Post on 09-Aug-2020
Strategies for coping with the COVID-19 challenge
Supporting Managers Through Disruptive Change
Bec Richmond richmonb@advisory.com
@BecR27
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Relying on Managers to Bridge the Gap
New Protocol
Goal achieved
Managers must: • Learn and internalize the proposed change themselves
• Introduce and communicate the change to frontline staff
• Develop department/unit-specific timeline and milestones
• Implement new policies, procedures, and process steps
• Help frontline staff understand how their actions impact goals
• Monitor and track adoption of the change over time
• Keep costs within or below budget
“Strategy Execution”
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Representative Change Initiatives from ExecutivesExecutive Asks Often Make Manager Role Harder
CQO CNO CHRO CFO
Culture of Safety
Action Plan
MagnetRedesignation
Action Plan
Engagement Action Plan
Labor Savings Action Plan
Culture of Safety
Magnet Redesignation
Employer of Choice
Cost Savings Initiatives
Number of annual change initiatives at one representative
health care organization BEFORE COVID-19
400
Number of individual change initiatives hitting a manager at any one time
5–15
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Three Interventions to Stop the Overload
Help Managers Help ThemselvesInvest in developing skills to increase manager capacity
Build Support into Manager RoleAlleviate span of control and workload pressures on managers
Filter Initiatives from AboveControl the stream of new initiatives and unplanned work falling on managers
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Source: Texas Health Presbyterian Hospital, Dallas, TX; HR Advancement Center interviews and analysis.
Surfacing Demands from Other Departments
Critical Components for Effective Senior Leader – Manager Conversations
Establish a Dedicated Block of Time
1Steer the Conversation Towards Solutions
Create a Safe Space for Managers to Surface Issues
2 3Follow Throughand Communicate Candidly
4
“Conversations with Cole”• 90-minute quarterly meeting• All nurse managers invited• Voluntary, but encouraged
attendance • Open agenda, conversational style
Culture of Connection
“We need to authentically connect with managers and address the things that prevent them from being great leaders.”
Dr. Cole Edmonson, CNOTexas Health Presbyterian Hospital
Source: Texas Health Presbyterian Hospital, Dallas, TX; HR Advancement Center interviews and analysis.
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Component #2
Create a Safe Space for Managers to Surface Issues
Set Ground Rules Keep strict confidentiality; don’t track attendance or take minutes; let managers suggest other rules
Be Transparent Be transparent about the purpose of the conversation and what nurse managers can expect from leaders
Listen to Managers’ ExperiencesEncourage sharing, listen, and remind leaders to refrain from giving too much unsolicited advice
Exemplify Your Own TenetsModel free and open communication and encourage the same from leaders and managers
Source: Texas Health Presbyterian Hospital, Dallas, TX; HR Advancement Center interviews and analysis.
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Steer the Conversation Towards SolutionsComponent #3
How much time do you spend managing __________________each week?
What is a particular pain point caused by other departments?
1
2
In the last six months, is there something another department did that helped address these issues? 3
Starter Question Set
Cross-disciplinary issues
Source: Texas Health Presbyterian Hospital, Dallas, TX; HR Advancement Center interviews and analysis.
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Follow Through and Communicate CandidlyComponent #4
CommunicationLoop
Solicit input from managers during regular forums
Honestly report back what will be addressed and how; what will not be addressed and why
Share themes with senior leadership; exclude unit-specific identifying details
Determine action steps with senior leaders
Source: Texas Health Presbyterian Hospital, Dallas, TX; HR Advancement Center interviews and analysis.
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Sourcing Actionable Solutions from Managers
Source: Texas Health Presbyterian Hospital, Dallas, TX; HR Advancement Center interviews and analysis.
Three Components
1 2 3A specific priority that needs manager input
Dedicated working time in meetings
Executive-level participation
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Component #1: A Specific Priority that Needs Manager Input
Valley Children’s Monthly Leadership Meeting TopicsOctober 2016-February 2017
October
Topic: Transparent budget process
Group discussion: How do we talk about budget approvals and limitations to better engage staff?
November January February
Topic: Staffing
Group discussion: What does our engagement survey data have to say about staffing?
Topic: Strategic planning
Group discussion: How does engaging staff support our strategic plan?
Topic: Resource allocation
Group discussion: How can we use staff input to best allocate resources at the department level?
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Characteristics of a Challenge That Needs Manager InputChoosing the Right Challenge for Discussion
It will impact managers—either immediately, or in the long-term.
