Managing Change: Tools and Techniques

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Information about Managing Change: Tools and Techniques

Published on June 10, 2008

Author: MHTP

Source: slideshare.net

Description

A detailed look at lessons from mental health systems change and transformation initiatives in this presentation.

Managing Change: Tools and Techniques Vijay Ganju Director, Center for Mental Health Quality & Accountability NASMHPD Research Institute, Inc. 703.739.9333 ext. 132 [email_address] Lessons from Mental Health Systems Change and Transformation Initiatives Presentation at the CMS Conference: New Freedom Initiative Access to Community Living Transforming Systems: Keys to Success Baltimore, Maryland  April 10-12, 2006

Mental Health System Recovery / Resilience Transformation Mental Health / Health Consumer / Family Driven Eliminate Disparities Early Intervention Evidence-Based Practices Training / Research Technology & Information

The Quality Pyramid Performance Measurement SYSTEM OUTCOMES Evidence-Based Practices Quality Improvement

Evidence-Based Practices: Some Definitions An evidence-based practice is considered to be any practice that has been established as effective through scientific research according to a set of explicit criteria (Drake et al, 2001) . Evidence-based treatment is the use of treatments for which there is sufficiently persuasive evidence to support their effectiveness in attaining desired outcomes (Rosen and Proctor, 2002) . Evidence-based practice is an approach to healthcare wherein health professionals use the best evidence possible to make clinical decisions for individual patients (McKibbon, 1998). Evidence-based practice is the integration of best research evidence with clinical expertise and patient values (Institute of Medicine, 2001) .

An evidence-based practice is considered to be any practice that has been established as effective through scientific research according to a set of explicit criteria (Drake et al, 2001) .

Evidence-based treatment is the use of treatments for which there is sufficiently persuasive evidence to support their effectiveness in attaining desired outcomes (Rosen and Proctor, 2002) .

Evidence-based practice is an approach to healthcare wherein health professionals use the best evidence possible to make clinical decisions for individual patients (McKibbon, 1998).

Evidence-based practice is the integration of best research evidence with clinical expertise and patient values (Institute of Medicine, 2001) .

Number of States Implementing EBPs: FY 2003 N = 47

Implementation of Evidence-Based Practices for Children, 2003 N = 47

Moving Forward with Evidence-Based Services Federal Initiatives SAMHSA National EBP Demonstration Project NIMH/SAMHSA Planning Grants SAMHSA/CMHS EBP Implementation Grants SAMHSA National Registry for Effective Practices HRSA’s Federal Qualified Health Centers NRI Center for Mental Health Quality and Accountability

Federal Initiatives

SAMHSA National EBP Demonstration Project

NIMH/SAMHSA Planning Grants

SAMHSA/CMHS EBP Implementation Grants

SAMHSA National Registry for Effective Practices

HRSA’s Federal Qualified Health Centers

NRI Center for Mental Health Quality and Accountability

Preliminary Lessons from Toolkit Project Organizational development component is critical Outcomes must be integrated into EBP implementation Cultural competence issues need to be addressed Ongoing consultation was a great facilitator

Organizational development component is critical

Outcomes must be integrated into EBP implementation

Cultural competence issues need to be addressed

Ongoing consultation was a great facilitator

Lessons Learned from “Toolkit” Trainers, Consultants and Evaluators Desired Consumer Outcomes Practitioners Consumer Family Agency Implementing EBP Steering Committee State or County Mental Health Authority Strategies for Consumer/Family Strategies for the SMHA Strategies for the Agencies Strategies for the Steering Committee Training/TA Strategies for Practitioners

Factors Affecting State-Wide EBP Implementation System leadership Organized culture/consensus IT capacity/outcomes measurement Policies/procedures Integration with performance/quality improvement Human resource capacity/training Funding methods

System leadership

Organized culture/consensus

IT capacity/outcomes measurement

Policies/procedures

Integration with performance/quality improvement

Human resource capacity/training

Funding methods

Statewide Implementation of EBPs Demonstration projects Training Supports Organizational assessment Standards/ regulations Financing/fiscal incentives Training and support Contractual requirements Intensive technical assistance / support Early Adopters (“enthusiasts”) Late Adopters Non-Adopters

Demonstration projects

Training

Supports

Organizational assessment

Standards/ regulations

Financing/fiscal incentives

Training and support

Contractual requirements

Intensive technical assistance / support

Public Mental Health Authority Practitioner Knowledge Perceived advantage Feedback Consumer/Family Member Choice Commitment Perceived advantage EBP Cost Compatibility Payoffs Complexity Provider Organization Leadership Policies Regulation Resources Leadership Organizational Culture Administrative Support Information Technology

