The Key to

Organizational Transformation

is Personal Transformation:

Transforming the Way We Lead Change

NHLC

June 10, 2013

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Background

Transferring from St. Joseph’s Health Care London

Neonatal Intensive Care Unit

Perinatal Services

Women’s Ambulatory Care

500 staff and physicians

$43M budget

Relocating at LHSC

Pediatrics/Children’s Hospital

Perinatal Services

Women’s Ambulatory Care

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Complex Organizational Change

C Well planned and implemented complex change is

messy. It will:

Disrupt the workplace

Destabilize people Impacts of change cannot be eliminated, but they can

be reduced through skillful change leadership and transition management

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Patients, People, Processes

Staff and Physicians supported in the new environment Patients, Families, Staff, Physicians, Community informed and

engaged

High quality care provided before, during and after transfers and moves

Patient safety maintained Impacts to people and operations minimized

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Strategy: Four Key Elements

1 Leader Development

2 Cultural Change

3 Redesign Integration and Alignment

4 Talent Management

Building Organizational Readiness and Change

Capability:

Significant Planning for Safe

Quality Care…

...During an Incredibly Complex Initiative (pre, during and post)

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. Transformational Change

Builds permanent change in the organization culture

Produces change in individual and organization performance

Acknowledge and respect

Local history

Culture of the organizations involved

Knowledge and experience of all stakeholders

Uniqueness of the previous journeys that have been taken

No going back

Current Reality

Vision

Experiment

Learning

Course CorrectLearn & Share

Through Middle Layers

Course Correct

Adapted from “Beyond Change Management

by D. Anderson & L. Ackerman Anderson

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What We Thought We Knew

Resistance is a normal reaction during transformational change

When the human side of change is left unattended, the effects will surface in many ways

Allow for processing of the resistance and conflict

Identify and discuss barriers

Encourage people to discuss fears and concerns in teams

Address “what’s in it for me”

Give people in the organization(s) time to connect and establish relationships

Provide processes that emotionally support people through all parts of the change

Work to resolve issues

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Developing Change Leaders

Develop leadership capacity for leading and navigating transformational change

Focus on emotional intelligence

Resiliency of leaders in order to lead staff effectively through complex program transfer

Manage operational and change

complexity

Support staff undergoing transitions and new beginnings

Coach and mentor teams coming together

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Emotional Intelligence

Ability to recognize and understand your emotions and the emotions of others, and to use this awareness to effectively manage yourself and your relations with others

Dan Goleman, Emotional Intelligence

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• Tertiary and quaternary hospital on two sites

• Large academic teaching hospital

• 10,000 employees

• Higher employee turn-over

• One of many high profile programs

• “Small fish in a big pond”

St. Joseph’s Health Care London

Merging of Two Cultures London Health Sciences Centre

• Faith-based organization

• Small academic teaching hospital

• 4200 employees, many long-standing

• Services being transferred were the “pinnacle” programs

• “Big fish in a small pond”

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Cultural and Team Integration Cultural integration strategy designed to

honor the unique culture of both organizations

Interdisciplinary Steering Committee

Builds on the cultural strengths that will create the new culture, aligned with a compelling vision for the future

Develop common values and objectives to come together in a unified manner

Leveraged: ethics and ethical decision

making, commitment to shared leadership, and family centred care

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Engaging frontline staff and physicians through open forums, one on one meetings

Create a shared vision and desired culture

Understand cultural affinities and the real differences

Acknowledge and manage endings and building readiness for new beginnings

Build staff engagement pre and post transfer

Shared Leadership

High involvement in decision making and improvement in care processes

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Process: 6 interdisciplinary city wide

task teams (including patients)

Analyze the differences between the clinical services at both sites

Redesign based on: Patient Experience LEAN processes Best Practices Evidence Shared Leadership

Budget constraints and no new money

Outcomes: Patient and family centred care

272 recommendations

Alignment /revision of five unit

specific care delivery models based on best practice

Team development

Efficiencies

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Staff Engagement

Model of care and staff mix based on best practices

Options available to staff to follow work or accept packages

Recruitment strategy in development

Physician and Midwife Engagement

Identification of clinical issues

Develop strategies and services

Plan space allocations

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Education, Orientation and Integration

Completed for each move or transfer to ensure the delivery of safe, high quality care and service in the new clinical space and within the new inter-professional team

The Learning Simulation Pilot Project designed to augment and enrich education and orientation strategies Mock codes C-Sections Deliveries

Purposeful visits for staff to “work in” and “test” flow

and processes prior to move of patients 4 hour blocks of time with actual patient care

scenarios

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Prepared Staff, Physician & Midwives

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Identify and mentor formal and informal leaders affected by the change

Operational Leaders

Physician and Midwifery Leaders

Union Leaders

Clinical Leaders

Coaching 1:1

Succession Planning

Move leaders into new organization prior to transfer to support culture change prior to staff

