managing change – ProCRNA

Take charge of change

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

“Somebody ought to…” “If they were smart, they would…” Workers frequently discuss the management flaws during small talk in the lounge and call on those in charge to fix the system; however, it is common for the very people who criticize and call for change to adamantly resist any disruption of business as usual. Whether it arises from the front office or from a grassroots movement, and regardless of the merit of a new plan, variation of routine can be intimidating and evoke both active and passive resistance from the same people who are essential for putting a new strategy into action. Successfully guiding a team through a revision process is a multi-faceted task requiring a leader to unite the workers; a demand that will challenge the skills of even the most experienced boss.

“The world hates change, yet it is the only thing that has brought progress.”

~Charles Kettering

Writing in The Balance Careers, Susan Heathfield connects effective leadership with managing change by emphasizing the importance of the leader’s commitment to implementing the new policy. She suggests 5 essential elements for the leader to put in place if modification is to occur smoothly:

Have a vision
Communicate the vision
Be involved in planning
Provide structure to support the change
Designate an executive champion

At the core of implementing change is effective communication of both the proposed plan and the reasons that drive the need for adjusting current procedures. Author Steve Weber (Speakinggump.com) affirms that most people will accept workflow alteration if they understand the vision, are allowed to participate in development, and feel ownership during implementation. According to Weber, transparent disclosure of the plan and its necessity will have the following effects:

Defective systems will adjust
Redundant systems will be eliminated
Major flaws will be exposed and eliminated
Minor flaws will be tweaked

Leadership is essential for change implementation and management (CIM) regardless of its scope. In a recent conversation with a patient, Joe, an executive level consultant for managing change at USAA insurance provided additional insight about the importance of leadership by sharing actual stories from his work. According to Joe, meaningful and lasting change is difficult to impossible without Active Invisible Management (AIM) Like a duck that appears to be peacefully floating on top of the water and whose legs are churning below the surface, effective leaders display calm confidence in public while churning out some hard work behind the scenes to push the project forward. When I asked Pete about obstacles to anticipate when asking workers to set a new course, he noted two things that can derail implementation.

The first signs of success Most of us assume that signs of success are a good thing, but Pete noted that top leaders are busy people and as soon as it appears that success is on the horizon, attention gets diverted to other areas and the project loses its AIM. Having a designated executive champion who actively works until the new way becomes part of the team culture is essential, particularly when things appear to be going well.
Recognition and reward achieved under the old system High achievers who were rewarded under the old system have a vested interest in maintaining the status quo. Leadership must be sensitive and ensure that the most productive people under the old system can also anticipate gaining recognition and reward with the new system.

Even after clearly communicating the proposed plan and its necessity, you may still need to address a question from your team; “what’s in it for me?” Answer the question in a confident manner with a focus on benefits for both the individual and the organization with emphasis on the following:

Achieving personal / professional growth
Developing adaptive flexibility
Challenging old beliefs and accepting alternative methods
Showcasing strengths
Mastering the stress associated with the unknown
Breaking ho-hum routine
Opening the opportunity to create a fresh future

“Change has a bad reputation in our society. But it isn’t all bad – not by any means. In fact, change is necessary in life – to keep us moving, to keep us growing, to keep us interested. Imagine life without change. It will be static, boring, dull.”
–~Dr. Dennis O’Grady

Successfully guiding a team through the process of change is a multi-faceted process that can cause trepidation from even the most experienced leader. Rather than cowering in fear of the lunchroom nay-sayers, clearly communicate the new plan and engage high-achievers from the old system to assume a prominent position in the new scheme. Confidently position yourself and your team to be the trailblazers within the organization and be the first to reap the rewards that accompany successful implementation of change.

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist. Contact tom@prosynex.com to book a speaking engagement.

Kotter, for a change

By Thomas Davis, CRNA, MAE, Lt. Col. (ret.)

Follow @procrnatom on Twitter

“Change is the only constant in life.”

– Herculitis, Greek philosopher (535 BC – 475 BC)

We know that change in the workplace is unavoidable and that it can sometimes be painful, making people cling tightly to the secure comfort of status quo. Savvy leaders know that modifying and implementing new policies or guidelines is inevitable and to make the changes less difficult, they find ways to rally the team.

Writing in the Forbes.com blog, author, Larry Alton, agrees with the Greek philosopher and recommends addressing change head on. Culture evolves based on relationships. Therefore, to achieve a successful rollout of a new policy or plan, it is essential to build an energized team of individuals who can accept variation and take the lead during implementation.

John Kotter, professor emeritus at the Harvard Business School studied both the necessity for and the resistance to change. In his book, Leading Change (1996), the Kotter 8-step model for managing change is presented as a thinking framework to smooth the process of making modifications in the workplace. Repeatedly and successfully used in business, industry and healthcare, the Kotter model can be applied to just about anything that requires transformation. Here is an example of how we used this dynamic, interactive model to improve the workflow at our ambulatory surgery center.

