
New facility is much larger with many more employees, even individual services became larger. Important to look at the modalities to communicate – , staff meetings, message boards, etc. Make sure to get the message out.
Prochaska and DiClemente – “employee can do it” - focus on the people not solely on the process.
Meet the physical requirements – food, shelter, bathrooms, parking, place to sit and hang your coat. Need to ensure that this is done. Do we have phones, keys? Computers?
Before you ask people to jump aboard and do these amazing things – need to address Maslow’s Hierarchy of needs. Give your employees the basics.

21. “Any real change implies the breakup of the world as one has always known it, the loss of all that gave one an identity, the end of safety.”
James Baldwin

22. Organizational culture
“Total beliefs, behavior, knowledge, sanctions, values, and goals that make up the way of life of a people.”
“Historically transmitted patterns of meanings embodied in symbols by which men communicate, perpetuate, and develop their knowledge about and attitudes towards life.”
“THE WAY THINGS ARE DONE AROUND HERE”…
(Sara Breckenridge-Sproat, 2001)
Just read an article about the invisible culture of an organization, how do bring forward a new culture while holding on to the good things from the old cultures. Have new mission and vision of the hospital. New mottos – “What I do matters” and “ It’s my house”
What is the culture at your organization?
Its about the people
“culture resides in people”
If culture is needed to change you must try and transform mindsets and political patterns”
How do you reset your staff to think about a new ways of doing things and not rely on their comfort zone while they are still working in the other organizations?
Have to look closer at what things motivate their behavior and find things they both staff have in common
What are some examples of culture that you have?
The military itself has culture that is unique to all

23. Influence Organizational Culture
Physical structure
Rituals and ceremonies
Language
Stories and Legends
Leadership Considerations
Organizational culture resides in people, if culture is changed the leader must transform mindsets and political patterns.
It is the organization's personality. Artifacts must be replaced with new meaningful ones that reflect the new values and beliefs. We are still developing our culture and this will take time.
However, there is a whole committee created to incorporate some physical artifacts from WRAMC into the new hospital. The new culture perhaps will incorporate the diversity and history of the cultures from all those who integrated into WRNMMC.
Physical space and artifacts
Building
Scrubs
Lab coats
Pictures on the wall
Desks, chairs
Routines and habits
Greetings
Lunch
Breaks
Leave rules
Sign in
counseling's
Celebrations
Considerations
Create new artifacts
We created a combined logo and motto
Daisy award- new
Language
Catch phrases
“it’s my house”
Language:
SEL instead of NCOIC and LPO
Stories and Legends:
It’s my house pins – everyone wanted them

24. Organizational Culture
Artifacts -Army
Artifacts - Navy
Pictures of Generals
Walter Reed Sword
Auditoriums – Joel
Uniforms – “Class A”
Statue of Walter Reed
Ward 72 (gifts from dignitaries/DV)
Pictures of Admirals
Hall of Flags
Auditoriums – Clark/Memorial
Uniforms – “Dress Blues”
Quarterdeck
Substitute artifacts
Impact on patients
The emblem, the colors of the floor, the symbols, the signs.
The sad part is, we couldn’t even think of any Air Force artifacts except for flag. Imagine how this change affected the Air Force.

25. Transformational Leadership
A leadership style that fosters positive changes in those who follow
Characteristics of a transformational leader
Embraces change
Endorses participative leadership
Challenges the way things are done and who does them
Active listeners
Toxic Handler
Ambiguity Alleviator
Participative leadership:
Innovative, motivational, proactive
Transformational change making major or radical changes in an organization such as large restructuring.
It is transformational when it produces simultaneous changes in multiple system elements including structure, strategy, and culture among others.
To achieve rapid and organization wide performance improvement.
It Is intended to reshape the entire organization.
A transformational leader has Openness: the leader is an active listener (values the views and concerns of those at the front line), has visible leadership (walk arounds – available to all – risky – don’t want to be seen as not “Knowing the answers” – may avoid this) and open communication and language (state things simply – tell more that “what is needed to know to do the job”. More buy in when the bigger picture is clear (er) – obviously there are times/situations where it is not in the best interest of the organization to tell all. Transparency.
Some other characteristics they have are being a toxic handler and ambiguity alleviator.

26. Toxic Handler
Definition: “Managers who voluntarily shoulder the sadness, frustration, bitterness, and anger of others so that high-quality work continues to get done.”
(Peter Frost and Sandra Robinson, Harvard Business Review, July-August 1999)
Leadership Considerations
Need them in organizations, especially now as there are so many “change imitative” and down sizing.
Need to take care of them (protect them from burnout): they themselves suffer as a consequence.
Need to acknowledge the role and support the TH as much as possible.
Managers experiences with change: Study by R Stuart in 1995/1996 found that a significant number of managers reported worry, stress, angst, grief at a level normally associated with disasters, catastrophes, and abuse.
Rose: when working with a clinic that was having some issues – just knowing this role.
Any change should account for the emotional impact and strategies to respond to these impacts.
TH provide emotional support to staff in time of stress and change by listening empathetically, suggesting solutions, working behind the scenes to prevent pain, carrying the confidences of others and reframing difficult messages.
Find some quick wins…magic wands, wishes
A great example of toxic handler role is staffing of the CVHIR. Remember the staffing shortage we had in the CVHIR, able to create wins for both areas.

