Change Acceleration Process (CAP) Workshop

Change Acceleration Process (CAP) Workshop
Welcome and Introductory Remarks by Key Senior Leader? Pass around Sign in Sheet Tent Cards - ask participants to fill out both blank sides – give them the tip of folding the bent corner of the cards to make them stand up better. Suggested pre-made flip charts for Day One (prepare prior to class) Welcome Questions Action Items (WWW) Parking Lot Expectations Ground Rules Where am I now (CAP Self Assessment) (Laminated) Change Acceleration Process Tower Exercise Instructions Plus/Delta In Frame/Out of Frame Others you like to use? Prepare Tower Exercise Materials (for End of Day One) – see notes at the end of CAP Coach section for complete materials list.

Session objectives By the end of this workshop, you will be able to:
Understand and be able to explain the CAP model Learn CAP tools and how they can be applied to your department/organization Facilitate various CAP tools Understand the role of the CAP Coach/Change Agent Develop awareness and practice coaching/feedback techniques Share best practices Review objectives with class. Preview key points from upcoming modules & activities to give a greater appreciation for the big picture and how they can practically apply these skills in the workplace. Encourage participants to share their experiences as we go through the class. Explain that they are the experts in their organization and their stories/experiences will add depth and value to the conversation.

Team assignment Introductions/Expectations/Ground Rules
Individual Introductions Two learning goals/expectations for the session Two ground rules for the session Give tables minutes to complete this task. Revise as appropriate for the group and the organization. Suggestion: Refer to team roles that are listed in two slides and invite them to use these roles in this exercise. Have small tables report their learning goals and ground rules – capture on separate flipcharts (one for goals and one for expectations) as they report (consider using alternating colors as facilitator tip). Add icebreaker (e.g; Would you believe that I…) so they get to know each other. Expectations: Tell group we will be checking back to see how we met these expectations. Hang in a safe place for use on Day Three. Ground Rules: If needed, suggest other ground rules as necessary if the groups don’t get all the usual ones. Ask “What is the importance and rationale for using ground rules?” Ask: Will these ground rules that we have come up with today help us work effectively and are there others that we need to add that are specific to this organization (those notorious behaviors that stop them as a specific group from having effective meetings). Confirm with group that they can live with these ground rules. Hang in view. Move to next page dot exercise.

Clear Role Definitions Help Team Process!
Working as a team Summary of roles  Guides the group through various activities to achieve objectives. Ensures all group members participate. Focuses group attention on what needs to be done. Promotes discussion to help the group overcome differences and reach consensus. Leader Process Checker Maintains focus on agreed-upon processes being used. Suggests techniques to help the group achieve goals. Helps the group apply tools correctly. For example, when the group is brainstorming, make sure there is no evaluation. Scribe Time Keeper Presenter Records ideas verbatim. When flip chart is used, writes large enough so all can read. Makes sure all flip charts are labeled and clear. Leads initial discussion to allocate time to the agenda items. Monitors agreed-upon timeframes and gives updates on use of time. Leads presentation of group’s work to other groups. These are the roles that are also on their table tents. Set context of effective teams – those with clear role definitions can be more effective. Briefly review each role and tell class they will be having many opportunities to practice these roles each time we do a small group exercise. Add to scribe role, spelling & handwriting do not count. Also explain the pre made flipcharts that are hanging around the room such as parking lot, questions, etc. Explain the importance of the parking lot (not the dumping lot) and encourage participants to post questions. Because food and room temp are frequent deltas for the group and outside of the facilitator’s control, contract with the sponsor or someone in room to own communication of the groups needs (temp up/more pots of coffee, etc.) Natural place for a break: consider more frequent and odd break times (7 ½, 9 ½ ,11 minutes, 13 minutes) as they are remembered better. Use a timer (either one on the table or a countdown screen). Clear Role Definitions Help Team Process!

Change Acceleration Process
SUCCESSFUL UNSUCCESSFUL DESCRIBE THE CHANGE: In a few words, describe a successful change considering the following questions in your description: What did we want to change (performance, people, structure, etc.)? Who wanted the change to be made? Why was the change desired? DESCRIBE THE CHANGE: In a few words, describe an unsuccessful change considering the following questions in your description: What did we want to change (performance, people, structure, etc.)? Who wanted the change to be made? Why was the change desired? Have participants think of a change initiative they experienced, or at least know well. Suggestion: May have half of the participants think of successful examples and the other half unsuccessful ones if time is an issue at this point. Individually (quietly) jot down elements that will you will be sharing with larger group – time 2 minutes.

Quality X (Acceptance x Accountability x Alignment) = Effectiveness
Formula for results Q x A3 = E Q x A3 = E Quality X (Acceptance x Accountability x Alignment) = Effectiveness 62% of quality efforts fail (from lack of attention to the cultural and people sides of change – the “A”) Change Acceleration Process developed by GE to focus here Describe this equation as how we think about effective change. The foundation of our culture change can be found in one simple formula. The effectiveness of a change effort is equal to Quality (the solutions used) times the accountability for and acceptance of the change. Suggestion: Can demonstrate the following on flip chart to drive the point: Ask them to rank how effectively their organization makes change using the equation. They will usually rank Q high – in the range of 7-9 because we know how to come up with good solutions. Ask them to be honest about the A2 side. With some encouragement to be honest, you will see scores in the 2-5 range. Flip chart those results. Example: 9 X 4 = 24 (or 8X7, etc.) Tell that if A2 side of equation can be improved (which is what the CAP tools allow organizations to do), overall effectiveness of change efforts can be dramatically improved. Flip chart what that would look like: 9 X 9 = 81 – a 2.5 times improvement in effectiveness from 9 X 4! (adjust if their math is different from this example,) And, have them go back to the principals of successful change lists they made at their tables during the last exercise and identify which are Q and which are A – usually see over 60% will be the A side of equation – another way to validate the formula.

Effective Results (E) are equal to the Quality (Q)
CAP Overview Effective Results (E) are equal to the Quality (Q) of the solution times the Acceptance (A) of the idea and Accountability (A) and Alignment (A) of the implementation Q x A3 = E A proven formula for results

Implementing change Q x A3 = E
Effective Leadership Practices QUALITY Technical Strategy ACCEPTANCE Cultural Strategy Change initiative focused on customer needs (target) Linking Strategies Together: Match the activity or initiative with the type of strategy (T or C). Six Sigma Work-Out Communications Problem Solving Facilitation Skills Team Building Speed = Integrating Problem Solving with Engagement

Next we’ll share the Change Acceleration Process (CAP) Model. It is composed of seven elements to be accessed while moving from a current state (today) to an improved state (future target). (Optional: laminate a poster size CAP model for use during the class – this can be an effective visual during class rather than having to flip slides to find the CAP model when you want to reference it.)

Mobilizing Commitment Changing Systems & Structures
Change Acceleration Process Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last Walk through the model at a high level. Key Points: Is in chevron shape which integrates the current, transition, and improved states. They are phased in over time as the project progresses. Looks linear and is also iterative – you start one component in one phase of change and may need to come back and pay attention to it again as the change progresses. The plate spinners on the old Ed Sullivan show are an example of this iterative approach – they started plates spinning but had to go back and recharge some plates during their act. Tell that there are tools used during each of the 7 elements to improve the A2 side of change – how overall effectiveness can be made to improve. Option: If you are using a laminated CAP model, you can be referring to it on the wall and then come back to that laminated version as the class works through various elements of the model. You can use the CAP model as your first tool – can be a high-impact visual to help a team determine where they are relative to the various elements of CAP. Can be used to -Assess strengths and weaknesses of a change effort -Track progress over time -Generate dialogue and form perspectives about the organization performance on the various elements of the CAP model Monitoring Progress Changing Systems & Structures

Changing Systems & Structures
CAP Model Leading Change: Having a champion who sponsors the change. Leadership provides the time, passion and focus for the effort. Sy s t ems & St r uc t ur es Creating a Shared Need The reason to change, whether driven by threat or opportunity, is instilled within the organization and widely shared through data, demonstration, demand or diagnosis. The need for change must exceed its resistance. Lead i ng Change Shaping a Vision The desired outcome of change is clear, legitimate, widely understood and shared. Mobilizing Commitment Key stakeholders are identified, resistance is analyzed, and actions are taken to gain strong commitment from key constituents to invest in the change and make it work. Making Change Last Once change is started, it endures and flourishes. Learnings are transferred throughout the organization. There is consistent, visible and tangible reinforcement of the change. More specifically (but still not in too much detail) describe the specifics of the elements. Keep this discussion at a high level. Typically we point out the elements mentioned in the Changing Systems and Structures element so they can understand what we are referring to when we say “systems and structures” Monitoring Progress Progress is real. Benchmarks are set and realize. Indicators are established to guarantee accountability. Changing Systems & Structures Making sure that the management practices are aligned to complement and reinforce the change (staffing, development, measures, rewards, communication, organizational design, resources, systems).

Setting Up for Success - Roles
Where we are going next: Understand the key team roles and the importance of role clarity to team effectiveness. Understand the key elements of chartering a team What do you currently do to set teams up for success before teams start meeting? Reference the CAP model and tell participants that the activities of this section occur in the white space to the left of the CAP chevron.

Time invested up front pays rich rewards down stream –
Setting up for success Overview Why bother? A good start is essential to long-term success Even seemingly straightforward projects must be thoroughly scoped to ensure that attention is focused on essential elements and deliverables Effective teams are formed only through deliberate actions, starting with clarification of roles, responsibilities and expectations Clarify what we are after A well-defined scope of work is needed for the project so that all parties understand and are committed to achieving success An effective project has an execution structure and process Clear roles, responsibilities and expectations for all parties (Team Sponsor, Team Leader, Team Members, CAP Coach, others) Inquiry: Why do projects often fail to reach their desired results? Review and discuss bullets using key points. Key Points/Steps Questions: How many in room work alone on projects i.e. you are the “team.” How many use “virtual teams” or coordinate people on an as needed basis; How many have a team of 3-5 “members” (part time on project); How many of you are on more than one team? In all cases, when tasked to “lead this project,” leaders are dependent on others to cut through the business process complexity and across organizational boundaries to meet goals.. These tools will help launch those efforts in a way that engages the range of people whose expertise, skills and resources must be coordinated and help them work toward the project goals: whether a virtual team or ad hoc project team. Time invested up front pays rich rewards down stream – go slow to go fast!

Clarifying key roles prevents problems and confusion.
Setting up for success Roles Successful teams establish and clarify the following roles: Team Sponsor Legitimizes both the project and the team, and ensures that the right people are assigned to the team Provides critical resources and helps ensure that Team Members have the time needed to complete the project Helps remove roadblocks and resolve conflicts Team Leader Serves as the day-to-day leader of the team Ensures that Team Sponsor is informed of team’s progress Organizes the work of the team CAP Coach/Change Agent Helps Team Leader build an effective team process Provides coaching on the application of CAP tools Helps the team utilize CAP “Best Practices” developed by other teams Ask: “Why would a charter be important in this process?” and see if the participants themselves will define importance of this step for you. Example of hospital-related questions to ask for this slide: If you were coaching a project to decrease cycle times in the ED, who would be the sponsor? Will get several different answers depending on the organization where class is occurring. Sponsor will usually be a senior person who is responsible for the process – someone like …. Who would be the team leader? Team leader will be someone who is close to the process – even owns the process such as an ED Manager. CAP Coach? You might be the CAP coach/change agent because of your facilitation skills and knowledge of specific tools. Ask questions to help them understand roles. Clarifying key roles prevents problems and confusion.