It crosses multiple boundaries—limiting a single executive from having the full picture.
It has not been resolved yet—executives have not decided on a course of action and manager input could still be incorporated.
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Component #2: Dedicated Working Time in Meetings
Before
Agenda
80% Update
20% Q&A
AfterAgenda
20% Update
80% Exercises and discussion
• Lengthy top-down updates• Disengaging “data-dumps”• Rushed or non-existent
questions from managers
• Digestible updates• Engagement with issues• Meaningful dialogue and
thoughtful questions
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Breakdown of Valley Children’s Agenda on StaffingValley Children’s Restructured Leadership Meetings
Identify the Challenge or OpportunityShare data to demonstrate that “my unit/department has enough staff” has been a consistent opportunity on the engagement survey
Roundtable Discussion• What causes staffing challenges?• As a leader, what do you have control of
or influence over that impacts staffing?
Brainstorm ResourcesExecutives role play how to have difficult conversations and provide adequate transparency on organizational decisions
9:00–9:15am
9:15–9:45am
9:45–10:00am
Source: Valley Children’s Healthcare, Madera, CA; HR Advancement Center interviews and analysis.
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Keep Discussions on Track
Source: HR Advancement Center.
Tool 7E: 10 Tips for Troubleshooting Focus Group Pitfalls
Excerpt of the ToolSituation Recommended Technique and
Scripting
Teasing out partially formed ideas: You should clarify and get more information from the participant when you hear a partially formed idea.
“I think I hear you saying…”
“What do you think is causing that to happen? What else?”
“Can you expand on that? Can you tell me about a time when that happened?”
Determining if a new idea has merit: Engage the group to evaluate the idea and determine its relative importance.
“Do others in the room agree with that thought?”
“How many of you feel that this is one of the 2 or 3 most important causes of our problem?”
Access The HR Business Partner’s Guide to Better Solutions at advisory.com/hrac.com
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Representative Video Town Hall at Texas Health ResourcesComponent #3: Executive-Level Participation
Local Facility DiscussionFacility CNO facilitates in-person discussion with managers to surface questions, concerns, opportunities
15 minutes
System CNE Video UpdateGives an update on a system priority to all facilities at once
15 minutes
System-Wide Virtual DebriefLocal facilities report out to give leaders a system-wide perspective
20 minutes
Source: Texas Health Resources, Arlington, TX; HR Advancement Center interviews and analysis.
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Rethinking the “Command and Control” Approach
Collaborative Approach
1. Seek input early, before executives make a decision
2. Incorporate manager feedback into solution
3. Agree on a single course of action
Command and Control Approach
1. Senior leaders make an executive decision
2. Cascade decisions down to the manager ranks
3. Invite feedback, largely after the fact
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Cheyenne Regional’s Criteria for EMR Optimization RequestsWhat We Can Learn From Our IT Colleagues
Gives executives a way to objectively compare proposed changes and make consistent decisions
Considers the people impact of proposed changes
Criteria is weighted based on strategic priorities to give each proposed change a ranking/score
Additional criteria used in tool includes Provider Efficiency, Revenue Impact, and Compliance
Prioritization Criteria
Impact Score Average Score
Resource Conflicts -1 = No internal resources available for timeline proposed1 = Internal resources available for timeline proposed
Patient Safety Ramifications -1 = Decreased patient safety with change0 = No effect to patient safety with or without change1 = Minimal increase to patient safety with change2= Significant increase to patient safety with change
Staff Efficiency -1 = Cost > 5 minutes per day with change0 = No impact with or without change1 = Savings of 0 to 5 minutes per day with change2= Savings of > 5 minutes per day with change
Cost Impact -1 = Increased cost with change0 = No impact with or without change1 = Minimal decrease to cost with change2 = Significant decrease to cost with change
Training Implications -1 = System-wide face-to-face training with change0 = Face-to-face training needed for at least half of users1 = Face-to-face training needed for less than half of users2 = Minimal to no training needs required with change
Source: Cheyenne Regional Medical Center, Cheyenne, WY; HR Advancement Center interviews and analysis.
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Cheyenne Regional’s Decision CategoriesMake Principled Decisions Based on Criteria
The “No List”(Score: -100 to -50)
Changes not pursued
The “Magic Quadrant”(Score: +101 to +200)
Changes resourced now
On Deck(Score: +1 to +100)
Changes approved, but will be resourced later
On Hold(Score: -49 to 0, or no
resources are available)
Changes on hold, or need more information
Source: Cheyenne Regional Medical Center, Cheyenne, WY; HR Advancement Center interviews and analysis.