27. “Neurosis is the inability to tolerate ambiguity” Sigmund Freud

28. What is Ambiguity? Why is it important to explore?
Definition: doubtfulness or uncertainty of meaning or intention, unclear. (dictionary.com)
Can be harmful to a work environment
Decrease forward movement towards a goal
Staff can become paralyzed by it
Staff may create their own false realities and perceptions
Effects successful group direction and progress
Negatively impacts staff morale
Leadership Considerations
There are many different specific forms of neurosis: obsessive-compulsive disorder, anxiety neurosis, hysteria (in which anxiety may be discharged through a physical symptom), and a nearly endless variety of phobias as well as obsessions such as pyromania. According to Dr. George Boeree, effects of neurosis can involve:
...anxiety, sadness or depression, anger, irritability, mental confusion, low sense of self-worth, etc., behavioral symptoms such as phobic avoidance, vigilance, impulsive and compulsive acts, lethargy, etc., cognitive problems such as unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc. Interpersonally, neurosis involves dependency, aggressiveness, perfectionism, schizoid isolation, socio-culturally inappropriate behaviors
What are some examples that we faced that were ambiguous? What are ambiguous situations we faced? (as leaders or employees)
A. Not knowing how the (new) P & R area fit into the hospital? Again the CVHIR
work group helped "alleviate" the ambiguity of the role of the area, etc.
B. Not knowing how the IR nurses/Cath Lab nurses/P & R nurses all fit in and
would work together
C. Not knowing how the new CVHIR would work as an outpatient clinic - also had
"CVHIR" work group meetings for the inpt side
1. Not knowing what the uniform of the day was? (class B's vs. ACU's)
2. Not knowing if there was money for training/education
3. Not knowing if there would be parking?
4. Not knowing how the administrative chain worked/fit in
5. not knowing how our jobs were going to change (related to new co-workers)
and new mission/additional missions
Do you think for the CVHIR success story that we could include the fact
(cleverly disguised) that the as a leader (toxic handler) you were able to
move people in other areas to P&R to make a win/win for both groups?
Certainly, can use the CVHIR work group as a great example of how
transformational (the leadership) the development of that area was by working
together with other groups/areas. Also, great example of how resilient a group
is with "good" leadership vision even if there are lots of bumps in the way of
achieving the goal.
Summary should be again something to the effect of:
Use many different models (good parts in all theories)
Plan well but expect the unexpected (even simple things like the patient move
weren't simple - enter Hurricane Isabel)
Be flexible
Take care of yourself as a leader (don't burn out, have some personal time to
rejuvenate - especially if you are "toxic handler" etc.)
Celebrate the successes (not matter how "small" - not noticing the uniform,
not thinking my way/your way, coming together - just like you and I have to
work together/collaborate)

29. “The creative person is willing to live with ambiguity
“The creative person is willing to live with ambiguity. He doesn't need problems solved immediately and can afford to wait for the right ideas.”
Abe Tannenbaum

30. Ambiguity Alleviator Characteristics Role Function Actively assess
Accepts accountability
Asks and answers
Aides and abets
Avoids attack
Role Function
Close gaps of the unknown (ambiguity)
Connect staff who have the knowledge and answers
Establish actions on how to move forward
Know what to do when there are no good answers
When going through change there is a lot of unknown, you as a leader can help alleviate ambiguity and get staff through the change
Helps manage expectations – better to have the questions answered than not to know at all. People weren’t afraid of the answers, just not knowing. Sometimes there aren’t any good answers but articulating this is important as well.

31. Ambiguity alleviator: Actions words with positive movement
Align
Achieve
Amplify
Acknowledge
Apply
Advocate
Advance
Ascertain
Applaud
Folks in the organization who get things done by bringing people together, getting needs met, knowing when to bring things up the chain of command, transparent with the way forward and not afraid to admit when they don’t know the answer
They don’t or not
Abolish
Abhor
Aggressive
adverse

32. Summary Change theory can help frame foreseeable challenges
Organizational Culture can positively impact change
Transformational Leaders are key
Identify them early and tap into their resourcefulness
Accept that even best laid plans will have to change
Seek out and celebrate success - no matter how small
Actively Alleviate Ambiguity
Find common ground and move forward
There are many theories and approaches to managing change. We have discussed several. These can be overwhelming to the manager just trying to “get through the week/day” when discussing change and reviewing the literature, we find there is no “one right way” or “one answer”. By familiarizing yourself with the theories, you, as a manager, can match them to your particular circumstance and bring about successful change.

33. Final thoughts
All big changes in human history have been arrived at slowly and through many compromises.
Eleanor Roosevelt
All big changes in human history has been arrived at slowly and through many compromises
Change means the unknown
Eleanor Roosevelt