Team Members serve as role models and leaders of change.
Setting up for success Team composition Project team composition should: Involve key stakeholders plus individuals who can contribute to and are necessary for the completion of the project Be more process-based than functionally based Represent a diagonal slice of the organization Be based on complementary expertise and skills, not on availability Involve people willing to make the investment necessary to participate fully in project Speak to slide – hit key points. Examples of questions for understanding – continuing with ED example. Who might be members of the team? ED nurses ED Docs Lab Techs RADI Techs Admitting Bed Mgmt Unit Nurses (from units that get admits from ED) Others? Team Members serve as role models and leaders of change.

Setting up for success Team charter
Launch team with clear charter of responsibilities: What processes are the team responsible for and why are they important to the organization? What requirements or boundaries (non-negotiables) are givens for this team? What is the reporting relationship to the sponsor? What authority to act or decision-making influence does the team carry? On what issues is the team expected to consult or inform the Team Sponsor? What deliverables are expected? What milestones and timelines? How will the team be measured? What will success look like? Speak to slide –hit key points. Use this series of questions with the team and sponsor to clarify expectations. Additional talking points: How will teams benefit from knowing the elements the charter provides? Key learning: Teams benefit greatly when the sponsor, leader, CAP coach are all in agreement as the teams starts. This avoids confusion later on which is wasted time and effort.

Selecting a project exercise Setting up for success: Assignment
Now they select a project which will be used by their table the rest of the class. For this exercise, consider rearranging them so they can work with new people for the rest of the course. Might have started out the day with the people they already knew. Class Projects Criteria: Q is well defined (direction has been decided) Everyone at the table can relate to topic and has interest in and is willing to work with the the next day and a half Real Situation Scope is w/in 6-9 mos This change requires people to “DO” something differently To stimulate projects coming forward – remind participants that if they recommend a project they are working on (regardless of the stage of the project), they can take all pages that are developed in class to use as models for themselves. Sometimes this helps get people to come forward. Should take 3-4 minutes to pick a project. Have them report out by table to check the projects for usefulness and overlap. Natural break/ lunch. Communicate time limits: lunch 30 – 45 minutes based on group decision (and availability of food in room or not). If too early for lunch, can often go through In/Out of Frame practice.

Setting Up for Success – Project Definition
It has been said that successful change is as much as 80% planning and as little as 20% execution. One critical step of planning is defining the change project itself. This includes: 1. Identifying the right projects to do. 2. Outlining the boundaries of the project scope 3. Ensuring alignment of team members and stakeholders around project mission and success. Ever been in a situation where there was not adequate discussion upfront about project expectations and success? How did this impact the team/project? In this next section we will look at 7 tools to: Understand the importance of project definition and scoping. Understand project bounding tools and how to apply them. Practice some of the tools we will see on the projects you have selected. Again, reference the CAP model and tell participants that the activities of this section occur in the white space to the left of the CAP chevron.

Project definition: Significance
Project screening Project screening questions: Is there a significant, measurable benefit or a positive internal/external customer impact? Are data and measurement systems available? If not, would getting them be cost-effective? Can benefits be quantified? Is there a Team Sponsor/Champion willing to provide or help acquire resources and monitor the project? Is significant process improvement feasible? Can the project be done in a reasonable amount of time? Is the project translatable to other divisions/businesses? Can we involve the necessary span of stakeholders needed to gain acceptance as we conduct the project? Are resources available (or given time) to work on the project? Talk to slide – hit key points. Ask for additions to the list. Can ask: This is a suggested list only and a list of wise thoughts. What would the group add? Additional Talking points: In Setting Teams up For Success, we talked about getting teams started successfully before they even start meeting. In this section, we will be getting even more specific into project definition. How do you currently make sure projects are well defined? What are the symptoms of a project where there was confusion around definition? And projects need to be important or significant: Does the goal of the project tie to a mission critical business goals? If it does, you may have a better chance of getting support and resources.

Project definition: Bounding
Includes/Excludes chart Tool: Includes/Excludes chart – A process tool that challenges the team to clarify and agree on what is included and what is excluded in the scope of work. Dimensions can be added (What, Who, Where, etc.) to address aspects of the project the team feels essential to resolve (such as adding a dimension of key deliverables if this is an aspect that has little clarity and/or agreement associated with it). Uses: A simple tool to begin to define the boundaries for the project. Can easily be done in a storyboard fashion and could then be used to modify or extend the original contract with the Team Sponsor, and/or to orient new members to the team and the project. Timing: This tool can be used at an early meeting of the team to further clarify what has already been stated in the contract with the Team Sponsor. It can be used in an ongoing way to update the project scope as the project unfolds. Key Points/Steps Commercial: A “sound bite” that gives a team a chance “to see” a tool before using it. Why and When: To scope a project in a structured process and determine where there is agreement/disagreement about the work to be done. Use with sponsors, quality leaders, MBBs as well as with a team when a project is started. Review when a team gets bogged down or conflict seems focus on “what we are trying to do here.” Parts & Steps: Aspects (what, where, when etc) and boundaries (included or excluded). Using post its or flip charts for each aspect, brainstorm ideas, then discuss where there is clear agreement first; then where there is a conflict. Check carefully for word meanings vs. arguing positions. Don’t demo until you get to the blank example slide – demo then.

Includes/Excludes chart Tips: This is a simple tool that lends itself to both storyboarding and to use as prework for a team meeting. As a prework assignment for Team Members, each might be asked to complete the chart prior to coming to the team meeting, and then use the meeting to identify areas of agreement and disagreement. After it has been completed, it could also serve as an effective tool for testing the scope of work with key stakeholders. Steps: 1. Individually complete the chart. 2. Distribute storyboard cards and ask Team Members to transfer a major point from each dimension to a card and place them on the wall-sized chart. 3. Discuss and resolve differences. 4. OPTION: You can save a bit of time by distributing the storyboard cards as part of a prework assignment and have people arrive at the meeting with their cards ready to be placed on the wall chart. Speak to key points – demo using next slide.

Includes/Excludes chart Includes/Excludes WHAT, WHERE, WHEN, WHO and TIME boundaries: On a divided flip chart, write “Includes Excludes” at the top. Down the left side write: WHAT, WHERE, WHEN, WHO, TIME. Ask the team to begin to define the project for each of the categories. Project Scope Includes Excludes What: When: Who: Option to actually Demo the tool So class can see how it is used. Suggestion: Process flow in the ED. Suggestion: Can have a flip chart pre-made of the tool. Can also have sticky notes pre-made with 5-6 typical responses to a brainstorming session. Work through each sticky to have the class decide with you where each one would fit – make some that are obvious include, some that might be on the line and some that are clearly exclude so the tool can be demonstrated effectively. Can remind team that this might be a time to check with sponsor if confusion is significant. Debrief: How could this tool be useful to a team? Responses – team will be clear on what’s in bounds and not in bound – clarity will decrease confusion, increase participation and team effectiveness. Are there other ways you have used to bound a project? Where: Time:

Includes/Excludes chart: Example for ED cycle time reduction project Includes Excludes Project Scope ED Patients admitted to hospital bed Patients discharged From ED Only the ED at XYZ Hospital Second shift in the ED Psych pts being boarded in ED The bed assignment process Paperwork to complete admission The inpatient discharge process Cycle time from disposition to admit Rapid Evaluation Patients First shift in ED Other EDs in the System This example shows the results of the team brainstorming using the includes and excludes tool. All elements match the charter and show alignment. Ask: What if someone brainstormed that the inpatient discharge process to be on the included side of the flipchart? Would show confusion and/or lack of alignment which can be corrected with discussion and review of charter.

In/Out of the frame Tool: In/Out of the Frame -This is a visual tool based on the analogy of a picture frame. It challenges the team to identify those aspects of the project (the type and extent of end results or deliverables, the people impacted, timing, product lines impacted, sites involved, etc.) that are in the frame (meaning clearly within the scope of work), out of the frame, or half-in-half-out (meaning this is either up for debate, or some aspects are in the scope of work but only in a partial way). Hit the key points of the slide. Suggested Commercial: What: a fairly unstructured tool for clarifying and agreeing on the scope of a project. Similar to includes/Excludes with slightly different approach. Why determine where there is agreement/disagreement about the work to be done. How “Post its” using Nominal Group technique. Demonstration is optional. Use In/Out OR includes/Excludes but not both. If demo: possible points to make: Writing may be about type and extent of end results, people impacted, time frame, product lines, sites, etc. Make sure there is adequate time for people to really debate and reach consensus on the final placement of each card. At the end of the session, if there are still cards on the boundary, i.e., may be in and may be out, these should be taken to the team’s sponsor for clarification. Many teams take their completed scoping frame to their sponsor as an “acid test” or double check of their thinking. Uses: Not as complex as SIPOC/COPIS, but useful when you feel there are many boundary issues facing the team (differences of opinion as to what is and isn’t in the scope of work). Timing: As with the Includes/Excludes chart, this tool can be used at an early meeting of the team to further clarify what has already been stated in the contract with the Team Sponsor. It can be used in an ongoing way to update the project scope as the project unfolds.

In/Out of the frame In the Frame/Out of the Frame Flip Charts Draw a large square "picture frame" on a flip chart (or use tape on a wall) and use this metaphor to help the team identify what falls inside the picture of their project and what falls out. This may be in terms of type and extent of end results, people impacted, timeframe, product lines, sites, etc. Suggested Demo: As with Includes/Excludes, have some sticky notes made up with responses that a team might have made during a brainstorming session and work the class through where they would be: in frame, out of frame, or on the frame. Those might require a visit with sponsor for clarification. Tip: In/Out of the Frame the typical question is “What are all the things we have to consider around the ED?” They brainstorm on stickies then sort, is it in our scope or out of our scope? If in, the stickies goes inside the frame. If out, outside the frame. When they disagree it goes on the frame for further discussion and confirmation with sponsor. Same Debrief: How could this tool help a team? Why is clarity important at this early stage of team development? Who is the final authority to determine if the item is in or out of scope?