One of the myths that our ASC embraced is the belief that every female patient who is not post-menopausal must have a pregnancy test before receiving anesthesia. Being a fast-paced GI center with rapid patient turnover, any delay caused by waiting for a urine specimen slowed the work flow and ultimately caused subsequent patients to experience delays. Many of our patents have zero likelihood of being pregnant and the drugs we use pose no risk to the pregnant patient, therefore, many on our staff felt strongly that it was time to change the policy. A grassroots movement was emerged and we were well on the way to fulfilling the requirements of the first step on the Kotter model:

Create urgency Often when things don’t seem to be quiet right, the initial response is “somebody ought to change that” and the sentiment quickly progresses to “we gotta fix it.” At our ASC, Doctors, CRNAs and nursing staff all complained about delaying cases while awaiting a pregnancy test. The concerns of the staff were reinforced by negative feedback from patients when they were solicited to evaluate their experience at our center. Specifically, evaluations from patients expressed dissatisfaction with the ASC due to the required pregnancy test. ASC staff and managers sensed urgency to change the policy and we collectively agreed that we WILL address the issue head-on and take corrective action.
Form a powerful coalition There is strength in numbers. When building a coalition to support a proposed change, it is important that all stakeholders are on board with the new plan. Building a coalition involves gaining consensus among your peers who share your view point as well as from collateral professionals who look at the same problem from a different perspective. Our coalition of stakeholders included doctors, nurses and support staff; all of whom were included in the development of the new policy to modify our current practice. Patients were the ultimate stakeholders and, although we took their feedback seriously, we did not include them in revising the policy.
Create a vision Having identified the problem, we clearly knew what we didn’t want: Unnecessary testing that slowed the workflow without adding value to the process. We turned our attention to what we did want: A policy that maintained patient safety, facilitated workflow and elevated patient satisfaction. After a “best practice” review of the literature to ensure that we were on solid ground, our efforts were rewarded when the new plan was developed to support our goal.
Communicate the vision Before implementation, the new plan was shared with every worker at the ASC through email and informal discussions. The sense of urgency already in place from step 1 smoothed the process of sharing the plan with the entire group. The ASC team quickly embraced the vision that would improve workflow and patient satisfaction.
Remove obstacles There were very few obstacles for our proposed change. Knowing that involving stakeholders would increase buy-in, we reduced potential resistance by making sure that everybody was kept informed. In addition, we made sure that everybody knew that our new policy was in line with safe practice.
Create short-term wins This was a change to a local policy and it did not have a big impact on the organization, so the sense of achievement was confined to our workgroup. We gave recognition to those who were instrumental to developing the plan; however, the nature of the project did not warrant a major celebration.
Build on the change The Institute for Healthcare Improvement (IHI) recommends the plan, do, study, Act (PDSA) model for improving a plan. The PDSA model involves implementing a pilot plan, evaluating the results, modifying the plan and re-implementing a better version which, hopefully, will produce even better results. Our plan improved the overall workflow by eliminating mandated pregnancy testing and had the collateral effect of improving patient satisfaction. Success with this project motivated us to look at other workflow issues and seek ways to make further improvements.
Anchor the change in corporate culture “That’s the way we’ve always done it,” does not mean that it’s still the best way, nor does it mean that we must to continue a non-productive practice. Our new corporate culture includes the knowledge that grassroots initiatives are received in a positive light and that change can be initiated by any person in the organization.

Eliminating the need for every female to receive a pregnancy test before undergoing anesthesia is only one example of the use of the Kotter model for introducing and managing change. What is the greatest need for revision in your organization? Take time to pre-plan and practice the Kotter model when change is required. Apply it chronologically, one step at a time. It will be self-defeating to build a coalition before creating the sense of urgency or trying to implement a vision without first developing a plan. Embrace transformation and proactively use Kotter’s model to reach your desired outcome.

Heraclitus observed that change is inevitable, but he did not say that change is a bad thing. The great philosopher also said, “You could not step twice into the same rivers; for other waters are ever flowing onto you.” Today, one thing that has not changed over time is that the only constant is change.

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.

Leading Frontline Change

Leading Frontline Change:

Today’s leadership investment yields tomorrow’s team dividends

By Thomas Davis, CRNA
Follow @procrnatom

Effectiveness as a leader is not based on popularity but rather on the ability to manage change

“The only constant is change.” Modifications to best practice protocols are initiated internally and are meant to improve both workflow and patient outcome. Other initiatives have an external source and are mandated by new regulations or alterations in reimbursement. Frontline managers and team leaders set the tone for how the work group will respond and the attitude projected by the leader will ultimately contribute to the success or failure of the initiative. Frontline Leaders are critical to success whenever the status quo is altered.

