Creating, Leading and Sustaining Organizational Changes

1. Creating, Leading and Sustaining Organizational Changes February 9, 2010 Baltimore, Maryland

2. Outline • Session facilitator • Douglas Olson, UW-Eau Claire • Expert panel • Ellen Rychlik, RN, BSN, Director of Nursing at Elderwood Health Care at Lakewood • Ira Schoenberger, Senior Administrator, Heritage Hall East, Genesis Health Care • Chris Boldt, Vice President, Operations, Benedictine Health System • In abstentia, Mark Cairns, Administrator of Madonna Living Community of Rochester and Lee Larson, CEO/Administrator of St. Gertrude's. • Conversation with attendees

3. Learning outcomes • Understand why people are hesitant to change • Identify effective strategies to create and sustain organizational performance • Learn to weigh the risks and benefits of change and how to adopt policies that encourage and sustain desired results

4. Background & context The assumptions - Current environment - Need to change & move forward Challenged the panelists Three different… - roles - organizations - areas of focus

5. The Keys to EffectiveChange Management“Implementing a Primary, Permanent Nursing Care Model” Ellen Rychlik, RN, BSN Director of Nursing Elderwood Health Care at Lakewood Hamburg, New York

6. What is Change? • Constant in both professional and private lives. • People’s reaction to change • don’t resist change • resist being changed • Organizational change • normally involves some threat, real or perceived, of personal loss for those involved.

7. Change Management • Vision, • the process by which an organization gets to it’s future state. • Getting started • creating a vision for change • then empowering individuals to act as change agents to attain that vision, examples • Sub committee development • key to clearly understanding how groups function in the organization and how “the work” is really done. • All change involves loss. • At a minimum the individual may have to give up familiar routines.. • Clearly defined • reason for change • empowerment of the employee in decision making • Identification of role playing is key • This allows you to zero in on any obstacles “people who like the old ways” & monopolize on your strengths. • You must implement the system to do what it does best • structure repetitive work and let the people do what they do best – think, be creative, and solve problems.

8. Keys to Process Success: & • Change Management • Critical that people truly understand the vision/the reasoning behind the change for the change to be successful. • Sustainability – • Ability to embrace change is dependent on the organizations ability to engrain the process(s) in its culture, the way we function on a day to day basis. • Key to success is to develop systems within a culture that promotes autonomy and ingenuity in line with the organizations vision that are not dependent on a single individuals presence.

9. Primary Permanent Nursing Care Model - concluding thoughts The Process • Vision • Strategic Planning • Aim Statement • Action Plan • Sub Committee • PDSA Practical tips • Keep a finger on the pulse. Fine line between micromanagement and crisis management. • Never losing touch with the front-line staff.

10. Development & Learning as a key strategic focus: Heritage Hall East – Campus on a Campus Ira Schoenberger Senior Administrator Heritage Hall East Genesis Health Care

11. Foundation OUR CORE BELIEFS: • Our employees are the vital link between Genesis Healthcare and our patients and residents. They are the service we provide, the product we deliver…they are our most valuable resource. Achievement of our vision comes only through the talents and extraordinary dedication they bring with them every day of the year.

12. Campus on Campus Program description • Since 2001, ‘this program has emphasized learning as a central part of development both in an academic and workplace setting. • Helped employees both professionally and personally to reach their goals. • Valuing our staff has resulted in their empowerment and commitment to the quality and full life of our residents. • Nursing center evolve into a “learning center” • Taps into staff motivation and potential that already exists • A learning center • engages individuals in their own development • gives them the tools they need to move forward. • Fosters a dramatic improvement in loyalty & commitment • Strong loyalty and commitment lead to: • improved retention • fertile ground for promotion from within • ultimately improved quality of care.

13. Win/Win Perspective Organizational Needs • Strategies to increase recruitment, loyalty & retention of nursing staff • Mechanisms to promote from within into CNA and licensed nursing positions. • Establish a formal pipeline with area nursing schools for clinical rotations. • Become employer of choice. • Become a culture of learning organization. Employee Needs • Opportunities to improve communication skills • HS credentialing and basic educational offerings • Increased self esteem and confidence • Reduction of barriers to continued education, such as needs for childcare or transportation. • Financial assistance to cover educational costs

14. Key Components “As a result of our organizational vision aligning with our core values the Campus on a Campus became a reality.” Leadership structure. Building Partnerships. Acquiring Adequate Financing. Engaging and Supporting Employees. Securing a Package of Educational Offerings.

15. Barriers and Lessons learned Barriers • Slim resources • Challenge of scheduling courses • Ongoing support of staff, leadership and outside partnerships. • A lack of employee self-confidence SomeLessons Learned: • Need for regular mgmt team meetings • An open door policy • Providing consistent reinforcement and outreach to employees • Developing strong relationships with all key departments within the partner schools

16. Sustainability – Focus on Results Nursing Student Clinical Placements • Prior to 2008- 125 total students • 2008 – 2010 - 235 and 225 Students • Variety of participating Nursing programs • All buildings participated Grant Activities Organizational ROI: • Elimination of Agency • Growing your own Nurses • Increase retention COC participants Future Innovation: • SIM Experiences for LTC • Employee Preceptors for SH Students. • Linking Individual employee Ed Plans to employer based education/core competencies • Dedicated Unit for clinical rotation for Gerontology students

17. Opportunity for Change: A System LevelService Recovery Process Chris Boldt, Vice President Regional Operations Benedictine Health System • In abstentia, Mark Cairns, Administrator of Madonna Towers & Lee Larson, CEO/Administrator of St. Gertrude's.

18. Initial Steps • System improvement identified • Communication • Change in paradigm • Reservations • Core Values • Customer Service Standards • CEO commitment and support • You have to draw a line in the sand making a commitment –”Yes, we are going to do this”.

19. Planning for Change • Process Owner • Communication • Cross functional team • Evaluated current state • Gathered best practices • PDCA • Risk/benefit analysis

20. Implementing Change • Communication • Piloted on small scale • Training process • Break down into sections & set time frames • Technology support • Deployed on regional level • Training at facility level • Educate on How & Why to change • Follow up • We knew we provided quality, but hadn’t stopped to evaluate how

21. Sustaining Change • Outcomes/Results • It is not easy, but seeing results is worth the effort • BHS eSource data collection • Dashboard and Action Planning • Sharing effective practices • Feedback/solicitation • Know when to stop • Think proactively   • Quality is a journey, not a destination

22. Audience Questions and Dialogue with Panel Resources AHCA Award Process itself Specific areas Leadership Kotter Heart of Change - Quality & Performance Closing Comments- Doug Olson Thank you!