In/Out of the frame: Example for ED cycle time reduction project Inpatient Discharge Process Rapid Evaluation Pts Patients Discharged From ED First Shift In ED XYZ Emergency Room Physician Staffing Plan Admitted Patients New ED FTEs Bed Assignment Process ED Staffing Plan Pts Boarded in The ED Other Emergency Rooms Paperwork Needed to Admit Team has brainstormed and accurately placed these sticky notes. There are sticky notes on the frame (neither in or out) meaning the team is not sure during the brainstorm session where they belong. Ask: What will the team need to do with the notes that are on the frame? Will need to go back to the charter and/or maybe even the sponsor to find out if they are going to be included in this project. How will being sure about the two elements on the frame assist the team? Will appropriately bind the project so that as the team goes forward, energy is focused accurately. Cycle Time From Disposition

Project definition: Alignment
15 Words Tool: 15 Words Flip Chart – This is an alignment tool that challenges Team Members to define the project in specific terms and then check for common elements among Team Members’ definitions. Each Team Member is given a flip chart page and marker. They must write, in 15 words or less, the project definition. Post all and check for agreement. By circling and clarifying all unclear words, underlining key words/themes, and identifying language where there is disagreement, the team can then move to draft a project statement with team alignment. Key Points/Steps Do the commercial. When to use it. How to use it. No demonstration for this tool. What: a tool to check alignment and to make apparent differing perceptions so they can be resolved. Why: The critical point is that this is a visual and listening exercise; an individual and then team “test of alignment. Parts: Name of project, individual flip chart papers and pens; a gallery of “what we are about” statements. As you compare key words, ask, “What does it look like?” or “How will we know when we have it?” as a way to check for understanding of words we assume we all agree on. When: When you think you have consensus on the scope of the project and before you write a mission statement. This is a great and efficient method for drafting the mission of a project/team. Uses: A simple tool to begin to define the boundaries for the project and to test for alignment. Can easily be used to refine the outcomes/deliverables of the project by asking "What does it look like?" or "How will we know it when we have it?" Timing: This tool can be used at an early meeting of the team to further clarify project definition. Can aid in the development of a contract with the Team Sponsor.

Project definition: Alignment
15 Words 15 Words Flip Chart Each Team Member is given a flip chart page and marker. They must write, in 15 words or less, the project definition. Post all and check for agreement. Team Members should double check all “fuzzy” or unclear words by circling them and clarifying understanding among the group (add words if necessary). Underline common words, themes and phrases. Language that creates concern within Team Members should be identified and addressed. Teams then can draft one statement. PROJECT DEFINITION Option: If you have time, could have three examples flipcharts made up regarding an example like flow in the emergency room. Could make one that is really off base and talk how you might approach that as the facilitator. Tip: Can pair people on the team up to complete the sheets which is especially helpful when people struggle when English is not their first language, or they do not feel comfortable with spelling, handwriting, or the other people in the group. __ Underline key phrases Circle unclear Check heartburn

Setting Up for Success – Building the Team
By raise of hands, how many of you have been asked to fill at a meeting you do not normally attend? Were you clear or unclear of your role? Where we are going next: -To build successful teams it is necessary to outline the team charter. -Understand the key team roles (including key stakeholders) and the importance of role clarity to team effectiveness. Outline all aspects of teamwork Questions to start discussion: What steps are currently taken in your organization to help teams come together and begin to function as a team? Ever been in a situation where there was not adequate prep? How did this impact the team? Again, reference the CAP model and tell participants that the activities of this section occur in the white space to the left of the CAP chevron.

Setting up for success: Building the team
Contracting Sample Template Date _____________________________ Team Sponsor CAP Coach Project title Team Leader Project rationale Team Members Key deliverables Critical milestones Customers/suppliers who must be involved Constraints (money, people, time, technology) Things out of project scope How the project will be measured How the team will be measured When the team must check with Sponsor When the team has full authority to act Review contents of slide. Slide is called contract but can also be thought of as a charter – similar contents. A simple contracting/chartering document which can be modified to the hospital setting or project setting. Questions: Who has used contracts for putting teams together? What was the result? Clarity How will clarity help teams in early stages? Documenting and agreeing on key deliverables and milestones is extremely helpful to decrease confusion, increase team effectiveness and speed of achieving deliverables. When the sponsor has the right to veto (Note: This is only a sample contract; add/delete sections as required to fit the project.)

Role definition: Building the team
Team Charter Checklist Tips: Don’t hesitate to add to or delete items from this basic checklist. Use this charter to orient new Team Members and to help the team maintain an effective group process when the project becomes especially challenging or when conflicts arise. Steps: 1. Distribute copies of the checklist to all Team Members prior to a team meeting to discuss these questions; invite Team Members to add to the checklist. 2. Meet as a group to discuss and resolve issues related to the checklist. 3. Share certain aspects with Team Sponsor if appropriate. 4. OPTION: This chartering discussion may be more effective when combined with some traditional forms of team-building activities. As per previous section, this is a page provided for their reference later on when they come back to use the tool – move on to full page charter checklist for discussion.

TEAM CHARTER CHECKLIST
Role definition: Building the team Team Charter Checklist TEAM CHARTER CHECKLIST Key Result Areas ___ In what areas are results absolutely essential? ___ What milestones must be met? How will the team be measured? Boundaries ___ Who outside our team must we involve, inform or consult with? ___ What decisions need approval from someone outside our team? ___ What is not in our scope of work (though others might think it is)? ___ What authority does the team have to act independently? Roles and Responsibilities ___ What is the reporting relationship to the Team Sponsor? ___ What role and area(s) of responsibility does each Team Member have? ___ What unique responsibilities does the Team Leader have? ___ Who will serve as the timekeeper, recorder, facilitator, etc. during team meetings? Guiding Principles ___ What behaviors are we going to hold one another accountable for that are essential to creating an effective team environment? Operating Agreements ___ How will the team make decisions, resolve conflicts? ___ What are acceptable/unacceptable levels of involvement? ___ How often and how long will we meet as a team? Capture key points from previous page to introduce this tool. The tool that can be completed by the team at one of the first meetings as a warm-up exercise for clarity about why the team has been formed. And can be used to go back to use to assess teams that are struggling – some of these elements may need bolstering or redefining. Suggestion: Use examples of teams you have seen get weeks/months into their work and suddenly someone gets clarity all of a sudden with the words “Well that is not what I thought we were doing all this time?”. Total effectiveness of this team to this point?

Role definition: Building the team
GRPI Checklist Expanded Version of the Tool: Useful when a more detailed look at team elements is required. 0% 50% 100% Purpose & Outcomes We understand and agree on our project mission and the desired outcome (vision). Customer & Needs We know who the project stakeholders are, what they require, and why this project is really needed. Goals & Deliverables We have identified specific, measurable & prioritized project goals & deliverables linked to our business goals. Project Scope Definition We understand/agree on what is in/out of our project scope & tasks. The project scope is “set.” Roles & Responsibilities We have defined & agreed on our roles, responsibilities, required skills & resources for the project team. Authority & Autonomy Our team is clear on the degree of authority/influence we have to meet our project mission. Critical Success Factors We know & are focusing on the key factors needed to meet the project goals & mission. Plans & Activities We have an effective game plan to follow that includes the right tasks, clearly defined/assigned. Monitoring & Measures We have an effective monitoring process & specific metrics linked to progress & goals. Schedule/Milestones We have defined our project schedule and know what the key phases & milestones are. Team Operating Agreement We have shared expectations, agreed & followed guidelines for how our team works together. Interpersonal/Team We have the necessary relationships, trust, openness, participation & behaviors for a healthy & productive team. P G R I Slightly different format, expanded version, of the previous page – a bit more detailed. When would this version be helpful? Either one works really well.

Decisions and dynamics - Consensus definition
Role definition: Building the team Decisions and dynamics - Consensus definition Consensus = agreeing to proceed with no hidden reservations It does NOT mean that everyone agrees. It does mean that everyone agrees to implement and actively support the decision and that this decision is the best one under the circumstances. They will personally live with the decision because they believe their reservations and concerns were heard and considered. Define consensus: Consensus = agreeing to proceed with no hidden reservations. All have had a chance to voice their concerns and will support the decision moving forward. Can you think of a team situation when this might be helpful? How will knowing (by a visual display) the level of consensus you have be helpful? Can use example of a situation where you simply asked if “We have consensus?” but did not check the level of agreement? (Using the ED as an example: “Do we have consensus that these are the three most pressing issues in the ED and if we move forward to correct them we will see meaningful results?” Heads nod but people walk out then gather are water fountain to discuss why they did not support the decision. Transition: Our next tool: Fist to Five is a way to actually see consensus

CAP Coach/Change Agents
We spent Day One discussing how to set teams up for success even before you start using CAP tools and just now how to be an effective coach. We now start looking at the sections of the CAP model and will start with Creating a Shared Need. Suggested way to set context for this section. Ask when you want to make change, why should you bother to create a shared need? Can you think of business leaders who have had to wake up and/or seriously transform their companies? Why is creating a shared need so important? Can get their ideas before starting into the material.

What would you add to this list?
Advice from CAP coaches/change agents Be patient Don’t try to do everything Have realistic expectations Concentrate on doing 2 – 3 things really well Shadow with an experienced facilitator Have a plan Contract with Team Sponsor/Manager on expectations Establish how Coach and Team Leader will work together Let participants have 95% of the air time Be flexible using tools Use tools and deal with topics that are important to the participants If this isn’t working, try a new approach Decide when & where to intervene in the session Use tool as the vehicle to stimulate discussion Sense of humor helps What would you add to this list? Ask What would you add to this list – add ideas. Tower Building Ex. Use pre-made Flip Chart to give directions. Facilitator note: Co-facilitator to distribute tower building kits after giving instructions. Kit (1/team): 1 pair of scissors, 6 sheets flip chart paper, 6 paper plates, 6 paper cups, 1 roll of masking tape, Optional (6 straws). Review instructions: Divide group into teams of 5-6 and have them go to corners or open areas of the room. Instruct them that they are to build a tower from the materials provided, (state of the art, we spared no expense). The tower must be free standing, cannot be attached to anyone or anything, be at least 5 feet tall and able to withstand a moderate breeze. They may NOT TOUCH the materials during the Planning Phase. Ask who is close to 5 feet tall, they will be our “height requirement” Ask someone to demonstrate a “moderate breeze” they will be our breeze Clarify the term freestanding: the bridge should be able to be picked up and moved and not connected to chairs, tables, people, etc. Timing (begins after all teams have received their materials): 7-15minutes to plan 9 minutes to build (can give several minutes extension if they are not all done) Note: when the planning is half way, I go to each team and congratulate one member (someone talkative and involved) and tell them they have been promoted and come with me. Go to another team, leave the new person and congratulate someone else and remove them. (optional: repeat during building phase) At end of time: ask participants to select one team member to describe their tower and give it a breeze. Ask large group if the bridges meet the remaining criteria. Congratulate and move to next tower working your way around the room. Finish is Large Group debrief (next page)

{ T I P S CAP coaches/change agents tips TOOLS INFORMATION PLANNING
SHARING { Be aware that tools are just tools Prepare and provide examples Be attentive to team’s needs, alter tool order if needed Clarify your role prior to the session start Challenge the team, ask “What If” questions Ask open-ended questions Set ground rules Do not rush Be flexible Help the team define the technical side of the project Make sure the team has the right skill mix Be a source of network information - Best Practices Share success stories Make easy what seems difficult TIPS for Change Agents: Ask: What stands out to you? Discuss key points. Wrap up the section with any key learning participants have about this role. Tower Building Exercise Debrief Some debrief questions for Tower Building: Did you assign roles? Did you have a plan? Did they select a leader or did one rise from the group, or did it rotate? What did they do when they lost a team member? How was it for those of you who we moved mid-course? How did it feel to join a team – were they welcoming? Like work? How did they treat the new member? Did they share best practices with other teams? Or were they automatically competitive? Did you ask for more resources? Think you couldn’t? How did this activity compare to what happens in the workplace? Key point: How effective was your planning? After spending hours talking about preparing teams for success, did you just jump in? Change is Hard! END OF DAY Activities: Day One Key Learning Points – sections, key points from each module, questions. Pluses and Deltas – can do verbally and chart responses or use sticky notes. Act on Deltas. Closing – remind participants of start time and communicate any announcements if necessary.