As recently as 5 years ago, in order to accommodate the need for Nurse Anesthetists and ICU nurses to work 12-hour shifts, several hospitals offered workers 3 X 12 hours per week to count and be paid as a 40 hour work week. The response was positive and the hospitals had a plethora of applicants working the popular shift. Over time, changes in healthcare reimbursement took place and the 36-paid-as-40 model was no longer viable. Hospitals were forced to implement new schedules that required 40 hours of work for 40 hours of pay. For example, two individual hospitals in the same community implemented the change to the 40-hour work week with very different results. Although the change was not popular at either hospital, one system made the change smoothly with the team focused on all of the other positive benefits offered by the employer. As a result, there were no resignations. At the second hospital, 18 members of the department abruptly quit their jobs. The difference was Frontline Leadership.

Status quo does offer a level of comfort, however, change is often an opportunity for the frontline healthcare leader to experience personal growth as well as growth and development of the team. The leader’s personal response to the change will set the tone for the entire workgroup. By using asset based thinking (ABT), creativity and good communication, your workgroup can lead the way in the implementation of change. Remember, change does not necessarily threaten your personal vision. With creativity, change can actually move your vision forward. In the example of implementing the 40- hour work week, the successful leader held true to the vision of making the hospital an employer of choice. The reason behind the change was thoroughly explained to the workgroup and the implications were revealed. The group learned that the change would bring financial stability to the organization and add security to their jobs. The group actively participated in creating a new schedule that was acceptable to all. When the change was made, even though they preferred the 36-hour work week, the change went smoothly. Conversely, at the other hospital the change was implemented as a mandate from above. The attitude was, “if you don’t like it, find another job”…and many did.

Build on a solid foundation

Change is commonly perceived as threatening when the frontline worker sees no personal benefit. Strong leaders have an opportunity to thrive during times of change as opposed to weak leaders who wilt and eventually perish. Leaders who are successful at embracing and implementing change are people who have a long history of being connected with the workgroup. A leader may safely assume that at some point policies and procedures will be altered. Establishing yourself as a trusted and confident person who cares about each team member on a personal level will give you credibility with the team when they feel threatened by the need to modify the status quo.

To be an effective leader:

Role model excellence in every phase of the job. Take your turn on the front line of patient care along with the members of your workgroup and earn respect for your skills.
Develop a one on one relationship with each member of your team. Know something personal about each person and have a sincere desire to promote their professional development.
Have a vision for the group and communicate it regularly. Every member of your team must know and support your vision. Encourage open discussion to clarify your vision.
Be upbeat and confidently demonstrate ABT. Anticipate success.

Do your Homework

With change comes anxiety and when people are uncertain, rumors emerge. You will be amazed at what a friend of a friend heard someone say in the elevator. Once gossip takes on a life of its own, it will taint how we perceive people and problems. Writing in Science, Eric Anderson states, “Gossip does not impact only how a face is evaluated – it affects whether a face is seen in the first place.” Once the gossip starts, time is of the essence to get it stopped. A leader must quickly understand the proposed change and the reasoning behind it, connecting the new policy to the greater goal of the organization, and then communicating it honestly and openly.

Before you talk with your team about the upcoming change, become the expert on the topic. Read the new policy and have a one-on-one conversation with your superiors and other stakeholders. Succinctly share your concerns privately in a proactive and asset-based manner. Always speak and listen with good intent and with a commitment to understand.

Before you meet with your team:

Clarify the specifics of the future state and the advantages that will emerge with the new policy.
Identify and utilize key stakeholders and sources of support.
Identify obstacles and explore ways to remove them.
Involve key people in the workgroup to help with the rollout of the new plan.
Develop a timeline and abide by it. Delaying will only give more time for rumors and gossip to spread.

Communicate

Sincere, two way communication is essential for implementing and managing change. Set a positive and confident tone when discussing the future. If members of your team perceive that you are uncertain and lack confidence, they will not openly support you. Your ambivalence will be compounded by the negative effects of rumors and gossip causing morale to drop along with the effectiveness of your leadership. Now is the time for you to display self-assurance and maintain control. Being recognized and respected as a leader is status that is earned over time. From day one a leader must earn the trust of the team. Once you have done your homework related to the change and you know the details of both why and how the change will be implemented, you are ready for one of the most important roles of a leader – keeping the team informed.

To keep the team informed:

Schedule a town hall meeting where the change can be openly discussed.
Be open and honest and share all that you have been asked to share. If you have been asked not to share something, don’t pretend that you don’t know. Simply state that you cannot yet share that detail.
Let people know that gossip is not acceptable(will not be tolerated?). Honestly answer all questions in order to prevent and dispel rumors.
Listen to each member of the team with the intent to understand. Acknowledge individual concerns.
Use ABT to focus on positive aspects of the change.
Where possible, connect the proposed change to your personal vision and the greater goal of the organization.
Challenge the team to actively participate with implementing the change.

As the leader of a team of frontline healthcare workers, you want everything to run smoothly on a daily basis with great workflow, safe patient outcome and a happy staff. Although change can be challenging to the team, it can also be an opportunity for the talented Frontline Leader to shine. Make a commitment to establish a solid foundation with your team and to connect with each individual. The groundwork that you lay today will pay huge dividends when it’s time to implement the inevitable change.

Thomas Davis is an experienced clinical anesthetist, leader, speaker and the owner of Frontline Team Development and Leadership.