Lynne Gallacher Senior Vice President, Organizational Excellence Solutions

1. Canadian Hospital Pharmacy Leadership Conference June 7-9, 2013 Lynne Gallacher Senior Vice President, Organizational Excellence Solutions HORNlgallacher@horn.com 905-761-8000 ext. 266

2. Context A Model for Change My Observations • Challenges/Barriers • Success Strategies to Overcome Challenges/Barriers

3. Kotter’s 8 Reasons Why Change Fails #1 • Not Establishing a Great Enough Sense of Urgency #2 • Not Creating a Powerful Enough Guiding Coalition #3 • Lacking a Vision #4 • Under-communicating the Vision by a Factor of Ten #5 • Not Removing Obstacles to the New Vision #6 • Not Systematically Planning for and Creating Short-Term Wins #7 • Declaring Victory Too Soon #8 • Not Anchoring Changes in the Corporation’s Culture Source: Kotter, John P. “Leading Change: Why Transformation Efforts Fail.” Harvard Business Review (Jan 2007); p. 99

4. Kotter’s 8 Reasons Why Change Fails #1 • Not Establishing a Great Enough Sense of Urgency #2 • Not Creating a Powerful Enough Guiding Coalition #3 • Lacking a Vision #4 • Under-communicating the Vision by a Factor of Ten #5 • Not Removing Obstacles to the New Vision #6 • Not Systematically Planning for and Creating Short-Term Wins #7 • Declaring Victory Too Soon #8 • Not Anchoring Changes in the Corporation’s Culture Source: Kotter, John P. “Leading Change: Why Transformation Efforts Fail.” Harvard Business Review (Jan 2007); p. 99

5. Kotter’s 8 Steps to Guiding Successful Change Institutionalize New Approaches 8 Consolidate Improvements and Produce Even More Change 7 Plan for and Create Short-term Wins 6 Empower Others to Act on the Vision 5 Communicate the Vision 4 Create a Vision 3 Form a Powerful Guiding Coalition 2 Establish a Sense of Urgency 1 Source: Kotter, John P. (1996) Leading Change. p.21

6. #1 Establish a Sense of Urgency Culture of complacency No major crisis “Status quo is working” mindset The human challenge: converting intention to action Identify the need for change Challenge the feasibility of maintaining the status quo Reinforce the consequences of status quo / change Success Strategies Barriers

7. #2 Form a Powerful Guiding Coalition Lack of executive “active” sponsorship Lack of dedicated project teams Lack of broad-scale involvement and buy-in(VP staff) Influence CEO / VP championship with aligned goals Commit focused resources to plan/implement Ensure broad “powerful” participation (VP, staff, physicians, patients) Success Strategies Barriers

8. #3 Create a Vision No clear purpose Unclear desired outcomes Inability to make choices Confusing Plans and Programs with Vision Create a concise articulation of your desired future state Define measures of success / KPIs Success Strategies Barriers

9. #4 Communicate the Vision False perception that communication is an “event” Messaging doesn’t connect with hearts and minds Leader words and actions are misaligned Brand it Use all existing communication channels Communicate … over and over Focus on the “why” and “WIIFM” Live it – “Walk the talk” and “Walk around” Success Strategies Barriers

10. #5 Empower Others/Remove Obstacles Assumptions that obstacles are too great to overcome Influential resistors Systems/structure/ process misalignment Anticipate real barriers (people, systems, structures) Proactively address barriers Equip/educate on new roles/behaviours Engage broad stakeholders in solutioning Success Strategies Barriers

11. #6 Plan and Create Short-term Wins Lack of momentum No tangible evidence of improvement Plan short-term goals (12-24 months) Action / achieve them Show demonstrable progress / improvement Celebrate / acknowledge successes Success Strategies Barriers

12. #8 Institutionalize New Approaches Unclear expectations Distractions Lack of momentum No tangible evidence of improvement Create “system” that defines/measures expectations • SOPs • Management / communication routines • Accountability systems Explicitly link results to change in behaviour Don’t stop until it’s in the organizational “DNA” Success Strategies Barriers

13. So What? What is the need for change in your hospital? What’s standing in the way of making that change a reality? What can you do to lead the change you want?

