{"id":227272,"date":"2022-11-03T06:05:16","date_gmt":"2022-11-03T12:05:16","guid":{"rendered":"http:\/\/corevalues.com\/?p=227272"},"modified":"2022-11-03T06:05:16","modified_gmt":"2022-11-03T12:05:16","slug":"managing-change-doesnt-need-to-be-painful","status":"publish","type":"post","link":"https:\/\/corevalues.com\/dev\/2022\/11\/03\/managing-change-doesnt-need-to-be-painful\/","title":{"rendered":"Managing Change Doesn\u2019t Need to be Painful"},"content":{"rendered":"

\"managing<\/a>Managing change is as messy as it is exhilarating.\u00a0 It’s a rational process and also \u00a0a creative one. This enabling framework that manages the people side of change is more than a communications plan where leaders cascade information.\u00a0 It\u2019s a whole gamut of support for the organization through its transitions from the current state to the future state.<\/p>\n

It isn\u2019t as difficult as you think.<\/p>\n

Yes, that\u2019s oversimplifying it.\u00a0 People are usually resistant to change.\u00a0 When confronted with a scenario where they are forced to adapt to something new, decisions aren\u2019t always driven by logic.\u00a0 Emotions take center stage.\u00a0\u00a0 People worry more about negative performance reviews, being given the boot, engaging a learning curve that makes them feel vulnerable or being demoted to a lesser role.\u00a0 \u00a0And then there\u2019s the issue of getting stakeholders on the same page which calls for a different ball game altogether.<\/p>\n

Managing change stories that hit the target<\/h2>\n

Accounts and stories I\u2019ve come across are thrilling to read even for leaders who are not change geeks like me.\u00a0 Take the story of Beth Israel Deaconess Medical Center.\u00a0 Based in Boston, Massachusetts, the Beth Israel Deaconess Medical Center (BIDMC) was formed through a merger of two hospitals in 1996 (the Beth Israel Hospital which was founded in 1916, and the New England Deaconess Hospital which was founded in 1896).\u00a0 It is now known as a teaching hospital of the Harvard Medical School.<\/p>\n

The merger\u2019s main objective was to form a larger hospital (over 600 beds) that would be able to compete with the Birgham Women\u2019s Hospital and the Massachusetts General Hospital.<\/p>\n

The two hospitals had different cultures.\u00a0 Beth Israel\u2019s work culture encouraged professional autonomy and creativity.\u00a0 They had always valued a casual management style.\u00a0 New England, on the other hand, was known for its hard-core, rule-based, top-down approach to management.<\/p>\n

Loyalty clashes<\/h3>\n

Staff was hard-core loyal to their own.\u00a0\u00a0 After the merger, the Beth Israel culture overshadowed New England\u2019s.\u00a0 Those who couldn\u2019t cope (mostly nurses), left to work for competitor hospitals.<\/p>\n

By the year 2002, BIDMC was losing up to $100 million a year.\u00a0 They were on the verge of a financial meltdown.\u00a0 Problems with the safety of care and quality were beginning to pop up.\u00a0 The low morale was compounded even more by the deteriorating relationship between the clinical staff and management. \u00a0\u00a0Media attention only worsened BIDMC\u2019s reputation.<\/p>\n

Consultants to the rescue<\/h3>\n

External management consultants were immediately brought in.\u00a0 They recommended drastic measures to turn finances around.\u00a0 In 2002, Paul Levy was appointed chief executive officer.<\/p>\n

While he had no healthcare background and little knowledge of hospitals, Paul Levy felt that this gave him an edge.\u00a0 As an \u201coutsider\u201d he was a \u201cstraight talker\u201d who could act as an honest broker.<\/p>\n

The staff of course was skeptical.<\/p>\n

Levy\u2019s strategy was based on TRANSPARENCY<\/a> and COMMITMENT<\/a> to quality.\u00a0 His first action was to disclose the full scale of financial difficulties to all the staff.\u00a0 He created what he would call a \u201cburning platform\u201d \u2013 a scenario escapable only via radical change.\u00a0\u00a0\u00a0 His second action was an absolute commitment to continuous improvement of quality.\u00a0 His objective was to build TRUST and establish a sense of common purpose.<\/p>\n

When asked to describe his management style, Levy admits that he had an overly developed sense of confidence.\u00a0 But his management approach encourages people to WANT to do well and to WANT to do good.\u00a0 \u201cI create an appropriate environment.\u00a0 I TRUST people.\u00a0 When people make mistakes, it isn\u2019t incompetence.\u00a0 It\u2019s insufficient training or the wrong environment.\u201d<\/em>\u00a0<\/em><\/p>\n

Levy\u2019s Leverage\u00a0<\/em><\/h2>\n

His strategies were applied in three phases.<\/p>\n

Phase 1:<\/h3>\n

To alleviate the financial burden, Levy decided to let go of people.\u00a0 Save for the nurses, hundreds had to go.<\/p>\n

Phase 2:<\/h3>\n

To improve the poor relationship between medical staff and management, Levy hired Michael Epstein in 2003 as chief operating officer.\u00a0 Epstein, a doctor, met with each clinical department to win their support for the hospital\u2019s non-clinical objectives.\u00a0 His goal was to break down tribalism.<\/p>\n