Creating a Shared Need We spent Day One discussing how to set teams up for success even before you start using CAP tools and just now how to be an effective coach. We now start looking at the sections of the CAP model and will start with Creating a Shared Need. Suggested way to set context for this section. Ask when you want to make change, why should you bother to create a shared need? Can you think of business leaders who have had to wake up and/or seriously transform their companies? Why is creating a shared need so important? Can get their ideas before starting into the material.

Change Acceleration Process Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last Slide shows position of Creating a Shared Need (CSN). Remember CSN will answer the question: Why? Why are we doing this, Why are we making the change? And, why do we need to make this change now. We need to start this process early if we are going to gain momentum and mobilize the commitment of stakeholders. Monitoring Progress Changing Systems & Structures

Creating a Shared Need Overview Why bother?
Forces any resistance or apathy to be addressed head-on Validates why the project is important and critical to do Builds the momentum needed to get the change initiative launched Clarifies what we are after Develops a shared recognition, by both the team and key constituents, of the need and logic for change Increases dissatisfaction with the status quo (greater than the natural resistance to change) Creates the ability to frame the need for change as both a threat and an opportunity To summarize -- Creating a Shared Need -- Addresses resistance head-on -- validates why the project is important to do -- provides the momentum building urgency you need to get the change project going As a result of Creating a Shared Need You want to have created enough of a barrier that there’s no slipping backwards, for there is too much at risk if we maintain the status quo. Creating a Shared Need produces the “WAKE UP CALL,” building early momentum for the change initiative.

Creating a Shared Need Creating a Shared Need Tools
Shared Needs Assessment Threat vs. Opportunity Matrix (Appeals to Right Side) Three “D’s” Matrix (Appeals to left side) Data Demonstration Demand These three tool can be used alone or together effectively to create a shared need.

Creating a Shared Need Assessment To what extent:
Are all members of the project team aligned in terms of the need for change? Have we framed the need for change in such a way to reflect the concerns of customers and key suppliers? Would each Team Member deliver essentially the same message regarding the need for change if asked by someone outside of the team? The key stakeholders affected by this initiative, and how much importance does each give to the initiative? Can we help others increase their sense of the need for change? This assessment can be used as a checklist: “Can I answer Yes to the majority of these questions?” Key questions about creating a shared need. Again ideally, you can answer “yes” to all these questions early on in a project. If you cannot, there is work to be done in this area. For instance, ask: How do you create a sense of alignment in your team, or within the impacted group, around the need for change that an important process improvement project has created or will create? Key highlight: The shared need may change slightly from stakeholder group to stakeholder group, depending on what is in it for them. The need should be framed in a way the compels key stakeholders to want to make the change – they might say after hearing/seeing the shared need tools “Well if that is the change your team is going to make, count me in to help get there!”. Creating a Shared Need involves framing the need to appeal to the interest of key stakeholders.

Creating a Shared Need Threat vs. Opportunity Matrix
Tool: Threat vs. Opportunity Matrix – Best Practice organizations know how to frame the need for change as more than a short-term threat. They work to find ways to frame the need as a threat and opportunity over both the short and long-term. By doing so, they begin to get the attention of key stakeholders in a fashion that ensures their involvement beyond what can be gained from a short-term sense of urgency. Suggested story for introducing the first tool: John Kotter, Professor at Harvard Business School. His research on change efforts (article in HBR, book) found the number one reason for failed change was that no sense of urgency was established. No passion around what needs to be done. How can you rally support around what needs to be done? These tools are excellent, to help you create that “burn” for improvement & for change. Two tools are highlighted. T/O matrix. It’s used to frame the need for change as some combination of threat and opportunity over two time periods and you or your group specify that time period – based on what’s appropriate. T/O helps generate a sense of urgency and 3D helps support this urgency with the needed data, facts and experiences. T/O is not “pros and cons”. It is “what are the reasons for changing from our current state?” or What are the multiple sets of “cases for change” that will appeal to people who 1) work from short term “hot seat” or 2) long team “inspiration”. The cases for change include both the threat or risk and the opportunity or improvement. Explanation of tool continues using next slides and large version is provided for final details. Uses: Building the case for change is one of the first and most important tasks of the team. This simple tool helps the team discover how to frame the need for change more broadly and perhaps break some old habits about change only as it applies to a short-term threat.

Creating a Shared Need Threat vs. Opportunity Matrix
Steps: 1. Determine short-term and long-term goals for the project ( example: 3 months, 6 months) 2. Working individually, identify 2 – 3 items for each of the 4 quadrants. Share and record responses on a flip chart and discuss similarities and differences. 3. OPTION: Individuals then write a 3 – 4 sentence statement of the need for change using language that speaks to as many of the 4 quadrants as possible. 4. OPTION: Team Members read their statements and the team debates and discusses each to create a statement that encompasses the best of each individual effort. This statement is then modified to appeal to key constituent groups (physicians, nursing, administration, patients, community, etc.). 5. OPTION: Though most teams find this discussion fairly straightforward, some struggle with the degree of specificity required to really frame the need for change along both dimensions. Therefore, it may be useful to begin this discussion and then table it for additional work once the vision has been articulated and the key stakeholders have been identified. It is not unusual to find a team finally ready to use this tool after they have worked on the vision and begun to do a stakeholder analysis. . Again, this slide is also provided as reference for when they actually come back and use the Tool – move to the full page of the tool.

Creating a Shared Need Threat vs. Opportunity Matrix Short Term
Long Term Threat Opportunity Suggested discussion points for the tool. A great tool to use early in a team’s work to get the team on board and to share with key stakeholders when the time is right. “Threat” section is the threats/risks that will occur if we don’t make the change (Threats if we do nothing) “Opportunity” (with success) we will experience if we make the change. A completed chart gives us the message we need to Create a Shared Need! Team must define what short term and long term mean: Short: less than thirty days, less than six months, less than a year? Long: over thirty days, over six months, over a year Depends on change required, situation, organization ,etc. Demo Suggested Approach: Use an example like reducing the time it takes to get admitted patients through the ED. Either use one of the tables as a mock team or have sticky notes already made up. Have team help define ST and LT – get sticky notes up for threat of not doing anything. Then repeat for Opportunity of making improvements. Classes will learn tools as effectively as you demo them so use the tool accurately and effectively during demos. Option: Approach is adaptable – use the chart as it is or can make two separate charts: 1. The threat if we don’t make the change and opportunity if we make the change. 2. The threat if we do make the change and opportunity if we do not make the change (Used to evaluate the need to move the project forward –if it hasn’t already been decided to proceed).

Creating a Shared Need Threat vs. Opportunity Matrix: Example for ED cycle time reduction project Threat (Of Doing Nothing) Opportunity (With Success) Dissatisfied ED Patients Unhappy ED Staff Members Compromised Quality of Care Diversion: Loss to XYZ Bottom Line LWOBS: Loss to XYZ Bottom Line Physician Complaints Continue Short Term: Up to Six Months Cycle Times will Decrease Pt Satisfaction Rates Improves ED Staff Satisfaction Improves Diversion Rate Decreases LWOBS Rates Decrease Long Term: Beyond Six Months Patients Go to Other Emerg Depts Staff Members Quit and Leave Physicians Stop Referring to XYZ ED XYZ Closes the Emergency Room Due to Significant Losses Community Reputation Cycle Time Goals Accomplished XYZ Emergency Reaches Growth Goals Staff Turnover at All Time Low Level Employer of Choice Best Place to Practice ED Medicine XYZ ED Best Performing in System Results of a brainstorming session where the ED team completes the Threat vs. Opportunity Matrix. Ask: How will this help the team? Will help them define and show the project in relationship to both short and long-term threat. Also helps the team define what opportunity is created with success. Can give them information to use with other key stakeholders (stakeholder analysis tool). This tool appeals to the hearts and emotions of team members and key stakeholders as opposed to Thee D tool which is more focused at appealing to the minds of key stakeholders (data). When both are developed – a broad range of appeal is established. Optional Approach: Develop a matrix for threat of doing nothing and opportunity of doing nothing And another matrix for the threat of taking action as well as the opportunity of taking action.

Creating a Shared Need Pitfalls
Teams can potentially derail when they: Fail to check for alignment and build true consensus Assume the need for change is obvious Fail to frame the need for change in a meaningful way Assume that when others fail to appreciate the need for change it's "their" problem Fail to search beneath the surface for root causes Underestimate the resistance to change Close discussion on this tool with key points from pitfalls slide. Ask: What are cases where shared need has been defined but not accepted? Answers might include online banking, self serve check out at grocery stores, etc. What happens if teams do not take the time to effectively create a shared need? Where has that compromised change in your organization? Another example of slowing down to go fast. Avoiding these pitfalls early on in the change initiative saves valuable time and effort!

Shaping a Vision Might use this opportunity to ask if there are any other questions regarding creating a shared need before moving on. Suggested introductory exercise: Take 60 seconds and write down the details of your dream trip such as: Where you would go How you would get there What you would see The food you would eat The shopping you would do The fun activities you would do With the partner next to you, tell them your vacation – make sure you do it in a way describes your actual behaviors without even naming the particular destination. Give first partner one minute then have them switch for one more minute for second partner. Debrief: Explain the experience of how you felt telling? How did you feel hearing? Anyone want to go along on the trip, even if you didn’t know the destination? Sense the sense of energy in the room? The compelling power of a well articulated vision – you want to go there, wherever it might be!

Change Acceleration Process Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last Again the reference to where the shaping the vision activity is in relationship to the chevron and it is during current state and moving into transition state. Note it gets developed before you go to mobilize commitment with stakeholders. Monitoring Progress Changing Systems & Structures

Shaping a Vision Overview
Why bother? Visions paint a picture that appeals to both the head and the heart, and answer the question, "Why change?" Clear statement of the future state helps gain genuine commitment A well-articulated vision helps establish the milestones to monitor progress and change Systems & Structures Clarifies what we are after Demonstrates a clear statement about the outcomes of the change effort Identifies a view of the future state that is: Customer-focused Not just one person's dream Challenging Evolving, not static Easy to understand Behavioral and actionable Make key points from slide – this is a shared vision. Not just one person’s vision. Can be used to shape a vision inside the team to be then shared with key stakeholders when the time is right. Visions provide direction and motivation for change.

Vision Mindsets Behaviors
Shaping a Vision Bulls eye From vision to action: Vision Mindsets Behaviors Key Point to remember when using Shaping a Vision Tools: We need to “behavioralize” the vision… A shared vision is more than a flowery statement of a future state. It defines how people will act and perform when they are aligned with the vision. The Vision needs to be “behavioralized”, translated into actions and behaviors so that you can communicate specific behaviors that people will need to demonstrate. Again, we see the value of defining behaviors in terms of what we expect to see more of and less of. Facilitator review slide: Bull’s Eye Chart: We look at this from the outside in. Start with your vision or mission statement for the change in the outer circle, i.e, Become a world-class patient centered facility. Then move to the mindset – doing whatever it takes to please the patient. Finally, what are the specific behaviors that we will do more or less of. Push for specific actions and words—smile at every interaction, less complaining, walking a customer to destination when asked directions, etc. Another example: Nordstrom – it’s vision is exemplary customer service, the best in retail. Mindset needed: store associates need to do whatever it takes to satisfy the customer. Behavior: Sales associate offers to find your size at another Nordstrom and have the item shipped directly to your home at no extra cost. Also, if someone brings something back to the store, even if it didn’t come from Nordstrom's, they will take it back. They also allow employees to reduce the price of merchandise a certain percentage without asking a manager.