14. Best Practices for Leading and Facilitating Change June 9, 2013 Lynne Gallacher Senior Vice President, Organizational Excellence Solutions HORNlgallacher@horn.com 905-761-8000 ext. 266

15. 8 Steps to Guiding Successful Change Institutionalize New Approaches 8 Consolidate Improvements and Produce Even More Change 7 Plan for and Create Short-term Wins 6 Empower Others to Act on the Vision 5 Communicate the Vision 4 Create a Vision 3 Form a Powerful Guiding Coalition 2 Establish a Sense of Urgency 1 Source: Kotter, John P. (1996) Leading Change. p.21

16. 8 Steps to Guiding Successful Change Institutionalize New Approaches 8 Consolidate Improvements and Produce Even More Change 7 Plan for and Create Short-term Wins 6 Empower Others to Act on the Vision 5 Communicate the Vision 4 Create a Vision 3 Form a Powerful Guiding Coalition 2 Establish a Sense of Urgency 1 Source: Kotter, John P. (1996) Leading Change. p.21

17. What Great Change Leaders Do • Self-Manage • Support and Empower Team Members to Act • Communicate their Vision for Change … over and over • Build Broad Organizational Support

18. “Leading others through change starts with leading oneself.” Art Horn

19. How many words per minute do we… Think? 450 words/minute Speak? 150 words/minute

20. Self-talk Judges & Evaluates Tends to beNegative

21. The Cause and Effect of Self-talk I take Actions based on my beliefs, conclusions and emotions I’m presented with a Situation I interpret the situation based on my Beliefs I expressEmotionbased on my conclusions I draw Conclusions (judgments, generalizations, assumptions)based on my beliefs Based on work by Chris Argyris, popularized by Peter Senge (2006) in The Fifth Discipline: The Art and Practice of the Learning Organization.

22. Self-talk Thinking of a current or pending change in your organization, how is your Self-talk impacting your actions (or lack of action)? Personal Reflection:

23. Managing Self-talk STOP CHALLENGE CHOOSE

24. Self-talk STOP: Thinking of the current or pending change in your organization: CHALLENGE: What assumptions are driving your negative Self-talk ?What if the assumption were not true?How could you view the situation differently? CHOOSE: What different course of action could/should you take? Personal Reflection:

25. What Great Change Leaders Do • Self-Manage • Support and Empower Team Members to Act • Communicate their Vision for Change … over and over • Build Broad Organizational Support

26. “All of the great leaders have had one characteristic in common: it was the willingness to confront unequivocally the major anxiety of their people in their time. This, and not much else, is the essence of leadership.” John Kenneth Galbraith

27. Motivations and Barriers to Change - SCARF Status – relative importance to others – Certainty – being able to predict the future – Autonomy – sense of control over events – Relatedness – sense of safety with others (friend or foe) – Fairness – perception of fair exchanges between people – Source: Rock, D. (2008) SCARF: a brain-based model for collaborating with and influencing others. NeuroLeadership Journal, 2008 (1), pp. 1-9.

28. Typical Human Reactions to Change Deflector “Not Me” Victim “Poor Me” Personalizer “It’s Me” Naïve Optimist “No Problem” Agent “Here’s What I’m Going to Do”

29. Empathy Our ability to identify with the perspectives and feelings of others, When we demonstrate genuine Empathy, it lowers others’ natural defensiveness and related Self-talk, and causes them to feel “truly heard.” As a result, they are more open to sharing information, which allows both parties to become aligned in their views. “The main barrier to communication is our tendency to evaluate, to approve or disapprove of, what another person is saying.”Dr. Carl R. Rogers Source: Rogers, Carl R. (1952) Gateway to Communication; Harvard Business Review Horn, Art. (2010) The Gifts of Leadership: Team Building Through Empathy and Focus.

30. Self-talk The Irony of Influence Judge Sense of Self Difficult to Empathize People Don’t Listen Not as Likely to Influence

31. Purpose An inclination towards consistently setting goals, aligning goals with other parties, and actively striving to ensure goals are achieved. Defining goals increases the likelihood of achieving them The effect of aligned goals can be very powerful! Establishing aligned goals can allow us to communicate: • “I understand your goal. To prove to you that I do, let me demonstrate to you exactly how your goal aligns with mine.” Source: Horn, Art. (2010) The Gifts of Leadership: Team Building Through Empathy and Focus.

