Managing Transitions Helping your People to Support Change

1. Managing TransitionsHelping your People to Support Change Demi Haffenreffer, RN , MBA Haffenreffer and Associates, Inc. www.consultdemi.net

2. Today’s Topics • Change • What is possible & is it necessary? • Transition • The three stages • Your role in leading and supporting your staff • Some Baldrige leadership criteria • Assessing your transition readiness • Exercises and case studies

3. Some questions for you to discuss • How is your current CQI program operationalized? • What are your key measures? • What is your staff’s understanding of Quality? • How are they measured? • Are your measurements based on regulatory compliance? • How and when are they analyzed? • Who develops and implements QI plans? • What are your results? • What is your current change project?

4. WHAT COULD WE BECOME?

5. CQI program is primarily involved in auditing Staff fear CQI audits Structured activities Facility belongs to staff Organizational charts Staff make all decisions for residents Task oriented jobs Nurse is the boss CQI program is based on root cause analysis that assists in identifying if a problem exists; the cause; and strengths. Staff are excited by opportunities to improve – no fear – no failure – only feedback Spontaneous activities Facility is home to res. Flattened structure Residents/families make decisions Care delivered to res. needs & desires Team work – nurse is a consultant The present and the future

6. Staff float Nighttime care includes every two hour rounds Restrict mobility – keep safe Tray service All meals at set hours Surveyor job is to determine compliance Follow OBRA rules to pass survey Make decisions based on fear of citations Residents who have died are hidden & rushed out Consistent assignments Residents sleeps until they wake up Keep me safe – let me move Dining Staff/residents can make meals & choose when to eat Risk is part of life – no one has all the answers Use OBRA to create autonomy & independence Make decisions based on resident need & desire All staff/residents are given opportunity to mourn the death of a resident The present and the future

7. WE ARE THE PROBLEM!! “When people who are actually creating a system start to see themselves as the source of their problems, they invariably discover new capacity to create results they truly desire.” Presence Senge, Scharmer, Jaworski & Flowers

8. Proverb “If an organization is not growing It is dying”

9. Organizational Renewal

10. “In order for change we need to connect more with OURSELVES & leave our other selves behind.” Demi Haffenreffer

11. Transition • Passage from one form, state, style, or place to another. • A transition or change, as to a spiritual existence at death • Differs from change • Change focuses on outcomes – transition is a process • More people focused • Transition’s starting point is the ending – focuses not on the change but on the letting go of the old reality before the change took place

12. Stages • Letting go of the old ways and the old identity people had • Going through an in-between time when the old is gone but the new is not fully operational – “neutral zone” • Coming out of the transition and making a new beginning – this is when change occurs

14. Helping your people • You change first! • Plan & organize • Help them to let go – manage the endings • Lead them through the neutral zone • Launch the new beginning

15. You Change First - Leadership “Let him that would move the world, first move himself” Socrates

16. Become Self-Aware • Discover Self • Become a real human being • Do your people know who you are? • Discover your world view • What’s in your briefcase? • Test your integrity • Matching your vision / values with that of your organization

17. Leading - Planning • Who are your leaders? • How do they lead? • What behaviors & attitudes will need to change? • Who will lose what under the new system? • Talk to them – involve staff at all levels • Teach your leaders about transition • Visit other organizations • Who are your champions? • Where is your commitment & motivation?

18. Case Study New Heights Rehab. Facility decided to flatten its organizational structure by developing self-led process improvement teams; self-scheduling; & renamed all positions. Policy and Procedure manuals were updated; staff trained; & the program implemented one month ago. The purpose of this change was to implement other person-centered measures. You have been hired to assist with this implementation.