Practitioner

Knowledge

Perceived advantage

Feedback

Consumer/Family Member

Choice

Commitment

Perceived advantage

EBP

Cost

Compatibility

Payoffs

Complexity

Leadership

Policies

Regulation

Resources

Leadership

Organizational Culture

Administrative Support

Information Technology

Lessons Learned from National EBP Demonstration Project INFORMATION TECHNOLOGY Implementation Leading to Transformation System Leadership/ Implementation Plan Policies and Procedures Organizational Structures Funding Methods Human Resource Capacity Quality/ Performance Improvement

Causal Connections Recovery Infrastructure Goal: Interaction with Provider Evidence- based and “ best” practices

Interaction with

Provider

Evidence-

based and

“ best” practices

 

Transformation Logic Model Outcomes - Impact Target Systems Outputs Activities Inputs Situation Inefficient use of resources Lack of information Inade-quate value orientation Ineffective-ness regarding outcomes Stakehold-ers Staff Resources Leadership commitment Develop-ment of new structures Resource development reallocation Information/ technology development New cadre of leaders Restructur-ing Availability of new information and technologi-cal capacities Internal External Short-Term Leadership development Training capacity Information (services, money, competen-cies) Innovation opportunities Policy development/changes Interagency coordination Intermediate Multi-stakeholder engagement/consensus Identifica-tion/flexibility of resources Increased competenc-ies New models /protocols New structural arrange-ments Long-Term Consumer outcomes Population outcomes (e.g. anti-stigma) Resource efficiencies Disparity reduction Data Leadership capacity Policy changes Workforce competencies availability Use of data Values orientation Resources available Data Consensus/ engagement assessment Resource allocation/ development Contract expectations Data NOMs Recovery/ resilience Community indicators Financial indicators Technology Fragmenta-tion Stigma Lack of EBPs Lack of technology application SMHA CMHAs Other agencies

Inefficient use of resources

Lack of information

Inade-quate value orientation

Ineffective-ness regarding outcomes

Stakehold-ers

Staff

Resources

Leadership commitment

Develop-ment of new structures

Resource development reallocation

Information/ technology development

New cadre of leaders

Restructur-ing

Availability of new information and technologi-cal capacities

Internal

External

Short-Term

Leadership development

Training capacity

Information (services, money, competen-cies)

Innovation opportunities

Policy development/changes

Interagency coordination

Intermediate

Multi-stakeholder engagement/consensus

Identifica-tion/flexibility of resources

Increased competenc-ies

New models /protocols

New structural arrange-ments

Long-Term

Consumer outcomes

Population outcomes (e.g. anti-stigma)

Resource efficiencies

Disparity reduction

Data

Leadership capacity

Policy changes

Workforce competencies availability

Use of data

Values orientation

Resources available

Data

Consensus/ engagement assessment

Resource allocation/ development

Contract expectations

Data

NOMs

Recovery/ resilience

Community indicators

Financial indicators

Technology

Fragmenta-tion

Stigma

Lack of EBPs

Lack of technology application

SMHA

CMHAs

Other agencies

NRI Conference on Change Management in Mental Health Systems Agenda: June 22-24, 2005, Albuquerque, New Mexico Hodges, Wotring Use of Evaluation Ganju, Isaacs Cultural Competence Power, McCracken Leadership Development Hudgens, Reynolds, et al. Mental Health Change Models Blasé Implementation Research Findings Mulkern, Hills Supporting Creativity / Innovation Morris, Kanary Workforce Development / Training Clark, Armstrong Funding McCracken Tools for Change McCracken, Aarons Change Management: The Science

Agenda:

Definition of a Change Project Cuts across organizational boundaries Has defined start and completion dates Generates observable, measurable results Requires significant change in both attitudes and the way work is performed Creates both active and passive resistance Requires a dedicated change team

Cuts across organizational boundaries

Has defined start and completion dates

Generates observable, measurable results

Requires significant change in both attitudes and the way work is performed

Creates both active and passive resistance

Requires a dedicated change team

Role of Change Management Training Explains objectives and provides information on desired activities and outcomes. Project Management Involves tracking, monitoring, measuring, and reporting. Establishes performance standards and metrics; provides objective measures of progress against plan; anticipates obstacles and recommends corrective action. Change Management Intensive, field-based exercise in changing behavior. Focuses on communicating the initiative; creating alignment; identifying and overcoming resistance; embedding change into the organizational culture.

Training

Explains objectives and provides information on desired activities and outcomes.

Project Management

Involves tracking, monitoring, measuring, and reporting. Establishes performance standards and metrics; provides objective measures of progress against plan; anticipates obstacles and recommends corrective action.

Change Management

Intensive, field-based exercise in changing behavior. Focuses on communicating the initiative; creating alignment; identifying and overcoming resistance; embedding change into the organizational culture.

