Masterclass on Best Practices of Managing Change - Day 3 Case Hospital - learning and teams

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IMPROVED STRATEGIC MANAGEMENT CAPACITY

PROJECT

9.10.2013 - Ankara

Management of Change: Learning from International Best

Practices

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The Long Conversation:Building Key Org. Capabilities


edilmektedir Hospital of Children in Minnesota, USA

• Medical errors are estimated to kill 44,000 to 98,000 patients annually.

• Each year, in USA’s hospitals, 6.7% of all admitted patients experience a medical accident.



• Anne Wilson is the Chief Operating Officer at the Hospital

• She was recently witness of a nearly fatal event related to a morphine overdose at the Hospital. Immediately after the incident, a team began to examine its causes.

• Anne prepared her meeting with the child’s parents. This was a challenging and stressful situation for her and the parents.



• Anne came to Hospital with the expressed intent to make

safety her highest priority.

• She began by assembling a core team of people to help design and launch the Patient Safety Initiative.

• She also started to gather data on the current state of

patient safety; she conducted 18 confidential focus groups with doctors, nurses, pharmacist, etc. Employees felt relieved to have a safe place to discuss their experiences with medical errors.

• “As we conducted the focus groups, my office became a confessional”.



• Anne launched a strategic planning process to define the organization’s goals and objectives for the next five years.

• Anne coined the acronym SAFE to summarize the four components

of the Hospital’s strategic plan. SAFE stood for Safety, Access, Financial, and Experience.

• The safety component established the objective of achieving zero defects in the delivery of clinical care and medications to patients.

• Access involved eliminating deferrals, improving cycle time, and increasing the number of patients served each year.

• The financial component established goals related to cash flow, return on capital and productivity.

• Experience focused on enhancing patient/family satisfaction.


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Improve performance against Agency Mission

Type of Public Organization

Mission Examples Performance Objectives/Metrics

Service Delivery Provide specified services to the public as efficiently and effectively as possible

Health care agencies, infrastructure development programs, financial services, information distribution, social service agencies

Efficient delivery, security and integrity, error minimization

Analysis and reporting Provide policy makers with specified information and analysis

Treasuries, budget authorities, intelligence agencies

Accuracy, timeliness, risk management

What is my organization’s mission?How is it expected to create public value?


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Lack of a performance culture

Before Change:• OSHA measured success in terms of the

number of inspections and fines (sanctions) imposed.

• Punitive attitude toward business.• Employees lose sight of the overall

mission.


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Lack of a performance culture

After Reform:• Commitment to Mission.• “Reducing the number of injuries, illness,

and eaths in the workplace.”• Goals and metrics related to “the

elimination of all preventable workplace ills in ten years.”

• Literally impossible to achieve --) goal was to stimulate innovative thinking.



Anne wanted to transform the organizational culture to provide an environment conducive to discussing medical accidents in a constructive manner



She took several important steps.

She created forums where staff members could come together to discuss safety issues

and learn more about current research in the field.

Second, she instituted a

blameless reporting system for recording medical errors.



Anne established several structures and

processes to oversee and implement the patient safety initiative

• Patient Safety Steering Committee

• Focused Event Analysis Process

• Medication Administration Process

• Safety Actions Teams



Patient Safety Steering Committee:

• Oversee the safety initiative.

• Included many physicians as well as nursing union leaders, a Board member.

• Committee took collective responsibility for setting goals for the safety initiative and for revising hospital policies and procedures.

• For example, the committee created the Focused Event Analysis Process.


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Change Program must be…Element Description

Organizational structure Teams and Social Open Networks

combined to provide both depth of dimensional (function, processes) detail, and breadth of multi-dimensional perspective. Effective governance by the cross-unit management team with participation of key users.



Focused Event Studies:

Conduct investigations following serious (and less serious) medical accidents,

Learn a great deal about improving patient safety by applying this structured problem-solving procedure frequently.

Conducting a confidential blameless analysis of the incident.