19. What will you do? • Explain the changes in posted memos • Get to know employees & figure out how behaviors & attitudes will affect the change • Analyze who will loose what • Redo the compensation package • Sell the change • Change the environment • Create a slogan & a logo • Train teams in conflict resolution & how to be team members • If this system does not seem be working be ready to change it and implement another. • Bring in a motivational speaker • Provide them with info on pros & cons of new system • Plan ceremonies and celebrations • Talk to individuals about the transition and what it does to people • Develop teams – plan social events • Rewrite job descriptions • Visit other organizations who have done something similar • Break the change into smaller stages • Pull the best people together as a model team to show everyone else how to do it • Change individual targets to team targets & give bonuses • Appoint a change manager • Design temporary systems • Create a disciplining system • Get rid of the individual sabotagers • Set up a hot-line

20. Help them to let go • Team meetings – give information • “You can’t quarterback from the stands” – Nancy Fox • Losses • Accept the importance of losses • Expect overreaction • Acknowledge losses • Expect grieving • Compensate for losses • Define what is over and what is not • Treat the past with respect • Let them take a piece of the old with them • Show how endings ensures continuity of what really matters – expect the best

21. Leading them through the“Neutral Zone” “When we’re learning something new, we can feel awkward, incompetent, and even foolish. It’s easy to convince ourselves that it’s really not so important after all to incorporate the new – so we give up.” Presence Senge, Scharmer, Jaworski & Flowers

22. Problems • Anxiety increases and motivation falls • Increased absenteeism – decreased productivity • Old problems get worse • Mixed signals and messages • People become polarized • Sabotage

23. What will you do? It has been two months since the change at New Heights; absenteeism is up; a number of errors have occurred in care and services; some of the old ways have crept back in; groups are starting to form & managers are maintaining their old ties; communication is declining; the new system is failing and teams want to go back to the old organizational structure.

24. What will you do? • Explain the changes in posted memos • Get to know employees & figure out how behaviors & attitudes will affect the change • Analyze who will loose what • Redo the compensation package • Sell the change • Change the environment • Create a slogan & a logo • Train teams in conflict resolution & how to be team members • If this system does not seem be working be ready to change it and implement another. • Bring in a motivational speaker • Provide them with info on pros & cons of new system • Plan ceremonies & celebrations • Talk to individuals about the transition and what it does to people • Develop teams – plan social events • Rewrite job descriptions • Visit other organizations who have done something similar • Break the change into smaller stages • Pull the best people together as a model team to show everyone else how to do it • Change individual targets to team targets & give bonuses • Appoint a change manager • Design temporary systems • Create a disciplining system • Get rid of the individual sabotagers • Set-up a hot line

25. Solutions • Interventions – Intervene at these points: • Behavior • Justification for the behavior • Cultural communications • Hiring – members who “fit” the new culture • Organizational culture as a whole • Remove those who deviate from the culture • Normalize – Create slogans • Create temporary systems • Strengthen intragroup connections • Consider a transition monitoring team

26. Solutions • Encourage brainstorming of solutions, experimentation • Suspend your normal ways of thinking

27. The New Beginning “Just because everything is different doesn’t mean that anything has changed!” Irene Peter American Writer

28. Exercise • Rearrange yourselves in groups according to your birth date month. • Rearrange yourselves according to your birthdates

29. The New Beginning • Remember not all are going through these stages simultaneously • Rebuild and maintain trust • Clarify and communicate the purpose • Understand that with CQI change is a normal process • Create a Plan – Reinforce the new • Be consistent • Ensure quick successes • Symbolize the New Identity • Celebrate

30. Assessing your organization’s readiness for change • Where are you today? • How do individuals interact? • How are tasks accomplished? • Group norms (myths, rumors, stories) • Standards of behavior • Stated values and formal philosophies • In what ways does the organization support these? • Rules for getting along • Overall climate (calm, learning, supportive, fear based, disorganization, someone is out to get us)

31. Assessing your organization’s readiness for change • Embedded skills • How to groups interrelate • Special competencies • Subcultures? Leaders within these subcultures? • Artifacts (dress, furnishings, architectural, assigned parking, location of offices) • Does the overall environment support person-centered care? • Who are the heroes/mentors • Who do staff look up to other than residents?

32. Other resources • Bridges, W. (2003). Managing Transitions: Making the Most of Change. Cambridge, MA: Da Capo Press. • Dana, B. (2006). Developing a Quality Management System (2nd edition) - AHCA • Fox, N. (2007). The Journey of a Lifetime: Leadership Pathways to Culture Change in Long-Term Care. Eden Alternative. • Senge, P. M. et al (2004). Presence: An Exploration of Profound Change in People, Organizations, and Society. Random House: NY.

33. THANK YOU!