Shaping a Vision Assessment To what extent:
Has a vision been clearly articulated for the project? Is the vision simple and straightforward? Is the vision motivating and energizing? Is the vision shared and understood across the business? Is the vision actionable? And finally, How aligned is the team around the vision? Again this assessment can be done at this stage, teams can hopefully answer YES to all of these questions before moving on from Shaping a Vision. And, these assessments can be used to go back with a team who might be struggling to assess their effectiveness at shaping a vision. These tools can be revisited at any point the team feels like they are losing touch with their vision. Transition: Take a look at JFK’s address to Congress in 1961. How can you sharpen and deepen the VISION for your project?

Shaping a Vision Backwards imaging
Tool: Backwards Imaging – Getting a clear vision for the change initiative is easier for some Team Members and stakeholders than others. Also, creating a picture of the future state that is behavioral is usually challenging even for the most well-grounded change projects. This tool guides the team's thinking to focus on what people will be doing in the future state, rather than staying with a vision so lofty that few truly understand what the future will really be like when the project comes to fruition. Imagine a point in the future when the project has been very successful. 2. Find words to describe what you would see, hear, feel as you observe key stakeholders functioning in the new, changed state. Collate, debate, reach consensus, "test" on others and modify. Uses: This is an excellent way to help teams wrestle with the specifics of what the future state will be like in terms that can uncover both support and resistance. It asks people to describe the future as they expect to see it when the project is successful, and to do so in specific, behavioral terms. Often this will be the team's first confrontation with the realities imbedded in their more generalized statement of project scope and team mission. Timing: Relatively early on, preferably after the team has framed the need for change to some level of detail, and before any significant attempts at winning over key stakeholders. Provide a quick commercial for this tool. The title may seem a bit confusing, but what you are after is a look in the future that provides an image to define the vision. Going backwards to today, the team recognizes the gap to be crossed through the project. This is a simple tool to understand and do with teams – teams like the energy.

Shaping a Vision Backwards imaging It’s ________ from now and your team/project has been successful. Find words to describe what you would see, hear, feel as you observe key stakeholders functioning in the new, changed state. Can do a quick commercial by filling in blank and using the ED cycle improvement goal as an example. Just ask the room of participants to give you images from the future and see how quickly they pop up. Again note energy in the room, the power of the vision, and how you might actually start to feel the desire to work in that redesigned ED! Stakeholders are the ED team and customers would be the patients in this example.

Shaping a Vision More of/Less of chart
Tool: More of/Less of Chart – Another tool for helping the team spell out their vision in behavioral terms, this chart asks them to describe the future state by listing what they expect to see more of and less of when the project is completed. As with the Backwards Imaging exercise, it is essential that the team describes the future state in specific, behavioral terms. Do a quick demo of this tool to show how it can be used. This is a good choice of Tools to ask them to use in small groups. (It could be exchanged for Backwards Imaging for the tool time) This is another tool to help the team shape a vision. Uses: This tool generally follows the drafting of a statement of project scope (what the boundaries of the project are) and a team mission (what the team is charted to deliver).

Shaping a Vision Vision: Behaviors: More of/Less of chart
_____________________________________________ Behaviors: Demo this tool on a pre-made flip chart asking class participants to help fill out the sides while you scribe. Make sure they get the more of and less of into behavioral terms – something that could be observed and even measured. Can a picture be taken of what has been written? (I.E - can’t take a picture of a satisfied customers, but could of “customers are smiling” or “Patient Satisfaction score rising x%”) More Example, it is not faster cycle times, it is cycle times that are at or less than 2 hours from disposition to upstairs room from ED. Less Example, it is not less dissatisfied customers but less customers actually filling out complaint forms. Elements lining up as opposites of each other are not ideal, but sometimes it happens. Try to steer the team away from that.

Shaping a Vision Behaviors:
More of/Less of chart: Example for ED cycle time reduction project Vision: XYZ Hospital ED cycle time from disposition to hospital admit is consistently less than two hours Behaviors: Admitted patients not mad Patients complaining to JCAHO Patients praising speed of care Patient beds in the ED corridors Floor nurses calling for report Pts leave ED without being seen Patients calmly waiting in ED ED staff yelling at each other Days without any diversion XYZ ED loosing pts and revenue Again, ED team has brainstormed this tool. The items are all listed as behaviors (something we could take a picture of) Ask: How would creating this tool help the team? Would create a vision that is grounded in the actual work world. Why is this important? Because when staff can actually “see” how things are going to change at their every-day-work level, they can get engaged more effectively. Can be a “Well if this is what success looks like, I am in!”. Also a tool to help get key stakeholders on board. ED staff smiling at each other Doctors being angry at nurses Prompt bed assignment Clarifying calls on orders Coordination from transport Patients waiting on transport

Visions impel us to change as we are attracted to the desired state!
Shaping a Vision Pitfalls Teams can potentially derail when: Everyone has their own vision, and no effort is made to gain alignment Vision statements remain at such a lofty level that no one pushes back The vision changes too often or, conversely, is so rigid that others feel excluded The vision fails to reflect the interests and needs of customers and/or key suppliers The vision is too complex to be easily understood or translated into day-to-day behaviors A strong link between the need for change and the vision of the desired state is missing or vague Close discussion with examples of what may happen if teams do not take the time to effectively shape a vision. This is another example of slowing down to speed up later. Tip: Is this a natural break for lunch? Decide time for lunch and consider the odd number approach: If they say 45 minutes – ask them to take 43. It will be remembered better. Plan an energizer for when they come back from lunch. Example: 2 truths and a lie icebreaker to help them through the postprandial lunch effect. Visions impel us to change as we are attracted to the desired state!

Mobilizing Commitment
Now starting material on Mobilizing Commitment. When we originally started discussing the CAP model, we created the CAP gap diagrams of our ability to make change at this organization. We talked about the 3 front end and back end of the CAP model needing to be done at least 50% effectively. Then we discussed that Mobilizing (which is the middle element) should be done the most effectively? Why is it so important that mobilizing commitment be done so very effectively? Because it is the most important element in the CAP model and also the most difficult to do really effectively without some great tools to assist.

Change Acceleration Process Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last Notice the position of Mobilizing Commitment on the CAP model – it is the only element that straddles Current state, Transition State, and Improved state chevrons. In other words, this has to be started before you roll out change and continue after the change has occurred. It is the point where you need to promote positive action that lines up with the vision for the change. Monitoring Progress Changing Systems & Structures

Mobilizing Commitment positions the team for downstream interventions.
Overview Why bother? Need sufficient support and involvement from key stakeholders Critical mass must be won over Key difference between success and failure What are we after? Coalition of committed supporters Identification of potential resistance Conversion of key influencers Make key points off slide. Can stress that successfully mobilizing commitment of key stakeholders is the key difference between success and failure. To check for understanding: Was there a recent organizational change? Are new processes, procedures, or systems being implemented? Does tension between certain departments cause problems? Issues with responsibility? Important concepts: 1- Know who the Key stakeholders are and work with them proactively to gain commitment from the “critical” mass. 2- Understand where resistance may come from. It is not always people resisting. We will look at other possible sources of resistance. How is this model of mobilizing commitment different than how we usually have planned change regarding key stakeholders? Do we ever get a committee together, meet behind closed doors for a few month, plan a change, roll it out and hope that key stakeholders will not resist the change too badly. A recipe for failure. Unless you put plans in place to reduce the natural resistance to change.. Getting stakeholders on board even before you create plans for change, during the change, and after the change is a much more effective way of identifying and breaking down natural resistance to change. The tools in the CAP section are very effective at helping you as the CAP coach and your teams make successful change. Transition: Let’s talk more about resistance. Mobilizing Commitment positions the team for downstream interventions.

What Resistance Do You Hear/See?
Mobilizing Commitment Moving through resistance What Resistance Do You Hear/See? Ask; What resistance do you hear and see in this organization when it comes to making change? Optional: “Turn & Buzz” to their neighbor or table for 1 min. Task them to discuss about what resistance occurs at their organization and have quick report out. For understanding: Hear any of these comments? We are different,nobody has the same epidemiology and type of patients we have Our physicians are specialist and time should be spent on patients and not change Our staff is too busy now, they can't do any more We have tried this with other groups Just buy good Information Systems and we can move The Cardiology Department rules the hospital, they get what they want, no use for us to save money for them to waste

Moving through resistance Helping Behaviors Active listening Dialogue first, problem solve second, persuade last Connect vision to interests Reward and recognize early adopters Provide hands-on, “kick the tires” experience Honor the past Hindering Behaviors Ignore or discount feelings Hammer with logic and data and presume objectivity will carry the day Change focus and priorities Attack people vs. problems Ask others without first asking yourself Ask for new, but measure the old In finding and working with the key stakeholders, these are behaviors we know in our organization to work successfully. Hit key points on slide. Helping: Bullet points 1, 2, and 6 Hindering: Bullet points 2 & 4

Assessment How well has the team: Identified key stakeholders? Analyzed sources of resistance? Maximized win/wins through conflict resolution? Developed problem-solving processes to build commitment? Make key points off slide. Again as you have seen before, the questions teams should be able to answer as all yes if they have mobilized commitment effectively. Effective mobilization requires significant up front team introspection.

Stakeholder analysis/commitment chart Timing: When the team is ready and able to handle a discussion of specific individuals and how these key stakeholders currently view the change initiative. It can also be used throughout the process to strategize about how to bring on board a new stakeholder who has just emerged. Tips: This tool can sometimes be seen and used as a grading chart for individuals that rates people as good or bad. This is a very potentially destructive way to view a stakeholder analysis. It is not about being good or bad, but rather about how key individuals view the merits of the change initiative. Someone may be strongly against a change initiative for what the stakeholder feels are very good reasons (just as each of us is either for or against or neutral about proposals to improve government). Avoiding this tendency to see the rating as good or bad is critical to getting the most from this tool. If there is the tendency within the team to label people, it might be useful to forego the numerical rating and simply discuss key stakeholders as to whether they are for this initiative or against it. These are the detailed slides that are provided for your reference when you return to use the tool – we will skip to the full slide of the tool.

Stakeholder analysis/commitment chart Steps: 1. Identify the key stakeholders to be charted. Remember that a key stakeholder is anyone who controls critical resources, who can block the change initiative by direct or indirect means, who must approve certain aspects of the change strategy, who shapes the thinking of other critical constituents, or who owns a key work process impacted by the change initiative. To avoid becoming bogged down in this analysis, it is wise to initially limit the list to no more than 12 – 15 key stakeholder groups/individuals. If the team's list is considerably longer it probably contains individuals who are important but not essential to launching the change effort (or, it means the team is working on a very large-scale initiative like implementing a new technology system across an entire business). 2. List each stakeholder along the left side of the chart and proceed to discuss where each is currently at with regard to the change initiative. In discussing each individual, examine both objective evidence of where the individual is (e.g., "At the last staff meeting Bill clearly stated his unwillingness to assign a member of his group to the team.") as well as subjective opinion (e.g., "Betty is likely to be strongly supportive because of her unit's objectives in this area."). It may be useful to first have each Team Member rate each stakeholder without discussion, and than tally individual ratings and discuss obvious differences. While it probably isn't critical to strive for complete consensus, it is usually worthwhile to take the time to generally agree on whether each stakeholder is against, neutral or supportive. These are the detailed slides that are provided for your reference when you return to use the tool – we will skip to the full slide of the tool.