The director for performance assessment and regulatory compliance, Kathleen Murray, joined BIDMC in 2002.\u00a0 Prior, the hospital had no annual operating plans.\u00a0 She began with two departments (orthopedics and surgery) that had volunteered in phase 1.\u00a0 Other departments soon joined.\u00a0 Her operating plans had four goals in mind: 1 \u2013 addressing quality and safety, 2 \u2013 patient satisfaction, 3 \u2013 finance, and 4 \u2013 staff and referrer satisfaction.\u00a0\u00a0 The bigger goal was to make the staff proud of the outcomes and create a sense of achievement.\u00a0 The big change here was doctors\u2019 performance would now be closely monitored.\u00a0 Surprisingly, the introduction of operating plans was seen as a welcome and major turning point.<\/p>\n

Phase 3:<\/h3>\n

While medical errors are inevitable, they had to put measures in place to whittle down incidents.\u00a0 Levy appointed Mark Zeidel as the chief of medicine.\u00a0 Zeidel then introduced measures that cut \u201ccentral line infection\u201d rates.\u00a0 This reduced both financial costs and harm to patients.\u00a0 It also provided the much need motivation for more improvements.<\/p>\n

The board of directors wasn\u2019t too happy with Levy\u2019s suggestion that performance data be published but Levy was quite persuasive.\u00a0 He would publish this information in his blog (an initiative he began in 2006) \u2013 which quickly became popular with staff, the public, and the media.\u00a0 Back then, 10,000 visitors a day was huge traffic.<\/p>\n

Levy explained that transparency was key.\u00a0 People like to see how they compare with others.\u00a0 They also want to see improvements.\u00a0 For clinical leaders, patients, and insurers, being transparent cannot be overemphasized. \u00a0\u00a0As a result, they began to get encouraging feedback from patients.\u00a0 They also managed to avoid a major controversy with the media despite their directness.<\/p>\n

Most importantly, what this created was what Levy would call \u201ccreative tension within hospitals\u201d so that they hold themselves accountable.\u00a0 This accountability is what drives doctors, nurses, medical staff, and administrators to seek constant improvements in the quality of patient care and the safety of patients. \u00a0\u00a0Other initiatives Levy implemented included hiring staff with expertise in lean methods.\u00a0 Training in quality and safety was now mandatory for trainee doctors who had to take part in improvement projects.<\/p>\n

Collaboration emerged<\/h2>\n

In no time, the culture became COLLABORATIVE<\/a>. \u00a0\u00a0Nurses had the respect of doctors and more patients were opting for BIDMC for the quality of nursing care. Departmental quality improvement directors met twice a month to share experiences. Discussion of adverse events was no longer shunned.<\/p>\n

By 2010, BIDMC had 6,000 employees. It was a leading academic health center in the United States with state-of-the-art clinical care, teaching, and research.\u00a0 Annual revenues were now over $1.2 billion.<\/p>\n

Happy endings<\/h2>\n

This story had a happy ending, but I could imagine the in-betweens.\u00a0 Organizational change is often problematic.\u00a0 This short narration doesn\u2019t reveal backstories, the nitty gritty, or the happenings in and out of the corridor.\u00a0 You could imagine how challenging it was to persuade people to accept new ways of thinking that could possibly make their skills, knowledge, and working practices obsolete — or how people will react to new roles, relationships, or dynamics.<\/p>\n

Does \u00a0change really need to be that difficult?<\/p>\n

My answer to that is\u2026 only if change isn\u2019t well managed and lacks employee input and empowerment.<\/p>\n

According to a study by Keller and Aiken, (2008, Burnes, 2011 and Rafferty et all, 2013), most estimates put the failure rate of planned changes at around 60% to 70%. In a global survey of 2,000 executives by the consulting company, McKinsey, only 26% of respondents said that their transformational changes had successfully improved performance and enabled the organization to sustain further improvements.<\/p>\n

How then do you improve the outcome for your organization?<\/h2>\n

In our story, you may recall that the hospital was a merger of two organizations with vastly different cultures.\u00a0 The dominating culture was the one with a casual management style, one that also pushed for professional autonomy and creativity.<\/p>\n

This alone is a huge green light.\u00a0 When a work culture encourages professional autonomy, empowerment and creativity, it says a lot about TRUST, the first of the TIGERS 6 Principles.\u00a0 When there is trust, the organization is likely more open to change.\u00a0\u00a0 In a huge sense, employees are will be more \u201cagile\u201d and responsive.\u00a0 A top-down approach, on the other hand, means that change will be slow (if it happens at all).\u00a0 Anything new needs due process and committee cycles.<\/p>\n

Trained change managers are key<\/h2>\n

Another aspect that stands out is the importance of a change leader.\u00a0 Change managers are pictured as champions and deviants. Often they are senior managers with considerable power and prestige. Paul Levy spurred change, but so did several managers under his care.<\/p>\n

Look closely and you\u2019ll see that real change begins from the middle.\u00a0 Research has consistently demonstrated the key role that middle managers play in organizational change and change management.<\/p>\n

    \n
  1. Gathering information<\/li>\n
  2. Championing and justifying alternatives<\/li>\n
  3. Facilitating adaptability by relaxing rules and \u201cbuying time\u201d<\/li>\n
  4. Turning goals into action and promoting initiatives to staff<\/li>\n
  5. Facilitating accountable decision-making and planning teams<\/li>\n<\/ol>\n

    Middle managers are key to change implementation precisely because they understand frontline operations and issues much better than senior management. They are therefore able to mediate between the top team and the front line. They are best able to identify and promote the need for change.<\/p>\n

    Change management, of course, can be found at all levels of an organization but providing your managers with the right tools to effect change as effectively (and as painlessly) as possible certainly makes a difference.<\/p>\n

    Nobody has to suffer when managing change<\/h2>\n

    With the TIGERS principle, we teach your leaders to:<\/p>\n