32. The Balancing Act How well do you balance Empathy and Purpose in your team interactions?

33. Supporting your Team through Change • Show genuine interest • Observe • Assess their tolerance for change • Ask questions • Understand their motivations • Demonstrate understanding • Validate • Align goals • Communicate the need for change • Reframe their perspective • Communicate the WIIFM – “what’s in it for them” • Move them to “agency” and action

34. What Great Change Leaders Do • Self-Manage • Support and Empower Team Members to Act • Communicate their Vision for Change … over and over • Build Broad Organizational Support

35. “My own definition of leadership is this: The capacity and the will to rally men and women to a common purpose and the character which inspires confidence.” General Montgomery

36. CHANGE Influential Messaging Framework

37. CHANGE Example Connect • I want to connect with you to give you more context about the smoking-cessation counseling initiative. • I’ll reinforce why this transformation really does make sense for our hospital • And, why I’m personally excited by what it means for our patients, and for our pharmacy team • I also want to answer your questions so you are 100% clear and aligned History • We first started discussing this initiative over a year ago, in response to the CSHP 2015 Quality Initiative • Since then, we’ve made great strides in developing our strategy and counseling approach, and the pilot program has gone very well – we’ve proven to ourselves that this will work! • It’s time now to roll it out to 100% of our hospitalized patients who smoke Ambition • I’m excited about our Vision for this program – to provide smoking-cessation counseling to 100% of our hospitalized patients who smoke • We all know the health risks associated with smoking, and the long-term benefits of quitting – with this program we will provide the information, tools and support necessary to help our patients better understand the risks, and hopefully choose to quit so patient outcomes improve

38. CHANGE Example Need • Our patients who smoke need our help – some aren’t aware of all of the health risks, and most don’t know there are tools and supports that will make quitting much easier • In our hospital, we don’t currently have a program in place to provide that help, either through the pharmacy or other health care providers • We’re committed to CSHP 2015, and it’s time to live up to those commitments Getting in the Way • I know this program is something above and beyond what we’re currently doing – it will take time and energy to implement, and we’re busy as it is • Good news is there are other initiatives, like our new automated unit dose system, that are taking a few things off of our plates, and will make room for this • It’s also a change in terms of the scope of our duties, that requires others to give us access to 100% of our smoking patients – over time, we’ll get everybody on board Encourage • So, as we roll this program out, I ask that you: • Support each other in managing through the ups and downs • Be open-minded by challenging some of your own assumptions about our role in the hospital, and in patient care • Share what’s on your mind openly. I want to hear your perspective and ideas • Join me in believing in and pursuing our Vision for smoking-cessation counseling • Together, I know we can make a huge impact on our patients lives!

39. What Great Change Leaders Do • Self-Manage • Support and Empower Team Members to Act • Communicate their Vision for Change … over and over • Build Broad Organizational Support

40. “The key to successful leadership today is influence, not authority.” Kenneth Blanchard

41. Building Broad Organizational Support WHO is influential? WHAT is their disposition? HOW can I influence them?

42. WHO? – DIG (Decision Influence Group) Decision Influencers Identifying Clues Focus • Balancing the budget • Impact on patient care • Average case costing Approver • Direct access to funding • Releases funds • Veto power • Expertise matched to specific requirements Recommender • Gatekeeper • Gives go/no go recommendation • Track record in managing similar projects/initiatives efficiently Advisor • Impacted by decision • Gives advice • Can’t say “yes”; maybe “no” • Success with a proposal Coach • Provides guidance re: organization, players and proposal

43. WHAT? – Motivations and Disposition WHAT are their Motivations (Business & Personal)? • What do they crave? • What do they fear? WHAT is their Disposition toward you/the project? • Advocate, Neutral, Adversary WHAT is their Influence Level in your hospital? • High, Med, Low

44. HOW? - Influence Strategy High Develop Leverage INFLUENCE Monitor Support Low Adversary DISPOSITION Advocate

45. Leverage Ask for coaching Influence others - the “Develops” Develop Establish and maintain contact Address issues, perceptions, objections Align project benefits with their motivations Support Expose their ideas to more influential stakeholders (Leverage and Develop) Promote them Monitor Neutralize objections proactively leveraging more influential stakeholders Remain open to opportunities to build bridges HOW? - Influencing your DIG

46. What Great Change Leaders Do • Self-Manage • Support and Empower Team Members to Act • Communicate their Vision for Change … over and over • Build Broad Organizational Support What will you do differently to be a Great Change Leader?

47. Canadian Hospital Pharmacy Leadership Conference June 7-9, 2013 Lynne Gallacher Senior Vice President, Organizational Excellence Solutions HORNlgallacher@horn.com 905-761-8000 ext. 266