Organizational Culture of a Mental Health System Solidarity Sociability Networked Communal Fragmented Focused

Change Tools and Techniques Index 30 Payoff Matrix 23 Stakeholder Analysis/Influence 22 Attitude Charting 19 Elevator Speech 17 Threat/Opportunity Matrix 16 Is/Is Not 12 Team Competency/Influence 11 Sponsorship Alignment 10 Backwards Imaging Page Number Tool

Payoff Matrix

Stakeholder Analysis/Influence

Attitude Charting

Elevator Speech

Threat/Opportunity Matrix

Is/Is Not

Team Competency/Influence

Sponsorship Alignment

Backwards Imaging

Launching the Product Desired Outcome Well-defined project that is doable, yet challenging Clear agreement and commitment from sponsor A team with competency, influence, and representation that has been prepared for the challenge

Desired Outcome

Well-defined project that is doable, yet challenging

Clear agreement and commitment from sponsor

A team with competency, influence, and representation that has been prepared for the challenge

Backwards Imaging Imagine a point in the future when your project or initiative is very successful Find words to describe what you see, hear, feel as you observe the key constituents functioning in the new, changed environment Discuss and reach consensus with your team members on what this new, improved future will look like As a team, develop the obstacles you will likely have encountered and overcome during the impelmentation

Imagine a point in the future when your project or initiative is very successful

Find words to describe what you see, hear, feel as you observe the key constituents functioning in the new, changed environment

Discuss and reach consensus with your team members on what this new, improved future will look like

As a team, develop the obstacles you will likely have encountered and overcome during the impelmentation

Sponsor Discussion – Typical Questions Describe the initiative in your own words. Why is this initiative important? What will success look like to you? What is outside the scope of this initiative? What else is on your agenda – where does this project fit? Who are the key players and how do they view this initiative? What excites you the most about this initiative? What concerns you the most about this initiative? What do you think our biggest challenge will be? Who should be on the core working team, and how can we get their commitment? What role do you see yourself playing? How involved do you want to be? What key decisions do you want to make or be involved in? Do you have any words of advice or suggestions for me in the meantime?

Describe the initiative in your own words.

Why is this initiative important?

What will success look like to you?

What is outside the scope of this initiative?

What else is on your agenda – where does this project fit?

Who are the key players and how do they view this initiative?

What excites you the most about this initiative?

What concerns you the most about this initiative?

What do you think our biggest challenge will be?

Who should be on the core working team, and how can we get their commitment?

What role do you see yourself playing?

How involved do you want to be?

What key decisions do you want to make or be involved in?

Do you have any words of advice or suggestions for me in the meantime?

Tool: Team Competency/Influence Tool: Team Competency – A useful tool to help the team determine if they have the right team members relative to the competencies and influence necessary to execute the initiative Competency/Influence Team Member H = High M=Medium L=Low Uses: This exercise is particularly useful for two situations: (1) when initially forming the team, it can help the sponsor and/or team leader determine who should be on the team; (2) if the team is already in place and they may be struggling due to lack of ability to do certain facets of the initiative, this tool can be used to determine if adjustments in team members are warranted. Timing: Before starting the initiative and/or anytime during the initiative when the team seems to be struggling due to lack of competency or influence. This often occurs when a new phase of the initiative begins.

Team Start-Up: Levels/Types of Decisions I’ve made the decision. Here’s what it is and why I had to make it. I’m leaning strongly in this direction. Tell me what the team thinks, then I’ll make the decision (your input, my decision). We need more information before the decision can be made. Help us see all sides of the issue, then we’ll make the decision based on consensus. I’m willing to go with whatever the team decides on. Let me know your decision and I’ll support it.

I’ve made the decision. Here’s what it is and why I had to make it.

I’m leaning strongly in this direction. Tell me what the team thinks, then I’ll make the decision (your input, my decision).

We need more information before the decision can be made. Help us see all sides of the issue, then we’ll make the decision based on consensus.

I’m willing to go with whatever the team decides on. Let me know your decision and I’ll support it.

Team Start-Up: Consensus Consensus is reached when everyone can state: I believe that you understand my point of view I believe that I understand your point of view Even though this may not be the way I would decide things by myself, I will support the decision 100% because it was arrived at in an open and fair manner

Consensus is reached when everyone can state:

I believe that you understand my point of view

I believe that I understand your point of view

Even though this may not be the way I would decide things by myself, I will support the decision 100% because it was arrived at in an open and fair manner

Creating Organizational Alignment Desired Outcome: A clearly defined project scope A sense of urgency and commitment among key stakeholders Clear, consistent, organization-wide communication of the project

Desired Outcome:

A clearly defined project scope

A sense of urgency and commitment among key stakeholders

Clear, consistent, organization-wide communication of the project

Is / Is Not Is ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ Is Not ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ ________________________ Helps a team to think through the project by more clearly defining what is inside and outside its scope. Often the “ is not ” portion of the discussion is more important than the “ is ” part – that’s where the disagreement usually lies. It can be used during the definition phase as well as later when the team is stuck and needs to be refreshed on the projects boundaries.