Stakeholder analysis/commitment chart Steps (continued): 3. When there is general agreement about where each stakeholder is currently, the discussion turns to where each key stakeholder needs to be for the change initiative to be successful. Remember, some stakeholders need only be shifted from strongly against to neutral (meaning they will no longer be an active blocker), while others may only need to be moderately supportive. 4. Take a moment before concluding this exercise to look for logical relationships between and among these stakeholders in terms of who might assist the team in gaining the support of others. For example, if a key stakeholder who is strongly supportive is also a thought leader for others on your list, it might be useful to enlist his/her support in shaping the thinking of other less-supportive stakeholders. It may also be useful to use the TPC analysis model to better understand the nature of resistance for those key stakeholders who must be influenced to become more supportive. It is also important to use some technique to validate this assessment of support. At a minimum, check the team's perceptions by seeking the input from individuals outside of the team. In some cases, it may even be appropriate to talk with key stakeholders themselves to validate the team's assessment of their level of commitment. 5. OPTION: Some teams have used this tool to assess the commitment and buy-in of individual members of the team itself. Though risky and probably inappropriate when a team is in the early stage of development, this can be an influential team-building exercise for a mature team, if well-facilitated and all agree to be open and candid in their assessment and feedback. These are the detailed slides that are provided for your reference when you return to use the tool – we will skip to the full slide of the tool.

Moderately Supportive
Mobilizing Commitment Stakeholder analysis & resistance tool Name (Key Stakeholders) Issues/Concerns “Wins” Influence Strategy Strongly Against Moderately Against Moderately Supportive Strongly Supportive Neutral This tool is very useful – one of the most effective tool in the arsenal. Is an expansion of the previous tools and the last column is the most important. Must do something when you know the Demo this tool for one line to show how the last two columns can be developed. Caution: This should be a confidential conversation. All assumptions are subject to validation with the key stakeholder.

(Key Nurse Stakeholders) Moderately Supportive
Mobilizing Commitment Stakeholder analysis & resistance tool: Example for ED cycle time reduction project Name (Key Nurse Stakeholders) Issues/Concerns “Wins” Influence Strategy R. Jones, RN X ∗ Project taking 16 wks to complete Project shows results quickly Keep informed, Ask for help as needed B. Smith, RN Impact of project on ED staffing Project completed without delays Focus on Laws, Wills and Kiles T. Alsop, RN ∗ X Loss of Control and Power Increased Control Assign alternative project. Involve in long term monitors K. Laws, RN 30-yr employee –resists change Load of work is leveled for staff Smith to show WIFM or “options”. P. Wills, RN Sees new duties of techs as risky Fully understand tech license laws Smith to share laws with her. B. Kiles, RN Thinks RNs should transport all pts Understand tech ACLS training. Smith to show her ACLS training. Strongly Against Moderately Against Moderately Supportive Strongly Supportive Neutral ED Director ED Manager Day Charge Evening Charge Example of a stakeholder analysis completed by the ED Team. Key points: Even those stakeholders identified as supportive will still have issues and concerns – note Jones and Smith. Alsop shows as strongly supportive and why this might be problematic is that this person might always agree with all projects – a “yes” person. So a strategy to channel that support(assigning an alternate project) might be appropriate. Wills and Kiles are thought leaders in the ED and noted as important stakeholders. Ask: How will developing this tool help the ED team successfully work with key stakeholders? The key stakeholders are identified, their position to the project confirmed (must do this) and strategies put in place to help them become properly aligned with the project. Dealing with this resistance before solutions are rolled out is paramount to the success of the project. Key point: In the GE CAP model, Mobilizing Commitment is the pivotal element and the one element that must be done very effectively. Thought Leader Thought Leader X: Current level of commitment. ∗:Level of commitment we need.

Action plan Tool: Action Plan – Once key stakeholders are known and their political attitudes have been discussed (and verified), the job turns to one of building an effective strategy for influencing them to strengthen, or at a minimum, maintain their level of support. The team's task is to determine what actions need to be taken to influence the stakeholder, who can best influence each individual, and when will actions be taken. Last tool is this WWW example. KEY NOTE: This tool should be completed after the use of any CAP tool. These are the action steps necessary to move forward on the ideas identified in the CAP facilitated discussion. In this particular example, specific steps will address garnering the support of key stakeholders.

Action plan Uses: Once the team knows who the key stakeholders are, the more difficult task of figuring out a strategy to win their support begins. This simple planning tool can help the team assess the issues and concerns of each stakeholder who must be moved to a higher level of support for the project, and identify a strategy for doing so. Taking time to talk through the issues and concerns important to each key stakeholder and validating this with the individual involved is time consuming but critical to the formulation of a strategy for influence. In this instance, an issue is something the stakeholder feels strongly about regardless of the change initiative. (E.g., a purchasing manager will certainly have many issues around effective supplier management.) Likewise, each stakeholder will have one or more concerns regarding the change initiative itself. (E.g., the same purchasing manager may be most concerned that the change initiative not derail his/her own initiative that involves training employees in the new supplier management process.) Timing: Any time the team is discussing a key stakeholder whose support must be won. Tips: This tool is very straightforward and easy to understand. The only trap some teams fall into involves the strategy itself. Careful thought needs to be given to who will have most impact on this individual, what will be done to influence and when should the influence process begin. These are the detailed slides that are provided for your reference when you return to use the tool – we will skip to the full slide of the tool.

Action plan Steps: 1. List the key stakeholders who need to be influenced. Remember that even if someone is already moderately or strongly supportive, they will have issues and concerns that need to be addressed by the team. 2. Discuss each stakeholder's issues and concerns and agree on a method for validating these perceptions. 3. When the team has validated their understanding of the stakeholders' issues and concerns, it is time to proceed with developing an influence strategy. At this point, it is often useful to consider a number of aspects of the influence process which may not have been addressed before: • What is this person's style? (E.g., Is he/she a numbers person who will be most likely to be swayed by data and statistics?) • What history needs to be taken into account as we talk with this individual? (Has he/she been negatively impacted by similar initiatives in the past? Does she/he have an issue with any of the Team Members that might make it difficult to support the initiative?) • Is there a part of the change initiative that, if we could give it to this person, would guarantee their support? These are the detailed slides that are provided for your reference when you return to use the tool – we will skip to the full slide of the tool.

Action plan Steps (continued): 4. Be sure assignments are made that will ensure the influence strategy will be implemented appropriately and in a timely fashion. 5. OPTION: Some teams combine this discussion with the formulation of their communication campaign for change. These are the detailed slides that are provided for your reference when you return to use the tool – we will skip to the full slide of the tool.

Action plan Quick commercial – a tool that is helpful to back up the tools that you have used before in this section. Natural Place to take a break. Or proceed into the next activity and tell teams they can take a break during the time allotted.

Pitfalls Teams can derail when they: Have little political sensitivity Fail to recognize need to share the glory Assume a technical solution is sufficient Don't involve others due to time constraints Use only 1 or 2 conflict resolution styles Fail to appreciate the human side of problem-solving And finally, what happens when teams do not effectively mobilize key constituencies and key stakeholders. By amassing a core group of supporters, momentum builds for change implementation!

Making Change Last Next section of the CAP model for discussion is Making Change Last. Where we are going next is to help participants understand how to plan for sustaining change over time. To set context might ask: Once a team has accomplished the change they have set out to accomplish, why is it so hard to make that change last? Every initiative competes for time resources, attention, etc. We have spent so much time making change, we run out of energy to sustain it. Optional: Change 5 things Exercise which is great fun an a great metaphor for the difficulty of making change and staying “changed”. .

Change Acceleration Process Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last So, in our organization we know that there must be deliberate attention paid to making change last. The element comes after mobilizing commitment and will be started as the transition begins to occur and continue into the improved state. Monitoring Progress Changing Systems & Structures

Making Change Last Overview Why bother?
Experience shows that successful, sustained change is difficult to achieve without attention from the entire team Every change initiative will compete for time, resources and attention We often spend most available time on the launch of an initiative rather than its institutionalization Clarifies what we are after Creates consistent, visible, tangible reinforcement of the change initiative Integrates the new initiative with ongoing work patterns Identifies changes to organizational Systems & Structures that help make the change a natural part of individual and team behavior Make key points from slide. What organizations desire is sustained change. Strategies must be built and implemented for change to truly be sustained. Sustained change occurs when change leaders and agents build and implement strategies for making change last.

Making Change Last Assessment
Tools Making Change Last tools: Making Change Last Assessment Making Change Last Checklist Force Field Analysis A checklist and one tool in this section. Ask: What have people done to make change last in their personal lives? Possible responses: support from family and friends; celebrate significant events; learn from others who were successful; were committed to the change, etc. Making Change Last draws on these same elements just described except that it is in an organizational context. Transition: The next page shows the different elements that have been found to help make change last.

Making Change Last Assessment
To what extent have we accurately estimated: The magnitude of the total change effort? The level of resistance this initiative will face? The amount of time required to implement the change(s)? The level of clarity and alignment regarding the kind of implementation process required? To what extent: Has the change effort been integrated into other business initiatives? Are needed resources made available? Have we altered (or used) existing systems and structures as “levers for change”? Making Change Last – Checklist Share the checklist that they can use to determine how well they are/will implement Making Change Last strategies/considerations(can be yes/no or scale of 1 to 5 type of checklist/assessment). Based on that assessment, the team they can build action plans to enhance this CAP element. Early development and implementation of strategies for Making Change Last is essential

Making Change Last Checklist
Early Successes: What early successes can we leverage to make change last and to build momentum? Are they communicated to other functions and locations? Are early successes built into the project plan? Are they linked to larger, longer term outcomes? Is progress and are results recognized and celebrated? Commitment: Where do we need additional commitments to this change initiative such as leadership, resources, funds, manpower, time and focus? Is there a continued visible, impactful sponsorship? Is there a continuing sense of energy and excitement? (Did the business continue to let everybody know that the project was important?) Are sufficient funds continually committed? Does sufficient employee time continue to be committed? Are appropriate deadlines honored? (Or was the project completion date arbitrarily advanced, or were people prematurely diverted to other work?) Excitement: Where and how can we build excitement around this change initiative? Does the team visibly show its excitement & enthusiasm? Does the Team Sponsor maintain a high level of personal enthusiasm? Is their excitement genuine & dramatic? Is the excitement broadly communicated through words & action? What points in any of these categories needs explanation? Reinforce key points as needed. Can be used as an exercise to help participants see what currently exists in their respective organizations that can be utilized to make change last. See next page for optional round robin/gallery walk once you have hit the high lights from both pages of elements.

