Leading in Difficult Times: Instilling Direction, Energy & Hope

1. Leading in Difficult Times: Instilling Direction, Energy & Hope Lynn M Madden, MPA CE0, APT Foundation Coach, NIATx

2. Real Change “Years of study and experience show that the things that sustain change are not bold strokes but long marches – the independent, discretionary, and on-going efforts of people throughout the organization….. In difficult situation, leaders who have neglected the long march often fall back on the bold stroke.” - Rosabeth Moss Kanter, 1999

3. Starting Assumptions Everyone is acting as they should, given the system they are in Acting without understanding the system is meddling Your current system is perfectly designed to produce the results it is currently producing To produce different results you must change the system We must expand our thinking to look at how the system components interact and evolve together We all contribute to the system that we are a part of, both positively and negatively A Systems Thinking Orientation

4. Systems Drive Behavior “most managers get into trouble because they forget to think in circles. I mean this literally. Managerial problems persist because managers continue to believe that there are such things as unilateral causation, independent and dependent variables, origins and terminations. Karl Weick, The Social Psychology of Organization, 1979

5. Change is not an event, it is a process. Leadership starts from within, and requires a commitment to self-exploration and change. Beliefs and values matter. CAN I INSPIRE YOU?

6. 19 million Americans need treatment 25% are able to access treatment 50% of those in treatment do not complete The way services are delivered is a barrier to both access and retention A Compelling Situation

7. Transformational leaders make others feel strong. They “enable others to take ownership by enhancing their competence and …by listening to their ideas…by involving them in important decisions, and by acknowledging and giving them credit for their contributions.” Kouzes and Posner, The Leadership Challenge How do you inspire others?

8. Theory – Stephen Hacker Theory – Chip Heath and Dan Heath Action Ideas - NIATx The Next Hour or So

9. “Integral to transformational leadership is the ability of the leader to bring clarity of purpose and meaning into the organization.” Challenge – to create a place where purpose dominates action and individual spirit radiates. Theory - Stephen Hacker and colleagues

10. This type of change is different than standardization or continuous improvement approaches It combines both traditional management and traditional leadership skills in three key domains: 1.Individual 2.Personal relationships 3. The Organization or Enterprise Framework for Change – Seeking Breakthrough Improvement

11. Leaders often represent role models of how to think, respond, and perform the business of the organization. As the requirements for the organization to be successful change (and change), “a personal rebirth into a perspective of possibilities, not a step by step management formula is required.” Personal or Individual Transformation

12. Burning platform An opening experience Planned self dialogue Understanding one’s life purpose, relationship to a larger life spirit Personal transformation

13. A defining characteristic of organizations is one of interpersonal relationships. A conscious relationship is one that exists for a purpose and with direction. For the organization, purposeful relationships are more resilient and able to change when needed. Relational Transformation

14. Consciousness of the enterprise points to people’s degree of awareness of a particular endeavor and their collective understanding of its scope, risks and intricacies. Enterprise Transformation

15. Switch – How to Change Things When Change is Hard. Three key approaches: 1. Direct the Rider 2. Motivate the Elephant 3. Shape the Path Theory – Chip Heath and Dan Heath

16. There is a duality inherent in each of us – ie; the Planner and the Doer Id and the superego (Freud) Elephant and the Rider (J. Haidt, The Happiness Hypothesis) A challenge to change – it is not essentially about logic

17. Our Emotional Side is an Elephant • The Heaths suggest that since our emotional and rational minds compete for control, both must be appealed to in order to create effective change.

18. The Rider is Much Smaller Than the Elephant

19. “Perched atop the Elephant, the Rider holds the reins and seems to be the leader. But the Rider’s control is precarious because the rider is so small compared to the elephant. Anytime the six-ton elephant and the rider disagree, the rider is going to lose. He is completely overmatched.”