Medication Administration Process:

Effort to overhaul the hospital’s medication administration system with the goal of achieving zero defects.

Effort to demonstrate how the organization could improve patient safety by redesigning processes and systems.



Safety Actions Teams:

Mary, a clinical nurse specialist, decided to create a safety

action team in the hematology/oncology unit.

This cross-functional team of eight employees began to meet monthly to discuss medication safety issues.

After the meetings, the team members briefed their co-workers about the problems they discussed and the improvements they hoped to implement.

Each person also gathered ideas and suggestions to share with the rest of the team at the next meeting.




Two other units observed the Mary´s efforts and launched safety actions team in their areas.

Witnessing these successful efforts, the Core Committee directed the manager of each clinical unit to establish a safety action team.




Mary, a clinical nurse specialist, decided to create a safety

action team in the hematology/oncology unit.

This cross-functional team of eight employees began to meet monthly to discuss medication safety issues.

After the meetings, the team members briefed their co-workers about the problems they discussed and the improvements they hoped to implement.

Each person also gathered ideas and suggestions to share with the rest of the team at the next meeting.


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Changing the collective behaviour of the group changes the culture…

The Long Conversation: Building Organizational Capabilities


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edilmektedir Collaborative network

Element Intra-unit team Social network

Org. Scope Functional or business units Multi-functional and multi-business

Size and cohesiveness

Small, closed and tight Large, open, and loose

Members Employees affiliated to functional or business unit

Users across the organization at all levels.

Perspective Depth of dimensional detail, regarding function, product, geography or channel.

Breadth of multi-dimensional interdependences

Paradigm Variety

Low. Social and technological affinity induces shared paradigms among members.

High. Paradigms may clash, exposing conflicts and dilemmas.

Coordination Role

Key user coordinates intra-unit work and learning, connecting it to the larger multi-dimensional perspective addressed by the social network.

Key users participate in cross-functional action-learning and knowledge diffusion across the social network, informing it with their narrow intra-unit perspective.


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Final Thoughts


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Leading through an involved and developmental style of leadership

that creates a supporting atmosphere for learning &

exploration



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…working on the short and long terms in parallel, you are going to

be stronger.



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Change Program must be based on…

A structured chronological framework

A Development and Learning process


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Strategy Bidirectional alignment between organization and the adoption strategy. Automation, coordination and information support opportunities are identified by a discovery process that contains Osmosis, Growth and Adaptation. Strategy is not only deliberate, but also emergent.

Leadership Top managers create the appropriate environment for exploring opportunities and learning; this environment is neither directive nor laissez faire but “involved and developmental”. Cross-unit management team stimulates convergence of the learning process.

People Key users/agents are catalysts of learning acting as pivots between the deep intra-area perspective in their units and functional domains and the broad inter-area perspective of internal and external business processes and systems. Supporting specialists work under a “prototype” mindset.

Organizational structure

Teams and Social Open Networks combined to provide both depth of dimensional (function, processes) detail, and breadth of multi-dimensional perspective. Effective governance by the cross-unit management team with participation of key users.


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Planning and Control

Directed incrementalism: a management decision making approach that balances direction (expressed as vision and objectives) with incremental execution. Visions are translated into strategic options and put into practice through action-learning. Fast learning cycles eliminate non promising options and concentrate resources on most promising ones, progressively revealing appropriate transition paths. This approach is key to handle the inherent uncertainty and political context of the Long Conversation.

Motivation People motivated by an environment of collaboration, discovery, conjoint design and public recognition of contribution, combined with the satisfaction that results from achieving business value from ES by co-creating a path of small, progressive victories.


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Be a Leader, not a Bureaucrat



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Oswaldo LorenzoProfessor of Management

Deusto Business School, SpainBlog: www.longconversation.com

@Lorenzooswaldo

http://www.longconversation.com/

Masterclass on Best Practices of Managing Change - Day 3 Case Hospital - learning and teams

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Transcript of Masterclass on Best Practices of Managing Change - Day 3 Case Hospital - learning and teams