Leading Through Change

Transcription

1 Leading Through Change Shannon Studden Program Specialist II July 18,

2 Rural Health Innovations Purpose Rural Health Innovations (RHI), LLC, is a subsidiary of the National Rural Health Resource Center (The Center), a non-profit organization. Together, RHI and The Center are the nation s leading technical assistance and knowledge centers in rural health. In partnership with The Center, RHI connects rural health organizations with innovations that enhance the health of rural communities. 2

3 Upcoming Initiatives Create a culture of learning Develop capacity of local EMS to deliver classes Develop capacity of hospital Laboratory departments to provide hands-on components of MLT/MT curriculum Expand relationships with health care facilities Create/expand local or regional health care academy Create a Workforce Development Committee 3

4 More Upcoming Initiatives Identify services that will be discontinued following grant period Promote collaboration between entities that are competitors Hand off leadership of stakeholder group Develop a pilot program to provide transportation to health care appointments Find solutions to barriers that arose during grant period 4

5 You Know How! Created a Bachelor s degree program Built relationships with academic institutions Built relationships with health care facilities Increased awareness of Allied Health disciplines Convinced educational partners to expand programs to rural sites Collaborated with local community college to expand high school health care career academies Convinced employers and job seekers to use website for employment (ruralhires.org) 5

6 You Really Do Know How! Broadened scope of traditional health care network participants Educated 229 people on EMS-related topics Increased number of EMT students passing the state exam Implemented CHW training program Created Health Care Academy offering CE/CME to rural health care organizations Implemented school-based health center management 6

7 Questions We ll Answer Why do people react differently to change? How can we help others navigate the change process? How can we manage our own emotions during the change process? 7

8 Rider vs Elephant Rider: Rational Elephant: Emotional Jonathan Haidt, The Happiness Hypothesis Chip and Dan Heath, Switch 8

9 Recent Research on Emotion Clinical Decision Making Providers clinical decisions are influenced by their own emotions, particularly anxiety, stress, fear, and denial (Kozlowski et al.) Behavioral Economics When we re feeling sad, we ll pay higher prices than when we re feeling disgusted (Lerner et al.) 9 Emotional Contagion Nurses implementing a Shared Governance initiative caught emotions from their colleagues, influencing perceptions of the intended change (Bartunek et al.)

10 Change Curve 10 Kubler-Ross, E., 1969

11 The Journey Through Grief The Journey Through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation 11 Scheck McAlearney et al., 2015

12 Change Curve: Denial It s probably been one of the most unsettling things I ve seen for physicians throughout our entire system. Denial 12 Scheck McAlearney et al., 2015

13 Change Curve: Anger By the time you ve actually done all that, your patient encounter is halfway over. Anger 13 Scheck McAlearney et al., 2015

14 Change Curve: Bargaining Why do we need a cover letter? Isn t it enough if I add a progress note? Bargaining 14 Scheck McAlearney et al., 2015

15 Change Curve: Depression / Trap Door The first two weeks, I could have quit medicine. Depression Trap door of despair 15 Scheck McAlearney et al., 2015

16 Change Curve: Acceptance I have all I need at my fingertips. I think it s a great system. Acceptance 16 Scheck McAlearney et al., 2015

17 17 Why do people react differently to change?

18 18 Reasons for Different Responses to Change

19 Difference in Circumstances Input during the change process Understanding Nature of the change Impact of the change 19

20 Areas of Impact Technical: Resources & Knowledge Does the organization have the technical resources I need? Do I know enough? Political: Power & Influence How much power will I have to affect my environment? Cultural: Values, Norms, Mindsets What s important to me? How are things normally done around here? 20 Tichy, 1982

21 Differences in Personal Characteristics Experience with the topic Openness to experience Comfort with ambiguity Anxiety 21

22 22 How can we help others navigate the change process?

23 Appeal to the Rider and Elephant Riders without elephants: Understanding without motivation Elephants without riders: Passion without direction 23

24 Denial Manage expectations ( the party s over ) Make the case for quality Communicate the vision Denial Scheck McAlearney et al.,

25 Anger Acknowledge difficulties and affirm support Communicate the vision Form a coalition or find a champion Anger Scheck McAlearney et al.,

26 Bargaining Listen to and implement suggestions Acknowledge competing priorities Bargaining Scheck McAlearney et al.,

27 Depression Allow time to adapt Reiterate support Depression Scheck McAlearney et al.,

28 Acceptance Reaffirm positive statements Continue to ask for input Acceptance Scheck McAlearney et al.,

29 29 Tichy, 1982 Addressing T, P, and C

30 Addressing Personal Characteristics Less experience Time to absorb and adapt Direct support Less comfort with ambiguity, higher anxiety Defined plan Clear end vision Frequent check-ins 30

31 Don t Forget You may be farther along than they are Fundamental attribution error 31

32 How can we manage our own emotions during the change process? 32

33 Manage Your own Elephant Pause Acknowledge feelings Avoid judgement 33

34 Where are you Stuck? Technical: Resources & knowledge Political: Power & influence Cultural: Values, norms, mindsets 34

35 When You re REALLY Stuck What s the story? What are some alternative stories? If a given alternative story is true, how might you respond? 35

36 Helpful Resources Books Susan David, Emotional Agility: Get Unstuck, Embrace Change, and Thrive in Work and Life Chip & Dan Health, Switch Daniel Kahneman, Thinking, Fast and Slow John Kotter, Our Iceberg is Melting Podcast Hidden Brain, March 12, 2018: Daniel Kahneman: On Misery, Memory, and Our Understanding of the Mind Blog Post Marshall Goldsmith: Learn to Respond, Not React! National Rural Health Resource Center Website 36

37 References Bartunek, J., Rousseau, D., Rudolph, J., & DePalma, J. (2006). On the receiving end: Sensemaking, emotion, and assessments of an organizational change initiated by others. Journal of Applied Behavioral Science, 42:2. Bridges, W. (2003). Managing Transitions: Making the Most of Change. Philadelphia: DaCapo Press. Kozlowksi, D., Hutchinson, M., Hurley, J., Rowley, J., & Sutherland, J. (2017). The role of emotion in clinical decision making: An integrative literature review. BMC Medical Education, 17:255. Kubler-Ross, E. (1969). On Death and Dying. New York: MacMillan. Lerner, J., Small, D., & Loewenstein, G. (2004). Heart strings and purse strings: Carryover effects of emotions on economic decisions. Psychological Science, 15:5. Scheck McAlearney, A., Hefner, J., Sieck, C., & Huerta, T. (2015). The Journey Through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation. Health Services Research, 50:2. Tichy, N. (1982). Managing change strategically: The technical, political, and cultural keys. Organizational Dynamics, 11(2),

38 Contact Information Shannon Studden Program Specialist II Get to know us better: 38