20. The Elephant looks for immediate gratification, but also has the energy and drive to get things done. The Rider has the ability to think for the long-term and to plan for the future, but also a tendency to spin his/her wheels – overanalyze and overthink. Both have strengths and weaknesses but the elephant is just plain bigger

21. Motivate the Elephant

22. When we try to change things, we are tinkering with behaviors that have become automatic, and changing behavior requires careful supervision by the rider – which is tiring. Change is hard because people wear themselves out. What looks like laziness is often exhaustion. We have to break through to feeling – the elephant. Self supervision is tiring

23. Find the feeling Shrink the change Grow your people – cultivate a sense of identity Motivate the Elephant

24. Follow the bright spots. Script the critical moves. Point to the destination. Direct the Rider

25. What looks like resistance is often a lack of clarity. Eat a Healthy Diet vs. Buy 1% Milk (Reger and Booth-Butterfield) Two communities in West Virginia changed their milk buying choice from 18% to 41% lowfat after exposure to a two week ad campaign. Decision Paralysis

26. Systems Drive Behavior “most managers get into trouble because they forget to think in circles. I mean this literally. Managerial problems persist because managers continue to believe that there are such things as unilateral causation, independent and dependent variables, origins and terminations. Karl Weick, The Social Psychology of Organization, 1979

27. Tweak the Environment Build Habits Rally the Herd Shape the Path

29. Social learning approach Simple tools, easy wins Colleagues around the country – free sharing of ideas NIATX – A blueprint for harnessing both the rider and the elephant?

30. Rapid Cycle Change – appeals to both the rider and the elephant The Walk-through – an opening experience Business case – tying change to strategic advantage – right now NIATx – Breakthrough Innovations

31. NIATx Aims – Shaping the Path Reduce Waiting Times Reduce No-Shows Increase Admissions Increase Continuation Rates

32. Conducting a Change Exercise PDSA cycles • Plan the change • Do the plan • Study the results • Act on the new knowledge Rapid cycle changes • Changes should be doable in 2 weeks

33. Play the role of a client and a client’s family member seeking treatment at your agency Try to think and feel as the client/family member would, and think about what they would want changed Ask staff what changes would make the process better for clients and for staff Compile a list of client and staff needs and possible improvements that could address these needs Conducting a Walk-through

34. Understand and involve the customer Focus on key problems Select the right change agent Seek ideas from outside the field and organization Do rapid-cycle testing Five Key PrinciplesEvidence-based predictors of change

35. Economics really do drive an organization’s ability to offer services and the State’s ability to pay for services A positive economic position is a better leverage point for clinical and/or organizational change Programs that drain resources from the organization/State are rarely expanded – they also have more difficulty attracting staff The Sixth Predictor - Business Case is the Key to Sustainability

36. The Business Case is a Strategic Advantage that can be measured: * Improved efficiency * Improved effectiveness * Lower employee turnover * Improved bottom line Defining Business Case

37. It is possible to target one payer group, but we have learned over and over again that if you open access, it will help people in every payer class equally. What if more people come, but no one can pay?

38. Addiction Resource Center – Brunswick Maine Wait Times Are Down 77% From Baseline

39. Addiction Resource Center - MaineIOP Volume Is Up 150% Over Baseline

40. Addiction Resource Ctr Business CaseMedicaid Net is up 53% Over Baseline 3’rd Party and Private Net Is Up 50% Over Baseline

41. Aroostook Mental Health Center tackles the no-show rate

42. Aroostook Mental Health Center – decreasing no show rate

43. A 3% improvement in the no-show rate = $1100/month or $13,300/year This program is in a group of programs that together were intended to produce an operating margin of $15,123 This data helps answer the question – are we moving in the right direction? Small Changes Really Matter

44. Waiting for Scarce Resources Acadia Hospital was running a waiting list for extended shelter beds – meanwhile the beds were being utilized at the rate of 80%.

45. Waiting Days to Admission – APT Foundation

46. APT Foundation Outpatient Census

47. 11,024 New client weeks = $466,646 in new net revenues APT Foundation – New Growth Means Financial Stability

48. Performance Management MetricServices that people can and will come to, that we can pay for, and that work. RESOURCE EFFICACY ACCESS

49. Maintaining the Status Quo is an action. The Elephant loves it, and will spend a lot of energy to ensureit.

50. The cost of passing up the next best choice when making a decision. For example, if an asset such as capital is used for one purpose, the opportunity cost is the value of the next best purpose the asset could have been used for. Opportunity costs include the resources of staff time. Opportunity Cost