Making Change Last Checklist
Learning from Experience: How can we learn from experience and Best Practices around this change initiative? Did "downstream" project activities reflect and benefit from key learnings gained early on? Are project learnings and Best Practices shared widely throughout the organization? Does it sound as though the Team Members have grown, as a result of the experiences, in their capacity to act as leaders of change? Is it likely that another CAP project launched by them would be successful? Resources: Are the resources allocated at the right time/phase of the project, in sufficient manner and effectiveness, etc.? Are adequate resources available throughout the project? Have new resource needs been identified in a timely fashion? Do resource allocation decisions leverage CAP processes? Has timing of new resource allocation been linked to emotional life cycle of project team? Who can we partner with to share resources/create synergy? Integration with other Initiatives: Is this change initiative well-integrated with other organizational initiatives or customer requirements? Are the efforts on behalf of the project well-integrated with other organizational initiatives? Is there a systematic effort to communicate the relatedness of the project to other ongoing initiatives? Is adequate attention paid to the need to consider the consequences of the project on the organization's "Systems & Structures”, i.e., staffing, development, rewards, measurements, communications and design? What points in any of these categories needs explanation? Optional Round Robin/Gallery Walk Activity Instructions: Set Up: Arrange six flip charts around the room with the headings from each bubble in the “satellite” chart. (Learn from Experience, Commitment, etc.) a) Have the class divide themselves evenly between all six of the flip charts or assign tables to come up with two to three ideas for a bubble. b) Give them 90 seconds to brainstorm what already exists at their business that they could share as best practices for “making change last.” c) After 90 seconds, have all groups shift one flip chart to their right. Give them another 90 seconds to brainstorm. Repeat a third time. d) Have each group pick two to three of the best ideas from their chart and present to the group. Note: You may want to have these flipcharts typed up and distributed to everyone before the close of the course. Will be a powerful tool when the team has been working for a while.

Making Change Last Force field analysis Force Field Analysis
Used for assessing forces in the internal and external environment, which will either help to make change last or make it difficult to do so HELPING HINDERING Make key points from slide. This tool may be familiar to you. Optional Demonstration Approach: Ask a volunteer to come up to work with you. Using a single sheet of paper (8X10), tell the class you will demonstrate the force field at play. Put the sheet of paper flat between your right palm and the volunteers palm pushing tight against each other so the paper stands upright and is held still. Ask the volunteer to push with his palm against your palm with enough force that it pushes you to step slightly backward. Tell him you will push back to show the give/take of the two forces. Explain that he is the helping forces and you are the hindering forces and the teams target rests slightly behind you. To help the team be successful, we can use the force field analysis to identify and enable the helping forces and decrease the hindering forces so team can achieve and sustain the target. A fun visual for consideration. Attention to some simple but influential Best Practices can lay a good foundation for MAKING CHANGE LAST.

Making Change Last Force field analysis
Tool: Force Field Analysis – A well-known tool applied to the analysis of what will “enable or restrain” or “help or hinder” the project implementation and integration over the long haul. By understanding these forces, you can build action plans to close the gap between where you are and where you want to be. HELPING HINDERING Uses: Primarily used to assess forces in the internal and external environment that will make change last or hinder change over the long term, this tool can help the team develop plans to ensure that the change initiative becomes integrated into the fabric of the organization. It can be applied to the project as a whole, or to each of the other six CAP processes (e.g., "What is enabling or restraining Creating a Shared Need on this project?"). Timing: Probably most effective when some significant work has already been done on the overall project plan and clear resistance has been encountered. Also can be used early on to predict what will help or hinder; but if done this way, the assumptions should be validated a number of times as the project progresses. Add additional key points from slide. Remind them this is the reference slide that will be here waiting when they decide to use the tool.

Making Change Last Force field analysis
Tips: Though we assume that this tool is familiar to many CAP Team Members, it may be necessary to review some of the simple dynamics of its use (e.g., remembering that the "enablers" and "restrainers" are those things currently in the environment that are helping or hindering attainment of the vision). It can sometimes be useful to assign a degree of weight or impact for each of the enablers and restrainers, thus assessing which will be most helpful or hindering (so that the team can concentrate on the few that will make or break the project). It’s important than to follow up with action plans to leverage what is helping and minimize what is hindering. Steps: 1. Draw line down the center of the flip chart. If desired, write “change initiative” on the vertical line or write the question the group is addressing, e.g., “What is helping or hindering _____?” Label the left side as “Helping” and right side as “Hindering.” 2. Team Members brainstorm items for each side of the chart. Some teams have found that a storyboarding process works best to generate a lot of ideas without endless debate and conflict. 3. Next, agree on an edited collection of enablers and restrainers, while sorting out those members who see quite differently; e.g., "I see _______ as an enabler and you have it listed as a restrainer." 4. Assign weights to the items on each list and pick those enablers the team thinks can be further strengthened and those restrainers they think must be lessened or eliminated. A scale (5 = very strong, 4 = strong, 3 = medium, 2 = low, 1 = weak) may be used to evaluate the relative impact of the forces. 5. OPTION: Each of the restrainers can be further analyzed for root cause using a Fishbone diagram technique. 6. Build an action plan to address items in #4 above. Remind them this is the reference slide that will be here waiting when they decide to use the tool.

Put in enlarged FF graphic here
Making Change Last Force field analysis Change Initiative ___________________________________________ Change initiative can also be written on the center vertical line in the chart. Force Field Analysis Put in enlarged FF graphic here Demo the tool. Suggested approach: Have a pre made flip chart ready and ask one table to participate. Have them brainstorm (might have to use imaginations a bit) one idea per sticky note regarding what already exists in the environment of the organization that might help the ED team (or the example you are using) reach their target. Use round robin to collect at least 5 sticky notes. Repeat for Hindering. Assign weights or magnitude of force ((you can use a scale of (1 to 5). Five being the strongest force and one being weakest)) to items from Helping side as a demo. Then do a WWW for the most heavily weighted. Remind you would do same for Hindering. Middle line is current state and far right edge is desired state. Making Change Last would suggest that the middle line should not move back to the left (people retreating to old behaviors) and should continue to move to the right as more progress is made. Football analogy: Line of Scrimmage advancing to the Right

Making Change Last Force field analysis: Example for ED cycle time reduction project Change Initiative: Reduce cycle times for patients being admitted from ED. -There are 4 open RN positions At the current time. (4) -The orientation process to get new RN’s fully functional is a months-long process.(3) -ED physician group leader (who Is very supportive of project) is retiring and leaving in two months.(5) -New construction project in ED has been put on hold for six months.(2) -Board and C Suite supportive of this project. (3) -ED Director and Manager very supportive of this project. (4) -Transporters are all trained in ACLS so can transport pts. (2) -Staffing plan changes will have major impact on RN ability to implement new plan.(5) -Bed board re-training well received by nurses (3) - Similar project done at ABC hospital was very successful.(5) The completed example from the ED Team. Discuss findings and tie back to the scenario. Ask: How can using this tool help this ED Team? Can identify all elements that can help and/or hinder the project and in ranking them, can develop strategies for making change last. Ask: Which elements would the team focus on? At least the elements that have received fives. Ask: What are next steps? Develop an WWW for next steps with those elements that need addition strategies developed and implemented.

Making Change Last Pitfalls
Teams can potentially derail because of 10 classic implementation pitfalls: Underestimating the time Unexpected problems Poorly coordinated activities Competing distractions Inadequate capabilities and skills of employees Lack of support for the initiative Unclear goals and objectives Lack of involvement of key constituents Dismissing complaints outright Uncontrollable externalities (Life Happens) What can happen if teams do not intentionally spend time planning strategies for how to Make change last. End of Day Activities: See Day One End of Day. To avoid pitfalls, change initiatives must be a series of commitments instead of “assignments” !

Monitoring Progress Day Three Opening Activities: See Day Two Opening Activities Where we are going next is: Help participants develop and implement a plan for monitoring their progress around the change initiative. Help them develop and assess the effectiveness of their change initiative measurements. Optional questions for setting context: Who is on a diet right now? Maintaining a health weight right now? When you are dieting or maintaining how do you monitor your progress? You weigh yourself or go to WW and have someone weigh you. How often do you weigh yourself? Well, some do it daily, others at least once a week. Point is, there is some effective frequency for checking progress toward goal. What happens if you don’t weigh yourself or weigh infrequently? You may get off course without even knowing it. Key takeaway: If you want to maintain progress, you have to monitor your progress frequently enough so you can know you are off track, do root cause, take actions, and get back on track quickly.

Change Acceleration Process Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last So, you see Monitoring Progress starts during transition and continues into the improved state. Monitoring Progress Changing Systems & Structures

Monitoring Progress Overview Why bother?
An accurate measure of the project provides focus, direction and momentum Corrective action can only occur if you know you're off track Monitoring Progress enhances your ability to reward key events and milestones, building momentum and commitment Clarifies what we are after Agreement and understanding on what the change effort will produce, in measurable and observable terms Baseline data and milestone results of the change process tracked and widely shared Increasing momentum as people begin to see progress and results are being realized Make key points on the slide. Optional: A word about Metrics (what we measure) and Measurement. (how we collect it) from the business perspective. It is estimated that most professionals spend 25% of a typical day reviewing data. Data, however does not necessarily mean they have information useful to guide leadership action and decision-making. Rules of thumb: concentrate of the vital few variables to measure select measures that translate to little Y’s and big Y’s when reviewing with sponsors and other stakeholders successful measurement is about balance, i.e., the Q and the A and the E measure what is important, not what is easy -- don’t confuse the what (e.g. commitment levels) with the how (surveys, observations). not everything must be variables data to be useful -- attribute works too. ensure that measures help you monitor in-process work, not just end-state results e.g., blood pressure readings vs. # of heart attacks e.g., commitment levels vs. final sign-offs Research at Xerox (their Six Sigma efforts) showed “ that ‘roughly right’ accounting (e.g. Cost of Quality measurement) and non-accounting data available to influence teams is more useful and provides more valuable information than elusive accounting systems that try to be perfect and account for everything.” Most companies are good at “project management” and tracking results -- did we get them? Few are good at tracking “in process” indicators of implementation and buy-in. A balanced set of measures allows a team or sponsor to track the progress of the Q (implementation of the technical solution) as well as the degree of buy-in (A) and lasting change. Measuring and tracking progress along the CAP dimensions demands special attention by the team.

Monitoring Progress Assessment To what extent:
Have we stated our objectives in concrete terms? Have we translated these objectives into observable behaviors? Have we set milestones that all understand and agree to? Are expected results tied to external and internal goals, and have we ensured that outcomes will be evident to stakeholders? Are individuals and teams accountable for results? Do we know which existing data will pick up progress toward our goals? Have we established new ways to gather data? Do we have accurate and timely baseline data to work from? Ask for words that are significant on the page – what seems meaningful? Use this assessment after the first few meetings of a team so they can plan HOW they will monitor their progress pro-actively. While we discuss Monitoring Progress is late in the model, the foundation for monitoring progress needs to be considered early on in your project development Ask group for examples of this from their own projects or others they have seen in their businesses. As you have seen several times, it is possible to use these questions to test if the team has effectively covering the necessary components of Monitoring Process. Transition: Professionals spend approximately 25% of their day reviewing data. Does this mean they have the data they need to make the best decisions? Not necessarily. Let’s look at several components of a measurement system… Laying the foundation for Monitoring Progress must begin early in the project.