Is

________________________

________________________

________________________

________________________

________________________

________________________

________________________

________________________

Is Not

________________________

________________________

________________________

________________________

________________________

________________________

________________________

________________________

Tool: Threat/Opportunity Matrix 1 3 2 4 Tool: “Best Practice” organizations know how to frame a change initiative as more than a short-term threat. They work to find ways to frame it as both a threat and an opportunity. By doing so, they are able to create a sense of urgency and commitment among key stakeholders. Threat Opportunity Short Term Long Term Uses and Timing: Building the case for change is one of the most important tasks of the team. This simple tool helps it to redirect the initial focus on short-term threats and generates a clear sense of why the initiative is essential. Gain Pain

Example: Threat/Opportunity Threat Opportunity Short Term Long Term Physician Group Initiative More flexibility/agility Improved patient satisfaction Able to provide measurably higher quality care Increased capacity through improved asset utilization Able to recruit and retain better administrative and clinical staff Physicians will be more productive Won’t achieve our objective Will have to work with fewer staff Control our future Shake up the organization Will create uncertainty and staff anxiety Physicians will resist any change Productivity will drop Won’t be able to fund other projects Patients are likely to be confused Overhead burden may rise

More flexibility/agility

Improved patient satisfaction

Able to provide measurably higher quality care

Increased capacity through improved asset utilization

Able to recruit and retain better administrative and clinical staff

Physicians will be more productive

Won’t achieve our objective

Will have to work with fewer staff

Control our future

Shake up the organization

Will create uncertainty and staff anxiety

Physicians will resist any change

Productivity will drop

Won’t be able to fund other projects

Patients are likely to be confused

Overhead burden may rise

Measuring and Overcoming Resistance Desired Outcome: Identification of sources of both active and passive resistance An effective strategy to influence key stakeholders

Desired Outcome:

Identification of sources of both active and passive resistance

An effective strategy to influence key stakeholders

Resistance to Change: What Does it Look Like? Resistance to change is typically divided into two distinct categories: Active resistance Passive resistance

Resistance to change is typically divided into two distinct categories:

Active resistance

Passive resistance

Attitude Charting Innovators (5%) Early Adopters (10%) Early Majority (35%) Late Majority (35%) Resistors (15%)

Stakeholder Analysis Steps: 1. Plot where individuals currently are with regard to desired change. (  = current) 2. Plot where individuals need to be (X=desired) in order to successfully accomplish desired change-identify gaps between current and desired 3. Indicate how individuals are linked to each other, draw lines to indicate an influence link using an arrow to indicate who influences whom 4. Plan action steps for closing gaps Names Strongly Against Moderately Against Neutral Moderately Supportive Strongly Supportive

Example #1: Stakeholder Analysis Chief of Surgery Dr. Bobbitt Dr. Clampett CEO Chief of Staff Medical Director Chief of Medicine CFO Asst. Med. Director Chief Administrator Dr. Barnes Chief of Nursing Sharon Reams, RN       Strongly Against Moderately Against Neutral Moderately Supportive Strongly Supportive       

Example #2: Stakeholder Analysis Chief of Surgery Dr. Bobbitt Dr. Clampett CEO Chief of Staff Medical Director Chief of Medicine CFO Asst. Med. Director Chief Administrator Dr. Barnes Chief of Nursing Sharon Reams, RN       Against Moderately Against Neutral Moderately Supportive Strongly Supportive       

Example #3: Stakeholder Analysis Chief of Surgery Dr. Bobbitt Dr. Clampett CEO Chief of Staff Medical Director Chief of Medicine CFO Asst. Med. Director Chief Administrator Dr. Barnes Chief of Nursing Sharon Reams, RN       Against Moderately Against Neutral Moderately Supportive Strongly Supportive       

Some Examples New Mexico Purchasing Collaborative Oklahoma Department of Mental Health Washtenaw Community Health Organization (Michigan) Licking and Knox Counties Mental Health Services (Ohio) Australia

New Mexico Purchasing Collaborative

Oklahoma Department of Mental Health

Washtenaw Community Health Organization (Michigan)

Licking and Knox Counties Mental Health Services (Ohio)

Australia

“ They always say time changes things, but you actually have to change them yourself.” ~Andy Warhol

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