Making Change Work For You Focus on Faculty

Transcription

1 Making Change Work For You Focus on Faculty APDIM Spring 2013 Plenary Lia S. Logio, MD Herbert J. and Ann L. Siegel Distinguished Professor Vice Chair for Education Department of Medicine Weill Cornell/New York Presbyterian Conflict of Interest: Disclosure I am a full time faculty member at Weill Cornell Medical College I receive small royalties from McGraw Hill Publishing. I have no other financial relationships with commercial entities producing healthcare related products or services...not amazon.com nor Barnes and Noble

2 Learning Objectives Introduce a framework for your work as leaders. Explain three key components to managing change. Define a few strategies to address motivation as it relates to faculty and getting them in the boat with an oar. Demonstrate a method for identifying where the problem is when it s not going well. Apply the models to the problem of enlisting faculty in NAS.

3 You are all. Leaders Change agents Motivators and Coaches Influencers Innovators Special ACGME NAS ACGME rules GME Cuts

4 The Leadership Challenge As leaders, we must understand Kouzes and Posner s model. Model the Way Inspire a Shared Vision Challenge the Process Enable Others to Act Encourage the Heart

5 How do you get people to start behaving in a new way? Issue of situation plus heart and mind. But, heart and mind don t always agree Ever try dieting? Made a New Year s Resolution to exercise more? How to Ride An Elephant

6 The Rider: the intellect, analytical, logical side of us, mind The Elephant: the automatic parts, acts without thinking, passion, emotion, motivation, heart

7 The Path: The direction; make it easy for the elephant and the rider to see their feet on the new path Example: 100,000 Lives Campaign Here is what I think we should do. I think we should save 100,000 lives. And I think we should do that by June 14, months from today. Some is not a number, soon is not a time. Here s the number: 100,000. Here s the time: June 14, a.m. Healthcare is broken. Let s fix it.

8 Direct the Rider and Shape the Path Proposed six specific interventions to save lives (e.g. proven procedures for prevention of ventilator-associated pneumonia) IHI team provided research, step-by step instruction guides and training IHI team arranged conference calls for hospital leaders to share victories and struggles Encouraged successful hospitals to become mentors Managing Elephants Find the Feeling Knowing something isn t enough (smokers) Make people feel something. Shrink the Change Break down the change so it no longer spooks the elephant Grow your People Cultivate a sense of identify Instill the growth mindset

9 Faculty Evaluating Residents in NAS The Rider: variability in current state,? value, NAS The Elephant: make this simpler, more relevant to real life, special to your environment, your expertise The Path: just talk about what house officers do on your rotation; what do you reliably see for every single resident that you can measure/assess? Weill Cornell: The Process to Date A seasoned and vocal curmudgeon Retreat to play with ideas Curmudgeon became credible advocate Pilot - low hanging fruit; improved the process Early adopter; well respected, busy began to play with EPAs Now Energy Trepidation

10 Drive Motivation 1.0 (biologic) Motivation 2.0 (extrinsic) carrots and sticks deeply unreliable Motivation 3.0 (intrinsic) Autonomy Mastery Purpose Change Means Changing Behavior

11 Influencer Willing Able Personal Social Structural Patterson et al: Six Sources of Influence MOTIVATION ABILITY PERSONAL 1 Make the Undesirable Desirable 2 Overinvest in Skill Building SOCIAL 3 Harness Peer Pressure 4 Find Strength in Numbers STRUCTURAL 5 Design Rewards and Assure Accountability 6 Change the Environment Kerry Patterson, et al, Influencer; The Power to Change Anything (New York: McGraw-Hill, 2008)

12 Change Means Changing Behavior 1. What, specifically, are you trying to do? e.g. obtain reliable data from faculty about resident performance 2. What behaviors would constitute this? Focused bird watching as faculty look at performance 3. How do you create the desire and motivation to bird watch? 4. How do we ensure that people have the skills to do this? 5. How do we make this a group effort? 6. What structural elements support this behavior? 7. How do you reward, in this case, reliable identification of resident performance around defined EPAs? Patterson et al: Six Sources of Influence MOTIVATION ABILITY PERSONAL 1 We want stellar trainees. 2 Training faculty for specific birds. SOCIAL 3 Advertise early adopters 4 Mentoring system one-on-one STRUCTURAL 5 Visible reports and rewards 6 Simplify (shorten) evaluations Kerry Patterson, et al, Influencer; The Power to Change Anything (New York: McGraw-Hill, 2008)

13 For change to succeed. The change must mean something to those who are affected by it Multiple system strategies must be activated to influence the change, and Resistance to change must be understood & appropriately managed Thank you for your attention.