Monitoring Progress Characteristics of measurement systems
Tactics & Tools Include: Characteristics of a good measurement system Used for: Building a measurement process that avoids typical shortcomings and generates useful data Completeness The extent to which a measure adequately measures the phenomenon rather than only some aspect of the phenomenon Timeliness The extent to which a measurement can be taken soon after the need to measure, rather than being held to an arbitrary date Visibility The extent to which a measure can be openly tracked by those being measured Controllability The extent to which the measure can be directly influenced by those being measured Cost Whether the measure is inexpensive, making use of data easily obtained or already being collected for some other purpose Interpretability The degree to which a measure is easy to understand, and produces data that is readily comparable to other organizations and/or time periods Importance Whether the measure is connected to important business objectives, rather than being measured merely because it is easy to measure Ask: What are the important elements from your perspective and why? Completeness: Does the data give enough of the right information to make a decision? Timeliness: i.e, require changing behavior daily but only giving feedback monthly isn’t appropriate Visibility – for example a one-page dashboard report. What are other ways to make information visible? How can I see the efforts are moving to the goal? Controllability – i.e, do clinicians have direct control over patient no-show rats? Yet are they measured again no-show targets? One questions to ask when choosing a metric to measure: How is an individual to control this? Provide the tools to have influence over the component. Cost – i.e, can the equipment we have provide the data rather than do it in a handwritten manner? How much will it cost us to monitor progress? Look at the most cost effective mechanisms that are already in place. Interpretability – does everyone read the same way? If not, we have a problem and need to simplify. Importance – are the outcomes tied to strategic objectives? Example: Dashboard that we create when we do an improvement project with clients. If we did the project for ED admission, a dashboard would be created early on in the project so the ED manager (and the team) could know every day if they met their discharge targets for the patients from the day before. If they did - celebrate. If not, do root cause analysis, make corrections (might mean reinforcing behaviors with key stakeholders or checking availability of supplies, etc.) Not to wait a month for the data then try and go back and find out what the problem is. A good measurement system can make the difference between a hit and a miss.

A detailed plan helps monitor progress in a timely, accurate manner.
Monitoring Progress Monitoring Progress checklist Tactics & Tools Include: A simple checklist Used For: Building a plan for monitoring progress along both the technical and cultural dimensions Step 1 Make sure that all Team Members know and agree on the key objectives of the project in clear, measurable terms Step 2 Agree on milestones for each key objectives. Check for alignment with other internal goals and external issues Step 3 Assign individual and/or team accountability for objectives and milestones Step 4 Identify existing measures that will generate data to track progress; agree on baseline data Step 5 Identify new measures that will need to be put in place to pick up critical additional data Quick commercial only. Follow these 5 steps to build a plan to monitor progress both technically and also culturally. Transition: On the next page these 5 steps are formatted to be a checklist the team can use to ensure they are completing them all. A detailed plan helps monitor progress in a timely, accurate manner.

Monitoring Progress Monitoring Progress checklist
Monitoring Progress Checklist Tool All Team Members know and agree on the key objectives of the project in clear, measurable terms. All Team Members agree on milestones for each key objectives, and these objectives are aligned with other internal goals and external issues. Accountability for objectives and milestones has been assigned. Existing measures that will generate data to track progress have been identified, and the team agrees on baseline data. New measures that need to be put in place to track critical additional data have been identified; an action plan is in place to establish this new measurement process. Highlight key parts of each step. Successful measurement is about balancing the Q and the A components.

Monitoring Progress Project plan (WWW)
A project plan is a tool to build a plan for monitoring progress along both the technical (Q) and cultural dimensions (A). Quick commercial only. Do you always know who “owns” the data or where it has come from?

Monitoring Progress Pitfalls Teams can potentially derail when they:
Want results too soon and fail to look for long-term indicators of progress Assume all stakeholders know how things are going and fail to keep them informed Measure only against internal issues or goals, forgetting that customers are often impacted by the change initiative Don’t see how the change project is connected to other initiatives and fail to measure impact Think some things are too soft to measure and only look at hard indicators of progress Simply get too busy to track progress Fail to report to the appropriate stakeholder The pitfalls of ineffective progress monitoring. Successful change progress is the result of many measurable individual and team actions!

Help participants develop and implement a plan for building change into their ongoing systems. Have you ever implemented a change just to realize that you do not have all the necessary support pieces to successfully complete the change or sustain it long term? Ask to share examples What you will find is that the end result is often a “work-around” for the desired solution and will only work for so long. In this section we will talk about the importance of aligning organizational systems and structure to support change.

Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current Transition Improved State State State Making Change Last Note this element is what we consider one of the book ends (or wine barrel stays) of the CAP model. It is one of the elements (with Leadership) that holds that model on course. It is appropriately placed as the foundation of all change. Consideration for Changing Systems and Structures begins at the start of the project and continues through all elements. If the foundation is not strong, all the change will only happen temporarily Great metaphor for how systems (demonstrated by people) change back to whatever the Norm was a the first opportunity unless systems and structures become hardwired to Reinforce them in the changed state. Monitoring Progress Changing Systems & Structures

Overview Why bother? To identify key Systems & Structures areas that must be addressed to assure long-lasting project completion and implementation. To align our Systems & Structures with desired behaviors. For when the way we organize, train, develop, reward, compensate and promote is changed, we are likely to see individual behavior change. Successful changes usually involve significant realignment of organizational infrastructure. We need to develop the capacity to change, not just the ability to change – Can we build this change into our ongoing systems? To better utilize Systems & Structures Best Practices. Draw out conversation on the key elements of the slide: To check for understanding, ask: What is an example of how you have changed rewards structures to support change? Job descriptions? When have you had to realign infrastructure to support change and how did it help? Identifying and realigning key Systems & Structures is necessary for successful, long-lasting change.

Changing Systems & Structures Assessment
To what extent: Have we identified key Systems and Structures that should be considered for further evaluation, review, observation? Have we considered how these Systems and Structures elements might need to be addressed to assure long-lasting success? Are necessary support pieces/resources in place to successfully complete the change effort? Is there clear focus for action around Systems and Structures work needed to implement the change? Have we assessed if our measurements align with the desired performance? Do we have a plan to clearly & frequently communicate our change strategy? Changing Systems and Structures – Checklist Share the checklist that they can use to determine how well they have performed to this point in the Changing Systems and Structures (can be yes/no or scale of 1 to 5 type of checklist/assessment). Based on that assessment, the team they can build action plans to enhance this CAP element. Changing Systems And Structures conversation NEEDS to take place as we move farther into our projects—when we get to Improve and Sustain conversations, the same exercises can be discussed but now with the perspective of: What elements must be addressed to assure long-lasting project completion and implementation or need to be realigned to ensure the new process/behaviors are CONGRUENT. Provide example of when S&S elements are not congruent and how that will impact the desired BEHAVIOR you wish to see—i.e. lab metrics for success were individual performance yet new process created team concept, but if the metrics don’t change people won’t behave as team. Identifying and realigning key Systems and Structures will be necessary for successful, long lasting change

Worksheet Helping Hindering Suggested Actions Staffing Development Measures Rewards Communication Organization Design Information Systems Quick commercial as another tool for potential use. Resource Allocation

Analysis/Action plan The Systems & Structures Worksheet is a tool to help you identify specific opportunities to use or modify various Systems & Structures to make change lasting and successful. Looking at the existing Systems & Structures, what should be modified or added? Staffing Development Measures Rewards Communication Organization Design Information Systems Resource Allocation Quick commercial as an action plan for use following Control and Influence assessment

Analysis/Action plan Example The Systems & Structures Worksheet is a tool to help you identify specific opportunities to use or modify various Systems & Structures to make change lasting and successful. Looking at the existing Systems & Structures, what should be modified or added? Staffing Need to add one additional headcount to team. Need to cover weekend. Development Train staff in process mapping to understand bottlenecks/workflow. Measures Implement ongoing Referring Physician survey. Post targets and update monthly. Rewards Design a creative reward system that recognizes coordinated care delivery vs. individuals/depts. Communication Assure access to the clinical information system and coordinate timely communications. Organization Design Reorganize the department structure to centralized function. Information Systems Need remote printing capability in xyz area. Install fax option. Automate Referring Phy. Survey. Resource Allocation Dollars needed to be budgeted for overtime to convert to new process and capital equipment. And filled out for reference.

Measuring Performance Checklist
Changing Systems & Structures Measuring performance checklist Measuring Performance Checklist Do existing measures test against the characteristics of a good measurement system? Have measures that provide little to no information about any of the desired behaviors been eliminated? Have new measures been added if desired behaviors cannot be reliably measured by any existing measure? If we achieve our desired changes, have all existing measures that could potentially emit false signals, erroneously indicating that performance is degrading, been eliminated? If an employee carries out each of the desired behaviors, will our organization be supportive? Within our existing rewards, do we have both financial and non-financial rewards? Do existing rewards test well against the characteristics of a good reward system? Have we set up systems to reward the new, desired behaviors not currently being rewarded? Same tool in an actual “checklist” format

Communication plan Audience Message Media Who When/Where (inform, persuade, influence) (written, events, one-on-one, etc.) How many of you listed “Communication” in some way as a characteristic of Successful or Unsuccessful Change? (Usually everyone raises their hand) Yet do we deliberately plan our communication strategy? If yes, not normally to this level of detail and unfortunately that is where the gaps in what, how and to whom our message is/isn’t communicated. This tool should be a component part of every change conversation. Step through the component parts. Give several examples. I.e. This was a banner year for the organization and everyone will be getting a 5% raise. Contrast the strategy of this message: “With the slowing economy, every department budget will be asked to cut 10% in operating expenses”

CAP communication planning matrix:
Changing Systems & Structures CAP communication planning matrix: Channel Announce the Project Clarify the Vision Begin to Mobilize Commitment Monitor Progress Changing Systems & Structures Written: Newsletter Bulletin Board V.P. Memo etc. Spoken: One-on-many All employees meeting Weekly staff meeting Operating managers meeting Etc. Spoken: One -on-one Symbolic: Offsite conference Press conference Used For: Communication Strategy (various Channels) Indicate those that are suitable for: Providing Information Persuading Empowering Include: Audience Who When Where We should be deliberately discussing our communication strategy during every step of the change process. This Planning Matrix: Combines several element of the previous tools and adds the rigor of making us devise a specific communication strategy for every stage of our CAP Plan. Included are several brainstormed channels of communication from which to choose. Others? Ask participants to share best practices or mistakes of communication. Give timely, accurate and honest information. Even bad news is better than no news. Make time to listen as well!

Pitfalls CAP teams can potentially derail when: There is a failure to realize that new competencies (acquired through staffing and development) may be required to fully implement their project. Good intentions directed at refining the reward system fail because of inattention to the critical measurement system. Early assessment of the organization’s measurement and reward systems (the characteristics of good measurement and reward systems) is not conducted. Effective communication about their project and its progress isn’t started immediately and maintained throughout the effort. Teams neglect to examine the organizational infrastructure for alignment with the new organizational goals and objectives required by their project. Draw out key points on the slide. Long-lasting, effective change acceleration requires a thorough examination and realignment of key organizational Systems & Structures!

Change Acceleration Process (CAP) Workshop

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