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Lifecycle of a Doomed InitiativeDo Away with the Projects that Won’t Die
Project Behind Schedule…
Project Paused
Key Milestone Missed…
Project Launched…
Project Re-Launched…
Project Behind Schedule…
Zombie Projects“Projects that, for any number of reasons, fail to fulfill their promise and yet keep shuffling along, sucking up resources without any real hope of having a meaningful impact on the company’s strategy.”
–Harvard Business Review
Unanticipated Barrier…
Source: Anthony S, Duncan D, and Siren P, “Zombie Projects: How to Find and Kill Them,” Harvard Business Review, March 2015; HR Advancement Center interviews and analysis.
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Decide When to Stop an Initiative—at the Start
Planned AbandonmentThe planned, purposeful review and abandonment of initiatives the organization is already doing
Source: Drucker P, “The Essential Drucker: The Best of Sixty Years of Peter Drucker's Essential Writings on Management,” Harper Collins: New York, NY, 2001.
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List of Potential “Stop Triggers”Option #1: Set “Stop Triggers” for Each Initiative
Stop Trigger When to Use What To Do
A predetermined end date
• When other large changes are scheduled in advance, for which you’ll need capacity
• When piloting an initiative• Reapply standard initiative prioritization criteria
to makea principled decision to stop or continue the initiative
• For initiatives that end, communicate decision to all managers
A threshold for how “past due” an initiative can be • When the success of an initiative is particularly uncertain
• When organizations want to proceed with caution; provides an “easy out” of an initiative
A threshold for how over budget an initiative can be
An interim milestone that must be met
A target goal that’s maintained for a certain duration
Recommended for all initiatives; clarifies when even a successful initiative should end
• Celebrate initiative’s success• Communicate to all managers that the initiative
has ended
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Two Questions To Assess Your Change PortfolioOption #2: Rationalize Your Entire Inventory
Health Plan Advisory Council interviews and analysis.
1 If we weren’t already doing this today, would we start it tomorrow?
2 If we want to start doing something new, what will we stop doing?
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Source: Stampler L, “Science Says Stress is Contagious,” Time Magazine, May 1, 2014; Robinson J, “Wellbeing is Contagious (for Better or Worse),” Gallup, November 27, 2011
Stress—and Wellness—Affects the TeamFar More Than a “Personal Issue”
Stress Is Contagious…
People who experience “second-hand stress” and increased cortisol levels
30%
Increase in wellbeing when people’s colleagues have healthy stress habits
…But So Is Wellness
20%
Case in Brief: Second-Hand Stress
• German study from the Max Planck Institute for Cognitive and Brain Sciences
• Participants who watched others go through stress test had increased stress hormones
• Participants who watched stressful TV scenes also had increased levels
Case in Brief: Second-Hand Wellbeing
• Gallup study of wellbeing across individuals in 105 workplace teams
• Participants 15% more likely to have high wellbeing if their managers did
• 20% more likely to have colleagues with high wellbeing six months later
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Four Types of Stress TendenciesPinpoint Your Blind Spot
Avoidance (A)Tendency to distract yourself from your stressor and to procrastinate
Complaint (C)Tendency to externalize stress and negative emotions onto others
Obsession (B)Tendency to focus all of your time and energy on the stressor
Self-Doubt (D)Tendency to blame yourself for your stress and second guess your actions
Source: “Stress in America: Paying with Our Health,” American Psychological Association, 2014.
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Tactics at a GlanceIntervene On Your Own Behalf
Avoidance (A)Tendency to distract yourself from your stressor and to procrastinate
Complaint (C)Tendency to externalize stress and negative emotions onto others
Obsession (B)Tendency to focus all of your resources (time, energy, etc.) on the stressor
Self-Doubt (D)Tendency to blame yourself for your stress and second guess your actions
Engage more with your stressor
Take breaks from your stressor Give yourself the benefit of the doubt
Get a more objective view of your stressor
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Reacting Productively to Stress: A simple Tool
Health Plan Advisory Council interviews and analysis.
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Reacting Productively to Stress: A simple Tool
Health Plan Advisory Council interviews and analysis.
Choose one tactic you want to try, and apply to the stressor.
Identify a current or recent stressor.
Describe how the tactic would help you respond differently to the stressor.
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