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Communication

Staff engagement Staff forums, meetings Transitions newsletters Corporate Building our Future newsletters Web

Patients/public London Free Press/media relations Communicate regularly with LHINs Web Newsletter for regional medical centres Patient info cards, memos, reminders Virtual tour/video

Celebration activities Celebrate new space Recognize St. Joseph’s “I was born at St. Joseph’s” campaign

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Monitoring and Evaluation

Currently tracking metrics associated with transfer and moves based on activities, timelines and risks

Post transfer evaluation based on:

Critical HR factors:

Absenteeism and sick time

Overtime

Turn-over rates

Time to fill vacancy

Workload grievances

Workplace climate pre and post move:

Relationships with Leader

Relationships across the team (interpersonal conflict)

Experience with workload

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Front Line Manager

Lived Experience

“Becoming Part of a

New Organization”

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The Starting Point

A long history in the NICU - Nurse, NP

First and only employer

Suspicious of change theory and Emotional Intelligence concepts

Not a big fan of the receiving hospital

Big, bureaucratic blowhards

Moments of aggressive response in meetings

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Hope The Beginning of the End

Early initiation of the change strategy ensured enough time for personal transformation

Enormous value in ensuring that leaders have moved through the change process a few steps ahead of the team

Personal Coach incredibly helpful

Assumed an Operational Leadership role 2 years prior to Program Transfer

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Cannot over-estimate the pain of change for individuals

Be prepared when experts decompensate

If possible, separate support role from logistics role

Become comfortable saying “I don’t know”

Resist the temptation to reduce ambiguity… embrace

co-creation

Postcards from the Edge

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Front Line Manager

Lived Experience

“Integrating A New Team”

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My EI Journey

Emotional Intelligent development work: the light bulbs

Beyond Personal Style: deep personal work

Uncomfortable at times and takes a personal commitment

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7 Core Needs

Safety

Inclusion

Control

Power

Competence

Justice/Fairness

Desire to be liked/connected

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7 Core Needs Lessons Learned

Create the space for staff emotions to surface i.e. town hall meetings, open forums

The small stuff matters i.e. where will I park, changes to commute

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Physicians Are People Too

Ask questions to better understand core needs e.g.

What will need to be in place for you to feel capable of delivering your best at LHSC?

What do you most want to preserve in your practice?

How would you define success in this transfer?

Build relationships on these needs or areas of interest

The patient creates mutual purpose

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For many the emotional reaction comes when the change actually

happens

Be prepared for “performance dip”

When Your Best is Not Enough

Feedback loops in place to identify negative impacts to operations, team

capability and stakeholder relationships

Be ready to launch a recovery strategy and plans when impacts

warrant

Round for feedback/Acknowledge Staff Contributions

Build a strategy to engage physicians in problem solving and

issue resolution

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Measures

Workplace Climate Survey

Performance Reviews

Excellent opportunity to take stock at a personal level, how staff were doing

Adverse Events

Marked decrease after the first year of the program transfer (150 to 90)

Sick Time

Different trend than expected, increase came later in the transition

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My Insights

Understand the source of staff emotions

Create space to share and acknowledge emotions

You will never get it perfect

Plan for the need to course correct

“People need to be heard and

understood before they can listen and

understand”

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Lessons Learned

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1. Staff change effort with right people

2. Accurately assess the complexity of the project/change process and capability of the organization

3. Help people invent their own future –they are unlikely to do it on their own

4. Leaders and other key “champions” must be EI ready

5. Talent Management should focus on leaders who are high performing and on learning agility

Lessons Learned Through Stumbles, Struggles & Missteps

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Lessons Learned Through Successes

1. You will need a comprehensive not just a project plan

2. Access expertise in change leadership, leadership development and cultural change

3. Apply a common change model and methodology to all organizational, people and culture changes

4. Leaders are the leverage point for successful change. Complete leader development WELL in advance of change.

5. Reducing variation in how people work/will work together is critical prior to integrating services and teams

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Lessons Learned Through Successes cont’d

6. Cultural differences do matter – Build bridges by leveraging what is important in both organizations

7. Communicate, communicate, communicate…

Even when there is nothing new to communicate

8. Ensure reliable feedback loops in place to enable timely course corrections

9. The impacts of change (to people and operations) will begin well before the change date and continue well after - plan accordingly

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Question & Answer Session

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Laurie Gould, Executive Vice President: laurie.gould@lhsc.on.ca Tim Rice, Interim Director, Women’s Care: tim.rice@lhsc.on.ca Julia Marchesan, Manager, Children’s Specialty Services julia.marchesan@lhsc.on.ca Lianne Collins, Senior Consultant, Change Strategy: lianne.collins@lhsc.on.ca

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