Managing TransitionsManaging TransitionsHelping your People to Support ChangeHelping your People to Support Change

Demi Haffenreffer, RN , MBAHaffenreffer and Associates, Inc.www.consultdemi.net

Today’s TopicsToday’s TopicsChange

◦What is possible & is it necessary?Transition

◦The three stagesYour role in leading and

supporting your staff◦Some Baldrige leadership criteria

Assessing your transition readiness

Exercises and case studies

Some questions for you to Some questions for you to discussdiscuss

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?

WHAT COULD WE WHAT COULD WE BECOME?BECOME?

The present and the The present and the futurefuture 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 The present and the futurefuture 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

WE ARE THE PROBLEM!!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.”

PresenceSenge, Scharmer, Jaworski &

Flowers

ProverbProverb

“If an organization is not growingIt is

dying”

Organizational RenewalOrganizational Renewal

“In order for change we need to

connectmore

with OURSELVES

& leave our other

selves behind.”

Demi Haffenreffer

TransitionTransition1. Passage from one form, state,

style, or place to another.2. A transition or change, as to a

spiritual existence at death3. Differs from change

1. Change focuses on outcomes – transition is a process

2. More people focused3. 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

StagesStagesLetting go of the old ways and

the old identity people hadGoing 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

Helping your peopleHelping your people

You change first!Plan & organizeHelp them to let go – manage the

endingsLead them through the neutral

zoneLaunch the new beginning

You Change First - You Change First - LeadershipLeadership

“Let him that would move the world, first

move himself”

Socrates

Become Self-AwareBecome Self-AwareDiscover SelfBecome a real human being

◦Do your people know who you are?Discover your world viewWhat’s in your briefcase?Test your integrityMatching your vision / values

with that of your organization

Leading - PlanningLeading - PlanningWho 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 levelsTeach your leaders about transitionVisit other organizationsWho are your champions?Where is your commitment &

motivation?

Case StudyCase StudyNew 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.

What will you do?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

Help them to let goHelp them to let goTeam 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 lossesDefine what is over and what is notTreat the past with respectLet them take a piece of the old with themShow how endings ensures continuity of

what really matters – expect the best

Leading them through theLeading them through the“Neutral Zone”“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

ProblemsProblemsAnxiety increases and motivation

fallsIncreased absenteeism –

decreased productivityOld problems get worseMixed signals and messagesPeople become polarizedSabotage

What will you do?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.

What will you do?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

SolutionsSolutionsInterventions – 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 slogansCreate temporary systemsStrengthen intragroup connectionsConsider a transition monitoring team

SolutionsSolutionsEncourage brainstorming of

solutions, experimentationSuspend your normal ways of

thinking

The New BeginningThe New Beginning

“Just because everything is different

doesn’t mean thatanything has changed!”

Irene Peter American

Writer

ExerciseExercise

1. Rearrange yourselves in groups according to your birth date month.

2. Rearrange yourselves according to your birthdates

The New BeginningThe New BeginningRemember not all are going through

these stages simultaneouslyRebuild and maintain trustClarify and communicate the purposeUnderstand that with CQI change is a

normal processCreate a Plan – Reinforce the new

◦Be consistent◦Ensure quick successes◦Symbolize the New Identity◦Celebrate

Assessing your Assessing your organization’s readiness for organization’s readiness for changechangeWhere 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 alongOverall climate (calm, learning,

supportive, fear based, disorganization, someone is out to get us)

Assessing your Assessing your organization’s readiness for organization’s readiness for changechangeEmbedded 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?

Other resourcesOther resourcesBridges, 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.

THANK YOU!THANK YOU!